The Gables

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

People continued to experience variation and inconsistency in the standard of care expected. There was still a breach of regulations in relation to governance and there was a new breach, due to the lack of a statement of purpose which is a legal requirement. Staff were not aware of the provider’s purpose for providing the service and the underpinning values and ethos of care. Staff felt they had lacked guidance and leadership. They did not feel adequately listened to. Staff lacked sufficient clarity about their roles and responsibilities. Risks to people and staff had not always been identified and addressed. People’s records were not complete. Staff had completed audits, but it was not always clear if resulting actions had been completed. However, there had been a recent change in management. The interim manager is also the registered manager for the provider’s other service. The interim manager will oversee the service until a new registered manager is appointed. They will then support the new registered manager for a period of time once they commence their role. The interim manager has a good understanding of the risks and challenges to making the required improvements to people’s care. They also appreciate it will take a period of time to change the culture of the service and to make the required improvements and to embed them. The interim manager has begun to work with staff to start to make changes to the service. Speaking with staff about what needs to change and why and providing them with the opportunity to raise issues. Staff we spoke with felt overall more positive about the future.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff spoken with were not all familiar with the content of the provider’s statement of intentions. They were not all aware of the provider’s purpose, the values or vision for the service. Staff feedback collected anonymously by the provider showed staff had found it a challenging service. Staff felt there were many areas that required attention, including a lack of guidance and direction, lack of feedback, poor environment, people’s care, and management of the service. Staff wanted to see more action taken when they raised issues. However, staff we spoke with now felt overall more positive about the future. They told us the new interim manager had already held a staff meeting to update and inform them about the recent changes. The interim manager told us they felt staff were caring and good with people. They felt staff had the right attitude to enable them to make the required changes to the service.

Staff lacked the required understanding and knowledge to enable them to fully support people. This had led to some poor practices, such as staff making DoLS applications for people when they were not required, and people having been left at risk of experiencing harm. There was not a statement of purpose as per the legal requirements for registered providers. However, the provider had a statement of intentions, which was displayed within the service for people to read. It set out the vision statement, mission statement and the core values for the service. It described the aims and objectives of the service and the core values.

The interim manager told us they were in the process of identifying the scope of the works required in order to meet regulatory requirements and to drive up standards for people. The interim manager was highly motivated to work alongside the staff team to drive the required improvements to the service. It will take further time for them to make the changes needed.

The registered manager had left the service 12 days before the start of the site visits. However, the provider had immediately arranged for the registered manager from their other service to oversee the service as the interim manager whilst the post was advertised. The interim manager was supported in their role by a deputy manager and senior care staff. However, further work was required to clarify the responsibilities and expectations of each of these roles, and to then ensure all staff in leadership roles were appropriately supported. To ensure they had the required skills and confidence to lead staff. The interim manager planned for senior staff to shadow senior staff from their own care home, to enable senior care staff at The Gables to develop their understanding. The provider also planned for the interim manager to support the new registered manager once appointed to ensure a smooth transition and continuity for people and the staff team. The interim manager was supported in their role by the area manager.

Staff did not all say they felt confident about raising any issues as they did not feel historically when they had raised issues they had been listened to or that their concerns were acted upon. Staff feedback obtained by the provider through the staff survey showed nearly half of staff had not felt confident about speaking out. Further work was required to ensure the culture was fully developed into one where everyone felt they could speak up and their voice would be heard, and any required actions would be taken. However, we also received some positive feedback about the changes which were taking already place. The interim manager understood the need to empower the staff and promote the value of raising any issues they identified. They understood the need to model openness, honesty and transparency in order to create a positive culture of speaking up.

The interim manager was in the process of setting up supervisions for all staff, to give them the opportunity to raise any issues on a one-to-one basis. Staff had access to guidance about how to speak out and with whom. The provider had actively sought staff’s views through the recent staff survey. It will take further time to be able to demonstrate the processes in place to enable staff to feel confident about speaking out and that when staff do, they are listened to, are effective.

Staff’s feedback from the provider’s staff survey indicated they did not always feel they had been treated equally.

A potential risk to a staff member had not been identified until we brought it to the interim manager’s attention. Although they took immediate action to address this issue, it should have been identified earlier. There was a lack of processes in place to demonstrate how equality, diversity and inclusion within the workforce were assessed and monitored.

Staff told us there was not sufficient detail noted in people’s daily records. They said there was no record of the time people’s care had been provided. Therefore, the provider could not demonstrate if people’s care such as re-positioning had been provided as frequently as required in order to mitigate the risks to people of skin damage. The interim manager told us about the actions they were taking, to ensure staff understood the importance of record keeping within the service.

We saw people’s records lacked sufficient detail. People did not have accurate and complete records. The sheet staff used to share important information about people contained minimal information for staff in order to enable them to provide people with safe care. CQC had not been provided with a written report of the action the provider intended to take to meet the requirements of the staffing breach identified at the last inspection, as legally required. There had been a failure to understand and meet legal requirements. There was a lack of clear and effective governance and management arrangements within the service. To ensure all staff had clearly defined roles, responsibilities and accountability which they understood. The roles of staff in leadership positions were not clearly defined. Staff had completed audits of the service; however, it was not clear if the identified actions had been completed. However, the interim manager had combined the identified actions from the previous audits into an overall service improvement plan which was being updated as they identified any new issues. This will enable them to have oversight of the identified actions and progress from all the audits of the service.

People and relatives spoken with did not all report feeling they felt they had been consulted with and they could not recall if their views had been sought through questionnaires about the service. However, relatives who had provided feedback to the service, said it had then been acted upon.

Staff told us there were links with the local church who came into the service for religious festivals. The interim manager told us they were now looking at further developing their links with the local community. The interim manager also informed us they were looking into obtaining a feedback QR code for the service. People, relatives and visitors could then provide their feedback as they wished, rather than having to wait for a questionnaire or survey to be sent out for completion. Staff will also then be able to then be more responsive to feedback. The interim manager had also arranged a meeting with relatives, to enable them to share their views and to keep them updated about the recent changes to the service.

Partners felt further work was required in order for the service to be able to fully demonstrate it was supporting care provision to people, service development and joined up care. However, they did report staff were becoming more open and were looking to work more with local services.

People had not always been fully involved in decisions about the service. There was a lack of evidence to demonstrate people had been fully involved in decisions about the service, such as the menus. Staff had not always ensured relevant referrals were made as required, such as SaLT referrals. However, there was evidence staff had consulted with the DoLS team about the impact of potential restrictions upon a person.

It will take further time to be able to demonstrate learning, improvement and innovation in the service is taking place. However, the interim manager demonstrated they understood how the service was currently performing, and the actions required to ensure regulations were met and people received a good standard of care. They told us they had already held a meeting with staff, to update them and enable them to ask any questions and share their views. The interim manager said they were a member of a registered manager’s group. This enabled them to update their knowledge and to share ideas for service improvement.

There was a lack of in-depth analysis or evidence learning had been shared or evidence identified actions had been completed. Staff had started to analyze trends, in terms of how many there were and where they took place. However, there was a lack of evidence to demonstrate what actions were identified as required as a result of this analysis in order to improve people’s care. There was a lack of evidence to show sufficient action had been taken as a result of analysis.