The Gables

We found the following examples of good practice:

• Safe arrangements were in place for professionals visiting the service. This included a confirmed negative lateral flow test, vaccination against COVID-19, requirement to show a COVID-19 pass, hand sanitisation and wearing personal protective equipment (PPE).

• Policies, procedures and risk assessments related to COVID-19 were up to date which enabled staff to keep people safe.

• All staff had received training and followed correct infection control and using personal protective equipment (PPE) processes. The provider ensured a sufficient stock of appropriate PPE and there were designated notice boards available to remind staff about correct guidelines and handwashing. There was a programme of training refreshers to ensure staff knowledge was kept up to date. Spot checks took place to ensure staff adhered to the training provided

• The service was clean and fresh, staff carried out a number of additional tasks, such as cleaning of any regular touchpoint surfaces. Regular infection control audits took place and actions had been followed up when required.

• The provider offered support to aid the wellbeing of the team, individual assessments had been carried out with staff members to ensure any individual circumstances or health conditions were known and the support could be offered as needed.

• The registered manager reported good support from the local health professionals and the team at the provider's head office.

We previously inspected the service in October 2017. The service was not meeting all the requirements of the regulations at that time and was rated ‘requires improvement’. There were breaches of regulations regarding fire safety and staff support. Following the last inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions ‘safe,’ ‘effective’ and ‘well-led’ to at least ‘good.' On this occasion, we found improvements had been made.

This service provides care and support for up to seven adults with learning disabilities in a family-style home. The building is a detached property with an enclosed garden. Five people were living at The Gables when we visited. Accommodation is provided on two floors, with five bedrooms downstairs. Equipment has been provided to assist people with daily living tasks, such as adapted baths and ceiling hoists. Each person has their own bedroom, close to toilet and bathroom facilities.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

We received positive feedback about the service. Comments from relatives included “It’s lovely. Home from home,” “They’re very much like a family home,” “We’re pretty happy with The Gables” and “I’m absolutely happy, I couldn’t praise them enough.” One person who lived at the home gave us a big smile and said “It’s alright” when we asked what it was like to live there.

People were protected from the risk of abuse. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. The staff, community professionals and relatives we spoke with did not have any concerns about how people were cared for. Staff told us they would report anything that concerned them.

Each person had a care plan which outlined their support needs. Risk assessments had been prepared, to reduce the likelihood of injury or harm to people during the provision of their care. People’s medicines were handled safely and given to them in accordance with their prescriptions. People were supported to access healthcare professionals when they needed to.

Information was not always provided in formats people could understand. We have made a recommendation about complying with the Accessible Information Standard. The Accessible Information Standard is a framework put in place from August 2016, making it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they are given.

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

We found there were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. Occasional use was made of agency workers. We found not all senior staff could access records sent by the agency to confirm the checks and identity of the staff they supplied. We have made a recommendation about this.

Staff received appropriate support through a structured induction, supervision and appraisal of their performance. The frequency of staff supervision had improved since our last inspection. There was an on-going training programme to provide and update staff on safe ways of working. We have made a recommendation regarding training on end of life care. Staff told us the training opportunities were good and they were encouraged to undertake higher level training, such as diploma level courses.

Some activities were provided for people, such as occasional trips out and visits by sensory therapists. There had been little progress in meeting a recommendation we made at the last inspection to improve this area of practice.

People were cared for in safe and well-maintained premises. There were certificates to show it complied with gas and electrical safety standards. Improvement had been made to fire safety measures, to ensure staff were suitably rehearsed in what to do in the event of fire. Lifting equipment was serviced to make sure it was in safe working order. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

The service was managed well. The provider regularly checked the quality of care at the service through visits and audits. We had not been told about the outcomes of the service applying to the local authority to deprive people of their liberty. We have made a recommendation regarding notification of significant events.

We previously inspected the service in November 2016. The service was not meeting all of the requirements of the regulations at that time. We asked the provider to take action to improve fire safety measures, prevention of accidents, updating risk assessments and care plans and ensuring staff received appropriate support. The provider sent us an action plan which outlined what they would do to make improvements at The Gables.

The Gables provides care and support for up to seven people with complex learning disabilities. Six people were living there at the time of our visit.

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.

We received positive feedback about the service. Comments from people included “It’s lovely here,” “They’re brilliant,” “I’ve not got any negative thoughts whatsoever” and “I’m lucky my (family member) is here.” A community professional told us “It’s a lovely environment and they really care for them.” They added “Staff are amazing, they work well together as a team and engage with the residents. I can’t fault them.” A healthcare professional said they were always made to feel welcome and added “It’s always relaxed here.” They told us “I’ve never had any concerns.”

Staff knew how to report any concerns they might have about people’s welfare. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Safeguarding issues were reported to the local authority and managed appropriately.

Improvements had been made to the management of risks. We saw written risk assessments had been updated to reflect people’s current care needs. Measures were put in place to reduce the likelihood of injury or harm.

