The Gables

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to their quality checks and overall governance.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider advocated “maintaining people’s dignity” and “taking plenty of time to understand individual residents, their likes and dislikes, and exploring all the ways we can make them happy and comfortable.” However, this was not consistently evidenced in the outcomes for people which were sometimes task focused and failed to deliver dignified care in a safe environment. People gave us mixed feedback about being involved in their home or being comfortable to openly and confidently express themselves. Staff members believed they held the values of providing dignified and person centered care and felt they had achieved this as they had not received any negative feedback from the management team. However, as the management’s quality checks had failed to identify or mitigate the issues we found, they had failed to effectively direct staff towards meeting their shared value of dignified care which supported people to be happy and comfortable.

Not all leaders understood the context in which the provider delivered care, treatment and support. They did not always embody the culture and values of their organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. For example, when things had gone wrong, they had not met with the person concerned and apologised when it was appropriate. Whilst leaders worked with us to make improvements during the inspection these were identified as part of our findings and not by the leaders responsible for driving the improvements.

The service had a culture where staff felt they could speak up and their voice would be heard. Staff told us felt able to openly speak up about anything that concerned them. Staff members had access to policies which informed their practice including the whistleblowing policy. Staff felt able to talk with the management team or share concerns.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. All staff members we spoke with stated they felt they were treated equally and supported fairly. Staff were aware of policies and procedures including, but not limited to, antidiscrimination procedures, which informed their working experience.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. For example, the management team completed spot checks of the environment. However, these checks failed to identify the inappropriate storage of food and drinks thickeners, uncovered radiator and hot water pipe or the trailing wires leading into an extension lead. The management team completed a recent infection prevention and control audit and awarded themselves 95% with a rating of ‘good’. However, this audit failed to identify the unsanitary conditions of 1 person’s bedroom, the unsafe storage of clinical waste, worn over chair tables and bed side furniture or dirty chair arms with dried on food and fluids. These ineffective quality checks compromised the safety and dignity of those living at The Gables. Since our visit the provider has told us they have made some improvements and engaged additional support. As a result, they feel their infection prevention and control practices have improved.

The service understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. People were supported by staff and the management team to engage with their local communities and partners. This included GP’s, and others involved in their care and support. This supported people to remain in control of their own care and supported their own independence.

The service did not always focus on continuous learning, innovation or improvement. They did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people. The provider failed to demonstrate they had kept up to date with guidance which promoted safe and dignified residential care. For example, the provider was unaware of the potential risks from unsecured furniture or the guidelines for the safe storage of clinical waste.

This lack of effective management put people at the risk of avoidable harm as the provider could not be assured people’s needs were safely met in a residential setting.