Archived: The Gables Care Home

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 assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of legal regulation in relation to the governance of the service.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Some health professionals shared some concerns around the service, their comments included, “My concern is that there is a language barrier with staff. They don’t always understand what I am saying so I don’t know how they are meeting the residents needs.” When we asked if partners feel that people are treated as individuals, one professional told us “I don’t know, I think from first impressions it seems things may be done to make staff jobs easier mainly because of things like lack of interactions.”

Various policies were in place to support an open culture, and the manager told us they have an open-door policy, but some of the actions we identified did not reflect that of a proactive culture.

Staff spoke about the visions and values of the service. One staff member said there was “Good values here.”

We found the manager approachable throughout our inspection, though due to the concerns we have identified appropriate care was not always being delivered. The management structure had not identified some of the issues we have found. There was an incident where the manager provided us misleading information and appropriate action had not been taken to ensure someone received appropriate support following a persons fall from bed. We had to ask for a referral to a GP to be made due to our concerns. These concerns should have been identified by the manager and not a CQC inspector. Further false information was provided by the manager about one person’s medication, we were told an item that had run out had been reordered but this was not the case.

Staff told us they felt supported in their role and that the management were approachable and fair to staff.

We raised multiple concerns onsite, and information provided did not align with factual evidence provided to us, meaning we could not be sure the service was acting in an open honest and transparent way. When we raised concerns, action was not always promptly taken. Because of this we could not be assured that leaders encouraged a culture of open-ness to prevent closed cultures from forming.

Staff were able to explain what whistleblowing was. The provider had a whistleblowing policy available to staff.

Staff told us they were treated equally and fairly. The service employed a diverse range of staff. An equality and diversity policy was in place which set out how they support equality and diversity.

Although multiple audits and oversight tools were in place they did always not always identify the issues we found during our inspection, and where they did identify issues or action required, this had not always been taken. Some audits were not regularly being completed. Some records were not up to date. For example, some policies in paper files required reviewing and updating. People’s personal records were not always being securely stored. Provider oversight was not robust. Some people’s records did not always appear to be appropriately or accurately completed or a detailed as they should have been as mentioned in this report.

The provider had not returned their provider information request we sent them despite a reminder being sent. The provider felt this failure was because we had an incorrect email address, which they felt they had informed us about. However, no records could be provided by the provider to confirm this. Staff told us they felt the home was well managed, though this did not align with our findings.

Feedback from partners was not always positive. One professional told us, “I don’t know (if the service works in a collaborate and joined-up way with their organisation to support service development). I know we offer MUST training (which is training to identify adults who are at risk of malnutrition or already malnourished) and they have never been to that.

Although we saw examples of the service working with various organisations, this did require improvement to support people to access the community more and also consideration was needed to ensure appropriate referrals were always made.

Peoples and their relatives generally felt the service worked in partnership with professionals, though we found this was not always the case.

People could gain access to advocates when needed.

Whilst we saw some examples of lessons learned following incidents, this was not consistent. We found some records following incidents were not complete. The service have failed to become complaint with regulations for the previous 5 inspections, despite enforcement action being taken. As the service has not managed to achieve a good rating for the previous 5 inspections it was not possible to see how improvement was being driven and sustained.

As some audits were not identifying the issues we found and due to the providers failure to act on past risk, this made it difficult to understand how the home was identifying concerns and how they learned and acted upon them.

Staff felt lesson learned was shared with them. One staff member said, “Lessons learnt are shared at handovers.”