We undertook an unannounced inspection on 7 September 2017 of The Gables. The Gables provides accommodation and personal care for up to 16 people with learning disability, autism and physical disability. At the time of this inspection, the service was providing care and support to twelve people.

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.

At the last inspection on 14 May 2015 the service was rated Good.

The premises were clean and tidy. There was a record of essential maintenance carried out at the home. Bedrooms had been personalised with people's belongings to assist people to feel at home. However, the water temperatures of three hand basins in people’s bedrooms had reached temperatures above the recommended safe water temperatures. The registered manager took prompt action during and after the inspection to fix the issue.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. Care plans were reviewed and were updated when people's needs changed.

Relatives informed us that they were satisfied with the care and services provided. Relatives also told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. Some gaps in medicines records were identified however these were resolved promptly.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that the relevant authorisations had been granted and were in place.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a management structure in place with a team of care workers, assistant team leader, the registered manager and provider. Staff spoke positively about working at the home. They told us management were approachable and the service had an open and transparent culture. There were systems in place to monitor and improve the quality of the service.

All the people we spoke with told us that they were happy with the care provided by the home. People we spoke with told us that staff looked after them well and supported them as and when needed to meet their assessed health and social care needs. For example a person told us: “I lay breakfast on the table and assist staff with making breakfast”. Another person said that staff supported them in administration of medication.

We found that people were involved in making decisions about their care and treatment. People’s care and support needs were assessed and regularly reviewed. Staff understood people’s care needs and knew how to protect them from risk and harm. We found staff had followed the provider’s correct procedures of medication administration to ensure the safe management of medicines. We saw there were enough experienced staff to meet people’s needs. Staff were supported to deliver care safely and to an appropriate standard.

People who used the service we spoke with told us they were "happy living here". People told us they were supported to maintain their independence and they were encouraged to go to a day centre, work, cook, clean and wash themselves if they were able. One person told us "I go to day centre three days a week”.

People told us staff looked after them and they felt comfortable speaking to staff about any problems or worries they had. We observed that they were being supported by staff that were patient and sensitive to their individual needs. One person told us; “I asked for a sandwich and had one this morning”. Another person told us they were supported by staff for “making healthcare appointments”.

We found that the provider acted appropriately when people did not have the capacity to manage aspects of their care. We found people's care and support needs were assessed and regularly reviewed, and all people had up to date risk assessments in place. Staff we spoke with felt they were adequately supported. However, other evidence did not support this.

Staff understood people's care needs and knew how to protect them from risk and harm. People told us that they felt safe and were able to express their views and concerns to staff. One person said “I like my key worker” another person said “I am really happy here”. The provider used effective systems to regularly check that care was being provided safely and appropriately.

This inspection took place on 14 & 18 May 2015 and was unannounced. At our previous inspection in September 2013, we found the provider was meeting the regulations in relation to the outcomes we inspected.

The Gables provides accommodation and personal care support for up to 16 people with a learning disability, autism and physical disability. At the time of our inspection the home was providing support to 15 people. The home 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.

There were safeguarding policies and procedures in place to ensure people were kept safe. Assessments were conducted to assess levels of risk to people’s health and well-being ensuring risks to people were minimised.

Accidents and incidents involving the safety of people using the service were recorded and acted on appropriately and the home had arrangements in place for foreseeable emergencies.

There were safe recruitment practices in place and robust recruitment checks were conducted before staff started work ensuring that people were cared for by staff who were suitable for the role.

Medicines were stored, recorded, managed and administered safely and the home had systems in place to monitor the safety of the premises and equipment used.

People were supported by staff who had appropriate skills and knowledge to meet their needs. Staff received appropriate training and frequent supervision that met their needs.

Staff demonstrated a good understanding of people’s right to make informed choices and decisions independently but where necessary for staff to act in someone’s best interests. Staff had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards.

People were supported to eat and drink sufficient amounts to meet their needs and ensure a balanced diet. People had access to health and social care professionals when requested or required.

Some people using the service were not able to verbally communicate their views to us about the service. We therefore observed the care and support being provided. Staff were familiar with people using the service and knew how best to support them and how to approach them respectfully. Relationships between staff and people using the service were very positive and were characterised by kindness and mutual respect.

Care plans documented detailed information for staff about how to meet people’s personal care needs, preferred activities and people’s ability and methods to communicate nonverbally. Care plans showed people’s care needs had been regularly assessed and reviewed in line with the provider’s policy.

People had access to specialist equipment enabling greater independence which met physical, emotional and sensory needs. People were supported to access community services to meet their social needs.

The home had a complaints policy and procedure in place and a pictorial complaints booklet displayed in the entrance hall of the home so it was accessible to all.

There were procedures and systems in place to evaluate and monitor the quality of the service provided. Staff spoke positively about the registered manager and the support they received. The home and provider took account of people’s views with regard to the service provided through residents and relatives satisfaction surveys that were conducted on an annual basis.