Archived: Gables Care Home

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

Improvements had been made since the last inspection, and they were no longer in breach of legal regulations in relation to the need for consent. However, further improvement was needed in relation to records relating to capacity and consent and the service remained in breach of legal regulation in relation to regulation 17 good governance.

This service scored 46 (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 did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Some assessments of people’s need had not been completed in full, and some key information was not always recorded. For example, it was documented that one person had type 2 diabetes but there was no risk assessment in place for this. Another person had inconsistent information in place on their risk of self-harm. The manager told us they were reviewing and updating care plans.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Staff said they had access to care plans. Some care records contained inconsistencies and gaps which had not been identified and addressed in reviews or audits meaning they could not be relied upon to ensure appropriate care was provided. Staff used their in-depth knowledge of people to provide safe care and support.

The provider did not always work well across teams and services to support people. For example, people and appropriate others, including those with lasting power of attorney and advocates were not always appropriately involved in decision making.

The staff team worked well together to make sure people’s needs were met. Advice and guidance from healthcare professionals was acted on.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control.

Gaps and inconsistencies in some care records and medicine records were evident. There was limited evidence that people, and appropriate others were involved in decisions to maximise their independence, choice and control.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. Gaps and inconsistencies in records relating to care planning, risk management and medicines meant robust monitoring was not evident.

The recording of food and fluid intake had improved and where targets had been set these were being met. One relative told us how their loved one had gained weight. However, we saw limited evidence of robust monitoring. The manager told us, “Weight [recording] was sporadic, there was some oversight but no manager oversight, so I introduced weight analysis.”

A relative told us, “I complained about them not looking after a wound on her leg. It got acted upon and it’s getting better now.”

The provider did not have robust oversight of ensuring the principles of the Mental Capacity Act 2005 were implemented.

There continued to be inconsistencies and gaps in relation to capacity and consent and the recording of Lasting Power of Attorney (LPA) status for people. The deputy manager had signed care plans giving consent on behalf of people with no consideration to people’s capacity to consent themselves or to the rights of people with LPA or an advocate. For one person who had a sensor mat, which is a restriction, a best interest decision was in place however there was no record of other people having been involved in the decision making aside from the staff member. Another person had an advocate but there was no evidence of their involvement in decision making.

The new manager was aware of the concerns and had confirmed with the local authority the position in relation to Deprivation of Liberty Safeguarding and deputyship. They had taken steps to review how external people were involved in obtaining consent, however there were ongoing issues with the recording of consent and the involvement of people, LPA and advocates in best interest decisions.