Five Gables Care home is a residential care home for 13 older people with dementia and sensory impairment. There are two floors with the first floor having access via stairs or a stair lift. There is a communal living and dining area and a quiet lounge on the ground floor.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People were protected from avoidable harm as staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. When people were at risk of falling or skin damage staff understood the actions needed to minimise avoidable harm. The service was responsive when things went wrong and reviewed practices in a timely manner. Medicines were administered and managed safely by trained staff.

People had been involved assessments of their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. 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 and their families described the staff as caring, kind and friendly and the atmosphere of the home as homely. People were able to express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

People had their care needs met by staff who were knowledgeable about how they were able to communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes. The home was in the process of reviewing the activities they offered people and were planning on creating an activity programme.

The service had an open and positive culture that encouraged involvement of people, their families, staff and other professional organisations. Leadership was visible and promoted teamwork. Staff spoke positively about the management and had a clear understanding of their roles and responsibilities. Audits and quality assurance processes were effective in driving service improvements. The service understood their legal responsibilities for reporting and sharing information with other services.

Further information is in the detailed findings below

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.One person told us that they had regular reviews of their care with their keyworker and if there was anything they did not agree with they "would go to the manager who would sort it out straight away".

We spoke to four people that live at the home and a relative. They were all happy with the care that was provided by the home.

One person told us "Staff excellent. Its lovely".

We found that there was an effective complaints system available.

One person told us "I have no complaints. Best thing that ever happened to me when they brought me here".

People we spoke with said they felt safe in the home and that they would speak to a member of staff if they had had any concerns

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

One staff member told us "Its really good. Very friendly".

The inspection took place on 21 December and was unannounced. The inspection continued on 22 December and was announced.

The service is registered to provide personal care and accommodation for up to 13 adults. The service has 12 bedrooms in total over two floors, which included one double, and 11 single rooms. All rooms had vanity units with mains supplied water and centrally stored hot water, many rooms had adjoining en-suites or were located close to bathroom/toileting facilities. The service had a large open plan living and dining area that people were free to use at any time. The accommodation is over two floors and the first floor can be accessed by stairs or a stair lift. Each room has a call bell so that people can call for help when needed. There is a level access shower room on the ground floor.

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 and relatives said they felt the service was safe. One person told us, “I definitely feel safe here, I know the manager and staff well, they wouldn’t put me in danger”. One relative told us, “The service is safe, it’s just like a home, it’s a very friendly place and I’m happy how mum is cared for her”.

Staff were able to tell us how they would recognise if someone was being abused. One staff member told us that they would look for signs of unknown bruises or people acting withdrawn. Staff told us that they would raise concerns with the manager. Staff told us that they had received safeguarding training and that it was regularly updated. We looked at the training records which confirmed this.

There were no risk assessments in place for the use of a hoist which meant that people and staff may be at risk and wrong slings maybe used to lift people. Risk assessments for daily tasks such as moving people who use wheelchairs and assisting a fallen person were not in place. A moving and handling trainer visited the service once a year and staff also completed a training DVD. A staff member told us, “We reduce risks by identifying them and informing the registered manager. They complete the risk assessments but I haven’t seen any”. We spoke to the registered manager about this who said that she will review the risk assessments and the action staff need to take in the event of them occurring in order to keep staff and people safe.

Personal Emergency Evacuation Plans were being put together during our inspection. These detailed how staff would support people in the event of a fire. There was a fire risk assessment in place which had been reviewed in September 2015.

Medicines were managed safely. Medicines were securely stored and only given by staff that were trained to give medicines. We saw that staff waited with a person while they took their medicine and offered a drink. A relative told us, “The service has supported mum off her medicine which is great”.

Staff were knowledgeable of people’s needs and how best to support them. We reviewed the training matrix which confirmed that staff had received training in topics such as safeguarding, medication, infection control and mental capacity act.

Staff had received training in Deprivation of Liberty Safeguards (DOLs) during their induction period. The service told us that no DOLs applications had been completed for the people currently using the service. The service told us that they do not see anyone as being deprived but would be concerned if some people suddenly chose to go out on their own one day. There was also a bolt on the front gate and two locks on the front door. We discussed DOLs with the registered manager, proprietor and deputy manager.

One person told us, “its good food here. I also get night cups of tea. These are important to me and they provide me with them. I get restless you see”. Another person told us, “I am partially vegetarian. They cater to my wishes and needs”. The service was recently awarded a 5 star rating by the Food Standards Agency. The chef told us that most meals were homemade and explained that the menu is done with people every Sunday.

People were supported to maintain good health and had access to healthcare professionals as needed. People’s health appointments and outcomes were recorded in their care files. A relative told us, “If I’m worried about mum’s legs I know I can ask the registered manager to arrange a DN or GP visit”.

The service was caring. One person told us, “Staff help in every way they can. They know our limitations are caring and helpful”. A relative told us, “Staff are caring and friendly. Mum is always happy, clean and tidy”. Another relative told us, “Staff will take time to spend time with mum”. We observed staff acknowledging people as they entered the room on several occasions. People were relaxed in staffs company.

Staff were polite and treated all people in a dignified manner throughout the course of our inspection visit. We observed staff knocking on doors before entering peoples rooms saying hello to the person and telling them who they were.

People’s care files had admission assessments completed and the information from these was reflected in their care plans and individual assessments. People’s individual needs had been assessed and were reflected in morning and evening routine guidelines for staff. There was evidence of care plans being regularly reviewed and updated which showed the service was responsive to peoples changing needs. A relative told us, “They review mum’s care plan regularly and we are involved in that”.

One person told us, “When I first came here I couldn’t feed myself or do much. Five Gables has helped me become independent. I am looking to move to sheltered housing soon”.

We observed on several occasions during the inspection that call bells were answered by staff in a timely fashion. A relative told us, “As soon as mum calls her bell staff respond to her”. We reviewed the services call bell event log which logs the location and time of bells being called and the cancel time. This showed us that in most cases call bells were answered within 2 minutes.

The service sent out quality questionnaires to people. The administrator/trainee deputy told us, “I received feedback in the last questionnaire that people didn’t know the complaints policy. As a result I issued everyone with a copy”. We observed that the complaints procedure was hung in the hallway by the main entrance. A person told us, “I know how to complain if I need to”. A relative told us, “I have completed a quality questionnaire and said how happy we are”.

People, relatives and staff told us that they all felt the service was well managed. A person who used the service told us, “The registered manager is hands on and leads by example”. Another person said, “I can talk to the registered manager and proprietor as and when I need to”. A relative told us, “The service is well led by a fabulous manager. She makes time to sit and chat to mum and involves her in her care”.

The service had a comprehensive set of policies in place and the folder is broken down into indexed areas. However, policies were generally undated and others very old, for example, the care of dying, staff code of conduct and fire precautions policies. It was unclear how these were audited to ensure they were kept up to date and relevant to people and staff at the service. We discussed this with the registered manager who said she will review the folder.

We saw that medication audits took place and covered receipt of medicines, storage, administration, recording and disposal. Health and Safety checks were completed and covered key areas such as premises, maintenance, Control of Substances Hazardous to Health (COSHH) and food hygiene. People’s money audits were completed and up to date.