The Gables Nursing Home

People’s experience of using this service:

People and their relatives universally praised the standard of the care at home. People said they felt safe and were supported by a consistent and experienced team. People said staff were kind and caring.

People’s care needs were assessed, and they received good quality person-centred care from staff who understood their needs well.

Staff were knowledgeable and received training, supervision and support to carry out their roles effectively. Staff were committed to providing person centred care and fulfilling opportunities for people. We saw a strong emphasis on people being offered individualised support. There were a very wide range of positive one to one and group activities available to people who lived in the home.

Some improvements were needed to the safety of the service. We identified security issues on the first day of the inspection. The entrance door was not secure, and a medicines trolley was open. This was addressed by the second day of the inspection. We were re-assured this was an isolated incident and we had confidence in the registered managers response to this issue. We have made a recommendation about improving systems to monitor safety and security.

The service had been accredited with the Gold Standard Framework (GSF) for their approach to end of life care. This is a framework used to ensure the highest standard of care is provided for people who are near the end of their life. We saw the home had assessed the needs of people living at the home and worked very closely with people and their families to discuss their preferences and plan their care.

The home and the grounds were accessible and well maintained. Some areas had recently been refurbished.

Medicines were generally safely managed. There were very close links with health professionals and other agencies to ensure people’s health needs were met and changes responded to promptly.

The registered manager provided people with leadership and promoted a supportive and inclusive team culture. The home was family run and there was universal praise from staff, relatives and people about the quality of the service. There was a warm and welcoming atmosphere throughout. One health professional said. “There is a family feel all the way down. Very good management. You can tell it is family run because there is such a vested interest in people and staff.”

More information is in the full report.

Rating at last inspection:

At the last inspection on 21 September 2016 the service was rated good.

Why we inspected:

The inspection was part of our scheduled plan of visits.

Follow up:

We will continue to monitor the service to ensure people receive safe, high quality care. Further inspections will be planned for future dates.

For more details, please see the full report, which is on the CQC website, www.cqc.org.uk

We undertook this unannounced inspection on the 21 September 2016. There were 43 people using the service at the time of the inspection, 35 who required nursing care and eight who required residential care. At the last inspection on 31 October 2013, the registered provider was compliant in the areas we assessed.

The service had a registered manager in post as required by a condition of registration. 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.

We have made the Caring domain outstanding. We have done this because we found the registered manager and staff team had developed very positive ways in ensuring people who used the service and their relatives felt cared for and supported, which had a positive impact on their wellbeing.

The end of life care people received was exceptional; everyone had an advanced care plan regarding the preferred place they wished to be cared for at the end of their life. A clinical nurse specialist in palliative care told us that people had been looked after to a high standard and staff had good knowledge of when end of life was approaching in order to rally the required support for the person and their relatives. They also said staff were very proactive in seeking the specialist nurse’s advice when required and with actions resulting from weekly meetings. They said they did not need to attend meetings as often now because of the nurses management regarding people’s end of life care.

We observed very positive staff interactions with people who used the service. Staff treated people with kindness, respect and dignity, offering encouragement and support when required.

Staff protected people from the risk of harm and abuse. There were policies, procedures and training to guide staff in how to safeguard people from abuse; they knew how to recognise signs of concern and how to report them. We found risk assessments were completed and kept under review. This helped to minimise risk and prevent accidents and incidents from occurring.

We found people were safe within the service. There were good recruitment systems in place and there were sufficient staff on duty to look after people and ensure their health and wellbeing.

Staff were aware of people’s health care needs and how to recognise when their health was deteriorating. The support they provided helped to maintain people’s health and wellbeing. Staff liaised with health professionals for advice and guidance when required. We found people received their medicines as prescribed. Staff managed medicines well by obtaining, storing, administering and recording them appropriately.

We found staff supported people to maintain their nutritional needs. They assisted people to make choices about their meals and to eat them safely when required. The menus provided were varied and offered choices and alternatives.

We found people were supported to make their own decisions as much as possible. For example staff offered people visual choices to aid decision making. When people were assessed as lacking the capacity to make their own choices, decisions were made in their best interest in line with mental capacity legislation. We made a recommendation that the registered provider seek advice regarding specific documentation tools to record best interest decisions.

People had assessments and care plans which guided staff in how to support them in line with their needs, wishes and preferences. We found people and their relatives were involved in assessments and developing care plans. Relatives told us their family members were cared for in an individual way; they were very happy with the service and had noticed there was a lot going on for people. There was a large range of activities for people to participate in and trips to local community venues were arranged.

Staff told us they received sufficient training to enable them to support people safely and to meet their assessed needs. Records confirmed this. We found staff received guidance, support, supervision and appraisal. This helped them to be confident when supporting people who used the service.

We found the service was well-managed. There was a quality monitoring system that ensured people’s views were listened to via meetings, questionnaires and day to day discussions. Audits and checks were completed and any shortfalls were addressed. There was an ethos of learning to improve practice and the service provided to people. Staff told us there was an open culture where they felt able to raise issues with the registered manager.

There was a complaints policy and procedure on display and people told us they felt able to complain in the belief any concerns would be listened to and addressed.

We found the environment had been adjusted well to respond to people’s individual needs. This included corridors with hand rails, the availability of moving and handling equipment, a passenger lift to the upper floor, signage to remind people of the location of toilets and light, airy communal rooms. The environment was safe and clean. Equipment used in the service was maintained and regular checks took place to identify any concerns.

People described the staff as 'kind', 'friendly' and 'very good'. They told us the home had a good reputation in the local community and said they had not been disappointed.

One person told us the physiotherapist had helped their relative to walk again after a stroke and another person said their relative had gained weight since they moved in. One person who used the service told us they preferred to stay in their bedroom and said staff brought them their meals.

People's relatives told us they were involved in planning care and were kept informed about any changes. One person said they had 'Peace of mind' knowing their relative was safe and well cared for.

One person told us a relative had received 'excellent' end of life care at the home last year. They said that was why they had chosen it for another relative when they needed residential care.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare and people's medicines were managed safely.

We found the home was clean and well maintained.

We found there were effective systems in place to assess and monitor the quality of the service that people received.