The Gables

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. This is the first assessment for this newly registered service. This key question has been rated Requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the ways people’s medicines were managed safely.

This service scored 62 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There were systems in place to ensure accidents and incidents were recorded and audited by the management team on a regular basis. This included frequent analysis of incidents and where necessary actions were implemented to reduce future risk.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider worked with people and healthcare partners to ensure there were safe systems of care. We found people and families had been involved in pre-admission assessments along with relevant professionals.

People were supported to make safe transitions into other services when their needs changed or required this. Records reflected the persons change in needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Systems were in place to protect people from the risk of abuse.

Staff completed training and understood the actions they should take if they felt some one was being harmed or abused.

Safeguarding incidents were appropriately identified and shared with the local authority safeguarding team.

Where people were unable to consent to care, the local authority had been informed of any restrictions which had been put in place to keep people safe, and the appropriate legal authorisation had been obtained through the Deprivation of Liberty Safeguards (DOLS) framework.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s needs and risks were reviewed regularly. Risks were identified and recorded appropriately within the care plans.

Staff we spoke with knew people well and their individual care needs, including areas of risk.

We observed safe working practices, such as moving and handling of people.

Families generally told us they were happy with the care provided for their relatives, however some families felt that relatives had to wait a long time to receive specialist pieces of equipment. For example, a family member told us their relative required a specialist chair and it had taken a long time to arrive. Without the chair they [relative] could not get out of bed easily; this meant they had to regularly eat meals in bed which limited social interaction.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Routine servicing records of the fire system, electrical system and equipment were up to date and generally there were certificates and records to reflect this, although not all certificates could be easily accessed by the management team.

General building and specific environmental risk assessments were undertaken regularly; however, it was not always evident from the records if there were any actions to be completed.

We found that not all locked cupboards on the units were secure, meaning that people could access the contents of these cupboards, although at the time of inspection we found no items which would be a risk to people.

Several quiet lounge areas on the units were being used for storage, these included Christmas decorations, crafting materials and continence products. These items created potential trip hazards for people and removed the ability for people to safely access quiet areas of the units.

We found that peoples personal evacuation plans were up to date.

The provider did not always make sure they had clear oversight of the recruitment of qualified, skilled and experienced staff. They did not always have oversight of staff competency checks.

We reviewed the staffing levels within the home and concluded they were safe to meet people’s needs.

We found the registered manager had not had clear oversight of all the checks which had been undertaken before staff were employed. This included overseas sponsored staff.

We found competency checks for agency staff were not readily available to the registered manager, this meant that the manager had no oversight of the training and skills of some staff.

We found that that governance around staff recruitment needed strengthening.

We discussed this with the provider, who told us that immediate actions would be put in place to ensure the manager had clear oversight and access to all relevant recruitment documentation. The registered manager took action during the inspection to provide all the relevant checks.

Some of the staff told us they felt there had been times when they were short of staff and there had been an increased use of agency staff. Staff told us that the use of agency staff had reduced more recently.

Families we spoke with told us they thought there were occasions when the home was short staffed. One family member told us that when they asked for something for their relative such as a drink it could take ‘ages’ for staff to respond.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We found the home to be clean and regular cleaning and infection prevention checks were being undertaken. Furniture and equipment were in good clean condition.

Families told us that they were happy with the level of cleanliness in the home.

One family said, “The home is clean and tidy, and my relative’s room is also clean and tidy.” Another family told us, "The home is nice and clean. The environment is good, for example my relative has an ensuite shower.”

Personal protective equipment (PPE) and hand sanitiser was regularly available within the home.

Food hygiene and handling was good. A recent Food Safety Inspection Report found no issues and was rated good.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

The majority of medicines were found to be stored safely, including medicines that required additional security and record keeping. However, we found prescribed creams were not always stored safely.

When people required thickener to be added to their drinks to reduce the risk of choking, this was not recorded. As a result, there was no assurance that thickener was added as required, placing people at risk of choking.

One person was prescribed a medicine to treat an allergic reaction. Staff we spoke to during the inspection had little knowledge of the medicine or when it might be needed.

When medicines were prescribed on a ‘when required’ (PRN) basis, guidance to support staff in knowing when to administer these medicines was not always available. We also found this information was not consistently reviewed within the stated review period and therefore there was a risk the information was no longer correct. This created a risk that people may not receive their medicines when required. In addition, where people were prescribed more than one medicine for the same condition there was not always clear guidance on which to administer first, placing people at risk of their conditions not being managed well.

Medicines that required administration at specific times, for example before or after food, were not always given in line with the manufacturer’s instructions. This meant there was a risk the medicines may not work as intended and that people could experience side effects. Where medicines required a specified time interval between doses, this was not always observed, placing people at risk of side effects.

When people were prescribed medicated patches, the manufacturer’s instructions to rotate the site of application were not consistently followed. This placed people at risk of side effects and skin irritation.

Records showed that topical medicines, such as creams, were not always applied as prescribed, and when people were prescribed multiple creams, staff did not clearly document which cream was applied to each area of the body. This meant there was a risk that people’s skin care needs were not being met.

The service had completed medicines-related audits; however, these had not been effective in identifying all of the issues found during this inspection.