The inspection took place on 4 October 2018 and was unannounced. At our last inspection in November 2017 the service was rated as Requiring Improvement overall. The registered manager sent us an action plan showing how they planned to improve the service. At this inspection we found improvements had been made and we have rated the service as Good overall.

Since the last inspection, new audit tools were being used, such as for ensuring the safe management of medicines, and records were more detailed, including staff recruitment, assessing people's needs and their capacity to consent to their care. Regular audits of the quality and safety of the service were taking place and recorded.

The Gables 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 accommodates up to 24 people in one adapted building. At the time of our visit 20 people were living in the home. There was an established 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.

People and relatives praised the quality of care and all commented about the homely feel of the service.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting accidents, incidents or concerns. Risks relating to people’s health and welfare were assessed and these were recorded along with actions identified to reduce those risks.

People were supported by staff who had received an induction into the home and appropriate training and supervision to enable them to meet people’s individual needs. There were enough staff to respond to and meet people’s needs.

There were suitable systems in place to ensure the safe storage and administration of medicines. Medicines were administered by staff who had received appropriate training and competency assessments.

The service worked well with community health and social care professionals to help ensure people received the care they needed.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people in a patient and friendly manner.

Staff developed caring and positive relationships with people, were sensitive to their individual needs and choices and treated them with dignity and respect. The service supported people at the end of life to remain in the home if they wished.

The managers and staff understood the importance of involving people and their relatives in their care and providing support that was personalised to their individual needs. People were supported to maintain relationships and links with the community that were important to them.

The service was responsive to people’s needs and staff listened to what people said. People were confident they could raise concerns or complaints and that these would be dealt with.

People were encouraged to provide feedback about the service they received, both informally and through a survey questionnaire.

People, their visitors and an external professional spoke positively about how the service was managed. Staff understood their roles and responsibilities and felt supported by the management to raise any issues or concerns.

The inspection took place on 1 November 2017 and was unannounced. We returned on 13 November 2017 to complete the inspection.

At our last inspection in 2015 the service was rated as Good. At this inspection we rated the service as requiring improvement overall Any shortfalls identified had been quickly acted upon and had not had an adverse impact upon people's care and wellbeing.

As a result of this inspection we have made one requirement. This is where we have identified a statutory breach of regulations. The breach in Regulation requires the service to make more effective use of audits to assess and improve the quality and safety of the service. This is because quality assurance processes did not always identify what improvements were required. We have identified some areas of improvement as part of the inspection process which effective audits should have addressed. We have also identified record keeping needed to be improved to maintain a complete and contemporaneous record in respect to care provided.

We have also made three recommendations where the service could improve. These regarded the management of medicines, staff recruitment and how they managed people’s consent to their care.

The Gables 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 accommodates up to 24 people in one adapted building. At the time of our visit 24 people were in residence and the service was providing some day care for two people. There was an established registered manager in post. They were well liked and led by example. They had a really good understanding of the people they supported and also had the support of their staff team. 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 all praised the quality of the service and said they felt safely cared for. The service had an open culture. This enabled all those involved to have confidence their views about the service would be listened to and acted upon. The registered manager was very quick to take action to review and improve procedures that had been questioned during the course of the inspection.

The Gables provides a homely, caring service staffed by a motivated and trained team who were employed in sufficient numbers to meet people’s needs. The low staff turnover meant most staff were employed for a sufficient amount of time to ensure they had a good understanding of what people needed in terms of their care and support. Staff also had a good understanding of people's interests and their preferred daily routines and they accommodated these as far as possible.

People's health and care needs were well understood and staff worked effectively and cooperatively with health care professionals to ensure needs were met.

We spoke with three of the 23 people using the service, two relatives, a GP who was visiting the service, two members of staff and the manager. The three people we spoke with told us they were happy and liked living at the home. One person told us, “I’m as happy as Larry”, and that they considered it a “home from home”. Another person told us the service and staff were “family”. A visiting GP told us they thought the staff and service were “very good”. We observed support given to people using the service during our inspection. People appeared happy and contented. We observed care and support to be respectful and responsive to individuals’ needs.

Staff ensured people were enabled to make choices and give their consent to care and support whenever possible. Where people did not have capacity to consent, effective systems ensured their rights and well-being were protected in line with legal requirements.

People living at the service and staff knew and got on well with each other. We reviewed care plans for four people at the service and found they were detailed, up-to-date and person-centred.

The service had effective systems in place which meant medicines were ordered, stored, administered and disposed of correctly. People were protected against the risks associated with inappropriate management of medicines.

The building and grounds were well laid out and maintained. People were living in an environment that supported their needs and was conducive to their health and well-being.

The provider’s recruitment and selection processes ensured all members of staff were suitable, and sufficiently skilled to provide effective care and support to vulnerable people.

The service was open and responded positively to comments and complaints.

This inspection took place on 27 August 2015 and was unannounced. A further visit took place on 2 September 2015 to complete the inspection.

The Gables Rest Home is registered to provide accommodation and care to a maximum of 24 people, some of whom are living with dementia. It does not provide nursing. At the time of this inspection 22 people were living at The Gables.

There was 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.

We received positive feedback about the care and support provided from people who lived at The Gables, from their relatives and from visiting professionals. A consistent view of the service was it provided caring support in a family like atmosphere.

One area where the home could improve  was in the the way in which staff sought people’s consent to their care to ensure they were acting within The Mental Capacity Act 2005. For example, to ensure consistent recording of assessments regarding people’s capacity to consent to aspects of their care and support. The registered manager had already taken action to start to address this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were in place or had been applied for.

People said they felt safe at The Gables and there were appropriate processes in place to protect them from abuse, to minimise identified risks and to ensure people received their medicines safely.

There was a sufficient number of suitable staff deployed. One of the strengths of the service was the consistent staff team. There was no need to employ agency workers as existing staff covered any temporary gaps in shifts. This meant people received continuity of support from staff who knew them well.

Staff received a good range of training and their competencies were assessed to ensure they had the skills to meet people’s needs. People received prompt assistance when they needed medical intervention or support as staff liaised with health care professionals appropriately. People were supported to have enough to eat and drink that met their needs and personal preferences.

The atmosphere throughout the home was friendly, calm and caring. The staff spoke about people in a respectful manner and demonstrated a good understanding of their individual needs.

People were supported to take part in social activities and there had been some adaptations to the environment to help them to remain as independent as possible. People were confident they could raise concerns or complaints and that these would be dealt with.

There was an open and inclusive culture within the service, with clear values which were understood by staff. The registered manager was approachable, accessible and welcomed and encouraged feedback. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.