This inspection took place on 11 December 2017 and was unannounced. The service was previously inspected in October 2016 and at that time, we found the service met all of the legal requirements.

The 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. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Gables Nursing Home is located in a residential area of Pudsey in Leeds, and is close to local amenities. The home provides nursing, residential and dementia care to a maximum of 23 older people.

The service has two registered managers, both were present at this 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.

Areas of the home required repair and refurbishment and the provider did not have a plan in place to address these issues. We have made a recommendation about this.

Activities provided at the service did not always suit people's care and support needs. We have made a recommendation about this.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. Staff protected people's privacy and dignity. Staff received one-to-one supervision meetings with their line manager. Staff felt supported and listened to.

People's needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments to protect people from harm as much as possible in their daily lives. They were regularly reviewed and amended as necessary to ensure they reflected people's changing support needs.

There were policies and procedures in place to assist staff on how to safeguard people from harm and abuse. There were sufficient numbers of staff on duty to meet people's needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Fire prevention processes were in place to keep people safe in the event of a fire on the premises. All servicing of utilities, systems and equipment had been carried out by the appropriate professionals. Some areas of the home required better cleaning. Accidents and incidents were investigated to make sure that any causes were identified and action was taken to minimise any risk of reoccurrence.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made before staff started work, including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure people were suitable to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with suitable amounts of food and drink and were happy with the meals they received. People's nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary. P

Our inspection took place on 24 October 2016 and was unannounced.

At our last inspection on 20 and 22 January 2016 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to safe care and treatment, staffing, responding to complaints, fit and proper people employed, quality assurance and notification of significant events. We rated the service as inadequate and placed it into special measures. At this inspection we found the provider had made the required improvements and concluded the service was no longer in breach of any regulations.

The Gables Nursing Home is located in a residential area of Pudsey in Leeds, and is close to local amenities. The home provides nursing, residential and dementia care to a maximum of 23 older people. On the day of our inspection there were 15 people using the service. There was a registered manager in post when we inspected. 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.

People told us they felt safe living at the home, and we found staff understood safeguarding and their responsibilities to report any concerns about people’s safety. Risks associated with care and support were well documented and contained guidance for staff to show how these risks could be minimised.

The provider carried out appropriate background checks before employing staff, and we found they were deployed in sufficient numbers to provide care and support safely. Accidents and incidents were managed safely; however, we found the information relating to actions taken was not always stored with the record of the incident.

Medicines were managed safely. Storage was secure and medicines were kept at appropriate temperatures. Records we looked at showed staff recorded when medicines were taken or refused. There was good guidance in place to ensure people got pain relief when this was needed.

Staff received training at induction and during their employment which ensured they were supported to be effective in their roles. Further support was given through a programme of supervision meetings and an annual appraisal.

People were supported to access a range of health and social care professionals. We saw advice from health professionals was incorporated into people’s care plans.

The provider ensured people who could not make decisions were appropriately supported within the requirements of the Mental Capacity Act (2005). Assessments of people’s mental capacity was assessed for specific decisions and, where needed, best interests decisions were made on their behalf.

People received a choice of meals and were able to have drinks and snacks throughout the day. We saw nutritional risk was assessed for each person on a regular basis.

We saw people who used the service had good relationships with the staff, and observed caring practice throughout our inspection. The registered manager and staff were knowledgeable about people they supported, and we saw care plans contained information about people’s likes, dislikes and preferences. Care plans were regularly reviewed, and people told us their involvement in the process was welcomed.

There were procedures in place to ensure concerns or complaints raised with the registered manager were acted on appropriately. We found information relating to the management complaints was not always filed in one place.

People had access to a planned programme of activities, and during our inspection we saw people enjoyed their participation.

We received good feedback about leadership in the home. We were told the registered manager was approachable and prepared to listen to suggestions. There were effective processes in place to asce

We inspected The Gables on 20 and 22 January 2016. The first day of the inspection was unannounced which meant the staff and registered provider did not know we would be visiting. We informed the registered provider of our visit on 22 January 2016.

At the last inspection in November 2014 we found the provider had breached several regulations associated with the Health and Social Care Act 2008.We found the registered provider was not was not submitting applications to deprive people of their liberty to the supervisory body (local authority). We could find no record of a formal action plan being received to outline how the provider would be addressing these issues. We also found the registered provider was not providing staff with regular supervision and appraisal and clinical (nurses) staff had not received clinical supervision as required by relevant professional bodies in these cases the Nursing and Midwifery council (NMC).

At this inspection we found improvements had been made around applications to deprive people of their liberty but not with regards to staff supervision and appraisal and clinical supervisions.

The Gables is registered to provide accommodation for up to 23 older people who are living with dementia and people who have a physical disability people, who require personal care and/or nursing.

At the time of the inspection 22 people were living at the service. The service is close to all local amenities.

The service had a registered manager in place. 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 were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. The service were not consistently reporting concerns to the local authority or informing CQC about statutory notifications as required.

We saw the registered provider did not have risk assessments or appropriate checks in place for all of the common hazards found in a care service setting and also when supporting people who displayed behaviours that may challenge. We saw appropriate risk assessments were in place and personalised for areas such as pressure care, moving and handling and falls. These had been reviewed appropriately.

