The Gables is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The Gables is also the registered address for a service which also provides care and support to people living in four ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection also looked at the personal care and support provided to people in the supported living setting.

The Gables can accommodate up to five people who have a learning disability and autism. At the time of our inspection five people were living there. People at The Gables had their own bedrooms with access to a shower and bathroom. They shared a lounge and two dining rooms. Grounds around the property were accessible. The supported living settings can accommodate up to 24 people who have a learning disability in four houses within the locality of Stroud.

The Gables had been developed and designed in line with the values that underpin the Registering the Right Support, Building the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service lived as ordinary a life as any citizen.

This inspection took place on 14 and 21 November 2018. At the last comprehensive inspection in March 2016 the service was rated as Good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

There were two registered managers in post to manage the two services. They had been registered with the Care Quality Commission (CQC) in 2010. 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. The registered manager of the supported living service was also the Group Manager for all services provided by Stroud and District Homes Foundation Limited.

People’s care and support individualised, reflecting their personal wishes and lifestyle choices. They were treated with compassion, kindness and care. They had positive relationships with staff, who understood them well. People enjoyed being in the company of staff. The atmosphere in their homes was light hearted with much laughter and happiness. Staff understood and respected people’s diverse needs. Staff knew how to keep people safe and how to raise safeguarding concerns. Risks were well managed encouraging people’s independence. There were enough staff to meet people’s needs. Staff recruitment and selection procedures were satisfactory with the necessary checks being completed prior to employment.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. They made choices about their day to day lives. People and those important to them were involved in the planning and review of their care and support. They chose the activities they wish to take part in. They said they liked to work on a farm, to the gym and to garden centres. They went on holidays, day trips, to social clubs an

The inspection took place on 29, 30 and 31 March 2016. This was an unannounced inspection. The service was last inspected in April 2015. There were two breaches of regulations at that time. A significant safeguarding event had occurred a couple of days prior to the last inspection but this had not been reported. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. Daily care records for the people receiving community services did not reflect an accurate account of the activities they completed during 1:1 time with staff. This was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

At the time of this inspection we saw evidence of safeguarding incidents being reported. People’s daily notes provided an accurate account of the activities they completed. The service was meeting legal requirements at the time of this inspection.

The Gables is registered to provide accommodation for up to five people in the care home and also provides a personal care service (domiciliary care) to 20 people who live in three shared houses (supported living arrangements). The three supported living houses are Barn Lodge and Stonehaven on the same site as The Gables in Stroud and Cotswold Grange in nearby Stonehouse. For the purposes of this report we have referred to the personal care service as the community service and used The Gables when referring to the care home. Both services care for people who have a learning disability...

There are two registered managers in post, one for The Gables and one for the community service. 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 suitable arrangements in place for the safe storage, receipt and administration of people’s medicines.

Risk assessments were implemented and reflected current level of risk.

People and their families were provided with opportunities to express their needs, wishes and preferences regarding how they lived their daily lives. This included meetings with staff members and other health and social care professionals.

People were supported to access and attend a range of activities. People were supported by the staff to use the local community facilities and had been supported to develop skills which promoted their independence.

People’s needs were regularly assessed and care plans provided guidance to staff on how people were to be supported. The planning of people’s care, treatment and support was personalised to reflect people’s preferences and personalities.

The staff at the home had a clear knowledge of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLs). These safeguards aim to protect people from being inappropriately deprived of their liberty. These safeguards can only be used when a person lacks the mental capacity to make certain decisions and there is no other way of supporting the person safely.

Where people lacked capacity, best interests meetings had taken place involving other professionals ensuring decisions were made in peoples’ best interests.

The staff recruitment process was robust to ensure the staff employed would have the skills to support people. Staff were knowledgeable about people. They had received suitable training to support people safely enabling them to respond to their care and support needs.

The service maintained daily records of how people’s support needs were met. Staff respected people’s privacy and we saw staff working with people in a kind and compassionate way responding to their needs.

