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Inspection carried out on 4 June 2019

During a routine inspection

About the service: The Gables is a residential care home that is registered to provide accommodation and personal care to a maximum of 43 people. At the time of our inspection, 30 people were living there, some of whom were living with dementia. Accommodation was provided over four floors.

People’s experience of using this service:

Auditing processes were in place to enable the service to identify where improvement was needed and in the main these were effective. However, we found some further improvements were needed to ensure risk assessments and care plans were accurate and sufficiently detailed.

People’s end of life wishes were not always documented fully so staff knew how to deliver care effectively, and we have made a recommendation about this.

Staff gained consent before assisting people with their care. Improvements were needed to ensure the service was fully adhering to the principles of the Mental Capacity Act 2005. Best interests decisions were not always in place where people lacked capacity to consent to some restrictions.

We have made a recommendation that the provider reviews best practice guidance to ensure that the building is designed and decorated in a way that supports people living with dementia.

Staffing levels were in the process of being reviewed by the provider. The registered manager had identified a need for extra staff at night. Following our inspection, an additional staff member was added, and we were informed the provider was also reviewing staffing levels during the day to ensure they were adequate. We observed that staff were available to people when they needed assistance.

People told us and we observed that staff were kind and caring in their interactions with them. Staff knew people well and used effective techniques to reassure people.

The registered manager and provider were responsive to feedback from the inspection, promptly taking action where needed to improve. They were open and transparent and created a culture which was friendly and welcoming.

Staff understood the need to keep people safe from abuse and what was required to do this. Recruitment procedures were robust to ensure staff were suitable for the role.

Health care professionals were involved in people’s care and referrals were made promptly.

Rating at last inspection: At the last inspection the service was rated ‘Good’ (Report published 15 December 2016).

Why we inspected:

We inspected this service in line with our inspection schedule for services currently rated ‘Good’.

Follow up: We will continue to monitor the intelligence we receive about this service and plan to inspect in line with our re-inspection schedule.

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

Inspection carried out on 21 September 2016

During a routine inspection

The Gables is a residential home that provides care, support and accommodation for up to 43 older people, some of whom may be living with dementia. At the time of our inspection there were 32 people living in the home.

The service had a 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 lived in a safe environment because staff knew how to recognise signs of possible abuse and knew the correct procedures for reporting concerns. Staffing levels were mostly sufficient to meet people’s needs and appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively. The premises were well maintained and any safety issues were rectified promptly.

Medicines were managed and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work and all new members of staff completed an induction. Staff were supported well by the manager and the provider.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The manager and staff understood the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance.

People had enough to eat and drink and enjoyed their meals. When needed, people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people’s dignity. Visitors were welcome and people who lived in the home were encouraged and supported to be as independent as possible. People were also able to follow pastimes or hobbies of their choice.

Assessments were completed prior to admission, to ensure people’s needs could be met. People were involved in planning their care and received care and support that was individual to their needs. Risk assessments detailed what action was required or needed to be carried out to remove or minimise any identified risks.

People and their families and friends were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible.

The service was well run and communication between the management team, staff, people living in the home and visitors was frequent and effective.

There were a number of systems in place in order to ensure the quality of the service provided was regularly monitored and regular audits were carried out by the provider in order to identify any areas that needed improvement.

Inspection carried out on 22 April 2014

During a routine inspection

We reviewed the evidence we had obtained during our inspection and used this to answer 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 lead?

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

People told us they felt safe and that they were treated with respect by staff. The service was clean and hygienic and there was a cleaning schedule in place to improve areas of the home where there were odours. One person told us, "The home is very clean. The cleaners are very good." Refurbishment plans were in place and ongoing to improve the quality and safety of the environment.

There were sufficient numbers of qualified, skilled and experienced staff on duty. Staff training was up to date and was relevant to the needs of the people living at The Gables. This helped to ensure that people's needs were always met.

