This inspection took place on 29 September 2016 and was announced.

Four Gables is a residential home providing personal care and accommodation for up to five people with learning disabilities, autistic spectrum disorder, physical disability and /or sensory impairment. At the time of our inspection visit, there were five people living there.

The service was last inspected on 27 May 2014, when we found the provider was complaint with the essential standards described in the Health and Social care Act 2008 (Regulated Activities) Regulations 2010.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager had recently been moved to work lon a temporary basis in another area of the country by the provider. Day to day running of the home was being undertaken by the assistant manager, who we refer to as the ‘manager’ in this report.

People were comfortable with staff and relatives were confident people were safe living in the home. Staff received training in how to safeguard people, and had access to the provider’s safeguarding policies and procedures if they had any concerns. Staff understood what action they should take in order to protect people from abuse. Systems were used to identify and minimise most risks to people’s safety. These systems were flexible so people could take risks if they were able to do so and build their independence.

People were supported with their medicines by staff that were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed. Regular checks of medicines helped ensure any issues were identified and action was taken as a result. There were enough staff to meet people’s needs.

The provider conducted pre-employment checks prior to staff starting work to ensure their suitability to support people who lived in the home. Staff told us they had not been able to work until checks had been completed.

Staff asked for consent before providing people with support. People’s ability to make decisions had been assessed and information was in place so staff knew how to support people with decision-making. Staff and the manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005, and the provider had ensured applications to deprive people of their liberty under the Deprivation of Liberty Safeguards, had been made as required.

Staff treated people with dignity and respect, and mostly respected their privacy. We also saw this in interactions between people at our inspection visit, and it was reflected in care records. People were supported to make choices about their day to day lives. For example, they could choose what to eat and drink and were supported to maintain activities, interests and relationships that were important to them.

People had access to health professionals whenever necessary, and we saw that the care and support provided was mostly in line with recommendations. People’s care records were written in a way which helped staff to deliver personalised care, which focussed on people being supported in ways they preferred. Staff tried to ensure people were fully involved in how their care and support was delivered, and people were able to decide how they wanted their needs to be met.

Relatives told us they were able to raise any concerns with the manager, and they would be listened to and responded to effectively, and in a timely way. Staff told us the management team were approachable and responsive to their ideas and suggestions.

There were systems in place to monitor the quality of the support provided in the home. However, these systems had not always identified gap

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

At the time of our visit there were five people living in the home.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, staff and carers told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We read customer feedback forms from five people who used the service and spoke to one person that used the service. All the people answered positively on the feedback form when asked, “Does the service keep you well” and “Do you feel safe in your home.” The person we spoke with told us that they felt safe in the home. The service had appropriate safeguarding procedures in place and the staff we spoke with had an understanding of safeguarding and had received safeguarding training. Staff had also received appropriate training in moving and handling people. The service had systems in place to ensure they learnt from events such as accidents, incidents and safeguarding investigations. This reduced the risks to people. Recruitment and personnel records showed that the service carried out appropriate checks to ensure the staff that were recruited were appropriate people to work in care. We saw that DBS (Disclosure Baring Service) checks and two written references were obtained for all staff that were recruited.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with had received DoLS training and understood their responsibilities in relation to this legislation.

Is the service effective?

When people were referred to the service details of their care needs, medical history, allergies and likes and dislikes were detailed in the referral forms. The service carried out an assessment of people’s care needs and the care plans we saw met the needs identified in referral forms and assessments. We saw detailed, individualised plans for people in the records we read. Staff told us, “People’s care plans are specific to them.” This meant the service was meeting the identified needs of people who used the service.

Is the service caring?

People were supported by kind and attentive staff. We read feedback forms that relatives of people that used the service had sent to the service. The relatives were positive about the care provided. Relatives said the service was providing a good service. One relative said, “X is extremely happy at the Gables.” We observed staff delivering care to people and saw that the interaction with service users had been warm and caring.

Is the service responsive?

We saw that the service had a system in place to respond to complaints and comments. We saw that the service regularly asked people’s view of the service and responded to what people told them. The records we read showed that people were asked what they wanted to do. The records showed the service supported them to access activities that were important to them. We saw that regular checks were made to ensure people had not changed their minds about what they liked to do.

Is the service well-led?

The staff we spoke with were aware of the aims and objectives of the home and quality assurance processes that were in place. We saw that the service regularly asked people for feedback and acted upon what they found. We saw that the manager of the service regularly attended meetings with senior managers within the organisation that owned the home. This kept the manger and staff updated on the strategic vision for the organisation.

All five people had lived at the home for many years. They were not able to speak with us about their care and support because of their complex needs. The three relatives we spoke with told us they were very satisfied with the care and support their relations received. Relatives told us, “It is like an extended family, home from home” and “That’s his home now” and “X is very happy there.”

In the two care plans we looked at, we saw that people’s needs and abilities were regularly reviewed. The manager had identified risks to people’s health and well-being and put measures in place to minimise risks. Care staff we spoke with understood that their role was to promote people’s independence and respect their decisions.

People were protected from the risks of infection because staff followed the manager’s infection prevention and control procedures. A relative told us, “It is always clean there.”

Care staff told us the manager was very supportive and they loved working at the home. They told us they had regular one-to-one meetings with the manager. They said, “I can talk to the manager anytime" and “It is down to the manager that it is so calm, controlled and well managed.”

The provider's quality assurance process included checking that people and their relatives were happy with the service they received. The manager told us they had recently proposed different formats for obtaining feedback and had asked people which format would suit them best.

We carried out this review to check on the care and welfare of people using this service.

None of the people who lived at the home were able to tell us about their experiences because of their complex needs. We used a number of different methods to help us understand their experiences. We spoke to relatives of two people who lived at the home and looked at the results of relatives' surveys that the manger had undertaken. We observed how people were supported, looked at the care plans for two people who lived at the home to see how their needs should be met, and talked with four staff.

We found that staff knew people very well and understood their individual needs and interests. People were encouraged to maintain their independence by regularly visiting their families and going out into the community, always with the support of staff.

We heard and saw staff encouraging people to engage with them and to take part in activities around the home. We saw that people were relaxed and comfortable in staff’s company.

Both of the relatives we spoke with were pleased with the care and support their relations received. One relative told us, “I am very happy with the care and carers.” Another relative said, “It is absolutely marvellous, I couldn’t imagine anything better for X.”