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Inspection carried out on 17 October 2019

During a routine inspection

About the service

The Gatehouse is registered to provide residential care for up to 31 older people. Thirty people were using the service when we inspected.

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

People received exceptionally caring support from staff who were kind, compassionate and thoughtful. There was an extremely strong person-centred culture within the service. Staff consistently recognised what was important to people and provided outstanding, caring support to help them meet their needs. People felt empowered to express their wishes and views knowing staff would respond with compassion and kindness. Staff consistently treated people with dignity and respect.

Staff were safely recruited and enough staff were deployed to meet people’s needs. People were supported by staff who understand their needs and how to safely support them. Care plans and risk assessments were regularly reviewed and updated to make sure staff had up-to-date information about people’s needs. People received safe support to take their prescribed medicines.

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. We made a recommendation about reviewing how people's mental capacity, consent to care and the need for DoLS were explored and recorded.

Staff provided effective care to meet people’s needs. They received an induction, regular training and had supervisions, appraisals and competency checks to support them to provide effective care. Staff felt supported by management and encouraged to learn and develop in the role. Staff worked closely with healthcare professionals to make sure people received effective care if they were unwell.

People praised the variety and quality of food provided. Drinks and snacks were readily available and staff provided effective care to monitor and make sure people ate and drank enough.

The environment was very warm, welcoming, clean and safely maintained. We spoke with the registered manager about regularly checking window opening restrictors were in safe working order and they acted to address this.

Staff understood people’s communication needs and used accessible information to help people be involved in decisions.

People were supported to take part in a wide range of activities and there were regular opportunities for meaningful stimulation. The provider was responsive to feedback and had systems in place to manage and respond to any complaints.

There was strong organisation and leadership within the service which promoted a person-centred culture and focussed on providing high-quality care to meet people’s needs and improve their quality of life. People told us management were approachable and supportive. Regular audits helped management monitor the quality and safety of the service and to identify where improvements could be made. There was a strong focus on continually learning and improving the service.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

At the last inspection service was rated good (report published 24 April 2017).

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.

Inspection carried out on 14 March 2017

During a routine inspection

At the last inspection, the service was rated as good, with one domain as outstanding. At this inspection we found the service had maintained their rating.

This inspection took place on 14 March 2017 and was unannounced, which meant the registered provider did not know we would be visiting the service.

The Gatehouse is registered to provide personal care and support for up to 31 older people. It is a large converted and extended, detached property, previously a private residence and is located in a residential area of Harrogate. The home is set in attractive grounds. A range of local amenities are a short walk away, including the Valley Gardens. The Gatehouse is approximately one mile from the town centre. All of the bedrooms are equipped with en-suite facilities. There is a passenger lift.

The home provides accommodation over three floors. There are bedrooms and bathrooms on the first and second floors, with a hairdressing area on the second floor. People have access to a communal dining room, lounge and various seating areas on the ground floor. There was also access to an enclosed garden area which people and their relatives enjoyed. At the time of our inspection there were 30 people living at the home.

There was a registered manager in post. 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.

There was an open welcoming atmosphere on entering the premises. All areas within the home had been designed for the needs of the people and planned works to some of the bathroom areas will enhance the facilities available. We observed that this was a safe home with a well-designed system enabling staff and visitors to move freely within the home.

The registered manager and registered provider were inspiring and committed to providing care, which met the highest of standards. They strived for excellence through consultation; they were passionate and dedicated to providing an excellent service for people. They led with a dynamic approach and continually reflected on how to improve the service further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The registered provider's vision and values were understood and shared across the staff team, and they were fully supportive of development plans. The culture of the service was open, transparent and progressive. All the staff were committed to continuous improvement of the service and individual care.

People's care plans were tailored for them as individuals with the involvement of their families at all stages. People were cared for by staff that knew them well and understood how to support them to maximise their potential. People's progress was monitored and any changes in their circumstances or health were promptly acted upon. Staff looked for opportunities to offer to people that would help them retain their independence.

People, staff, relatives and a healthcare professional gave us positive comments about the service and what it provided. Staffing levels were adequate to meet people’s needs. New staff were recruited in a safe way; all checks were in place before they started work and they received an induction. A programme of training was in place to make sure staff were competent in their work.

Activities were meaningful to people and designed around people's own interests. Staff ensured people received a nutritious, balanced diet. People who required it were supported to eat their meals. People told us they were given enough to eat and drink.

Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s right to make decisions. There was a system of audits, checks

Inspection carried out on 26 August 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 28 October 2014. Breaches of legal requirements were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook a focused inspection on 26 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Gatehouse on our website at www.cqc.org.uk

The Gatehouse is registered to provide personal care and support for up to 31 people older people in single, en suite accommodation. The home is set in attractive grounds close to Harrogate town centre.

