Archived: The GateHouse Residential Care Home

The Gatehouse Residential Care Home is a residential care home providing personal care to 25 people aged 65 and over who may also be living with dementia at the time of the inspection. The service can support up to 28 people.

People’s experience of using this service and what we found

People felt safe living at The Gatehouse Residential Care Home and they were very much at the heart of the service. We received positive feedback from people and their relatives about the care provided.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

Staff working at the service understood people’s needs and supported people in a personalised way. Care was provided respectfully and sensitively, considering people’s different needs.

Staff received frequent support and one to one sessions or supervision to discuss areas of development. They completed training and felt it supported them in their job role.

People were supported with their nutritional needs when required. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes

Staff had developed positive and caring relationships with people and their families. Staff were highly motivated and demonstrated a commitment to providing the best quality care to people in a compassionate way. People’s privacy and dignity was always maintained.

Regular audits of the service were carried out to assess and monitor the quality of the service. There were appropriate management arrangements in place and relatives were very positive about the management in the home.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was requires improvement (published 20 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection was unannounced and was carried out on 7 and 10 August 2018 by one inspector.

The Gatehouse 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.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The management of people’s medicines required improvement. The storage of some medicines was confusing and some people’s medicines were unaccounted for. We could not be assured that people received their medicines as prescribed.

People’s rights were protected because staff understood the principles of the Mental Capacity Act (MCA) 2005 and consent, although annual reviews of MCA assessments were a little confusing. Deprivation of liberty safeguards had been submitted to the local authority for authorisation when required.

Recruitment procedures were safe and ensured only suitable staff were employed to work at the home. There were sufficient staff deployed to meet people’s needs and keep them safe.

People were protected from abuse. Staff understood how to identify and report abuse if they suspected abuse was taking place.

Staff received training, supervision and appraisal to support them in their roles and to provide them with the required skills, knowledge and competencies.

Risks associated with people’s health, safety and welfare had been identified and assessed, and guidance was in place to help staff to reduce those risks.

Staff followed infection prevention and control procedures which minimised risks of cross infection. Effective cleaning routines ensured the home was clean and tidy.

Emergency evacuation procedures were in place and staff understood what to do in the event of an emergency. Health and safety checks, including fire safety were carried out regularly.

People had access to health care services when required and were supported by staff to maintain their health and wellbeing. People were offered a choice of food and drink that met their preferences and dietary needs.

Staff were kind and caring and treated people with dignity and respect. People were encouraged to maintain important relationships with family and friends who could visit at any time.

Staff empowered people to make choices and maintain their independence. People took part in a wide range of activities in line with their interests.

People and their relatives were involved in planning their care. Care plans provided clear guidance for staff in how people wanted to receive their care.

The provider met the Accessible Information Standards. Staff used a range of communication and provided information to people in a way they could understand, such as signs and gestures which helped them to make informed choices.

Systems were in place to monitor and assess the quality and safety of the service. People and relatives were offered opportunities to feedback their views about their care and this was used to improve the service.

Complaints procedures were available and displayed throughout the home in picture format. People knew who to speak to if they wanted to complain, although the home had not received any complaints.

There was a positive, supportive and open culture within the home. Staff felt supported by the registered manager who was approachable and involved them in the development of the service.

The registered manager understood their responsibilities under the Health and Social Care Act 2008, including submitting notifications of events as required to the Commission.

We last inspected the service in May 2016 when we found no concerns and rated the service as good. At this inspection we found one breach of regulations.

The Gatehouse Residential Home is a care home for older people, some of whom are living with dementia. The home is registered to provide accommodation for up to 21 people. At the time of this inspection there were 20 people living there. The home is set in well maintained gardens and consists of a main house with a large conservatory and separate lounge and dining room.

The service had 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.

People living at the home, their visitors and health care professionals were complimentary about the quality of care and the management of the home. The manager promoted a culture of openness and there was a clear management structure, with systems to monitor the quality of care and deliver improvements. Staff told us the morale at the home was good and they felt supported.

People were protected from possible harm. Staff were able to identify different types of abuse and what signs to look for. They were knowledgeable about the home’s safeguarding processes and procedures and who to contact if they had any concerns and this information was also on display for people and relatives if they needed it. Staff told us they felt they would be taken seriously and concerns would be acted upon.

People told us they felt safe and staff treated them with respect and dignity. People’s safety was promoted through individualised risk assessments and effective management of the premises. There were systems in place to manage, record and administer medicines safely. Staff had good knowledge of medicines and their competency was checked regularly to ensure they remained aware of their responsibilities in relation to medicines.

The provider operated safe recruitment processes. There were sufficient staff deployed to provide care and staff were supported in their roles with training, supervision and appraisals. Staff understood their responsibility to provide care in the way people wished and worked well as a team. They were encouraged to maintain and develop their skills through relevant training.

There was a strong commitment to provide personalised care, in line with people’s needs and preferences, and to create a homely, welcoming environment. Staff interacted positively with people and were caring and kind. They were reassuring to people when required and supported them at a pace that suited them without rushing.

People’s health needs were looked after, and medical advice and treatment was sought promptly. A range of health professionals were involved in people’s care including GPs, community nurses, dentists and chiropodists. Some minor issues identified in people’s care records were dealt with immediately.

Staff encouraged people to maintain their independence and provided opportunities for people to socialise. Staff supported people to make decisions and to have as much control over their lives as possible. The staff had good natured encounters with people, seemed to know them well, and had time to sit and chat with them. There was a range of activities on offer throughout the week. Most activities took place within the home, such as singing, entertainers and quiz games.

People were given choices and offered a varied diet, prepared in a way that met their specific needs. Important information, such as their likes and dislikes and allergens in food, was available to people and staff. People were given support and encouragement by staff if they needed help to eat.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood this legislation and had submitted DoLS applications for people living at the home where required. Staff were aware of their responsibilities under this legislation and under the Mental Capacity Act (2005).

We last inspected the home in September 2013 when we found no concerns.

We found that accurate and up to date records were now in place. Records were also stored appropriately to maintain people's confidentiality.

People's needs had been assessed and care plans developed to instruct staff on how to meet these needs. People were being well-cared for at the home.

The home had appropriate storage facilities for storing medication in the home. Medicines were being administered safely.

Staff were supported by management through training and supervision.

Records were stored confidentially however some records we looked at were not accurate or there were some gaps in recording.

We spoke with four people living at the home, two relatives who were visiting the home and two members of staff. We also spoke with an Environmental Health Officer who was inspecting food safety at the home that day.

Everyone we spoke with was very happy with the service being provided and no one had any complaints or adverse things to say about the home, the staff or the management.

People living at the home told us that their privacy was respected and that they could exercise choice in their lives. We evidenced this through observations and through seeing examples of this within people's personal files. People told us they were well cared for.

Generally, there was good practice concerning medication management, although we found the home's storage facilities for controlled drugs did not meet current legislation.

Staff we spoke to told us that they were appropriately trained and supervised and they demonstrated good knowledge of safeguarding procedures for vulnerable adults.

Overall, we found the home was well managed and there were systems in place to monitor the quality of service being provided.