People’s medicines were managed safely. They received healthcare support when they needed it. A healthcare professional told us the service made appropriate referrals to them or the GP if there were any concerns about people’s health and well-being.

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

People received the support they required. There were sufficient staff to meet people’s needs. Thorough recruitment processes were used to make sure people were supported by staff with the right skills and attributes. Relatives were treated with warmth and consideration and made to feel welcome.

Staff did not always receive all the support they needed. We raised this as an area to improve at the last inspection. We found some improvements had been made but staff supervision was still not taking place for all staff in line with the provider’s expectations. We found recent appraisals had been carried out to assess staff performance. Training was being updated to make sure skills were refreshed. We have made a recommendation about training on dementia care.

Improvements had been made to people’s care plans. These had been updated to make sure they were accurate and took into account how people wished to be supported.

Some activities were arranged for people to give them stimulation. We have made a recommendation for further work to be undertaken in this area to increase activity provision and access to the community.

The building was well maintained and complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Evacuation plans had been updated for each person, to help support them safely in the event of an emergency. We found continuing concerns about fire safety measures. Practice drills were not taking place in line with the provider’s procedures. This meant not all of the staff who worked at The Gables had taken part in drills and rehearsed what to do in the event of a fire. We have made a recommendation for the service to follow good practice in carrying out fire drills so that these are used as a learning opportunity.

The provider regularly monitored the quality of care at The Gables and made recommendations to improve practice. Records were maintained to a good standard and staff had access to policies and procedures to provide guidance on safe practice.

We found continuing breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to fire safety and staff support.

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

We previously inspected the service on 16 April 2015. The service was meeting the requirements of the regulations at that time.

The Gables provides care and support for up to seven adults with complex learning disabilities. Six people were living at the home at the time of our visit.

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.

We received positive feedback about the service from a healthcare professional. They said “The Gables is a wonderful unit. Well managed and well led. Staff know the residents well and treat them with kindness, care and respect. Good communication with the multidisciplinary team. Clean and well resourced and well staffed.”

We found people had been supported to look presentable and they appeared well cared for. Each person had their own bedroom which was individualised and comfortable. Equipment had been provided to meet the needs of people with disabilities. People were supported to attend healthcare appointments to keep healthy and well. However, where people sustained unexplained injuries, we could not see investigation had taken place into the cause, to help prevent recurrence in the future.

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. People’s medicines were handled safely and given to them in accordance with their prescriptions.

We found risk assessments and care plans had not always been kept under review to make sure they took into account people’s current needs. Various checks were made to ensure the premises were safe. However, we found people’s safety could be compromised as fire drills were not carried out regularly and the risks associated with ingesting disposable gloves had not been mitigated. We have made a recommendation about assessing the risk of disposable gloves being accessible to people living at the home.

We found there were sufficient staff to meet people’s needs. They were recruited using robust procedures to make sure people were supported by staff with the right skills and attributes. There was an on-going training programme to provide and update staff on safe ways of working.

However, staff did not always receive appropriate support through formal, regular supervision.

We read feedback from relatives which was complimentary of the service and standards of care. One described The Gables as “A real homely, caring home.” Another said “A warm welcome is always assured to all visitors and the standard of care for each resident seems to us to be very high.”

We found records had not always been kept of decisions made on behalf of people who lacked mental capacity. We have made a recommendation for further work to be undertaken in this area, to comply with the Mental Capacity Act 2005.

The provider regularly checked the quality of care at the service through visits and audits. The registered manager was aware of their responsibilities to notify the Care Quality Commission of reportable incidents and had done so.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, staffing and good governance. You can see what action we told the provider to take at the back of the full version of this report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. An application was made to the local authority in February 2013 regarding a possible deprivation of a person's liberty. No authorisation was required, as the local authority said the home was acting in the person's best interests and no deprivation of liberty was taking place. Staff needed to attend training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure there were proper safeguards in place.

There were effective recruitment and selection processes at the home. Two new members of staff had started at The Gables since our last visit. Recruitment files showed a range of checks were undertaken prior to their employment. This included obtaining references, occupational health clearance and checking the identity of the members of staff. Checks were also made of criminal convictions and inclusion on lists of people unsuitable to work with vulnerable persons. This protected people from the risks associated with unsuitable workers supporting them.

Staffing rotas were maintained at the service. These showed there were enough skilled and experienced staff to meet people's needs. We observed there were three staff on duty during the morning and afternoon/evening during our visit. This reflected typical staff cover at the home. We noted this was sufficient to meet people's needs. For example, helping people manage the evening meal at a relaxed pace.

We observed staff communicated well to ensure people's needs were met. For example, they checked with each other who had been given drinks and whether people had received both courses of the meal. We saw diaries accompanied people when they attended local day services. These were used to record significant information between the home and day services. This helped promote continuity of people's care.

