Archived: Three Gates

Updated 18 March 2021

The inspection

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

Inspection team

The team consisted of one inspector and an assistant inspector.

Service and service type

Three Gates 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.

The service did not have a manager registered with the Care Quality Commission. A service manager has been appointed and has commenced the registration process. This means the provider has sole legal responsibility for how the service is run and for the quality and safety of the care provided. The provider sent a senior manager at time of our inspection and we were assisted by them throughout the inspection.

Notice of inspection

We gave the service notice of the inspection just before we entered the home. This supported the service and us to manage any potential risks associated with COVID-19. The inspection site visits occurred on 3 & 16 February 2021. We visited the service to see and observe the people living there, speak with the manager and staff; and to review care records and policies and procedures.

What we did before the inspection

Before the inspection we spoke with local authority safeguarding, contracts and commissioning teams. We reviewed notifications of incidents we received and used all of this information to plan our inspection.

During the inspection

We spent time observing the care and support being provided to people in the home. We observed all four people who lived in the home and spoke with two support staff. We also spoke with the service manager, senior service manager. We looked at the care records for two people who lived in the service and records that related to how the service was managed including staffing rotas, recruitment, training and quality assurance.

After the inspection

We made calls to two advocates.

We asked the service manager to send us further documentation following the inspection which included copies of the training records, the staff rota and outcomes of questionnaires. These were supplied and considered when writing this report.

Updated 18 March 2021

About the service

Three Gates is a five-bed residential home providing personal care to four people at the time of the inspection. The care home supports people in an adapted building.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible life outcomes for themselves that include control, choice and independence.

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

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture. The new service manager and support staff promoted a positive culture in the service. People had experienced significant changes to their routines during the pandemic period and people could not pursue many of the activities and learning opportunities they usually enjoyed. Staff have been proactive in supporting people with alternative in-house activities which ensured people’s behaviour continued to be calm and settled. This helped promote people’s choices and independence even during the pandemic period when normal routines were disrupted. Improvements were required to ensure all aspects of people's care was safe and information was consistently available in care planning documents.

People did not always receive consistent safe care.

We completed this inspection over two days. Though the provider had made some progress from the point of the last inspection, there were limited infection control checks in place which resulted in a heightened potential for cross infection and cross contamination of infections. Infection control checks were not completed thoroughly to ensure risks to people were minimised. We brought the infection control issues to the attention of the provider where we had immediate concerns to people’s safety. We required the provider to complete an urgent action plan to demonstrate how they would mitigate risk. We then returned to the home to see if the provider had done what they had told us in the action plan We saw the provider had made a number of improvements. However, information in the range of documents within the care plan were not summarised consistently and left a potential to cause people harm.

There was little consistent evidence that any quality monitoring had been used to make improvements highlighted in the September 2020 inspection. The audit systems that were in place were not operated effectively or overseen by the provider to ensure people received a quality service.

Medicines were stored and administered safely.

Staffing levels were adequate to provide acceptable levels of care. People were unable to communicate verbally, their views of the service staff provided were sought on a day to day basis by staff reading the body language and vocal sounds people used.

People were safeguarded by staff trained to recognise potential abuses. Where errors had been made, staff were involved in discussions about incidents and included in any shared learning.

The new service manager understood their roles and responsibilities and had applied to be a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 9 September 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvement had been made, however, the provider was still in breach of some regulations.

Why we inspected

The inspection was prompted in part due to concerns received about infection control. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report. The provider has started to make changes to reduce risks, these will take some time to become fully embedded.

Enforcement

We have identified breaches in relation to the safety of people in the service and safety and monitoring of the environment they live in. Please see the action we have told the provider to take at the end of this report.

Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report. In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service.

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

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.