We saw staff training and competence checks were not up to date in all areas.

Family members and staff told us there had been occasions where not enough staff had been on duty to meet people’s needs. We saw on three occasions this had been the case. The registered manager and registered provider had recently managed a very difficult staffing situation and were beginning to re-build relationships with long term staff, new staff and families. We found safe recruitment and selection procedures were not being followed.

We found although staff were working in a way which supported people to make choices day to day they did not fully understand the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). We also found the registered provider was not sending statutory notifications when DoLS decisions had been made by the supervisory body (local authority).

We saw the management of medicines was not always safe and issues found meant people were at risk of not receiving their medicine as prescribed.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services. We saw the records monitoring people’s health outcomes day to day were not robust.

There were not effective systems in place to monitor and improve the quality of the service provided. We saw where issues had been ide

This was an unannounced inspection carried out on 7 November 2014. We last inspected the service in November 2013 and found they were meeting the Regulations we looked at.

The Gables Nursing Home is located in a residential area of Pudsey in Leeds and provides care, support and treatment to a maximum of 23 older people, some who are living with dementia. Most bedrooms are single but there are some shared rooms. Some bedrooms have en-suite facilities.

There is 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.

People told us they felt safe living in The Gable. We found staff were aware of their roles and responsibilities to keep people safe at all times. There were procedures to follow if staff had any concerns about the safety of people they supported.

The requirements of the Mental capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The registered manager was aware of the new guidance and was reviewing people who used the service to ensure new guidance was being followed. However we found a number of methods used by the service which may constitute a deprivation of liberty.

You can see what action we told the provider to take at the back of the full version of the report.

Some people were involved in planning their care and support and this was reflected in the care records we looked at. Staff were given sufficient information in each care plan to provide the appropriate level of care. All care plans were kept under constant review in order that changes could be acted upon as soon as they were noted.

People were able to develop friendships and join in activities, although some people told us that they would like more to do during the day. People told us they were happy with the food provided and the menus were varied with plenty of choice.

We observed people were treated with dignity and respect. People who used the service told us they felt staff were always kind and respectful to them.

People were encouraged to give their views about the quality of the care provided and a carers forum had been established to help drive up standards. Quality monitoring systems were in place and the registered manager had overall responsibility to ensure lessons were learned and action was taken to continuously improve the service.

We saw that staffing levels were good throughout all areas of the service. Training in all aspects of care and support was mostly up to date. We found staff were supported by the management team however regular staff supervision and appraisals were not up-to-date.

You can see what action we told the provider to take at the back of the full version of the report.

Procedures in relation to recruitment and retention of staff were robust to help ensure only suitable people were employed at the home.

We spoke with one person who used the service and they said they had a good choice of food. They told us they had their preferred choice each morning of egg and mushroom sandwiches.

We found the provider had taken appropriate action to protect people from the risk of inadequate nutrition.

We found the provider had taken appropriate action to protect people from the risks associated with medicines.

We spoke with two people who used the service and the relatives of another person.

People who used the service said they felt safe and well looked after. One said the staff were “very nice people” and another said “I get on with all the staff”. They said the home was “very clean and tidy”. They said they could have visitors whenever they wanted, one said “It is a good home, I am fine here”. One person said there had been a BBQ a few days before we visited which they had enjoyed. Another person said they sometimes got bored. During the inspection we saw staff engage with people on an individual basis on a few occasions but apart from that there did not seem to be much for people to do.

The relatives we spoke with told us they had no concerns. They said their relative was well looked after and they were kept fully informed. They described the staff as “brilliant”. They said they had been visiting for many years and had seen the staff always treated people with kindness and respect.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. However, we found people did not always receive the right support to meet their nutritional needs.

We found people were cared for in a clean and hygienic environment.

We found there were enough suitably qualified and experienced staff to meet people’s needs.

We found improvements were needed to the way people’s medicines were managed.

We spoke with five people who used the service to seek their views about the service provided. People said they were happy with the care and support they received. They said they felt confident to take any concerns to the manager and they made several positive comments about the staff. They said staff respected their privacy and dignity. People told us the care workers were supportive and the manager was approachable.

We saw the atmosphere within the home was relaxed and friendly and people appeared well looked after. We saw staff gave people time and engaged with them in a respectful, encouraging and patient way. Two people told us that there always appeared enough staff on duty and they never had to wait long if they required assistance.

Some people who live in the home had dementia and we were not familiar with their way of communicating, so we were not able to gain their views. The five people we did speak with, over the two days that we visited, said they were happy with the care that they received. People told us that they felt safe in the home and that they were happy and comfortable living there. People said they were well cared for. Some people said they were involved in planning their care and had a care plan. They said that that if they were to raise any concerns these would be listened to and addressed. People told us that the home was comfortable and that the special equipment that they used, such as wheelchairs, hoists and walking aids helped with their independence and were comfortable. No one had any concerns about the safety of the equipment and they all said that staff were caring and competent when using the equipment. People also said that the cook was more than helpful and the food was very good. Nobody raised any concerns about the home when we visited. However, we did find some areas that need to be improved. These were mostly about people’s care plans, risk assessments and care records.