Gables Care Home

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

The service has been rated inadequate. We found a breach in relation to person centred care and a continued breach in relation to consent to care and treatment. People’s rights were not protected as the principles of the Mental Capacity Action (2005) were not being followed. People’s care had not been planned with them and care plans were not sufficiently detailed to enable staff to provide safe, appropriate care which met people’s needs and preferences.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s health, care, wellbeing, and communication needs had not always been assessed and reviewed, meaning the effectiveness of their care and treatment was not always maximised.

Leaders acknowledged improvements were needed in relation to care planning. The activities co-ordinator was knowledgeable about people and said, “I take time to speak with people, ask them about their past hobbies and take time to listen. The zoo visit was born from speaking to [person] who used to go to the zoo and said they would like to go again, so I arranged for the animals to come in.”

People’s needs were not always assessed and reviewed. Where needs had been identified, the actions needed to meet their needs were not always identified or included in care records. One person’s care plan identified a need in relation to type 2 diabetes. However, the care plan contained no information in relation to how this was to be managed. Another person had been assessed as being at high risk of falls and had a wheeled walker to support them with their mobility. Their mobility care plan references the walker under ‘current status’ but made no reference as to how staff were to support or encourage the use of the equipment. Another person had been identified as having communication needs, with a sight and hearing impairment, however the care plan stated, ‘Does not require any support with this.’

People's care had not been planned with them, including what was important to them and what mattered to them. Care records provided no assurance people had been included in care planning, and resident surveys, completed by the provider in January 2024, provided mixed feedback on whether people had seen their care plan.

The leaders acknowledged care plans were a work in progress and said, “We are working on resident of the day forms which will be implemented, which includes involvement in care plan reviews for the person and their relatives.” This had not yet been applied. Resident of the day is an initiative when a particular person’s care is reviewed with them and their relatives on a regular and recurring basis. As well as focusing on people’s care needs it is generally used as opportunity to celebrate that person and make them feel extra special.

Processes were not in place to make sure people’s care was planned with them and was in line with current guidance. There was no evidence people, or their relatives had been included in care planning. What was important to people had not been documented in care records, nor where they detailed enough to make sure staff had sufficient information to support people safely, appropriately, in line with their preferences, and good practice. Food and fluid charts were poorly completed and did not demonstrate that people were consuming enough food and fluid. Food records for people who were at risk listed imprecise amounts of food eaten – such as ‘ate a little.’ Where people consistently refused food during the day there was no evidence that alternatives were offered. Fluid charts showed people were not achieving the required level of fluid set in their care plans. Some people, with a daily target of 1500mls, were only recorded as consuming 400mls or 600mls in a day. No action had been taken in relation to the low fluid intake. Care records were poorly completed or not completed at all. For example, people with type 2 diabetes had little or no indication in their care plans as to how they should be supported. One person living with Parkinson’s Disease had no action in any of their care plans to demonstrate how staff should support them.

People’s experience was impacted as staff did not have access to the information needed to appropriately assess, plan, and deliver peoples care due to care records not being sufficiently detailed.

Care staff told us they worked together as one big team and supported each other the best they could. However, care staff were unsure of the process to follow when people were due to move between services, saying it was managed by the nursing staff and the seniors. Staff said they were able to access care records on the electronic system if they needed to. However, it was found, and acknowledged by leaders, care records were not sufficiently detailed.

Partners and health care professionals involved in supporting the home told us they had significant concerns about staff culture within the home, a lack of effective information sharing between team members, and poor care plan recording. We were also told previous recommendations given by a health care professional were not being followed. This left people at risk due to a lack of staff knowledge and awareness.

Processes had not been implemented to ensure staff had access to the information needed to appropriately assess, plan, and deliver people’s care, treatment, and support, so they could assist people consistently and appropriately. Plans for transition and discharge did not fully consider people’s individual needs, circumstances, or ongoing needs. There was no evidence people were involved in assessing their needs to ensure continuity of care.

People gave mixed feedback, with one person saying, “The doctor seems to be on hand when we need them” whilst another said, “I feel I could do with seeing a doctor and in a timely manner. They have known this for more than 2 weeks now.” People and their relatives had provided feedback during a resident and relative meeting in January 2024. They had commented on meals, the maintenance in the home, including feeling cold in the lounge area, and a bath not working. However, no actions had been shared following the meeting. The registered provider confirmed the bath was working but there were repairs being made to the tiles and the room was temporarily out of use, while these were being mended. People’s care records did not include information on reducing their future needs for care and support.

