Five Gables Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection, in June 2017, the service was rated as 'Requires Improvement' although there were no breaches in regulations.

When we inspected in June 2017 we found that improvements were required under four out the five questions we always ask about safety, effectiveness, caring, responsiveness, and well-led. The provider and registered manager had taken timely and appropriate action at the time of the previous inspection but we needed to be assured that these improvements had been sustained.

At this inspection on 25 and 26 July 2018 we saw that all the required improvements that had been made had been sustained. At this inspection we found the service to be rated as 'Good'.

Five Gables Nursing Home is registered to residential care for up to 43 people who require support with personal care and nursing care. At the time of this inspection there were 29 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service met all relevant fundamental standards related to staff recruitment, training and the care people received. People’s care was regularly reviewed with them so they received the timely support they needed. Staff sought people’s consent before providing any care and support. They were knowledgeable about the requirements of the Mental Capacity Act (MCA) 2005 legislation.

People were cared for by staff that knew what was expected of them and the staff carried out their duties effectively. The staff team were appropriately deployed throughout the home to ensure people's needs were met in a timely way. Staff were friendly, kind and compassionate. They had insight into people’s capabilities and aspirations as well as their dependencies and need for support. They respected people's diverse individual preferences for the way they liked to receive their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received their medicines in a timely way. People were provided with a nutritious diet that took into account their tastes and preferences. Their dietary needs were assessed and monitored and appropriate external healthcare professionals, such as the dietician, were consulted when needed. Where people needed physical assistance to eat and drink this was provided.

People at the end of their life received the care they needed to ensure they were kept free of pain and discomfort.

The provider and registered manager led staff by example and enabled the staff team to deliver individualised care that consistently achieved good outcomes for all people using the service.

The service worked in partnership with other agencies to ensure the quality of care was sustained across all levels. Communication was open and honest, and any improvements identified were worked upon as required. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong so that the quality of care across the service was improved.

People, relatives and staff were encouraged to provide feedback about the service and this was used to drive continuous improvement. The provider had quality assurance systems in place that were used to review all aspects of the service and drive improv

This unannounced inspection took place over three days on 29 and 30 June and 3 July 2017.

Five Gables Nursing Home is registered to residential care for up to 43 people who require support with personal care and nursing care. At the time of this inspection there were 36 people living in the home. At the last inspection, in June 2015, the service was rated Good. At this inspection we found the service to be rated as Requires Improvement.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not always effective at identifying shortfalls. Where shortfalls were identified these were not always addressed in a sufficiently timely manner. People were not always protected from the risk of infection as some areas of the home were not sufficiently clean or maintained.

People did not always receive their care from sufficient numbers of staff and people felt that there was not enough social stimulation and activity available. Some people were left waiting for support to have their food and drink and people's nutritional risk assessments were not always accurate; although staff were aware of people’s nutritional needs and had accessed extra support as needed.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. Staff received training in areas that enabled them to understand and meet the care needs of each person.

People felt safe in the home and relatives said they had no concerns about people’s safety. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns.

People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed; relevant health care professionals were appropriately involved in people’s care.

People developed positive relationships with the staff, who were caring and treated people with respect, kindness and courtesy. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage complaints.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

The service had a positive ethos and an open culture. People, their relatives and staff told us that the registered manager was a visible role model in the home. There were opportunities for people and staff to contribute to the running of the home.

This unannounced inspection took place on 24 June 2015. Five Gables Nursing Home provides residential and nursing care for up to 39 people. There were 32 people living at the home at the time of our inspection

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was flexible and responsive to people’s individual needs and preferences. Staff used creative ways to increase people’s sense of well-being and quality of life. People were supported by staff that knew how individual people wished their care to be given.

There were procedures in place to assess people’s ability to make decisions about their care and support. Care plans were in place detailing how people wished to be supported and where possible people were involved in making decisions about their care.

There were robust and effective recruitment processes in place so that people were supported by staff of a suitable character.

Staffing numbers were sufficient to meet the needs of the people who used the service. Staffreceived regular training. Staff were knowledgeable about their roles and responsibilities and had the skills, knowledge and experience required to support people with their care and meet their needs.

People told us they felt safe, and there were clear lines of reporting safeguarding concerns to appropriate agencies and staff were knowledgeable about their responsibilities to safeguard people.

The manager and staff were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Medicine management systems were in place and medicines were stored administered and disposed of safely.

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

There was a suitable complaints system in place, complaints were responded to promptly.

Management audits were in place to monitor the quality of the service, and improvements had been made when required in a timely way. People and family members were encouraged to feedback about the quality of the service and changes were made as a result of this.

Our inspection looked at the care and welfare of the people who lived in the home. As we walked around the home we saw that the staff approached their work in a caring and supportive manner. When we spoke with the staff they were able to explain their role to us and understood their responsibilities to ensure people were cared for appropriately and their needs were met.

One member of staff told us, “It is a new career for me, I really enjoy it.”

Family members who visited their relatives at the home told us they were happy with the care and support provided. One person told us, "X is doing well here. If there are any problems I just talk them and it is sorted."

Another relative we spoke with told us, “I am really pleased with how X has settled, the carers do reallly care about the people."

As part of our inspection we looked at how the provider managed the information and records of the people who lived at the home. Overall we found that the provider had appropriate measures in place to keep informaiton records up-to-date and to make sure that information was kept securely.

There were 33 people living at Five Gables Nursing Home when we visited on 29 June 2012. We spoke with one person living at the home and three relatives about their experiences.

One person said there were many varied activities to take part in such as games and a singer who visited the home. She said that an activities co-ordinator did exercises with people who wanted to join in.

A relative said about their family member, “she’s happy and so am I.”

Some of the people living at the home had complex needs, which meant they were not able to tell us their experiences. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Many of the people living at Five Gables had a diagnosis of dementia; as such their ability to recall their experiences and express their views was limited. In order to obtain information about people’s experiences of living at Five Gables and assess how their needs were being met by the staff, we spent time observing people's engagement, demeanour and body language.

We saw that staff communicated with people well and actively involved them in decisions about their daily lives. We saw people looked well cared for and were dressed according to their age, culture, gender and the weather conditions. We observed staff cared for people in a kind and sensitive manner and saw that staff supported the choices people made about how they wanted to be cared for. People told us staff were helpful and caring and would deal with any problems. One person said, “the staff are great! If there is anything I need, I ask and staff are happy to help”.