St Mary's Gate Euxton

St Mary's Gate is located in a residential area of Euxton near Chorley. The home is within easy reach of the town centre and transport links can be accessed without restrictions. The home has living accommodation, a large dining area, a domestic kitchen and utility room used as a laundry. The home has four suitably adapted bedrooms and a bathroom. The home is a bungalow so access is only required to the ground floor level.

There was a registered manager for the home. 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.

At the last inspection on 22 December 2016, we found that the provider needed to take action to ensure the people in the home were protected in the event of a fire, and that the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection in March 2018 we found that following a visit from the Lancashire Fire and Rescue Service and discussions with the housing landlord, improvements to the fire safety system had been made, and the service was no longer in breach of the regulation.

At the last inspection on 22 December 2016, we found that the provider needed to take action to ensure the people in the home were protected at night as there was only one member of staff on duty. Immediately after the inspection, the night time staffing arrangements increased. This ensured people were now better supported as some of the care they received requires two members of staff.

People who used the service received an excellent personalised service that met their individual needs and preferences. People were at the centre of how their service was run and were fully involved in the planning and developing of the service. Staff used innovative ideas and actions to improve people's quality of life and to give them outstanding opportunities in daily life. People were supported with meaningful activities which supported their well-being and encouraged them to access the local community.

The provider had effective systems in place to ensure there was always the correct amount of staff with the appropriate skills and training needed to provide safe care for people. There was a structured induction program to ensure staff developed the skills needed to work for the provider and on-going training was in place that ensured staffs skills remained up to date. Staff were provided with support from their line manager to ensure they were working in line with best practice. Recruitment processes ensured staff were safe to work with people at the home.

Risks to people were managed and care was planned to keep people safe. The registered manager had submitted appropriate applications under the Deprivation of Liberty Safeguards (DoLS) to ensure people's human rights were protected. People's abilities to make choices were respected and where needed decisions were made in people's best interests. Risks to people were identified and appropriate action taken to keep people safe.

People's medicines were available to them when needed and stored safely. Appropriate support was provided, and advice taken to ensure that people's nutritional and hydration needs were met.

Staff were kind, caring and knew how to personalise care to meet people's individual needs. They respected people's privacy and dignity and people's achievements were celebrated. Staff understood people's communication needs and supported them to make their views known. People's personal environment had been decorated to reflect them as an individual and the care they needed.

Staff ensured that people's needs were assessed and care plans reflected their individual needs and were updated when people's needs changed. People and their relatives had been involved in planning their care.

Relatives were able to raise concerns and the provider took action to improve the care they received. People's views (where possible) about the quality of care they received were gathered and used to drive improvements in care. Additionally people were involved in the running of the home and their views were taken into account when recruiting staff or making changes.

The provider had effective systems in place to monitor the quality of care people received and took action when any concerns were identified. Staff felt supported and were encouraged to develop.

St Mary’s Gate is a residential care home supporting four ladies living with complex needs. St Mary’s Gate is located in a residential area of Euxton near Chorley. The home is within easy reach of the town centre and transport links can be accessed without restrictions. The home has living accommodation, a large dining area, a domestic kitchen and utility room used as a laundry. The home has four suitably adapted bedrooms and a bathroom. The home is a bungalow so access is only required to the ground floor level.

The home was last inspected in January 2014 under the Care Quality Commission’s old methodology. This is the first comprehensive inspection looking at all 16 regulations. The home met the standards of the five regulations inspected in 2014.

At this inspection we found staff approached their job with enthusiasm and optimism. People they supported were treated with kindness and respect. Staff were mostly of a similar age to the current ladies who lived in the home, which allowed for a mutual sharing of age related culture, fashion and interests.

We found the home managed people’s medicines safely and undertook risk assessments to ensure people were safe day to day and whilst they undertook the varied activities people were involved with. However, we found that more action was needed to ensure people and staff were safe in the event of an emergency. This included better systems to manage the safe evacuation of the building.

The home assessed people’s needs and any associated risks and managed these safely. However we found that assessments and decisions required under the Mental Capacity Act (2005) were not consistently completed.

