We last carried out a comprehensive inspection of Gables Care Home in September 2017 where we found the registered provider was in breach of four regulations. These related to the safe care of people; staffing levels; the requirements of the Mental Capacity Act (2005) not being met; and the effectiveness of the provider’s quality assurance systems and records. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) to at least a good.

This inspection took place on 17 April 2018 and was unannounced. During this inspection we found that the concerns identified at our previous inspection had been dealt with.

Gables Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Gables Care Home is a privately owned and managed establishment accommodating a maximum of 16 older people and adults with learning disabilities and/or mental health issues. 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. At the time of our visit ten people lived at the service.

There was 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. The registered manager was at the home during the time of our inspection.

There was positive feedback about the home and caring nature of staff from people who live here.

People knew how to make a complaint. Where complaints and comments had been received the staff had responded to try to put things right. We made a recommendation that the registered manager should review how they record what action had been taken to address people’s concerns.

People had access to a range of activities. These helped stimulate people’s minds to prevent them from becoming bored or isolated. The provision of activities was under review by the registered manager to ensure people did things that were meaningful and of interest to them.

People were safe at Gables Care Home. Staff understood their duty should they suspect abuse was taking place. There was an ongoing safeguarding investigation at the time of our inspection and the provider was working with the local authority safeguarding team.

Risks around people’s health and safety had been identified and clear plans and guidelines were in place to minimise these risks. The home was clean and staff practiced good infection control measures, such as hand washing, hygienic cleaning of the environment and equipment and correct use of personal protective equipment.

There were sufficient staff deployed to meet the needs of the people who lived at the home. The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received an induction when they started at the home and ongoing training, tailored to the needs of the people they supported.

Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building. Accidents and incidents were reviewed to minimise the risk of them happening again.

Before people moved into the home, their needs were assessed to ensure staff could provide the care and

This was an unannounced inspection that took place on 2 March 2016.

Gables Care Home is registered to provide accommodation with care for up to 16 people. There were seven people living at the home, some living with complex needs as a result from living with long term conditions. During our visit, we were informed that there were at least three people living at the home with dementia. After the inspection the registered provider informed us this was incorrect and only two people had received a dementia diagnosis. The accommodation is provided over two floors that were accessible by stairs.

The registered provider was also the registered manager for Gables Care home. 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.

Systems and procedures to protect people from harm were not being followed correctly. Whilst some risk assessments were in place, others were not, they were not person centred or in line with current guidelines.

There were quality assurance systems in place, to review and monitor the quality of service provided, however they were not robust or effective at identifying or minimising risk or correcting poor practice.

Medicines were administered safely, however arrangements in place for the management of medicines needs to be reviewed to ensure the safe storage and disposal of medicines. Protocols regarding the administration of as and when needed medicines (PRN) were not in place therefore people were at risk of not receiving this type of medicine in a consistent way. We made a recommendation that the registered provider reviews and ensures arrangements and systems in place for the management of medicines are in line with current national guidelines.

Staff did not have the appropriate support that promoted their development. However, people were supported by staff that had the necessary skills and knowledge to meet their assessed needs. Staff we spoke with told us they spoke to their manager about concerns they had. The registered provider confirmed that regular meetings with staff to discuss their work and performance had not taken place.

People were not always protected from being cared for by unsuitable staff because although recruitment processes in place, they were not always followed. We made a recommendation that the registered provider obtains information as specified in Schedule 3 of the regulations.

People living at the home had different opinions about how staff were deployed to meet their needs. During the visit we observed how staffing levels had an impact on how staff responded to people’s needs. We made a recommendation that the registered provider reviews best practice techniques when allocating the deployment of staff to meet people’s needs.

Staff had basic understanding of Deprivation of Liberty Safeguards (DoLS), the Mental Capacity Act (MCA) and their responsibilities in respect of this. Documentation regarding MCA and people appointed to make decisions on people’s behalf was not always fully completed in accordance with current legislation. We made a recommendation that the registered provider reviews its MCA assessments and DoLS applications to ensure that people are protected from having their freedom restricted in accordance with current legislation.

People attended activities in the home and in their community; however they were not always specific to people’s needs or preferences. We have made a recommendation that the provider reviews individual hobbies and interests and looks at ways these could be implemented and people supported to participate.

Staff responded to people’s needs and information about people’s care and support needs were not always detailed with the correct informa

On the day of our visit there were nine people residing in the service, including one person who lived in a self-contained flat adjoined to the main building. We were met by the registered manager.

We found that staff were always ensuring that people were giving their consent to care and respected their right to refuse care. We also found that staff had an understanding of mental capacity issues.

We found that people who used the service were generally happy with the level of care they received, and that people’s needs were being properly assessed, managed and reviewed.

We found that staff had a proper understanding of safeguarding people from abuse and would know how to respond to and report any incidents of abuse.

We found that although there were no visible signs that the service was understaffed the provider was unable to provide us with evidence that the service was fully staffed at all times.

We found that to a certain extent the provider sought the views of people who used the service, their relatives and staff regarding the quality of the service. However, we found that the provider was not currently taking any steps to monitor and assess the service in any systematic and audited manner.

Of the five people using the service at the time of the visit we only had opportunity to speak with two people at length. The following information reflects their views and experiences.

People were generally satisfied with the way their care and support needs were being met. They said staff promoted their independence and encouraged them to be involved in the day-to-day running of their home. They were able to express their views and make or participate in making decisions relating to their care and treatment. They said they felt safe and staff looked after them well, respecting their rights. People were happy with their bedrooms which were comfortably furnished. They had been supported to personalise their private space.

We initially visited this service on 15 February 2013 but were not able to complete our inspection due to staff illness. On 19 February 2013 we found that eight people were living in the service.

We saw that people had their needs assessed before admission and that they had been involved in planning their care and support. We noted that staff treated people who used the service with dignity and respect.

We observed that people looked well cared for and that those who wished to had seen the general practitioner who was in the service during the inspection. One person we spoke with told us, "They do ask how things are going and I do tell them if there’s a problem”

We noted that guidance regarding safeguarding people from abuse was available to staff and that they had received recent training. One person that we spoke with told us, I’ve never really thought about it. I just take it for granted that I am safe here”. We also saw that the general security of the premises and gardens appeared appropriate and adequate.

We saw that staff recruitment processes were thorough and that required checks had been carried out before staff were engaged. Staff had been provided with appropriate induction training for the role.

We noted that there was an effective complaints system in place. A person we spoke with told us, “If I have anything to raise I just speak straight to the manager. They do all they can and if they can’t help, they point you to someone that can”.