About the service

The Gables is a care home that offers nursing and personal care to 16 adults who have complex needs. There were 11 people living there when we visited.

People’s experience of using this service

• People showed they were happy living at The Gables, they felt safe and liked the staff who looked after them. The provider had systems in place to manage risks and keep people safe from avoidable harm. The provider employed enough staff to meet people’s physical, social and emotional needs. Staff gave people their prescribed medicines safely. They followed good practice guidelines to help prevent the spread of infection. Equipment was available so that staff could support people in a safe way.

• Staff had the skills and knowledge to do their job well and knew each person’s preferences. Kitchen staff cooked a range of nutritious meals to satisfy everyone’s taste and external healthcare professionals helped people maintain their health. Staff supported people to make decisions in all aspects of their lives.

• People and staff had warm, caring relationships with each other. A member of staff said, “We do so much more than just personal care. We’re helping people live their lives. It feels like a family – all looking after each other.” A relative described the staff as, “Professional, very caring and passionate about what they do.” Staff respected people’s privacy and dignity and encouraged independence wherever possible.

• People were fully involved with staff in deciding what activities, outings and entertainment each person wanted to do. People were part of the local community. People knew how to complain if they wanted to and were confident the registered manager would resolve their issues.

• Everyone praised the registered manager who gave staff strong leadership and managed the home well. Staff understood the provider’s ethos and values and made sure that people’s lives were as comfortable and fulfilling as possible. People, their relatives and other stakeholders had opportunities to comment about how the home was run. The quality-monitoring system included checks the staff and provider did to make sure that they identified any necessary improvements. A member of staff told us, “I like [registered manager]; everyone likes her. She is so passionate – [The Gables] is her baby and she knows what she’s doing.”

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection we rated this service Good (report published on 22 June 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we might inspect sooner.

The Gables is registered to provide accommodation for up to 16 people who require nursing and person care including those living with dementia, Autistim or with a learning disability. There were twelve people using the service when we inspected.

This unannounced inspection took place on 25 May 2016.

The service had a registered manager. 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.

Staff had been trained in, and were knowledgeable about, protecting people from harm.

A process and checks were in place to help ensure that staff’s suitability to work with people living at the service was to an appropriate standard. There was a sufficient number of suitably qualified and experienced staff to support people and meet their needs.

Staff were trained in medicines administration and they had their competence to do this regularly assessed. Only those staff deemed competent were then duly authorised to safely administer people’s prescribed medicines. People’s medicines were managed safely.

Risk assessments were in place to help manage each person’s assessed health risks. Staff used positive behaviour techniques to support people with behaviours which could challenge others.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service’s registered manager and staff were knowledgeable about when an assessment of people’s mental capacity was required. Staff were aware of the circumstances and conditions when an application to lawfully deprive any person of their liberty was required. Appropriate applications had been made and these had been acknowledged to lawfully deprive some people of their liberty.

Staff were regularly supported with both formal and day to day supervision. This was to develop their skills, increase their knowledge and help determine the most appropriate qualifications for their role.

People’s care was provided with compassion and in consideration of each person’s assessed needs. People were supported to improve their independent living skills by staff who knew the people they cared for well.

People were supported by staff with the person’s preferred means of communication. Relatives, nursing and care staff, health care professionals and social workers contributed to people’s to the assessment of people’s care needs. People’s care plans were in a format that promoted people to be as involved, as much as possible, in planning and determining their care needs and levels of independence.

People were supported and encouraged to access a wide range of health care professionals including dieticians, speech and language therapists and GP services. Staff’s adherence to the advice and guidance provided by health care professionals had a positive impact on people’s lives.

People were supported to eat and drink in a safe way and they were encouraged to eat and drink sufficient quantities to achieve a healthy and balanced diet. A choice of meal options were available and staff knew people’s preferred times and places to eat.

There were missed opportunities for people’s social stimulation including hobbies and interests. The registered manager adopted a proactive approach in dealing with and managing concerns that had been raised. Staff knew when people were happy with their care.

