We carried out an unannounced inspection on 4 June 2018.

White Gables 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.

White Gables is located on the edge of a village on the outskirts of Lincoln. It accommodates up to 55 people many of whom are living with dementia requiring high levels of care and nursing. The accommodation is provided on one floor and the building is separated into three separate units called Cedar, Castle and Cathedral. Cedar provides mainly residential care whilst Castle and Cathedral provides for people requiring nursing care. On the day of the inspection there were 42 people living at the home.

At our last inspection in December 2015 we rated the service good. At this inspection, we rated the service as requires improvement. Safe, caring, and well led remained good; however, effective and responsive required improvement. This is the first time the service has been rated Requires Improvement.

There was a registered manager in place. 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.

Systems and processes were in place to ensure people were protected from abuse and people told us they felt safe at the home. Risk assessments were completed to identify risks to people’s health and safety but care plans did not always reflect the actions required and we found an example of a delay in obtaining a piece of equipment required to improve a person’s safety.

There was a good culture of incident reporting and staff were able to speak up about concerns. Infection risks were controlled and managed well and checks of the premises were in place to maintain the safety of the buildings and equipment. People received their medicines as prescribed and arrangements were in place for the ordering and supply of people’s medicines.

People were supported to have maximum choice and control of their lives. Although staff supported people in the least restrictive way, they did not always have a full understanding of the Mental Capacity Act (2005) and specific best interest decision making was not always documented.

When people required support and encouragement with their eating and drinking, we had some concerns as to whether they were receiving sufficient fluids and whether sufficient steps were taken to maximise their nutritional intake. Improvements could be made to the care of people’s mouths particularly when they were not able to maintain a good oral intake.

People were supported to access health care and staff sought the advice of a specialist healthcare professionals were necessary. They worked well with other services and acted on the advice provided.

Staff were friendly, encouraging and caring in their approach. People and their relatives praised the attitude of staff and their kindness. They protected people’s privacy and dignity and respected their views and choices.

People and their relatives were involved in the development of their care plans. However, some care plans did not contain some key information and the amount of information about their life history and previous interests was sometimes limited.

People’s views were listened to and acted upon and complaints were dealt with responsively and effectively.

The home was well-led by a registered manager. People using the service, their relatives and staff praised the registered manager and the support they provided. People and staff were encouraged to contribute to the development of the service. Effective auditing processes were in place to monitor the quality of the

We inspected White Gables on 6 October. The inspection was unannounced. The last inspection took place on 10 January 2014 during which we found that the provider had met all of the outcomes we inspected.

White Gables provides care and support for up to 55 older people, some of whom experience needs related to memory loss requiring high levels of care and nursing. The building is split into three different units with each focusing on either nursing or personal care. It is located on the edge of a village on the outskirts of Lincoln and is surrounded by fields and woodland.

There was a registered manager in post at the time of the inspection. 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection 21 people who lived within the home had their freedom restricted and the provider had acted in accordance with the Mental Capacity Act, 2005 DoLS.

People were safe living within the home. Staff knew how to recognise and escalate any concerns so that people were kept safe from harm.

Staff had been supported to assist people in a personalised way. They provided care as set out in each person’s care record and we found this helped to reduce the risk inappropriate care being given. There were clear arrangements in place for ordering, storing, administering and disposing of medicines.

People were provided with a choice of nutritious meals. When necessary, people were given extra help to make sure that they had enough to eat and drink. People also had access to a range of healthcare professionals, including GP services and specialist healthcare services.

People were treated with kindness and respect. They were able to see their friends and families when they wanted. There were no restrictions on when friends and families could visit the service and visitors were made welcome by the staff in the home.

People and their relatives had been consulted about the care they wanted to be provided. Staff supported the choices people made about their care and people were offered the opportunity to pursue and maintain their interests and hobbies.

There were systems in place for handling and resolving complaints. People we spoke with and their relatives were aware of how to raise any concerns they may have.

The provider and registered manager had systems in place to enable them to continually assess and monitor the quality of the services they provided.  They had taken steps to address issues identified such as vacancies within the staff team and odours within the home.

One person we spoke with told us, "Staff were pretty good" and they felt, "Able to have a bit of fun with them". They said , If any of the staff were unpleasant they would go straight to the manager" but this was not their experience.

A relative told us they had looked for a suitable home for a long time before choosing this one. They said they had to, "Take two buses to get there but it was worth it because staff seemed to really care about the people who lived there".

Personal support plans were in place which described the person’s preferred routines and there were risk assessments in place for people who were at risk of falling and for those at risk of developing pressure sores.

Menu plans offered people choice and a wide and varied diet. We saw hot and cold drinks being provided for people several times during our visit. There were jugs of water or squash available in peoples’ rooms.

A computer system designed to support the management of medicines was in place. This enabled staff to order medicines and check stocks. A hand held device was used to record the medicines administered. Details about people’s medicines were also available on paper records in case there was a problem with the computer system.

We reviewed the provider’s procedures for recruiting staff and found they had effective systems in place for checking the fitness of staff to care for people. This included checking the qualifications and professional registration of health staff.

We did not ask any person using the service about this outcome area.

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed that they were supported to make choices and decisions about the care they received.

Comments included,"Staff always ask me what I want to do", "No problems with care staff they are all good", "I get on with all staff, they are all kind" and "I feel safe here."

During the visit we spoke with visitors who expressed their satisfaction with the standards of care in the home. They told us the staff were good and they were kept informed of any changes.