The Gables Nursing Home is situated in the town of Silsden between Keighley and Skipton. It is registered to provide nursing and personal care for up to 46 people, some of whom may be living with dementia. The service is a mixture of old and new buildings where there have been improvements and extensions over time. Most bedrooms were for single occupancy but there were six that were for people to share. There were bedrooms, communal rooms, bathrooms and toilets on all three floors which were accessed via a passenger lift and stairs.

We undertook this unannounced inspection on the 21 September 2016. There were 43 people using the service at the time of the inspection, 35 who required nursing care and eight who required residential care. At the last inspection on 31 October 2013, the registered provider was compliant in the areas we assessed.

The service had a registered manager in post as required by a condition of registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 have made the Caring domain outstanding. We have done this because we found the registered manager and staff team had developed very positive ways in ensuring people who used the service and their relatives felt cared for and supported, which had a positive impact on their wellbeing.

The end of life care people received was exceptional; everyone had an advanced care plan regarding the preferred place they wished to be cared for at the end of their life. A clinical nurse specialist in palliative care told us that people had been looked after to a high standard and staff had good knowledge of when end of life was approaching in order to rally the required support for the person and their relatives. They also said staff were very proactive in seeking the specialist nurse’s advice when required and with actions resulting from weekly meetings. They said they did not need to attend meetings as often now because of the nurses management regarding people’s end of life care.

We observed very positive staff interactions with people who used the service. Staff treated people with kindness, respect and dignity, offering encouragement and support when required.

Staff protected people from the risk of harm and abuse. There were policies, procedures and training to guide staff in how to safeguard people from abuse; they knew how to recognise signs of concern and how to report them. We found risk assessments were completed and kept under review. This helped to minimise risk and prevent accidents and incidents from occurring.

We found people were safe within the service. There were good recruitment systems in place and there were sufficient staff on duty to look after people and ensure their health and wellbeing.

Staff were aware of people’s health care needs and how to recognise when their health was deteriorating. The support they provided helped to maintain people’s health and wellbeing. Staff liaised with health professionals for advice and guidance when required. We found people received their medicines as prescribed. Staff managed medicines well by obtaining, storing, administering and recording them appropriately.

We found staff supported people to maintain their nutritional needs. They assisted people to make choices about their meals and to eat them safely when required. The menus provided were varied and offered choices and alternatives.

We found people were supported to make their own decisions as much as possible. For example staff offered people visual choices to aid decision making. When people were assessed as lacking the capacity to make their own choices, decisions were made in their best interest in line with mental capacity legislation. We made a reco

We spoke with three people who used the service and four people’s relatives. They told us they had “no concerns” about the service. They said they would not hesitate to speak to the manager if they had any concerns; however, they said they had no reason to complain.

People described the staff as “kind”, “friendly” and “very good”. They told us the home had a good reputation in the local community and said they had not been disappointed.

One person told us the physiotherapist had helped their relative to walk again after a stroke and another person said their relative had gained weight since they moved in. One person who used the service told us they preferred to stay in their bedroom and said staff brought them their meals.

People’s relatives told us they were involved in planning care and were kept informed about any changes. One person said they had “Peace of mind” knowing their relative was safe and well cared for.

One person told us a relative had received “excellent” end of life care at the home last year. They said that was why they had chosen it for another relative when they needed residential care.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare and people’s medicines were managed safely.

We found the home was clean and well maintained.

We found there were effective systems in place to assess and monitor the quality of the service that people received.

We talked with four people who use the service. All told us staff were “Very helpful” and “Friendly” and two described the staff as an “Extended family”. They all told us they were able to make choices about when they retired or arose from bed; they describe how the routine was “Flexible”.

We talked with four relatives who also told the staff were like an “Extended Family”. Two described the staff as “Outstanding”. All of the relatives described the routine as “Flexible” and two provided us with examples of how people were “Not rushed” and were able to take “As long as they liked” when eating.