The Gables

People were cared for by staff trained in safe infection, prevention and control, (IPC), practices who had their competencies regularly checked. Personal protective equipment, (PPE), such as gloves, aprons and masks, was in good supply and used in line with government guidance.

People told us they felt safe and well cared for. People were comfortable with staff and visitors wearing masks and understood it was to prevent the spreading of infection.

People living at the Gables, and the staff team, were fully engaged in both the COVID-19 vaccine and testing programmes.

The service communicated well with relatives so they were aware of what was expected as per current Government guidelines. The service completed social stories with the people who lived there at a manner and pace suitable to the person, this ensured they were well informed to make the decision to test and be vaccinated.

Family, friends and professionals visiting the service were required to carry out a rapid lateral flow devise test on the day and were issued appropriate PPE. Professionals and contractors were also required to evidence they had been vaccinated or had an exemption.

People were encouraged to socially distance, whilst being mindful of the need for a homely environment.

Risks assessments had been completed for outings away from the home, people receiving visitors and admissions. Risk assessments demonstrated that government requirements were being met whilst ensuring people’s rights and freedoms were upheld.

The premises and equipment were visibly clean and in good order. We observed staff cleaning touch points around the home, such as hand rails and light switches.

Policies and procedures were in line with current government guidance and used to inform staff, people and their families. Governance arrangements ensured that IPC policies and procedures were met.

The Gables is a care home registered to provide accommodation and personal care for up to eight people diagnosed with autistic spectrum disorders and learning disabilities. At the time of our inspection there were eight people living at the home in one adapted building in a residential area of Ferndown.

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. Registering the Right Support 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. Although the service is larger than Registering the Right Support recommends, people using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People told us they felt safe and enjoyed living at The Gables. People were relaxed and happy with staff, who knew them very well. People received a personalised service from friendly, supportive staff who treated people with patience, kindness, dignity and respect. Relatives spoke highly of the management and staff team and commented they were very happy with the service and level of care their relative received.

There were robust recruitment processes in place and people were supported by a consistent team of staff who knew them well. There was an ongoing process of staff recruitment and clear systems in place to monitor appropriate staffing levels to ensure people were cared for safely.

Staff spoke knowledgably on how to identify and report abuse and were well supported in their roles. Staff received regular supervision and annual appraisals to enable them to carry out their roles competently. Staff received core and specialist training and support to assist people in ways to meet their needs.

Risks to people’s health, safety and well-being were regularly assessed, reviewed and updated. People and their families were fully included and involved in their care and support. People's views and opinions were listened to and acted upon wherever possible.

People’s health care needs were met, and staff supported them to see healthcare professionals when appropriate. Medicines were managed, stored and administered safely. People were supported to take their medicines safely by staff who had received the appropriate levels of training.

Communication styles and methods were tailored to individual people and staff supported people to understand the choices available to them.

People received healthy, nutritious meals which they enjoyed planning. Meal times were a social occasion where people could choose to spend time with others. People told us they enjoyed the meals which were, “very nice”.

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.

The service was well led by a registered manager whoessionals and staff. There were clear quality assurance systems in place to drive improvement and ensure the home offered a safe, effective, caring and responsive service.

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

Rating at last inspection

This last rating for this service was good (published 24 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

The service is registered to provide personal care with accommodation for up to eight adults. The service had one ensuite bedroom on the ground floor. There was a large open plan living area which led round into a dining area which led into a large kitchen. Just off the hallway was a staff toilet and shower room. On the first floor there were seven bedrooms six of which were en-suite. There was one bathroom and a laundry room. Outside there was a large driveway with electric gates and an enclosed rear garden and patio area. The service had just renovated the Avatar. This was an area which people used for activities which also had a home cinema system.

The service has 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 aware of the Mental Capacity Act and training records showed that they had received training in this. However, people’s records did not always contain an assessment of their capacity. Where decisions had been made in people’s best interests around their care and treatment these were not always being recorded fully. This meant we were unable to tell, if decisions were specific, made in consultation with appropriate people such as relatives or were being reviewed. We did not find that people had been disadvantaged or that decisions taken were not in people's best interest.

People, relatives and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included outcomes and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored in people’s homes, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, autism, epilepsy, diabetes and learning disability.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this.

People were supported with shopping, cooking and preparation of meals in their home. The training record showed that staff had received food hygiene training.

People were supported to access healthcare appointments as and when required and staff followed health professional’s advice when supporting people with ongoing care needs.

People told us that staff were caring. During the inspection we observed positive interactions between staff and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.