We had some concerns around the staffing compliment at the home. This was specifically when people were left with just one carer. We did not think the risks of this had been appropriately assessed. Risks included people potentially having to wait to receive care and support which required two staff, risks in the event of an emergency and also risks associated to a situation happening through the night. Incidents could occur through the night which would result in more than one staff member being required. This could include someone form the home having to attend hospital or someone could need additional support. We have recommended the provider completes a thorough risk assessment on the current staffing deployment and ensures these risks are managed appropriately.

Staff were recruited safely to their role and peoples’ circumstances were considered when making appointments. The provider took steps to ensure staff were suitable for the role including sourcing appropriate references and checking potential staff criminal histories. However, we have recommended the provider develops procedures to assess the ongoing suitability of staff. This will help ensure people are always kept safe and supported by suitable staff.

Information was available for staff on how to support people in the home. We found for one person this information was easily accessible and included all assessments and plans to support the individual in one place. For others information was in different places. We acknowledged this was due to the recent implementation of an electronic support planning system; however we have recommended the provider spends some time to ensure the support plans include all the required information about the person to be supported. This would ensure all staff have easy access to the information they need to support people.

People who lived in St Mary’s Gate were supported to engage with all aspects of managing their day to day lives, including accompanying staff when completing domestic chores, to shopping for groceries and completing banking tasks. People were also supported to engage with a varied social and leisure calendar. This included usual weekly social events and numerous fun activities including skiing and horse riding.

Staff were caring and respectful. Steps were taken to ensure people’s privacy and dignity were maintained at all times. At the time of our inspection the ladies were clean and well presented.

The home and its staff took extra steps and went that extra mile to support people in the home. We found when people had been assessed, as no longer able to participate in daily activities, such as eating and experiencing food, the home worked towards supporting people to participate in these activities. An improved quality of life was high on the home’s agenda and with increased support people began to experience food where previously it was thought they could not. One person at the home had been supported to eat and experience certain food textures and tastes and another was about to be assessed to determine if they could begin to taste certain foods.

We also found the home took inclusive steps when engaging in social and leisure activities for the ladies who lived in the home. Certain activities that may be deemed inaccessible to people using wheelchairs were sourced to include people from the home who did use wheelchairs. This included skiing, trampolining and the erection of a garden swing at the home for people to use in their wheelchairs.

The home had very few complaints, but complaints that had been made were managed well and steps were taken to ensure the same issues did not arise. This included a quick response from the provider to the complainant and agreed actions taken. Information was then shared with the staff team to reduce risks going forward.

Family members we spoke with had nothing but praise for the home and its staff. We were told the home had been beneficial to the ladies it supported. We were told how the staff undertook their role with confidence and took time to get to know people they supported. People’s likes and dislikes were acknowledged and accounted for, including time taken to plan and prepare holidays for people and with people that were special to them.

The provider, manager and staff monitored the service it delivered and took account of the findings. The home’s model was one of service improvement, in order to drive up quality. Quality boards were developed and workshops to drive up quality were undertaken with people who lived in the home, family members and staff. Key areas of importance were discussed including, “We focus support around the individual.” And “Support focuses on people being happy and having a good quality of life”. We saw from the notes of one of the events that people commented on these themes and improvements were suggested and agreed.

We found the home had a calm and pleasant atmosphere and provided a positive environment to support the ladies who lived there.

You can see what action we told the provider to take at the back of the full version of the report.

We heard staff constantly offering choices to residents such as what to eat and where to sit. We noted staff approached residents in a kind and respectful way and residents responded positively.

The environment was very homely and comfortable. Some residents allowed us to have a look in their bedrooms and we saw these were very nicely decorated and personalised with pictures, posters and other such personal possessions.

During this inspection we assessed standards relating to people's care, welfare and medication management. We also looked at arrangements for staff training and processes used by the provider for monitoring quality within the service. We found evidence that the home was compliant in all the areas we inspected.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. Staff were observed to be patient, calm and treated people with dignity at all times. One relative described the service as follows, "_____ is very happy, everyone is treated with respect. Staff are very good, if a little loopy at times, which is great"! Another said, "Nothing gets unchecked or unresolved. We looked at a lot of places, this is by far the best from our point of view, it is fantastic".

From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop. At all times during our visit staff were seen to be treating people with dignity and in a person centred way that ensured users of the service were happy with the care and support received.