This inspection took place on 7 and 8 February 2017 and was unannounced.

The provider is registered to provide accommodation for up to 26 older people living with or without dementia in the home over two floors. There were 11 people using the service at the time of our inspection. The home provides nursing care for older people.

At our last inspection on 20 and 21 September 2016, we served warning notices on the provider in the areas of medicines and good governance. We also asked the provider to take action to make improvements in the areas of person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing. We received an action plan setting out when the provider would be compliant with the regulations. At this inspection we found that the concerns in the areas of safeguarding service users from abuse and improper treatment and premises and equipment had been fully addressed. However, while improvements had been made, more work was required in all other areas.

The registered manager was no longer working at the home. They had left in September 2016 and a new manager was in place. The new manager had started the process to be registered with the CQC at the time of our inspection. They were available during 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.

Staff did not always safely manage identified risks to people. Sufficient numbers of staff were not always on duty to meet people’s needs. The management of medicines required improvement.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Staff were recruited through safe recruitment processes. Safe infection control practices were followed.

People were not effectively supported by staff to have sufficient to eat and drink. Staff received appropriate induction and training but supervision and appraisal required improvement.

People’s rights were protected under the Mental Capacity Act 2005. External professionals were involved in people’s care as appropriate. People’s needs were met by the adaptation, design and decoration of the service.

Most staff were kind and permanent staff knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people. People received care that respected their privacy and dignity and promoted their independence.

People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care plans required improvement to ensure that they contained sufficient information to guide staff to provide personalised care for people. A complaints process was in place and staff knew how to respond to complaints.

The provider was not fully meeting their regulatory requirements. Some systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective. People and their relatives were involved or had opportunities to be involved in the development of the service.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 20 and 21 September 2016 and was unannounced.

Accommodation for up to 26 people is provided in the home on two floors. There were 12 people using the service at the time of our inspection. The home provides nursing care for older people.

At the previous inspection on 25 and 26 April 2016, we asked the provider to take action to make improvements to the areas of notifications, person-centred care, need for consent, safe care and treatment, safeguarding, meeting nutritional and hydration needs, premises and equipment, good governance and staffing. At this inspection we found that the concerns in the areas of notifications and meeting nutritional and hydration needs had been fully addressed. However, while some improvements had been made, more work was required in all other areas.

At the previous inspection the overall rating for this service was ‘Inadequate’ and the service was placed in ‘special measures’. At this inspection the overall rating for this service is ‘Requires Improvement’ and the service is no longer in special measures.

A registered manager was in post and was present on the first day of the inspection but not on the second day. 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.

Staff knew how to identify potential signs of abuse; however, restraint was being carried out by staff and they had not received sufficient training or guidance to do this. Staff did not always safely manage identified risks to people. Sufficient numbers of staff were on duty to meet people’s needs during our inspection, however, systems were not robust to ensure that sufficient staff were on duty at all times.

Safe infection control and medicines practices were not always followed. The most recent staff member had been recruited through safe recruitment practices; however, records were not available to provide assurance that all recent staff had been recruited safely.

Staff did not receive appropriate training, supervision and an appraisal. People’s rights were not always protected under the Mental Capacity Act 2005. People’s needs were not fully met by the adaptation, design and decoration of the service.

People received sufficient amounts to eat and drink and external professionals were generally involved in people’s care as appropriate.

Staff were kind but did not always respect people’s privacy. People and their relatives were not fully involved in decisions about their care. Advocacy information was made available to people.

People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care records did not always contain information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, however, they were not effective. People and their relatives were not involved nor had opportunities to be involved in the development of the service. However, the provider and registered manager were generally meeting their regulatory requirements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

This inspection took place on 25 and 26 April 2016 and was unannounced.

Accommodation for up to 26 people is provided in the home on two floors. There were 17 people using the service at the time of our inspection. The home provides nursing care for older people.

At the previous inspection on 14 and 15 April 2015, we asked the provider to take action to make improvements to the areas of person-centred care, dignity and respect, need for consent, safe care and treatment, good governance and staffing. At this inspection we found that improvements had not been made and more work was required in all areas.

