We inspected The Gables Care Home on 16 August 2018. The service 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. This was the first inspection since the service was re-registered following a change of provider in 2017.

The Gables is registered to provide support for up to 23 people. On the day of our inspection there were 17 people using the service, including one person who was in hospital.

The service was last inspected on 9 and 16 January 2017. Concerns were identified regarding risk management, inadequate staffing levels and ineffective quality monitoring systems. People did not receive personalised care that was responsive to their needs and the service was rated ‘Requires Improvement’ overall. At this inspection, we found necessary improvements, in these areas, had been made.

There was a registered manager in post, who was present on the day of the inspection. 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 received care and support from staff that were appropriately trained and competent to meet their individual needs. Staff received one-to-one supervision meetings with their line manager.

People’s needs were assessed prior to them moving into the service and improvements were being made in this area. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

People were placed at potential risk as staff recruitment procedures were not consistently followed and appropriate pre-employment checks had not always been made.

There were policies and procedures in place to guide staff on how to keep people safe from harm and staff showed a good understanding of their responsibilities.

People were supported with patience, consideration and kindness and their privacy and dignity was respected. People were protected from potential discrimination as staff were aware of and responded effectively to their identified needs, choices and preferences. People’s individual communication needs were assessed and they were supported to communicate effectively with staff.

Systems were in place to ensure medicines were managed safely in accordance with current regulations and guidance. People received medicines when they needed them and as prescribed.

The registered manager worked in partnership with health and social care professionals to ensure people received appropriate healthcare and treatment in a timely manner. People could access health, social and medical care, as required.

People and their relatives confirmed that staff sought permission before offering care. Appropriate arrangements were in place to assess whether people were able to consent to their care. The provider met the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

Systems were in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views regarding their care and staff were responsive to their comments