We looked at a range of records as part of this visit. This included care plans, risk assessments, staff rotas, staff recruitment records, training records, audits and monitoring reports. We found the standard of record keeping varied. This meant there could be inconsistencies in people's care. People's personal records were not accurate and fit for purpose. Care plans had not been kept under regular review and updated as necessary. Care plan folders were disorganised and contained much information that could be archived. We found training records had not been kept up to date. This meant they could not be relied upon to show an accurate picture of when staff had attended mandatory and other courses.

Is the service effective?

We found the home had equipment to promote the independence and comfort of people who used the service. This included an adapted bath downstairs, a mobile hoist and ceiling-mounted hoist. There was a stair lift to assist people moving between the ground and first floors. People were protected from unsafe or unsuitable equipment because the provider had ensured equipment was serviced by appropriate contractors. The most recent servicing was carried out in March this year.

Is the service caring?

We observed staff welcomed people back to the home after they returned from day services. People were asked if they would like a drink and then given their choice. People were made comfortable and were free to move around the home. One person went straight to the sensory room and enjoyed playing with brightly coloured balls. We heard staff informed people the evening meal was fish and chips, so they knew what was being prepared for them.

People's needs were assessed but information had not always been updated to ensure it reflected their current circumstances. We looked at two people's care plans. We saw assessments had been undertaken for a range of needs such as mobility and helping people with washing and bathing. In one care plan, some of the information was no longer applicable as the person's needs had changed.

Risk assessments had been written for a range of activities and situations. For example, moving and handling, the likelihood of developing pressure damage and risk of malnutrition. These assessments had not been reviewed on a regular basis to ensure information was kept up to date. This meant the assessments were not used effectively in helping to reduce or control the potential for people to experience harm.

We saw people's risk of malnutrition was assessed using a nationally-recognised tool. However, the manager told us staff had not received all the training they required to use the tool effectively. This meant there was the potential for risk levels to be unreliable if staff did not know how to use the tool in the way it was designed.

Is the service responsive?

The manager and staff said people received good support from the GP surgery and specialist advisers, such as the speech and language therapist and district nursing service. Records were kept of any appointments with or visits from healthcare professionals. This helped to ensure any follow up advice or recommended courses of treatment were noted, to help people keep healthy and well.

Each person had a personal emergency evacuation plan. These identified any support people would need to vacate the premises, such as in the event of a fire. We saw the home had an emergency procedures folder. This contained useful information. For example, staff and headquarters/senior managers' contact details, people's next of kin details and contact numbers of utility providers. This showed there were arrangements in place to deal with foreseeable emergencies.

Is the service well-led?

The provider had a system to regularly assess and monitor the quality of service that people received. However, it was not used effectively at the service to check people received good quality care and support. We found monitoring of the service had not been undertaken monthly by senior management, as expected by the provider. Reports were made available to us of the findings of monitoring visits which took place over the past financial year. This showed there had only been two monitoring visits in twelve months.

We read reports which showed the manager carried out themed audits of practice at the home. These included medication practice, safeguarding and safety, personalised care, treatment and support and involvement and information. We found actions which arose from these audits to improve the service were not always completed.

We met two relatives. They told us they were pleased with the standards of care at The Gables. One said 'I'm lucky to have found this place.' Neither person had any concerns about people's welfare. One relative said they spoke with the manager if there were any issues and these were then dealt with appropriately.

We observed how breakfast was managed at the service. We saw people were provided with a choice of suitable and nutritious food and drink. Staff provided gentle support to people who needed help in managing meals. They were aware of the need to refer people to their GP if there were any concerns about weight gain or loss. Staff followed the advice given by healthcare professionals to ensure people received adequate nutrition, to keep healthy and well.

We found people's medicines were managed safely. Staff had undertaken training to ensure medication was handled appropriately. Audits of medication practice showed staff were following the provider's policy and using safe procedures.

The premises were suitably designed and maintained, to provide a safe environment. Checks were made of gas and electrical safety. Satisfactory fire and food safety measures were in place to guard against the risk of harm.

There were enough staff to meet people's needs. Staff were knowledgeable about the support people required and interacted with them appropriately. Significant issues were communicated between staff to ensure continuity of people's care.

People's needs were recorded in care plans to make sure they received the support they required. One of the two files we read was not up to date in all areas but the person's care was provided appropriately and safely. We found people had been referred to specialist and other healthcare services to keep them healthy and well.

Staff had access to training and policies on infection control practice. The premises were generally clean and odour free. We had concerns about missing tiles in a bathroom, shower room and the laundry. This meant it was difficult to keep these areas clean and hygienic. The practice of storing items on the floor in the laundry also presented a contamination and hygiene risk.

We found there were sufficient staff on duty to meet people's needs. Staff had access to a training programme to keep their skills and knowledge up to date. We found staff communicated well with each other to make sure people's needs were met.

We looked at the statement of purpose for the service. This contained all required information and would be useful to anyone looking for a care service.