This inspection took place on 12 and 13 November 2018. It was an unannounced visit to the service.

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 thr

This inspection took place on 4 and 9 October 2017. It was an unannounced visit to the service.

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

This inspection took place on 18 and 23 November 2016. It was an unannounced visit to the service.

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 carried out an unannounced comprehensive inspection of this service on 6 and 10 November 2014. A breach of legal requirements was found. This was because staff did not receive appropriate supervision and appraisals to ensure they were appropriately supported in relation to their responsibilities.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to that requirement.

The Gables is a care home which provides support for up to seven people with learning disabilities. The home had 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.

During our visit on 16 April 2015, we found the provider had followed their plan to make improvements at the home. Staff were now receiving supervision to discuss how they were working and any developmental needs. Appraisals had also been carried out, to assess how staff had performed over the previous year.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Icknield Court on our website at www.cqc.org.uk

We spoke with people who used the service but they were not always able to tell us their views about their care. We relied upon our observations of care, speaking with staff and looking at records to help us understand people's experiences.

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 spoke with people using the service but they were not always able to tell us their views about their care. We relied upon our observations of care, speaking with staff and relatives and looking at records to help us understand people's experiences.

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.

We found improvements had been made at the service. Cracked or missing wall tiles had been replaced and the laundry had been re-fitted with storage space. These improvements meant staff could keep high risk areas of the building clean, to prevent the spread of infection.

We saw people were treated with dignity and respect throughout our time at the service. People were supported to be as independent as possible, such as taking their plate into the kitchen after the evening meal.

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.

We observed a member of staff ask someone if they could read out a postcard. They waited for agreement before reading it and then started a discussion with the person about the card and the person who had sent it. We heard staff ask a person if they were happy watching the television channel that was on, as a quiz programme that the person liked was about to start on another channel. The television was turned over at the person's request.

We observed staff use clothes protectors when people were eating and drinking. Gentle assistance was given at mealtimes and staff sat down to help people. We heard staff explaining what the meal consisted of. One person said the food, a chicken casserole, was nice. We saw that people had been provided with adapted cutlery and plate guards, where necessary, to help them manage independently.

We observed that personal care was carried out in private areas of the building. Staff that we spoke with said there was sufficient cover to be able to meet the needs of people living at the service. One member of staff said that training was ''brilliant'' and covered what she needed to know to be able to support people living at The Gables.

The Gables is a care home which provides support for up to seven people with learning disabilities. The home is a detached property with accommodation on two floors. There is a stair lift to help people access the first floor. All of the bedrooms are single occupancy, without en-suite facilities. Bathrooms and toilets are close to people’s rooms. The home was full at the time of our visit.

This was an unannounced inspection, carried out over two days on 6 and 10 November 2014. During the inspection, we met with all of the people who lived in the home, five staff and the registered manager. 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 also contacted two people’s relatives after the visit, to ask for their views about standards of care at the home.

We previously inspected the service on 3 June 2014. At that inspection, the home was not meeting all of the standards we assessed. We asked the provider to make improvements to the management of people’s care and welfare, record keeping and how they assessed and monitored the quality of service provision. The provider sent us an action plan to tell us about the improvements they would make. They said these would be completed by 31 October 2014.  

During this inspection, we looked to see if these improvements had been made. We found the provider had made some changes to improve the quality of people’s care although they had not completed all the actions they told us they would. Risk assessments were being reviewed to update them with changes to people’s circumstances. Some risk assessments still needed to be formally reviewed. We noted the current versions remained relevant to people’s needs therefore the likelihood of harm until they were reviewed was minimal.

Record keeping had improved. This meant information was easier to find to support people appropriately.

The provider had improved the way it monitored and assessed care practice. We saw records which showed monthly visits had been carried out by the provider to monitor standards of care. The registered manager told us a full care audit had been carried out since our last inspection.

There were no safeguarding concerns about the service. Staff undertook training to help safeguard people from abuse and had procedures to follow if any incidents arose.

Appropriate checks and servicing took place to maintain the premises in good condition. Personal emergency evacuation plans were in place for all of the people living at the home, detailing the support they needed in the event of an emergency.

There were enough staff to support people and meet their needs. We found the home used thorough recruitment procedures which included a check for criminal convictions and written references.

Medication was stored and administered safely. Staff undertook training so that they knew how to handle medicines safely and in line with guidance.

Staff supported people to attend healthcare appointments and keep well. Two healthcare professionals provided feedback for this inspection. The consultant psychiatrist commented “I have no hesitation in recommending their service and have always viewed them in a very positive light. The service is very caring, safe, well-led and fully meets the patients’ needs. The staff are always contactable and they have no hesitation in seeking advice from me when it is necessary.” The district nurse said The Gables was “An exceptional home. Communication is marvellous.”

We observed how lunchtime was managed and the support people received. People were given a choice of where to eat their meal. People were offered choices wherever possible. For example, if they would like tea or coffee. Equipment was provided to help people manage their meals independently. Staff offered gentle encouragement for people to finish their meals without rushing them.

We received positive feedback about people’s care. A relative told us their daughter "Always looks well looked after." They added "They (staff) contact me immediately if there are any concerns." The relative said "I feel very lucky to have found this place." Another relative said "I've got nothing but praise for the home. My daughter’s very happy there. It's lovely. All the staff are caring."

We found staff engaged well with people and respected their privacy and dignity whilst supporting them. Relatives told us they could visit the home at any time and were made to feel welcome.

Care plans and health action plans recorded the support people needed. Any concerns about people’s health were referred to the appropriate healthcare professionals. The district nurse told us “The slightest change (in people’s health) and they always ring us. They were very quick to act when a new wound appeared.” They added “I’ve no worries that if they noticed any concerns they would be straight on to the GP.”

We received positive comments about management of the home from everyone who provided feedback. A relative told us "It's an open house - you can see the manager anytime." Another relative said "Everything's right, the manager and deputy are exceptional, they run it beautifully." We noticed staff were at ease when speaking with the registered manager. One member of staff described the manager as “brilliant” during the general course of conversation about the home.

We found there was no system for staff to lead shifts when the registered manager and deputy manager were not on duty. This meant there was a risk of important tasks or activities being missed if no one took responsibility for co-ordinating each shift. We have recommended the provider takes action to address this.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to supporting staff. Staff had not received appropriate supervision and appraisal from their line managers. This meant staff performance and development was not appropriately assessed and monitored to make sure staff had the right skills and knowledge to meet people’s needs.

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