There was a complaints procedure for people, families and friends to use and compliments could also be recorded. We saw

This inspection only looked at the regulated activity of personal care (a domiciliary care service provided to people in their own homes). The service was provided to 19 people who lived in three supported living houses. Support workers were employed to work in one of the three houses. We were able to speak with five people who received care and support in their own homes.

People who used the service had been supported for many years by the staff and the service. They had copies of their care and support plans in their rooms. People made positive comments about how their care and support needs were met. They said “I like cooking, the staff take me shopping and help me organise my weekly menu plans”, “They are very nice to me and we all get on well”, “They have been helping me a long time” and “They help me and remind me to do things”.

People were looked after by staff who had been recruited following safe and effective recruitment procedures. Staff were well supported to do their job and received regular training and supervision.

Systems were in place to monitor the quality of service provision but the policies and procedures did not reflect that people were supported by a domiciliary care service. The homes records and practices did not reflect that this was a domiciliary care service and not a care home. We have asked the provider to make improvements with how they monitor the service, the way the service is run and how they maintain their records.

We saw that people were relaxed and comfortable when talking with staff and that they were treated with warmth and respect. People had individual care plans that had recorded their care needs, what they liked and disliked, and information about their health needs.

People were supported to access the community and to go on trips and holidays of their choice. People were involved in the planning of their care and had made decisions about their life style.

Staff understood how people should be protected from harm and knew how to report incidents of abuse. Staff had been supported in attending training and had been supervised regularly. This helped them to support people with their individual needs in a safe way.

There were clear processes in place that monitored the quality of care people received. These included asking people and their families for their views about the service. All aspects of the management of the home had been monitored on a regular basis.

The provider now has appropriate systems in place to assess and monitor the quality of service provided for the five people who live there.

We talked with three people. They told us about their activities. Two of the people told us that they liked to go out for lunch and one person liked to go for walks. One person said that they liked to be involved in the routines of the home such as cooking and baking. Another person said that they had chosen new flooring for their room. We observed staff talking to people calmly and with respect. One person told us that they had been to the doctor.

The inspection was announced. We gave the provider 24 hours’ notice of the inspection of the regulated activity personal care (the domiciliary care service provided to people in the three supported living houses) to ensure that the people we needed to meet with were available. The last inspection of this service was in April 2014 and no breaches of legal requirements were found at that time.

The Gables is registered to provide accommodation for up to five people in the care home and also provides a personal care service (domiciliary care) to 20 people who live in three shared houses (supported living arrangements). The three supported living houses are Barn Lodge and Stonehaven on the same site as The Gables in Stroud and Cotswold Grange in nearby Stonehouse For the purposes of this report we have referred to the personal care service as the community service and used The Gables when referring to the care home. Both services care for people who predominantly have learning disabilities needs.

There are two registered managers in post, one for The Gables and one for the community service. 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.

The registered managers and staff teams for both The Gables and the community service were knowledgeable about safeguarding issues however we found that a significant safeguarding event had occurred and not been reported to the managers, the local authority or CQC. The failure to report this event may have placed people at further harm.

Any risks to people’s health and welfare were assessed and appropriate management plans were in place. Where people needed support with moving and handling, there were safe plans in place. Medicines were well managed and staff followed safe work practices to ensure that errors were not made. Staffing numbers on each shift in The Gables were sufficient to meet people’s care and support needs. There were sufficient staff to provide the agreed level of support to the people in the three shared houses.

Staff were provided with the training they needed to do their jobs and were well supported by the managers and their colleagues. The staff ensured people had sufficient food and drink and encouraged people to eat a healthy diet. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

There were good long-term relationships between people who lived in The Gables and those who received a community service and the staff spoke respectfully about the people they were looking after. People were treated with respect and dignity and were involved in making decisions about how they were looked after and supported.

People received care and support that met their specific needs. They were encouraged to express their views and opinions, the staff listened to them and acted upon any concerns to improve the service.

Both The Gables and the community service were well managed with a strong leadership team for the support workers. People’s feedback was valued and used to make changes to service provision. The quality of service provision and care was monitored to ensure that people’s needs were met safely.

We found a number of 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 the report.