The Gables

On this page

• 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 requires improvement. At this assessment, the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

The provider and interim manager have since the last inspection, made the required improvements to consent and the service is no longer in breach of this regulation.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were happy with the care they received and felt staff understood their needs.

People’s initial assessments demonstrated they and their relatives had been involved in the assessment of their care needs. People’s care plans showed their physical, health, wellbeing and communication needs had been fully assessed. People’s needs had been assessed using a range of tools such as food and fluid charts and weight logs to ensure their needs were assessed and understood.

Staff told us people’s care plans were up to date and reviewed monthly as part of the resident of the day process which had been introduced since the last inspection. We heard staff consulting a person about an update they were making to their care plan, in response to a change in their care needs.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People were informed of what good practice looked like in relation to their needs. Staff told us a person who had the capacity to understand their food and dietary recommendations had not initially wished to follow them, which had been respected. However, with discussions over time they had since decided they would follow the guidance provided.

People’s pre-admission assessment identified their needs and preferences in relation to eating and drinking. Staff were aware of people’s likes and dislikes and any dietary or cultural requirements which were met.

We observed staff were alert to the risks to people from dehydration and frequently offered people drinks. People who were at risk of dehydration had their fluid intake monitored. People were provided with a range of choices of home cooked options for each meal and were able to have more if they wished or snacks. People were very positive about the meals. People’s feedback included, “The food is great” and “I always look forward to lunch. It’s always nice.”

The service worked well across teams and services to support people.

Staff were seen to work well together as a team. Staff had a daily allocation sheet to guide them about which people they were working with and their tasks for the shift. We heard staff consulting with each other about their work. Staff communicated as a team and ensured people were safe.

Staff used tools such as RESTORE2, which is a tool for care homes, in order to enable them to regularly monitor people and recognise the signs their health might be deteriorating. The interim manager told us staff could then hand over any minor concerns at the shift handover which had not already been brought to senior staffs’ attention or the on-call senior staff, if out of hours. Staff could also contact external professionals as appropriate and had a flow chart to guide them about when to ring the ambulance service.

The provision of people's care was co-ordinated effectively and any required referrals were made. Relatives told us they were kept updated by staff. People’s care records detailed any advice provided from professional's regarding how to manage the person’s care.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

People's care plans provided guidance for staff about the signs, symptoms and actions they should take to take in relation to conditions such as urinary tract infections. Staff had access to processes to enable them to share peoples’s information with professional’s quickly where required.

Staff were able to access additional training in areas such as dementia care, catheter care, diabetes care and oral care. Staff told us how crucial it was to people’s wellbeing to promote their oral care.

Staff told us how people were provided with healthy food options and how they would offer people biscuits, but also fruit. Staff also told us how they tried to keep people active with chair exercises. We saw people were encouraged to be as independent as possible by staff.

There was evidence relevant professionals had been contacted in a timely manner by staff when health concerns had been identified. We heard staff chasing a specialist referral for a person.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

People were asked about their expected outcomes from their care as part of their pre-admission assessment. People's care plans set out the planned outcomes from the delivery of their care and how these were to be achieved. People reported positive outcomes to us in terms of being happy with the care they received. Staff told us how, with the resident of the day process they both reviewed and monitored outcomes for people.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

The provider has made sufficient improvements since the last inspection and the service is no longer in breach of consent.

People’s care plans detailed their ability to make decisions, and any support they required to make decisions. People who had the capacity to consent to their care had done so.

Staff ensured they obtained copies of people’s Power of Attorney where these were in place, so they could check they were valid for the required decision.

Staff completed assessments of people’s capacity to make specific decisions where required. Staff ensured that if the person was assessed as lacking capacity to make the decision, a best interest's decision was then made, involving relevant people.

Staff spoken with told us they had completed MCA training and were able to explain its relevance and application to their role. They understood the need to make decisions for people where they lacked the capacity to make decisions for themselves, which took into account the person's known preferences.