The provider and registered manager had effective audits and quality assurance procedures in place. Information gathered from audits was used to identify what worked well and what did not work quite so well. Improvements made were consistent and sustained.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports the summary, please read the full report.

At the time of our inspection on 23 September 2014, the provider was not carrying out the regulated activity ‘Diagnostics and screening' at this service. This regulated activity was therefore not assessed on this occasion.

We used a number of different methods to help us understand the experiences of people using the service. Some of the people using the service had complex needs which meant they were not all able to tell us about their experiences. We observed care being provided and spoke with two people who lived at the home, five staff members and one health care professional. We also looked at three people’s records and records relating to the management of the home, including three staff member’s files.

Is the service safe?

People told us they felt safe with the staff who provided their care. The provider used a variety of risk assessments to ensure people's needs were met safely. We found that appropriate arrangements were in place in relation to obtaining, recording, storage, administration and disposal of medicines. Satisfactory pre-employment checks were obtained before staff began providing care to people. This helped to ensure that people were cared for by staff whose character had been reliably established.

Is the service effective?

People told us that the staff understood and met their needs. We found that care was planned and delivered in a way that ensured people’s needs were met reliably, and in the way people preferred. Where possible, people were involved in the planning of their care.

The staff we spoke with told us that the senior staff were very approachable. They said they had received comprehensive induction, training and support, including one to one meetings and annual appraisal. This helped them to meet the needs of the people they provided care and treatment to.

Is the service caring?

Both people we spoke with made positive comments about the staff who provided their care. One person said, “The only time I have to tell staff what to do is the new ones. But they’ve always read my care plans.” The other person told us, “All the staff are very nice all the time. I’ve no complaints.“ During our inspection, staff interactions with people were seen to be respectful and caring in their approach. People told us this was always the case.

Is the service responsive?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. People confirmed that they were consulted about the care and treatment they received. One person told us, “If I don’t want care, staff come back later.”

Is the service well led?

A new manager took up post in July 2014. Staff we spoke with told us that the home was better organised, which had improved the service provided to people who lived at The Gables. Staff told us they enjoyed working at the home and felt involved in the running of the service. One care worker told us, “I feel my view is counted. The nurses and [manager] listen to me and take on board what I say.”

The manager sought the views of people who used the service and acted on what they said. A comprehensive quality assurance system was in place. This helped to ensure that people received a good quality service at all times.

There were systems in place to audit the quality of the service and to report and monitor complaints, accidents and injuries. This meant that the service was able to learn from adverse events and take action to make improvements when necessary.

We found that the provider was compliant with the regulations in all the areas we assessed. If you wish to see the evidence supporting our summary please read the full report.

We saw that people with dementia were treated with dignity and respect. A relative told us, “The care given is the best in this area, this is the third home we have used for our relative and this is easily the best’.

The needs of the people were recognised and met, we were told that staff really listen and try out different methods of delivering care until they find what the person is comfortable with. We saw that future care was discussed and that the people had the opportunity to discuss end of life care.

Care records were reviewed regularly and were responsive to any changes in people’s circumstances. One relative told us, “I think X’s care is great quality. There are inevitably issues relating to individuals needs but my family and I are always consulted over changes to the care plan”.

We saw people with dementia were protected from harm because staff were trained and knew the people they cared for well and were able to respond to body language. The physical environment of the home needed attention as parts of it were showing sign of extreme wear and tear.

Care staff had been trained in the care of people living with dementia and were aware that people should live as full a life as possible and we saw that people were assisted in this.

During our visit on the 19 July 2012 people living at The Gables told us that the staff encouraged them to be independent but gave them help when they needed it. They told us that they could have visitors and that they were made to feel welcome. People also told us that they liked the food "Most of the time" but that they could choose something different if they didn't like what was on the menu that day.

People we spoke with during our visits told us that they got on well with the staff and that the staff supported them with their personal care and going out. People told us they would be having their bedrooms refurbished soon and had been asked to choose what colours they wanted in respect of redecoration and what furniture. They told us about their holidays and things they enjoyed doing. We observed staff supporting people in activities of daily living and recreational activities