A registered manager was in post and was present during 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.

Staff did not always safely manage identified risks to people. The premises were not always managed to keep people safe. Sufficient numbers of staff were not always on duty to meet people’s needs. Safe infection control and medicines practices were not always followed. Staff knew how to identify potential signs of abuse; however, restraint was being carried out by staff and they had not received sufficient training or guidance to do this. Staff were recruited through safe recruitment practices.

Staff did not receive appropriate training, supervision and appraisal. People’s rights were not always protected under the Mental Capacity Act 2005. People did not always receive sufficient amounts to drink. External professionals were not always promptly involved in people’s care as appropriate. People’s needs were not fully met by the adaptation, design and decoration of the service.

Staff were mostly kind but did not always treat people with dignity. People and their relatives were not fully involved in decisions about their care. Advocacy information was made available to people.

People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care records did not always contain information to support staff to meet people’s individual needs. A complaints process was in place and staff knew how to respond to complaints.

There were systems in place to monitor and improve the quality of the service provided, however, they were not effective. People and their relatives were not involved nor had opportunities to be involved in the development of the service. The provider and registered manager were not meeting their regulatory requirements.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it i

During the inspection we spoke with two people who used the service and asked them about their experiences of living at the care home. We spoke with three relatives. We also spoke with six staff, including the registered manager. We observed the care that was given to people. We looked at some of the records held in the service including the care records for three people.

During the inspection we gathered information to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. One person said, “[Staff] They’re very safety conscious.” Relatives we spoke with also told us they felt their family members were safe.

Staff told us they had read the safeguarding policy and would report any concerns. The manager told us that staff had attended safeguarding training since our inspection in April 2014.

We found that effective staff recruitment and selection processes were in place.

We used our SOFI (Short Observational Framework for Inspection) tool during the inspection. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We conducted a SOFI observation for 40 minutes, observing the care in the small and larger lounges during the morning. We saw people received appropriate and safe support.

We looked at the care records for three people who used the service. We saw care plans about different needs. A care plan is a document that should identify a person's needs and how staff can meet those needs. These mostly contained detailed information and were centred around people's individual needs. However, we found that staff were not always completing charts at the required frequency to record changes of position to protect people’s skin.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to records.

People who used the service told us they felt that the care home was well maintained. One person said, “The [maintenance staff member] who does the work is fantastic.”

People also told us they felt that the care home was kept clean. However, we found some concerns regarding cleanliness and infection control. We saw, for example, that the grouting behind the sink in a downstairs bathroom had deteriorated. We saw that some items that included bedside protectors were not clean.

We asked the provider to tell us what they would do to meet the requirements of the law in relation to cleanliness and infection control.

Is the service effective?

People who used the service told us they felt staff were good at their jobs. One person said staff were, “Very professional.” A person told us they received the support they needed and said, “The care, you couldn’t want better.”

Staff generally had a good understanding of the needs of people who we discussed with them. They told us they received training and supervision.

Is the service caring?

People who used the service told us staff were caring. One person said staff were, “Very, very caring.” They also told us staff treated them with dignity and respect.

Relatives told us staff were caring and friendly. One relative said, “They [staff] seem to be very caring.”

We saw staff communicated warmly with people as they supported them and staff were caring and kind.

Is the service responsive?

Staff told us they would involve other agencies when required. We saw some information in the care records that showed that the service had involved other agencies. However, the provider may find it useful to note that we saw that an external health professional had completed a care plan for one person that stated that behaviour charts should be observed. We saw that a care plan produced by the care home also stated that staff should document the person’s behaviour on behaviour charts. However, we saw no behaviour charts in place.

Is the service well-led?

People who used the service and staff told us they felt the service was well-led. One person said, “You’ve got a very good person in charge."

Staff told us they felt they could contribute their views on the service and a staff meeting had recently taken place. They also told us they felt the care home was well-led.

