Archived: The Gateway Residential Home

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The service was in a period of transition of ownership as the partnership, which owned and ran the service, was no longer valid.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.

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 15 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 provider had notified the Care Quality Commission (CQC) that they were no longer trading as a partnership; however, they had failed to process the change of the partnership to a single provider to ensure the service was registered correctly. This meant that the service was not legally registered. The provider did not have oversight or scrutiny of the service.

The registered manager had an understanding of the day to day running of the service and knew people well, however, they lacked knowledge of the regulations to ensure the service was compliant. Policies and procedures were undated and not 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 shortfalls found at this inspection.

Although people told us they felt safe living at the service, people were not fully protected from harm. Risks were not always managed safely. Risk assessments to show staff how to support people safely were not detailed, there was limited information on how to reduce the risks. Some risks had not been identified, there was no guidance for staff to use some equipment to support people with their mobility.

Accidents and incidents had been recorded but lacked detail of the incidents. They had not been analysed to identify what action could be taken to reduce the risk of further incidents.

There were environmental risk assessments which had identified areas of improvement, such as windows requiring repair and the garden not safe to use. However there were no maintenance plans in place to complete the work required.

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, but there were no records to show that the temperature of the water had been checked in people’s bedrooms to reduce the risks of scalding.

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.

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. The medicine audits carried out by the registered manager had not identified these shortfalls.

Staff were not always recruited safely. References had been obtained to check prospective staff’s conduct in previous employment, but these had not been verified.

Staff told us that they received appropriate training for their roles. However, we were unable to confirm that staff training was up to date as training records did not indicate when the training had taken place and when updates were required. Staff received supervisions and appraisals but these had not always identified the development needs of staff.

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.

Although staff sought consent from people when providing care, the assessments of people’s capacity to make decisions as required by the Mental Capacity Act (MCA) were not detailed or decision specific.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. Staff did not have a clear understanding regarding DoLS as there were people living in the service whose capacity had not been assessed, who needed constant supervision and were unable to leave the service. No DoLs applications had been made in these cases.

Staff were responsive to people’s needs but care plans were not always detailed or person centred. Care plans did not contain details of people’s choices and preferences. Care plans had been reviewed but changes to people’s care needs had not been recorded.

There were limited activities available for people. People were supported to express their views and raise concerns or complaints which were acted on and resolved to their satisfaction. People’s privacy and dignity was not always maintained, staff spoke to people loudly while in the lounge which was not necessary.

Staff understood how to report safeguarding concerns but the service’s 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. The registered manager had not consistently notified the Care Quality Commission of events within the service as required.

People were supported to eat and drink enough to maintain good health. Staff responded quickly to people becoming unwell. People were supported to access health care appointments and staff monitored their weight and general health, involving relevant health professionals as required. People were supported to maintain good health and their independence where possible.

Staff knew people well and knew their likes and dislikes. People and relatives told us the staff were kind and caring.

There were positive and caring relationships between people and staff.

We spoke with the registered manager and one member of staff. We also spoke with five people who used the service, staff and two relatives.

One inspector carried out the inspection.

We considered our inspection findings to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found. This summary is based on our findings during the inspection, discussions with people/representatives using the service, staff supporting people, the management team and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was safe. The systems in place to audit the safety of the service were effective to make sure people were receiving the care they needed in the safest way.

Safety checks had been done to make sure systems like the gas and electricity were safe to use. Fire safety checks and fire risk assessments had been completed.

There were processes in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.

Is the service effective?

The service was effective. The provider had a system that was used to regularly assess and monitor the quality of the service provided. People, their relatives, staff and visiting professional were sent surveys to ask for their views about the service. If any shortfalls were identified they were addressed by the registered manager.

Is the service caring?

The service was caring. Peoples care plans and risk assessments were checked regularly were up to date and contained the information that staff needed to give people the care and support that they needed.

Is the service responsive?

People and their relatives knew how to make a complaint if they were unhappy. If they had concerns they would speak to the registered manager or the provider. They were confident that their complaint would be taken seriously and acted on.

Is the service well-led?

There was an effective system to regularly assess and monitor the quality of the service to protect people's health, safety and welfare.

People said that they were happy with the care they received and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care.

Many comments received were complimentary of the service. One person said 'No concerns or worries this is the best place for me'. Another person said 'Staff are brilliant. If you need help staff are there for you'. Other people were complimentary of the food and had no concerns about the quality of care.

People were provided with a choice of suitable and nutritious food and drink.

People were cared for in a clean, hygienic environment. However, the lack of risk assessment potentially put people at risk.

Regular health and safety checks had not taken place. Fire safety checks had also not been carried out. Therefore, due to our concerns with regard to fire safety we have made a referral to Kent Fire Brigade to use their powers under the Fire Regulatory Reform Act 2005.

People who used the service, their representatives and staff were not asked regularly for their views about their care and treatment. The quality assurance system was limited and failed to identify shortfalls.

We met and spoke with some of the people who were at home and everyone we spoke with expressed that they were happy living at The Gateway. We observed interactions between the people and the staff and people's reactions to the staff. We observed to see how people were.

People told us that they felt safe, happy, and well looked after. One person said, 'On the whole, I feel very happy here, no complaints'. The relatives we spoke with were very happy with the care provided. One relative commented, 'It is a shame they don't do a little bit more activity'.

Staff engaged with people in a warm and positive way and supported people where needed. We were told that the staff 'Will do anything for you and I know them well'.

Staff commented, 'The residents are safe and very well cared for'.