Is the service effective?

People's health care needs were assessed and some people had signed to show they were involved in writing and reviewing their care plans. Health and risk assessments identified individual care needs. People were supported to be as independent as possible. One person told us, "Staff help as much as is needed which is how it should be."

People told us they liked living at The Gables and that staff were kind and caring. One person told us, "The staff are wonderful, the food is wonderful, they are all wonderful." People told us they had recommended the service to others. One person said, "I can't find the words to say how lovely it is."

Visitors told us they could see their relative whenever they wished and that staff always made them welcome. They spoke about how they had been concerned about an incident that they had raised with staff and this had been dealt with immediately to their satisfaction.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were warm, friendly and respectful and that they offered choices and encouragement to people.

People told us they received the care and support they needed and had agreed to. People's interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes and preferences. Staff told us they understood the diverse and individual needs and preferences of the people living at the home. One member of staff spoke about how they considered the diversity of people by always, �� asking, offering choices, and being open-minded.�

People told us they could spend their day where and with whom they pleased and staff assisted them to do this. Visitors were seen at the home and were greeted in a friendly and welcoming manner by staff

Is the service responsive?

People were able to access a variety of activities at the service. These included group and one-to-one activities and also outside entertainments. An activities coordinator had been appointed and was getting to know the residents with activities during the day of our inspection. Resident meetings were held regularly to discuss amongst other matters, what kind of activities they would like to take part in.

People knew how to make a complaint if they were unhappy. The complaints process was displayed in the entrance hall. People, visitors and staff were asked to complete annual questionnaires about the quality of the service. The results of these questionnaires were used to develop an action plan for improvement.

People's needs were assessed and reviewed on a monthly basis. Where changes occurred, the service referred to health professionals for advice and guidance whenever necessary.

Is the service well lead?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality audit system in place and records seen by us showed that identified shortfalls were addressed. As a result the quality of the service was continually improving. Care records were assessed and reviewed each month by senior staff. Audits of the environment were taking place regularly and these records were up-to-date and showed remedial action being taken where shortfalls were identified.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and this helped to ensure that people received a good quality service at all times.

Inspection carried out on 25 November 2013

During a routine inspection

During our inspection, we spoke with five people who used the service, five staff members and the registered manager.

All of the people who we spoke with who used the service told us that they were happy with their care. One person said �I am happy living here, you get plenty of food and we are all happy here. I have no complaints.� Another person said, �It is alright. They know what I like to eat and always make sure it is right.� A further person told us, �I am quite content. I don�t know what I would do without the place.� All of the people we spoke with said they would recommend the service to others.

People�s needs had been assessed and the care was being delivered to meet those needs. The risks to people�s safety had been assessed and the service was responsive to ensure that people were kept safe.

The staff we spoke with were able to demonstrate a good knowledge of how to reduce the spread of infection. However, some areas of the service had an unpleasant odour and some people�s rooms had not been cleaned to an acceptable standard.

The required checks on staff had taken place before they started working to ensure that they were of good character.

Staff told us that they were happy working for the service but that sometimes they felt unsupported. Staff were not being supervised in line with the provider�s �performance review and appraisal� policy. Some staff training in mandatory subjects was overdue.

Inspection carried out on 11 February 2013

During a routine inspection

We looked at the care records of four people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights.

We spoke with seven people who used the service who told us they were happy with the care and support they were provided with. One person said, "The staff are lovely to me." Another person said, "I'm nice and cosy in here (their bedroom), I sleep well." All people said that they were provided with enough to eat and drink. One person put their thumbs up (indicating 'good') when we asked if they liked the food they were provided with and they said, "I love my Sunday dinners the best." Another person said, "They (staff) always bring me a jug of water and lots of cups of tea."

We found that the provider was meeting the standards which we inspected. Where people had raised concerns prompt action was taken to address them.

Reports under our old system of regulation (including those from before CQC was created)