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

The service was now rated inadequate. We found a continued breach in relation to governance and a failure to notify the Commission of notifiable events and incidents. The provider had continued to fail to implement effective governance and accountability processes. Quality assurance measures were not robust and had not been effective in identifying concerns and prompting action to improve the service. There was limited evidence of learning when things went wrong, and a limited understanding of how to make and sustain required improvements. There was no formal strategy in place to develop a shared direction and positive culture and the provider had missed opportunities to engage with staff and people to include them in developing and improving the service. Leaders acknowledged inconsistencies in home management meant oversight had not been robust and quality assurance systems had not been implemented with integrity, openness and honest. The nominated individual commented, “We need to look at reasons why we haven't moved the care home forward, we will take responsibility for that.”

This service scored 29 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was no shared vision, strategy, and culture. Staff described a culture of low morale and some staff felt communication was poor. Leaders said they were aware the culture at the home had been historically difficult and felt the time was now right to follow human resource processes to address concerns, meaning performance management. They added they were explaining why changes needed to be made and informing staff of best practice expectations. However, there were no records of any staff meetings taking place and some staff had not had a support meeting documented, meaning there was no evidence any support had been offered or action taken in relation to addressing the culture. Leaders said they had systems in place to promote a positive culture, such as bulletins and a ‘Star of the Month’ process, although there was no evidence of Star at the Month being implemented at the home. There was no formal strategy in place to develop a shared culture, with leaders saying culture was a 'feel' rather than a tangible thing.

A values document was in place which detailed the values of the organisation as being Compassion, Aspiration, Respect and Empowerment (CARE). This document was a list of statements made by staff, people and relatives, followed by behaviours. For example, under Compassion it included, ‘Showing empathy and understanding in times of need’ and a behaviour was, ‘We put the people we care for and support at the heart of everything we do.’ During the course of the assessment, we found little evidence that leaders and staff were living the values of the organisation and embedding them into day-to-day practice. The values document wasn’t dated and didn’t provide a clear strategic plan to develop a shared direction and culture, built on transparency, equity, and learning. The results of the staff survey, completed in March 2024 provided ample feedback in relation to the culture of the home and areas for improvement. Yet leaders had missed the opportunity to engage with staff and work together to improve the service.

There were mixed views about the leadership of the home. Some staff felt they could have had more support from management, others said with the new management team they felt listened to. Staff commented morale was low and there had not been any real communication, so they didn’t really know what was happening with the home. The leadership team acknowledged there had been inconsistent leadership, which combined with insufficient oversight, meant the organisation’s values and visons had not been delivered upon. Leaders had some understanding of the issues at the service but had not been effective in leading improvements.

The organisation’s senior leadership team were a consistent team of staff. However, insufficient oversight and governance meant we could not be confident the context in which care, treatment and support was delivered at Gables Care Home was fully understood. There was a lack of documentation to evidence how staff, people, and relatives were being supported through managerial changes and how they were involved in identifying areas for improvement and development. Staff, people, and relatives had all shared feedback in relation to the home and there was no evidence this had been analysed and used to develop the culture of the home and improve the care and support people received. Inconsistencies in home management meant the oversight of the home had not been robust, quality assurance mechanisms had not been implemented with integrity, openness, and honesty, which meant they gave a more positive picture of the home than was the reality. Staff support and wellbeing had not been consistently supported and the provider had failed to ensure oversight, all of which was acknowledged by the leadership team. The senior leaders did feel that with the appointment of a new home manager, who commenced in post during the assessment, they were seeing a shift and staff were being more open and feeling more supported.

Leaders had not actively promoted staff to feel empowered to drive improvements. Whilst some staff said they felt listened to by the current management team, others did not. Staff had previously raised concerns, both in the staff survey and in some 1 to 1 support meetings but leaders had not acknowledged the concerns and no action had been taken to address issues, make improvements and foster a positive culture. Whilst leaders said staff meetings had taken place, they also commented there was a lack of staff meeting minutes and no documentation in place to evidence communication between leaders and staff.

The provider had failed to ensure leaders implemented a system by which communication could be shared openly and honestly with the staff team. Whilst staff had taken opportunities to provide feedback, leaders had failed to investigate the concerns and work with staff to learn lessons and drive improvements.