Staff said they were not involved in completing care records or risk assessments, although said they did listen to people and follow their choices. However, people were not always supported to live healthier lives as care records in relation to health and wellbeing were poorly completed or remained blank.

Processes had not been implemented to support people to manage their health and wellbeing, in order to maximise their independence, choice, and control. One person was said to experience regular urine infections which could cause confusion. However, the information on what staff were to look out for, to identify a potential infection was limited. One care plan read, ‘Staff to be aware of any changes and look out for signs of infection. May cause [person] to go to the toilet more often which could result in occasional accidents.’ There was no information about monitoring for changes to the person’s comprehension levels or the colour or smell of urine, which may indicate an infection. The same person was identified as having a number of risks in relation to nutrition, including refusing meals, needing a fortified diet, and experiencing a small weight loss. Actions for staff to follow were limited to, ‘Offer a well-balanced diet and fortified to be offered as well as snacks to boost calories.’ There was no information on how to encourage the person to eat, or to offer finger food as the person walked with purpose, rather than sitting for a full meal. Diabetes care plans contained no information on how to support people with the condition, nor did they include any signs and symptoms that should be aware of which may indicate a rapid deterioration in their condition.

People’s experience was influenced by the lack of detail in care plans, together with the lack of inclusion in care planning. There was no evidence people were included in care planning or reviews of care and, their hopes, wishes and preferences were not recorded or monitored.

Care staff told us they were not routinely involved in writing or reviewing care plans, as this was undertaken by senior staff or nursing staff. One care worker told us, “We don’t do the care plans. We have electronic devices where we record activities. We know where the care plans are if we need to see them. There’s a big blue folder with care plan information. But all the details are on the handheld device.”

The provider had failed to routinely monitor people’s care, to continuously improve it. There was no evidence outcomes were documented to ensure they were positive, consistent, and met both clinical and personal expectations. Care plan information was limited in most cases. Some sections of care plans had no actions listed for staff to follow and no measures listed to assess the success of interventions. There was limited evidence of effective care plan reviews, such as reviewing food and fluid intake for nutritional care plans or reviewing any changes in continence care plans. Reviews included frequent use of phrases such as, ‘care plan remains relevant’ and ‘Care plan remains the same at time of review.’ There was little or no evidence people or their relatives had been involved in both the establishment of care plans or the review processes. Some care plans had not been updated since being created. For example, one person’s care plan, related to their medical conditions, including diabetes, had been created on 24 January 2024 but showed no indication of review or update.

People’s experience was impacted due to the provider’s failure to follow the principles of the MCA in relation to capacity assessments and best interest decision making. Care records did not contain person centred information which also impacted people's experience in relation to understanding their rights around consent, and staff respecting people's wishes and preferences.

Staff told us they sought people’s consent by asking them. Comments included, “I would talk through what I’m doing and make sure they are happy. If someone was unhappy or resistive I would get help or leave them and then go back. A lot of people here don’t have capacity.” However, we found staff were not following the principles of the MCA and people were not always consenting to their care.

People’s care and treatment was not provided in line with the requirements of the Mental Capacity Act 2005 (MCA). We observed 7 people had sensor mats in their bedrooms but no appropriate capacity assessments or best interest decisions had been completed for the use of these. Under the MCA such devices are classed as being restrictive and require either consent or best interests decisions to be made for their use. Care plans relating to mobility and safety referenced the use of sensor mats but did not demonstrate appropriate capacity assessments or best interests decisions had been undertaken. People’s care records contained no evidence that an assessment of need or review of capacity had been undertaken in relation to the use of sensor mats. Where people were recorded as possibly having capacity to agree to such equipment, there was no record of informed consent, either through a signed record or through the recording of a verbal agreement. Were relatives were noted to have Lasting Power of Attorney for health and welfare, there was no evidence they had agreed to such measures being put in place. One person was receiving covert medicines. Whilst there were detailed instructions from the GP and community pharmacist about how these medicines should be given this did not amount to a best interests decision, as it did not consider if this was the least restrictive approach. There was no evidence people’s relatives or advocates had been involved in the decision. As the staff were responsible for the administering of the medicine, they are also responsible for completing a best interests decision or capacity review for the giving of covert medicines.