People in Action - Four Gables

Four Gables is a residential care home, providing personal care and accommodation for up to 5 people. There were 5 people living at the home at the time of the inspection. The home was divided into two separate floors with shared kitchen, lounge, gardens and dining room areas.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

What life is like for people using this service:

People and their relatives were placed at the heart of the service and were involved in choosing their care and support, from pre-admission to living in the home.

People received kind, responsive person-centred care from staff who were well trained, motivated and supported by a registered manager who led the staff team to provide the best care they could.

The staff team worked hard to promote people’s dignity and prevent people from becoming socially isolated within the care home.

Respect and dignity were cornerstones of the values upheld by the staff.

People were involved in making decisions about the service, and their day to day lives.

Staff understood how to keep people safe and embraced team working to reduce potential risks to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People using the service benefited from a well led service. The service was led by a registered manager and management team who were committed to improving people’s lives.

Partnership working enabled people to maintain their wellbeing.

Rating at last inspection: The last comprehensive inspection report for Four Gables was published in November 2016 and we gave an overall rating of Good with a rating of Requires Improvement in Well Led. At this inspection we found the service continued to be Good and have rated the service as Good in all areas.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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 any concerning information is received, we may inspect sooner.

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

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 gaps and inconsistencies in records, designed to keep people with specific health conditions safe, neither had they identified where care plans were not up to date.

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.

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.