Archived: Old Gates Care Home

Updated 20 January 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.

This inspection took place on 12 and 13 December 2016. The first day of the inspection was unannounced. We told the provider we would be returning on 13 December 2016 to continue to review the care people received in the service.

The inspection was prompted in part by information of concern we had received about the service; this information related to staffing levels, the lack of personal protective equipment (PPE) for staff to use and allegations of poor care; this inspection therefore included these areas of risk.

The inspection team consisted of two adult social care inspectors, a specialist advisor in the care of people with a dementia and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert had experience of residential and nursing care services.

Before the inspection we reviewed the information we held about the service including the last inspection report and notifications the provider had made to us. We also contacted the local safeguarding and quality assurance teams, the local clinical commissioning group and the local Healthwatch team to gather their views about the service.

During the inspection we spoke with seven people who used the service across all three units and 11 visitors. We also spoke with a total of 15 staff employed in the service. The staff we spoke with were the three unit managers, one registered nurse, six members of care staff including one who was employed by an agency, an activity organiser, a domestic, the chef, the maintenance person and the hotel services manager. In addition we spoke with the area trainer, a manager and clinical services manager from one of the provider’s other services who were supporting the service in the absence of the registered manager, as well as the area manager and the quality manager who were present throughout the inspection.

We carried out observations in the public areas of the service. We also undertook a Short Observation Framework for Inspection [SOFI] on the unit for people living with a dementia. A SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We looked at the care records for nine people who used the service and the records relating to the administration of medicines for a total of 25 people. In addition we looked at a range of records relating to how the service was managed; these included five staff personnel files, training records, quality assurance systems and policies and procedures.

Updated 20 January 2017

This was an unannounced inspection which took place on 12 and 13 December 2016. The service had previously been inspected in January 2016 when we found it to be in breach of one of the regulations we reviewed; this was because the management of medicines needed to be improved.

This inspection was prompted in part by anonymous information we had received which alleged people who used the service were receiving poor care, particularly those on the unit for people living with dementia.

Old Gates Care Home provides accommodation in three units, for up to 90 people who need either nursing or personal care and support. These units are Cherry, Holly and Rowan. Care and support for people living with a dementia is provided in Rowan. There were a total of 79 people using the service on the days of our inspection.

Although the service had a registered manager in place at the time of this inspection they were absent from work. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. We were told the registered manager would not be returning to the service as they had gained a different position within the organisation. A new manager had been recruited to the service and was due to start in January 2017.

During this inspection we found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. These related to staffing arrangements in the home, a lack of regular supervision for staff, recruitment processes which were not sufficiently robust, a lack of effective systems to ensure the safe handling of medicines and quality assurance processes which did not drive forward improvements in the service. You can see what action we have told the provider to take at the back of the full version of the report.

Staffing levels had recently increased on Rowan unit following a number of safeguarding alerts raised with the local authority. However we found there was no robust system in place to determine what staffing levels were required and the skill mix needed on each unit to meet the needs of people who used the service.

Although most staff told us they enjoyed working in the home and felt they received good support from senior staff, we found staff were not provided with regular supervision which was a forum to discuss their learning and development needs.

The recruitment process in the service needed to be improved. Additional checks had not always been undertaken when staff had worked previously with vulnerable adults or children to ascertain why their employment in that service had ended. Records did not show that gaps in applicant’s employment history had been explored.

A number of audits had been completed by the provider and internally within the home. These audits had shown that improvements needed to be made to the way the service was run in order to ensure people who used the service always received high quality care. Our findings during the inspection showed necessary actions had not always been completed in a timely manner.

Improvements needed to be made to the way medicines were handled in the service. However, we did not find any evidence that people had not received their medicines as prescribed.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. Staff were able to tell us of the correct action to take should they witness or suspect abuse.

People who used the service told us they felt safe in Old Gates and that staff were always kind and caring. The staff we spoke with had a good understanding of the care and support that people required. They told us, wherever possible, they would support people to maintain their independence.

Care records showed that risks to people's health and well-being had been identified, such as the risk of falls, pressure sores and poor nutrition. Where necessary we saw that people had charts in their rooms to confirm they had received the care they required to reduce the risk of pressure ulcers and poor nutrition. We saw that on Rowan unit these charts had not always been fully completed by care staff or signed by a senior member of staff; this meant we could not be certain people had always received the care they needed.

People were cared for in a safe and clean environment. Procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the premises and the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

Staff received the induction and training they required to be able to deliver effective care. We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. Where necessary applications had been made to the local authority to authorise any restrictions necessary to ensure people received the care they required.

Systems were in place to help ensure people’s health and nutritional needs were met, although one person’s relatives were concerned that a number of health appointments had been missed due to a lack of communication by staff. Records we reviewed showed referrals had been made to specialist services such as dieticians when any concerns were identified. People who used the service told us the quality of the food was good.

Although care records had been regularly reviewed and updated, there was limited evidence that people who used the service or, where appropriate their relatives, had been involved in formal review meetings. However, none of the relatives we spoke with had any major concerns about the care and treatment their family member received.

We saw that concerns had been raised in a number of different forums regarding the lack of meaningful and individualised activities in the service, particularly on Rowan unit. During the inspection we observed a number of activities taking place on Holly and Cherry units. However staff on Rowan were mainly focused on task related interventions with limited 1-1 attention given to people outside of these.

Systems were in place for receiving, investigating and responding to complaints. The provider kept a central record of all complaints in order that any themes and trends could be identified. The two most recent complaints in the service related to staffing levels and communication within the service. All the people we spoke with during the inspection told us they would be confident that any concerns they reported would be listened to and action taken by senior staff to resolve the matter.