However, we found that the systems in place to regularly assess and to manage risks relating to the health, welfare and safety of people who used the service were not always effective. We found, for example, that concerns we identified regarding records and cleanliness and infection control had not been identified and addressed by the quality monitoring systems. We also found that the provider had not taken some actions they told us they would take following our inspection in April 2014. They told us that Mental Capacity Act 2005 assessments would be completed when required. However, we found two people did not have capacity assessments in their care records when these were appropriate.

We spoke with three people using the service. Two people told us their privacy and dignity were respected. One person said, “The people are treated nicely.” However, they also told us they had not been involved in reviews of their care. They told us they did not receive enough information about the care in a way they understood.

They told us they were well cared for. However, one person told us they sometimes had to wait for staff when they needed assistance. Two people told us they would prefer more activities. They told us they felt safe.

We spoke with two relatives. They told us their relatives were well cared for. One relative told us there were enough staff. Another relative said, “Sometimes at night it can be a bit tight.” We found that the current management arrangements were not working effectively.

We found that care records we looked at were often not person-centred and did not include enough information about people's needs and preferences.

A relative told us the lounge needed decorating. We found that some items on the premises were not stored appropriately.

People using the service who we spoke with told us they felt staff were well trained. However, we found that staff did not always receive appropriate training, supervision and appraisal.

We found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received and records were not always fit for purpose and stored securely.

We asked people who used the service if they could consent to the care they received. One person told us, “I can decide what I do each day, staff always ask me what I want.” Another person told us,” The staff always speak to me about things first.”

We asked people who used the service about their experience of the care they received at The Gables. One person told us, “It’s excellent here, you could not wish for better. I am offered choices, my pain is managed well and the staff always care for me properly.” Another person told us,” I feel like it's home here, staff are lovely and I get lots to eat.”

We observed those people who were unable to communicate their views and found that they were seated comfortably, had their dignity maintained when receiving personal care and staff were observed to demonstrate genuine affection, care and consideration of their needs.

The Gables Nursing Home provides accommodation and personal and nursing care for up to 26 older people.

This was an unannounced inspection, carried out on 14 and 15 April 2015.

We last inspected The Gables Nursing Home on 9 September 2014. At that time it was not meeting three essential standards. We asked the provider to take action to make improvements in the areas of cleanliness and infection control, assessing and monitoring the quality of service provision and records. We received an action plan dated 10 November 2014 in which the provider told us about the actions they would take to meet the relevant legal requirements. During this inspection we found that the provider was meeting these legal requirements. However, we found that some improvements were still required at the home.

A registered manager was in post at the time of our 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 living at the home raised no concerns regarding their safety. Systems were in place for the provider to make safeguarding referrals when needed so that they could be investigated.

Staff supported people in a safe way. Risk assessments were mostly completed regarding people’s care.

There were enough staff present during our inspection. However, staff did not always respond in a timely manner when people needed assistance. Recruitment checks were completed. However, the recruitment process had not always been robust.

People received their medicines in a safe way. However, there were a small number of discrepancies regarding how medicines were managed.

The home was clean.

Staff felt supported and had received an induction, supervision, appraisals and training. However, formal supervision had not always taken place for some staff on a regular basis.

Staff respected people’s wishes when supporting them. However, a small number of staff had not received training on the Mental Capacity Act 2005. Some staff did not have appropriate knowledge of the Deprivation of Liberty Safeguards.

People received enough to eat and drink. Care staff knew about people’s eating and drinking needs. People were supported to maintain good health and referrals were made to health care professionals for additional support when needed.

Staff mostly treated people in a caring way and treated people with dignity and respect. However, we observed some examples where this had not occurred.

Staff knew people well and respected people’s choices.

People were supported to take part in social activities. However, opportunities for this were limited.

Relatives felt able to speak to the registered manager if they had concerns. The registered manager was very approachable and knew people well who were living at the home.

Some improvements had been made regarding how the service was monitored and risks addressed. However, further actions were required to improve the effectiveness of the systems in place.