The Gables Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. We found the provider did not always have systems in place to demonstrate learning and improvement. People overall were observed to be safe, although we were informed of 1 safeguarding concern. People and their relatives were not always involved in the planning of their care and care plans were not always up to date or reflective of people’s current care needs.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Apart from the 1 concern we found and reported, people we spoke with during the assessment had not had any issues or events that put them at risk. People felt the provider would be proactive in listening to them if there were any concerns. However, relatives told us they were not always informed of events which happen at the service. One relative told us they had not received an outcome to an investigation in relation to their family member. On the whole, relatives told us communication from the home could be better and one relative felt it would be useful to have a newsletter from the service.

Staff told us the management team investigated all reports made to them and these were learnt from. Although, we found systems were not always effective in identifying this. The registered manager uses root cause analysis to identify where development may be needed and to learn from events. The registered manager told us, “I am a firm believer in root cause analysis. It means we can learn together”.

The provider did not always have systems in place to fully demonstrate learning . For example, concern and complaint logs were not kept up to date and did not show actions taken or lessons learnt. Although people and relatives told us they would know the process for making a complaint, there were no accessible complaints procedure displayed within the home.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We were informed of a safeguarding issue which was observed by a relative. The relative told us this was reported to the home. No evidence was provided to us to demonstrate this was reported in line with the providers policy. However, on the whole, people felt safe living at The Gables. A person told us, “I feel very safe living here and the ambience of the house makes me feel safe”. Relatives we spoke with told us they felt their relatives were safe and received a good standard of care.

Staff displayed an understanding of safeguarding and protecting people from the risk of harm. Staff were aware of how to report any concerns to their manager. The registered manager told us of processes they have in place to keep people safe, including staff training. The registered manager told us they were, “Alert of bad practice”, and this is addressed promptly, if found. The registered manager told us they acted as a role model to other staff to promote good practice.

Communal areas at times were not always being observed by staff at key times, for example, mealtimes. We observed people spending long periods of time sat in one place throughout the day. However, we observed people to be comfortable and have a good relationship with staff.

A safeguarding concern was identified during our onsite visit. When we informed the registered manager they acted on this immediately and put appropriate actions in place to investigate this. The provider had a system to monitor safeguarding’s at the service, however, this was not kept up to date. We were informed of 2 safeguarding incidents from partner agencies whereby the registered manager had been informed. We were not made aware of these on our visit to the service. We did not see any records of these when reviewing safeguarding systems of what actions had been taken. Therefore, we could not be assured these were actioned.

People told us staff supported them to be as independent as possible. Where people were able to go out independently, this was promoted. One person told us, “Staff do encourage me to be as independent as possible”. Another person told us, “Staff support me very well, they help me to express myself where possible”. Although feedback overall was positive from people and their relatives, they did tell us they were not actively involved in their care planning or had been consulted on this.

Staff demonstrated how they would escalate any concerns to the management team, should they arise. Staff were able to recognise signs and alternative ways people may communicate to meet their needs , including recognising signs of distress and observing body language. The registered manager told us of systems they had in place to ensure safety and risk mitigation. This included, having specific care plans in place to support people and sensor beams for people who were at risk of falls.

We observed some people being left unaccompanied during a mealtimes and some people’s meals were served to them in a way which was not easily accessible. For example, on a small table in the lounge area, which was not directly in front of them. Drinks were readily accessible to people and served regularly by the activity coordinator throughout the day. When people were supported with their mobility, staff explained to the person how they were supporting the person, to put them at ease.

People’s care plans had not always been reviewed regularly or when their needs changed. For example, we found 1 person’s care plan referred to them having a catheter in place. This was not up to date information, and meant this person was at risk of receiving inconsistent care. Where people’s risk had been assessed, appropriate measures outlined within risk assessments were not always followed. For example, 1 person was known to show signs of distress throughout support with personal care. This person’s daily care records had showed they had not been supported with a bath or a shower within 2 months and only been given a wash. There was no record of what support had been offered to this person, and no behaviour monitoring charts had been completed, in line with the provider’s policy.

