About the service:

The Gables Nursing Home is a residential and nursing home that was providing personal and nursing care to 16 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People told us they were happy with the service. We received comments such as, “I feel much happier they (staff) are very very kind, “They always make sure we are sorted out”, and “I was all over the place when I was at home, now I am here I certainly feel safe.”

People were always protected against avoidable harm, abuse, neglect and discrimination.

People’s risks were assessed and strategies put in place to reduce the risks.

People experienced positive outcomes regarding their health and wellbeing.

Staff received good supervision and training, which provided them with the knowledge and skills to enable them to provide good care.

Care was person-centred and focused on ensuring people with dementia lived independent lives. The care was designed to ensure people’s maximum independence was encouraged and maintained.

There was a workplace culture that was open and honest. Staff told us they felt supported by the manager and they could speak with them at any time.

Rating at last inspection:

At our last inspection the service was rated Good and the report was published on (15 June 2016).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received. We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

The service provides nursing and residential care for up to 18 people. The service was previously inspected in March 2014 when it was found to be fully compliant with regulations. At the time of our inspection there were 15 people using the service. The service had a 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 saw people were well cared for and comfortable in the home. Everyone we spoke with commented how kind the staff were. People’s comments included “I have recently moved into the home and I can’t fault the staff they are very patient with me”. Care plans recorded people’s likes and dislikes and provided staff with information to enable them to provide care effectively.

We saw people were cared for with compassion and respect. Staff were well trained and motivated. The registered manager and directors provided effective leadership to the service and held regular residents meetings to ensure people were involved in the running of the home.

The service was well led and people’s care was regularly reviewed. The registered manager had an excellent oversight of the service. Staff told us they felt happy and supported working for The Gables.

The atmosphere in the home was warm and welcoming staff were able to spend time with people to ensure their needs were met.

The home did not have an activity coordinator at the present time but was actively seeking to recruit someone to take on this role. However, an activity coordinator from one of the providers other service visited regularly to provide activities for people. However, we did not see that a planned programme of activities was in place at the time of our inspection. We spoke to the registered manager and the director about this and they confirmed they are aware of this shortfall and were doing as much as they possible to recruit a suitable candidate.

We met with the manager of the home and spoke with four people who used the service. One person told us they felt "safe here." We found throughout the home that a new call bell system had been installed. This protected people from the risk of harm, as staff were able to hear and see where alarms had been triggered and respond appropriately and quickly.

We reviewed the care plans of four people. We found the provider had a clear understanding of how the Mental Capacity Act 2005 applied to the service they provided to people. We saw documents that recorded conversations with people about the decisions they had made.

We read guidance for staff on how to assist someone with memory problems to make choices and decisions each day. This demonstrated that the provider had in place suitable arrangements for obtaining and acting in accordance with the consent of people who used the service to the care and treatment provided for them.

At the time of the inspection The Gables was in the process of reducing the number of beds in the nursing home from twenty two to eighteen and developing a service for six people with a learning disability.

People living at The Gables told us they were happy with the care that was provided to them, and felt that they were able to give their views on how the service was provided. When we asked one person what it was like to live there, they said “it is good.” Another person told us “I like it here I sit and knit, watch a bit of TV and the food is good.”

A visitor told us that they were impressed with the way the service was run, and that their relative had had a number of falls before they moved to The Gables and these had now stopped.

We observed that people weren’t always able to summon support when they needed to, due to the staffing ratios. This may have put people at risk of injury or harm at busy times of the day.

We found that records reflected people’s care and health needs. People told us that staff were quick to respond to changes in their health needs and doctors were called upon where necessary.

We found immediate action was needed to ensure a gas cooker was safe to use. We were given assurances from the provider that this would be dealt with as a matter of urgency.

We found that staff supported people in a respectful manner and supported people appropriately taking into account their individual preferences and needs.

We did not speak with people for this review.

We carried out the inspection over two days. We found that in some areas the provider had improved on areas since our last inspection on 19 February 2013.

We saw that the garden area had been cleared of debris and now provided a comfortable and attractive area for people to use. Remedial work had been carried out on the gas cooker and ventilation system in the kitchen. This ensured that the people were protected from the risk of harm or injury. We also found that the alarm bell system was in need of upgrading to ensure that it was fit for purpose, for example being audible throughout the home so that staff could hear and identify where the alarm had been activated.

We observed that staff numbers had increased since our last inspection; this ensured that people who used the service had sufficient staff to meet their needs. .

We found more work needed to be completed in the area of staff training and implementation of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The provider took immediate action to address the needs of the staff and to source training and support from a private trainer and the local authority.

We spoke with three people who use the service; one told us that they were “very comfortable here.” Another person told us the manager was “lovely.” We spoke with other professionals from the local authority after they had visited the home; they reported people had told them they were happy with the service provided.