Leaders said they had a diverse workforce of staff, some of whose first language was not English. They commented that staff did not have any protected characteristics and there were no reasonable adjustments in place. One staff member had declared a health condition and had requested a specific risk assessment be implemented in relation to this, but leaders were not able to provide this during the assessment.

An Equal Opportunities Policy was in place, which was issued in Jul 2021 with a review date of January 2022. However, there was no evidence of a review, meaning the policy was out of date. Leaders commented that equal opportunities were monitored as part of the recruitment process and reasonable adjustments could be made. Regular bulletins were shared with teams; however, they did not include information around different culturally important events. Christmas was mentioned, however there was no reference to significant events which may have been important to other staff members, or which may increase staff knowledge of events which may be important to people with different cultural beliefs and backgrounds. Due to the limited oversight and governance of the home we were not assured leaders reviewed and improved the culture of the organisation in the context of equality, diversity, and inclusion.

Leaders said, “Fair to say audits haven't been transparent. The right people weren't given audits to be done, don’t fully understand what it was that needs to be done. Audits haven't been done robustly. Not a constant regional [manager] in there to have oversight and validation of audits. As a company we generally have systems in place but haven't used them properly. No benefit in doing audits if they are a work of fiction, validation [needs to be] built in to drive improvement. Systems do appear to be in place but haven’t been effectively or consistently implemented to identify areas for improvement and drive-up standards and quality.”

A range of audits were being completed; however, they had not been effective in ensuring accountability and good governance. There were no clear lines of responsibility and accountability for the completion of improvements, and quality assurance mechanisms had not been used effectively to manage and deliver good quality, sustainable care. Concerns identified during the inspection had not been identified by the provider, or where they had been the provider had failed to address them. Insufficient action had been taken to address the shortfalls identified at the last inspection meaning there had been a continued failure to improve. There was a failure to notify the Commission about some notifiable events, including the outcome of DoLS authorisations and some allegations of abuse raised by staff members. There was acknowledgment the provider needed to look at why they had not been able to move the home forward and make the required improvements, saying they would “take responsibility for that.”

Whilst the provider was engaged with partnership working the service was not working seamlessly for people to learn and collaborate for improvement.

Leaders said they were working in partnership with staff via staff meetings, however, there was no evidence staff meetings had taken place. They said the senior management team did a lot of coaching and individual discussions with staff but did not necessarily make a lot of records. They added, there was lots of learning, for example, in relation to the Electronic Medicine Administration System. They also said staff were told about verbal feedback and what outside agencies had said, but it wasn’t documented. Despite feedback from leaders there was little evidence that partnership working had resulted in shared learning and better outcomes for people.

Partners said that whilst, on the whole, the staff team worked in partnership with them the leaders were not able to affect the changes needed to improve the service and protect people from the risk of harm.

The provider has engaged in the Responding to and Addressing Serious Concerns process with the local authority safeguarding and commissioning teams for over 13 months. Whilst recent reports indicated some minor improvements the provider had been unable to evidence sufficient improvements which had been sustained, nor were they been able to evidence robust systems had been implemented to identify areas for improvement whilst learning with partners to develop and improve the service for people.

Leaders commented that there had been a number of different managers in the home, including senior managers who had not managed staff as the should have done. They said quality audits had been completed. However, they had not been applied consistently and accurately enough to identify areas for learning, or appropriately measure outcomes and impact. Leaders said people and staff were involved in discussions, however, there was no evidence these conversations had taken place and staff and people had commented communication was poor and at best inconsistent.

Audits had not been effectively or robustly implemented to make improvement and ensure continuous learning took place. There were no documented staff meetings, and no evidence staff were supported to speak up with ideas for improvement and innovation. When staff did speak up about concerns there was no evidence leaders listened to them and acted to investigate and improve. A service improvement plan was in place. However, it was supplemented by various action plans produced following audits, not all of which detailed target dates for achieving improvements or who was accountable for ensuring improvements and learning took place. The provider had failed to focus on continuous learning and improvement. Engagement with staff in encouraging creative ways of supporting the delivery of quality care and support for people was not evident.