People and their relatives told us they felt the home was safe. Everyone we spoke with said the home was clean throughout. They were highly complimentary of the cleaning staff at the home. One person told us, “I feel very safe here due to the location, and I am happy with the facilities”.

Staff told us how improvements were being made to the home, and this work was ongoing. Staff felt the home were safe and appropriate to meet people’s needs. The registered manager told us of improvements which had been made, and recognised further development was still required.

Although the home was in the process of being refurbished, we found multiple areas around the home which were stained from a previous leak. This included bedroom’s which had previously been renovated. We also found some bedrooms which had a malodorous smell and could not identify where this was coming from. We received assurances following our onsite visit that full deep cleans had been undertaken in these areas. We found the garden area was not fully accessible to people who may have limited mobility. The registered manager told us of their plans to rectify this in the future.

Daily walk arounds of the home were completed. However, these did not always identify the issues we found. The provider did have action plans in place to monitor where improvements were needed. These showed actions which had recently been completed. However, not all areas identified by the inspector were recorded or actioned.

People and their relatives told us they did not feel there were always enough staff. One person told us that contingency plans are not always in place for when the activity coordinator was on holiday, therefore, at times activities were limited. Overall, people were complimentary of the staff who worked at the service, and felt staff knew them well.

Most staff we spoke with felt staffing levels were sufficient. Staff told us they felt they had received enough training to do their roles effectively. Staff received supervision which was appropriate to their role and supported them to develop. For example, junior care assistants supporting in developing people’s care plans.

We saw staff were rushed throughout our on-site visit. People were observed to spend large periods of time in the same place and position throughout the day. We observed people being left unattended during mealtimes. Staff were observed to interact with people in a friendly manner.

The provider had a system which determined the level of staff needed at the service. This was not regularly updated when people’s needs changed, or when there had been new admissions to the home. There was no guidance to support how people’s needs were assessed, and it did not show accurate information in relation to people’s care needs at the time of the assessment. For example, we found one person who was at high risk of falls. This had not been updated and still showed this person’s mobility needs being low risk. Therefore, we were not fully assured that safe staffing levels were in place to meet the needs of the people using the service. Staff recruitment files contained large gaps and the provider’s auditing systems failed to identify these. We had assurance from the registered manager following our site visit, that issues identified would be responded to.

Overall, people told us the home was clean and tidy throughout. One relative told us they had observed their family member unclean at times and did not feel they were supported effectively with their personal hygiene. We were also advised that laundry was not always managed well and there had been occasions where people’s beds did not have appropriate bedding on, and some people’s personal items had been misplaced.

Staff and the management team told us of the procedures they had in place to reduce the risk of infection. These included, promoting hand washing, personal protective equipment (PPE), staff training and rigid cleaning schedules.

Overall we found areas were generally clean. There were areas of the home which would benefit from a deep clean, such as radiators and extractor fans. Some people’s bedrooms had damp and stains on walls from a previous leak. One person’s bedroom was observed to have wallpaper hanging off from the walls.

The management team complete daily walk arounds and monthly infection control audits are conducted. These had not been effective in identifying some of the issues found onsite during this assessment.

People were supported to receive their medicines in a way that met their individual needs and preferences. We observed people’s consent being sought prior to medicines being administered. However, 1 person told us this did not always happen, and they were not always told what their medicines are for.

Staff we spoke with told us they would report any medicine errors to their manager. The senior care assistant on duty at the time of our assessment told us of monthly audits in place and weekly cleans of medicine areas. However, from our findings during this assessment, these were not effective because we found several areas of improvement during our assessment which had not been identified during the provider’s audits.

The provider’s policy set out clear instructions for the reporting of medicine errors, including using an incident record. The registered manager told us that there were no forms which were used to monitor medicine errors at the time of our assessment. Plans were going to be made to put this into practice following our assessment. The provider did not have effective systems in place to ensure safe administration of medicines. Medicine audits which were completed were not successful in identifying the errors we found.