Gable Healthcare Services Ltd

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 good. At this assessment the rating 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 the managerial oversight and governance at the service.

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.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Capable, compassionate and inclusive leaders during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. The provider had a speak up and whistleblowing policy and procedure in place for staff support and guidance. There was a senior staff member allocated as speak up lead for the service that staff could contact directly and in confidence. Staff told us they would be confident to speak up if they had concerns and they felt they would be listened to.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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. Systems and processes were either not in place or were not effective in identifying the issues and concerns we found during inspection. We requested evidence of audits of people’s care files, these were not provided. If audits of care files were taking place they had not been effective in identifying errors, conflicting information, or missing records from people’s homes. We were not reassured that the provider had effective oversight of staff competency. The staff training matrix provided at the site visit did not include a number of staff, it was not clear how often and who was responsible for checking the competency of staff. However, a staff member told us that they had received training and competency checks via NHS nurses for supporting people with their PEG. In regard to medicines we identified a number of concerns with staff recording, administering and actioning errors. There was no evidence that staff had reported meds errors or sort advice. Medication audits we reviewed had not been effective in identifying concerns and errors for 4 people. Records did not evidence that supervision and spot checks were completed in line with the providers policy and procedure. However, staff told us they received regular supervision from the team leaders and the provider. Following our inspection the provider completed further training to enhance their leadership skills, this included, management skills, safeguarding and investigating incidents and effective rostering of staff.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. The provider had failed to meet contractual agreements including ensuring an effective system for monitoring staff attendance and time keeping and embedding and sustaining improvement of the safety and the quality of the service. Where stakeholders had completed quality monitoring visits and implemented action plans, actions were not always completed by the provider. Information requests from stakeholders were not always actioned or actioned promptly. The provider and staff had not always sought guidance from healthcare professionals when needed. For example, there was no evidence of medical advice sought for missed medication. We saw some evidence of where medical advice had been followed regarding adjustments to people’s medication and GP’s contacted to support people with appointments when they were unwell. People had a regular team of staff that knew them well, staff told us they would provide a thorough handover to emergency services where required.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. The provider did not have effective systems and processes to monitor the safety and quality of the service this meant that concerns about quality and safety were not identified and therefore could not be learnt from and concerns had continued. The provider did not demonstrate that they were always acting on feedback and learning and improving from stakeholder feedback on the quality and safety of the service. Learning from accidents and incidents and safeguarding was a particular concern as the provider did not evidence measures were implemented to prevent future risks. Following the inspection the provider completed further training to enhance their own knowledge and commissioned a consultant to support with improvements. The provider also implemented an electronic care system for record keeping to support improving oversight. This would need to be continued and embedded into practice.