About the service:

Seven Gables is a residential care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Seven Gables is registered to provide care for up to 25 people, including people living with mental health needs and dementia. At the time of the inspection, there were 25 people living at the service.

People’s experience of using this service:

• The environment was warm and homely. Communal areas of the home had recently been re-decorated.

• People told us they were happy living at Seven Gables. There was an established staff team that knew people well. One person told us, “I’m quite happy here.”

• Individual and environmental risks were managed appropriately. People had access to appropriate equipment where needed, which meant people were safe from harm.

• Medicines were administered safely and as prescribed. This was monitored through an electronic medicine administration system.

• Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

• Staff recognised people’s individual needs and supported them to make choices in line with legislation.

• People and their families were involved in the development of personalised care plans that were reviewed regularly.

• The registered manager and provider carried out regular checks on the quality and safety

of the service.

• The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection:

The service was rated as Good at the last full comprehensive inspection, the report for which was published on 26 July 2016.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.

This inspection took place on 1 and 8 July 2016 and was unannounced. Seven Gables provides accommodation and personal care for up to 25 older people including people with dementia. There were 23 people living at the home when we visited.

There was a registered manager at the home. 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.

Medicines were managed safely and people received these as prescribed. People and external health professionals were positive about the service people received. People were positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people were conducted regularly.

People felt safe and staff knew how to identify, prevent and report abuse. Legislation designed to protect people's legal rights was followed correctly. Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals.

Staff worked well together, which created a relaxed and happy atmosphere, that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

The registered manager and provider were aware of key strengths and areas for development of the service.

Quality assurance systems were in place using formal audits and regular contact by the provider and registered manager with people, relatives and staff.

We spoke with eight of the 23 people who were living at the home. They said that they were “very happy” with their care and the staff “knew how to care for them”. People also said the staff were “available when I need them”. Everybody said they were happy with the meals that were provided and told us choices were available. We spoke with six relatives who said they were “very happy with the care their loved one was receiving” and they were kept informed about any changes such as visits from the doctor. They said when visiting the home they had never observed anything which caused them any concern. We spoke with three visiting health professionals who said they were contacted appropriately and staff acted on their requests and guidance. They had no concerns as to how people’s health needs were met.

We also spent time observing care in communal areas. We found people had positive experiences. We observed staff were courteous and respectful of people's views. Choices were offered and where necessary informal consent was obtained. The staff knew what care and support people needed and they respected their wishes. We viewed three care plans. The care we observed generally corresponded with care plans.

We found sufficient staff were available and people received a varied diet with a choice at each meal. The environment was suitable for people and well maintained. Appropriate equipment was provided. All necessary records were held and these were stored securely.

We spoke with 10 of the 23 people who were living at the home. We also met and spoke with three visitors. People told us that they could make decisions about their day to day lives and that the staff were "very nice". People said that they had no concerns about how their care needs were met. We were told that staff were available when people needed them and knew what care they required. People told us that they felt safe and happy at the home. They told us that their privacy was respected.

We spoke with one health professional and one social care professional involved in the care of people. They were complimentary about the way the service met people's needs. We were told that they were contacted appropriately and staff followed any guidance and suggestions.

We observed that staff were courteous and respectful of people's views and opinions and that dignity was respected. We also observed that appropriate moving and handling assistance was provided. We spoke with three staff and looked at recruitment procedures which were appropriate and included all the necessary pre-employment checks. Although medication was stored and administered correctly there had been a short delay in obtaining medication for one person.

We were able to speak with four people living in the home and they told us they liked living in the home and that staff were kind and caring. We spoke to two visitors who told us they always find the staff welcoming and helpful. People told us they liked having a different activity session each day and we observed an activity session where people discussed how different senses trigger memories and events. People told us that in the warmer months there were also activities in the garden. People living in the home told us that they always see a doctor or nurse when they need to and receive help with taking their medication. People enjoy meals in the home and told us there is always a good choice on the menu with lots of alternatives offered to suit their preferences. We were told that staff are always available when people need or request assistance. We observed that staff engaged with people in a positive way and requests for help were met promptly. Staff told us they receive training for the work they do and feel supported. Staff told us they can speak with senior staff or the manager if they need additional support or have any concerns. The views of people who use the service are requested and listened to. However, the service has not yet developed robust quality assurance systems to monitor the overall quality of the service and to feedback to people what actions and improvements have been made.

This inspection took place on 22 and 24 July 2015 and was unannounced. The home provides accommodation and personal care for up to 25 people, including some people living with dementia. There were 24 people living at the home when we visited.

There was a registered manager at the home. 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 home was clean and hygienic with appropriate procedures in place to manage the risk of infections. Prompt action was taken to provide a hand washing basin in the laundry.

Individual ‘as required’ guidance and formal pain assessment tools were not in use. Medicines were stored securely, managed safely but not all were administered as prescribed.

Legislation designed to protect people’s legal rights was followed correctly in most cases although for one person their legal rights were not being fully protected. People’s ability to make decisions had been recorded appropriately, in a way that showed the principles of the MCA had been complied with. Family members told us decisions had been discussed with them, but best interest decisions had not been recorded. Staff were offering people choices and respecting their decisions appropriately.

The Deprivation of Liberty Safeguards (DoLS) were applied correctly. DoLS provides a process by which a person can be deprived of their liberty when they do not have the capacity to make certain decisions and there is no other way to look after the person safely.

People felt safe and staff knew how to identify, prevent and report abuse. Staff were correctly recording minor injuries on body maps but systems were not in place for these to be reviewed by the registered manager.

Plans were in place to deal with foreseeable emergencies although some personal evacuation information was not up to date. The home was well maintained although some aspects of the environment did not support people living with dementia or those with visual perception difficulties.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people’s individual care needs. However, not all care plans were reflective of the care people were receiving. People had access to healthcare services and were referred to doctors and specialists when needed. Reviews of care involving people or relatives (where people lacked capacity) were conducted regularly.

There were enough staff to meet people’s needs. Contingency arrangements were in place to ensure staffing levels remained safe. The recruitment process was safe and ensured staff were suitable for their role. Staff received appropriate training and were supported through the use of one to one supervision and appraisal.

People and relatives were positive about the service they received. They praised the staff and care provided. People were also positive about meals and the support they received to ensure they had a nutritious diet. A range of daily activities were offered with people able to choose to attend or not.

People and relatives were able to complain or raise issues on an informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. Staff worked well together which created a relaxed and happy atmosphere, which was reflected in people’s care.

The registered manager was aware of key strengths and areas for development of the service and there were continuing plans for the improvement of the environment. Quality assurance systems were in place using formal audits and regular contact by the provider and registered manager with people, relatives and staff.

There was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.