We inspected The Gables Retirement Home Limited on 24 April 2017. This was an unannounced inspection. The service was registered to provide accommodation and care for up to 35 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 18 people using the service.

At our last inspection on 21 October 2015 no concerns were identified and the service was found to be compliant in all outcome areas.

A registered manager, who was also the provider, was in post and present on the day of 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 were not always deployed appropriately to safely meet people’s care and support needs. People on the first floor had limited access to bathing and shower facilities.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs. People were able to access health, social and medical care, as required.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There was a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

We inspected The Gables Retirement Home Limited on 21 October 2015. This was an unannounced inspection. The service was registered to provide accommodation and care for up to 35 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. On the day of our inspection there were 20 people living in the care home.

At our last inspection on 17 July 2014 the service was found to be non-compliant in outcome areas relating to the safe control of medicines. This represented a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2010 and corresponded to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection, the provider told us what action they were going to take. At this inspection we found that the necessary improvements had been made and the service was no longer in breach.

A registered manager, who was also the provider, was in post and present on the day of 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.

People were happy, comfortable and relaxed with staff and said they felt safe. One person told us “I think they’re good girls, good as gold, everybody.” Another person said “It’s lovely here and they’re very good to me.” One relative told us “I’ve been highly satisfied with the care here. I don’t think you could have better anywhere.”

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Safe recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There was a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

We spoke with five people using the service, two relatives, two staff, the provider and observed the care provided. We also spoke with one external health professional.

This is a summary of what we found.

Is the service safe?

Where people lacked capacity, there was information on people’s capacity to make day to day decisions related to the care and support they required. We saw evidence that best interest decision- making was in place in people's care records.

We found medication administration record (MAR) charts were not completed consistently. We also found the recording and auditing of controlled drugs was inadequate to show what had come in and out of the service and whether or not medicines were still within their expiry dates. This meant medication procedures were not always robust enough to fully protect people from the risks associated with medication.

We found recruitment procedures were robust enough to ensure suitable people were employed.

Is the service effective?

People we spoke with were satisfied with the service and one person told us that their mobility had improved since using the service.

We found care records were up to date and contained useful information for the provision of care, with appropriate risk assessments and detailed evaluations of the care.

We saw that external health professionals were called in as required and one told us “Staff are always attentive and helpful” and they confirmed that their advice was followed. This meant people's medical needs were addressed.

Is the service caring?

People we spoke with told us they enjoyed using the service and were complimentary about the provider. One person told us “There’s plenty of comfort here”, another said “They’ve been very kind” and another “If I need any extra help, they would do it”. Relatives praised the service; one described it as excellent and another said “I’m generally pleased with it, the staff seem very kind and helpful”.

An external health professional told us "It’s very friendly" and our observation of people’s care found that staff were caring and helpful and attentive to people’s needs and we saw warm and friendly interactions. This meant people received assistance from compassionate staff.

Is the service responsive?

We found staff undertook relevant training to ensure they were competent to undertake their role.

An external professional told us that they were called in appropriately and any health issues were identified and dealt with. This meant people’s medical needs were addressed.

Is the service well led?

People using the service told us they would talk to the provider if they were not happy with any aspect of their care or if they had any problems. One person said “You can talk to him” and another said “He listens”. There had been no complaints received at the service since our previous inspection visit in January 2014 and we had not received any information about complaints at the Care Quality Commission in the same period.

This inspection was unannounced which meant the provider and the staff did not know we were coming. The Gables supported older people who may have a dementia related condition. There were 20 people in residence when we undertook our inspection.

We spoke with eight people living in the home, two visitors, two of the staff on duty, two visiting professionals and the registered provider.

People told us they were happy with the care they received and the staff were responsive to their needs. One person told us, “It’s grand here; you don’t need to worry about us.”

People using the service had care records which showed how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

People told us they could make choices about their food and drink. We saw people were provided with a choice of food and refreshments. Snacks and drinks were available throughout the day.

We looked at the suitability of the environment to ensure people lived in a home where the décor and environmental standards were appropriate. We found the home was clean, safe and well maintained.

We saw suitable systems were in place to monitor the service ensuring people received good care, support or treatment.

There were eighteen people living at the home at the time of our visit. One person told us that they were 'well satisfied', and that 'the nurses were very good'. Another person told us that 'it's a bit lonely when your family doesn't come, but the staff are very good to us. The food is nice, nothing wrong (and I can be a bit fussy). I feel that I could complain if I needed to.' A third person told us that 'they are looking after us well, very good. I am happy here.'

People told us that the provider organised a variety of activities and trips out. During our visit one activities co ordinators was organising a game of bingo for people. We reviewed the activities file and found a varied schedule of activities had taken place.

Staff we spoke to told us that they 'liked working at the home', and that they 'were happy with the standard of care' they were able to give to the people living at the home.

People told us that they were involved in planning and reviewing their care. Two people told us that the manager had asked about their preferences regarding daily routines. One person told us "staff remember how I like things to be done – that’s important to me".

People told us staff treated them with respect and we observed that staff had a calm and friendly approach. People told us their privacy was respected by staff.

People told us they were satisfied with the care provided to them. One person said "It suits me very well here".

People described the staff as friendly, kind, and patient. People told us they would go to manager with any concerns and they were confident he would listen and act appropriately.

People told us the staff were "very good", "caring", and "hard working". One person said "the staff know how to look after me."

People told us they were satisfied with the service provided. People said "I've no complaints" and "I can't fault it here".