People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people and stakeholders. Relatives confirmed that they had received and completed these. We noted that they contained mostly positive feedback.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints in place. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

People, relatives and staff felt that the service was well led. The management team encouraged an open working environment. People and staff alike were valued and worked within a service which ensured a positive culture was well established and inclusive. The management had good relationships with people and delivered support hours to them.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

The service monitored quality using a variety of effective systems. The covered areas such as health and safety, records, performance, the environment and medicines. Actions were recorded and completed within a set timeframe.

The service has 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.

People had risk assessments in their care files which identified the risk and had control measures in place to minimise them however people’s risks in relation to holidays were not appropriately assessed. The provider had a system to assess peoples risk and needs when being supported away from the home, however these were not followed. One person using the service was supported on holiday the week prior to our inspection.

Staff and relatives told us that there were not always enough staff to support people who had one to one hours which meant that sometimes these people were unable to access the community or do activities outside of the home. The proprietor told us there was no arrangement in place for deploying staff at different times during the day. They said they had recently recruited a new staff member and are currently advertising for more new staff.

Staff and relatives told us that some people lacked capacity to make decisions in areas such as medication, support planning and personal care. Staff were not able to show us any capacity assessments or best interest meetings which had taken place on behalf of people. The registered manager told us capacity assessments and best interest decisions are not completed but should be. Four people had a standard DOLs authorisation in place and two were in process with the local authority.

Staff and relatives told us that they did not feel the service was well led or managed. Staff told us that the manager didn’t support or listen to them. A relative said, “I don’t feel the registered manager has any idea what’s happening”. We discussed these concerns with the proprietor in the absence of the registered manager who told us they are in the process of taking action to address this.

People said they felt safe living at the service and that staff supported them. Staff and relatives told us they thought the service was safe. One relative told us, “My relative comes home every Sunday and they aren’t sad to go back which is good”.

Staff were able to tell us how they would recognise signs of abuse and what they would do if they had concerns that someone was at risk. One staff member said, “Signs of abuse may include changes in behaviour, unexplained bruising or money not adding up”. Training records we reviewed showed that staff had received training in safeguarding adults.

Medicines were stored and recorded safely by staff. Only trained staff administered medicines.

Staff were knowledgeable of people’s needs and told us that they had received regular training which related to their roles and responsibilities. We reviewed the training matrix and saw that refresher training was required in a number of areas. The proprietor showed us a list of confirmed training days which were coming up for all staff. Staff had not received training specific to their roles for example autism awareness, epilepsy or learning disability. We mentioned this to the proprietor who said that they will look into it.

Staff told us that they supported people to make decisions using different methods of communication which included pictorial, verbal, sign and body language. A staff member said, “I give people options and information to support them to make informed decisions and choices”.

People told us that they liked the food and had opportunities to cook. One person said, “I cook on Sunday and Wednesday, I like it”. Staff told us that most meals are home cooked and that there was a four week rolling menu. A staff member said, “We have residents meetings. Menus are discussed every season and new menu’s created”. We reviewed the menu and saw that it was pictorial and had a variety of nutritious meals.

People and relatives told us that staff were caring. We observed positive, kind and caring interactions between people and staff. Staff respected people’s privacy and dignity by closing doors and curtains when supporting them with personal care.

People were allocated key workers who coordinated the care and support for them. We reviewed care records which showed that person centred approaches were used and that people were supported and encouraged to be part of their care and support planning. Key worker monthly meetings took place with people and staff to gain feedback, discuss their areas of support and look at future goals.

People’s care files reflected individual areas of support and recorded what people can do and what they would like support with. Staff were able to tell us about how they had responded to peoples changing needs. Reviewed areas of care were shared with staff via a communication folder which staff were required to read and sign.

When there were enough staff on duty people were supported into the community and on outings and activities. Records showed that people worked at a local farm, went to clubs, discos and swimming to name a few.

People were involved in residents meetings. Notes recorded people’s feedback, updates and upcoming events. These meetings had a regular slot on the staff meeting agenda. The service produced a seasonal newsletter which was shared with people in these meetings. We noted that a meeting had not taken place for five months. We were told that one was in the process of being arranged.

People and relatives told us they knew how to complain and who to approach with any concerns. The service had a complaints recording system in place which captured the detail and steps taken to address them.

Staff and relatives told us the new proprietor was working hard to improve the service. Staff told us they were approachable, supportive and open to staffs ideas and suggestions. The provider told us, “Staff morale is very important to people, me and the service”.