Archived: The Gateway Residential Home

Updated 4 August 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 29 June 2017 and was unannounced. The inspection was carried out by two inspectors.

The registered manager had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We looked at previous inspection reports and notifications we had received. Notifications are information we receive from the service when significant events happen, like a serious injury.

We looked at all areas of the service and talked to five people who live at the service. Conversations took place with people in the communal lounge and their bedrooms. We observed the lunch time meal using a Short Observational Framework for Inspection (SOFI) and observed how staff spoke and interacted with people. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with two relatives, three staff, and the registered manager. We looked at a range of records including four care plans, two staff recruitment files, induction records, training and supervision, staff rotas and quality assurance surveys and audits.

The previous inspection was carried out in November 2016, when we found three breaches of the regulations.

Updated 4 August 2017

The inspection took place on 29 June 2017 and was unannounced.

The Gateway is a large detached property, providing residential care for up to 16 older people who may be living with dementia. The service is located within the town of Dover. The bedrooms are situated over the ground and first floors and are a mixture of single and shared rooms. The communal accommodation is situated on the ground floor and comprises of a large lounge with dining area and a small quiet area. There were 9 people living at the service at the time of the inspection.

There was a registered manager in post. 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 service was in a period of transition of ownership as the partnership, which owned and ran the service, was no longer valid. The long standing registered manager continued to run the service without support from the current provider, and there remained a lack of oversight and scrutiny of the service.

The registered manager had made some improvements to the service, however they lacked a full knowledge of the regulations to ensure the service was compliant with those regulations. Policies and procedures remained undated and were not all were reviewed in line with current legislation. There were systems in place to audit and check the service but these had not been effective as they had not identified the continued shortfalls found at this inspection.

Although people told us they felt safe living at the service, not all risks had been managed safely. The detail in the risk assessments had improved but there was not enough to ensure that staff had the guidance to move people safely and to support them with their behaviour.

Accidents and incidents had been recorded and action had been taken if people needed medical attention. However, the accidents had not been analysed to identify any patterns or trends to reduce the risk of further incidents.

There were environmental risk assessments in place which had identified areas of improvement, such as windows requiring repair and the garden not being safe to use, however no action had been taken to address the issues. The registered manager was ensuring that day to day repairs to the premises were being carried out; however there were no maintenance plans in place to improve the premises as a whole. People were not always offered choices of where to spend their time as the provider had not ensured the garden was safe for them to go outside and enjoy.

Checks had been carried out on the premises such as gas safety and the lift. There was a system in place to regulate the water temperature and temperatures were recorded to reduce the risks of scalding.

Effective systems were not in place to check the service was meeting the regulations.

The fire system had been checked on a regular basis and fire drills had been completed. However, not all staff attending these drills had been recorded to ensure that they all had a full understanding of what action to take in the event of a fire. The registered manager told us that they had checked the fire risk assessment dated 2016 and nothing had changed, however this was not assessed by a professional to ensure that the premises were safe. A recommendation has been made for the service to contact the local fire and rescue service for advice.

People told us they received their medicines at the times they needed them, however the systems in place to order and record medicines were not safe. There were no protocols for ‘as and when required’ medicines such as pain relief.

There had been no new staff recruited since the previous inspection however, checks on staff recruited at the previous inspection to verify they were safe to work at the service including police checks had been carried out.

The registered manager had identified the training shortfalls and some training, such as first aid, moving and handling, and mental capacity training had taken place since the previous inspection. However, further training was required to ensure that staff were up to date with current practice. Staff supervisions had lapsed and staff had not received their annual appraisal to discuss any further training and development needs of staff. A recommendation has been made in this report.

There were sufficient staff on duty to meet the needs of the people living at the service and the staff rota was consistently covered in times of staff absence. Staff sought consent from people when providing care and the assessments of people’s capacity to make decisions as required by the Mental Capacity Act (MCA) were in place.

Staff were responsive to people’s needs and care plans were personalised with people’s choices and preferences. Care plans had been reviewed each month to reflect people’s changing needs. There were limited activities available for people. People were supported to express their views and told us they did not have any complaints but would speak with the staff if they needed to.

Staff understood how to report safeguarding concerns but the safeguarding policy required updating to ensure that staff had the current guidance to refer to. Staff were aware of the whistle blowing policy and were confident the registered manager would take the required action.

People were supported to eat and drink enough and staff checked they had enough to drink to remain hydrated. People told us they were supported to maintain good health and encouraged to maintain their independence where possible.

People told us they were happy living at The Gateway. They told us they had lived at the service for many years and some of the staff had also worked there a long time so everyone knew each other well. They said the staff were caring, and positive relationships had been developed over the years.

We found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and one additional breach at this inspection. You can see what action we told the provider to take at the back of the full version of this report.