We inspected Three Gables Residential Care Home on 22 and 24 May 2018. The first day of the inspection was unannounced. We previously carried out an inspection at Three Gables Residential Care Home in April 2017 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found people’s records did not reflect their care and support needs and were not well completed. Although there was a quality assurance system in place and audits and checks had been completed these did not always identify areas for improvement. The provider sent us an action plan and told us how they would address these issues. We also asked the provider to make improvements to ensure there were enough staff to support people safely, to ensure people received the support they needed at mealtimes and to ensure there was information about how people who lacked capacity were enabled to make decisions.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had made improvements, and check that the service now met legal requirements. We found some improvements had been made, however the breach of regulation had not been met.

Three Gables Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Three Gables Residential Care Home provides accommodation and personal care for up to 19 people in one adapted building. At the time of the inspection there were 17 people living there. People living at the home were older people some of who were living with mental ill health including a dementia type illness. People had a range of needs associated with old age and their health.

There was a registered manager at the service, who was also the provider. 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 found improvements were needed to ensure people’s records reflected the care and support they required and received. Risks assessments were in place however these did not always include all information staff may need. However, staff had a good understanding of the risks associated with the people they looked after and their care and support needs. They gave us detailed and consistent information about how they supported people to remain safe.

There was a quality assurance system in place which helped identify areas that needed to be improved. People, visitors and staff spoke highly of the provider and there was a positive culture at the service.

Systems were in place to ensure accidents and incidents were safely managed and action was taken to prevent a reoccurrence. Staff understood the procedures and what steps to take to safeguard people from the risk of abuse, harm or discrimination.

Staff knew people really well. This enabled them to support people as individuals and provide good person-centred care. There was a variety of meaningful activities taking place each day. People were supported to take part in these or engage in other activities of their choice.

People were treated with kindness, understanding and good humour. Staff were patient and supported people at their own pace and respected people’s dignity and right to privacy. People were supported to make their own decisions and choices throughout the day.

There were enough staff, who had been appropriately recruited, working at the home. Medicines were well managed and systems were in place to ensure medicines were ordered, stored, given and disposed of safely.

Staff had received training

Three Gables is a care home that provides accommodation for up to 19 older people who require a range of care and support related to living with a mental health condition. This includes a dementia type illness and behaviours that may challenge others. On the day of the inspection 17 people lived at the home.

There is a registered manager at the home who is also one of the partners of the business. 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.

This was an unannounced inspection and took place on 24 and 25 April 2017. We returned on 8 May 2017 to meet with the registered manager who had been away at the time of the inspection. This was the first inspection at Three Gables since the new provider had been registered with CQC.

People were supported by staff who knew them well and were committed to providing them with kind and compassionate care. Feedback received from people was positive about the care, the approach of the staff and atmosphere in the home. People and staff had benefitted from an open and positive culture at the home.

There was a quality assurance system in place to help identify areas where improvements were needed. This required more time to become fully embedded into everyday practice to become fully effective.

There were risk assessments in place however; these did not clearly reflect all the risks identified in some people’s risk assessments. The information about one person’s diet and some information about people’s skin integrity was conflicting. There was limited guidance in place for people who needed ‘as required’ (PRN) medicines, other areas of medicines systems were managed safely.

People were supported by staff who were kind and caring. They had a good understanding of people’s individual needs and choices. This enabled them to provide good person-centred care. However people’s records did not always reflect the care people required or received.

Staff were busy throughout the day and attentive to people’s needs. However, we found at mealtimes there were not enough staff to support people in a timely way.

There was an ongoing training and supervision programme in place. This included observations of staff in practice. Staff told us they felt supported through the supervision process. Appropriate checks were undertaken to ensure suitable staff were employed to work at the service.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) had been submitted when required. However, there was not always clear information about how people who lacked capacity were supported to make decisions or how restrictions may affect them.

People were supported to eat and drink a variety of food of their choice and nutritional assessments were in place. However, some people did not receive the support they required to eat their meal in a timely and undistracted way.

Staff had a clear understanding of the procedures and their responsibilities to safeguard people from abuse. They were able to tell us about the types of abuse and actions they would take to protect people.

People were supported to have access to healthcare services this included the GP, district nurse and chiropodist. Feedback from visiting healthcare professionals was positive.

We found a breach of the Regulations 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.