At the inspection on 28 October 2014 we found breaches of regulations 20 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponded to regulations 17(2) (d) and 18(2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found improvements were needed to make sure that people’s care needs in relation to eating and drinking were recorded in a timely way and to ensure all staff received updated training.

There was an acting manager in post at the time. The acting manager confirmed that their application to be registered with the Care Quality Commission (CQC) was in progress. This was subsequently approved on 6 May 2015 and the manager is now registered. A registered manager is a person who has registered with the 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.

Following our inspection in October 2014 the manager wrote to us to confirm that they were actively addressing the issues we raised, working closely with staff to ensure more thoroughness when recording in people’s care records. Training providers had been identified and retained and staff training was in progress and ongoing.

At our focused inspection on the 26 August 2015, we found that legal requirements had been met. People were encouraged to participate in the assessment process, to ensure that their care needs and dietary preferences were known and acted upon. When special nutritional care needs were identified staff maintained appropriate records, to ensure that people received safe, consistent care.

There was an effective training and development strategy in place to ensure staff received appropriate training and support to enable them to carry out the duties they were employed to perform. A proactive management presence made sure that staff received on-going leadership and support on a daily basis to further promote good and consistent care.

Good professional relationships existed between staff and people who used the service. During our inspection we observed that staff spent time with people who needed assistance and were patient and kind. The senior manager undertaking an admission assessment was empathetic and used good communication skills to reassure the person and to promote their involvement and emotional wellbeing.

Inspection carried out on 28 October 2014

During a routine inspection

This inspection took place on 28 October 2014 and was unannounced.

We last inspected The Gatehouse on 29 October 2013. At that inspection we found the home was meeting all the essential standards that we assessed.

The Gatehouse is registered to provide personal care and support for up to 31 people older people. It is a large converted and extended detached property, previously a private residence and is located in a residential area of Harrogate. The home is set in attractive grounds a short walk to local amenities and the Valley Gardens approximately one mile from the town centre. All of the bedrooms are equipped with en-suite facilities. There is a passenger lift.

When we visited there was an acting manager in post. The acting manager confirmed that their application to be registered with the Care Quality Commission (CQC) was in progress. 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.

We found improvements were needed to make sure that people’s care needs in relation to eating and drinking were recorded in a timely way and to ensure all staff received updated training.

Although senior managers understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) increased staff awareness of the principles of the MCA would further enhance people’s care and support planning.

We found effective management systems were in place to promote people’s safety and welfare. The home had assessed potential and actual risks and had taken action to minimise these.

People told us they felt safe and trusted the staff team. They said there were always enough staff and rotas were flexible to support people’s preferred routines. Arrangements were in place to update the medicine systems and when we visited a new system was being implemented to ensure people continued to receive their medicines safely.

People spoke positively about the care they received. We saw verbal communication was very good between staff members making sure that people received safe, co-ordinated and effective care in practice.

People were cared for in a warm, comfortable and clean environment. Furnishings were of a high standard and people described the home as like a ‘five star hotel’.

People told us they were treated with compassion, kindness, dignity and respect. We heard of numerous examples of staff kindness during our visit. The nominated person came in for special mention for particular acts of kindness but people spoke positively about all the staff team and the care they received. We saw all staff displayed sensitivity towards people they supported and staff showed a kindness and warmth to people throughout our visit.

People followed a range of interest and pursuits and staff were encouraged to think creatively of new activities that might be of interest. There was much to stimulate interest and conversation, from chickens that had been hand reared to the dinner parties planned for the festive season. People could make choices about their meals and their preferences were incorporated into the daily menus. For people who had family living away social links could be maintained through the use of the internet.

People told us they received sensitive care and support when they were unwell. They had access to their doctors and other healthcare professionals to support their health. This was confirmed by speaking with people and from reviewing records.

People and their families were encouraged to discuss any issues they might have. People told us they were confident that any concerns they might raise would be dealt with appropriately.

The home’s management promoted an open culture to support people’s wellbeing. The nominated individual and the acting manager understood the home’s strengths and, where improvements were identified, they had put plans in place to achieve these. Future planned initiatives included a new communication tool to support person centred care planning and a programme to mentor care staff in thorough, best practice delivery of care. This showed us that managers encouraged a culture of continuous improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to some record keeping and staff training. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 29 October 2013

During a routine inspection

We spoke with people who lived at the Gatehouse, their relatives, a visiting GP, the management team and other staff members on the day of our inspection.

We found people looked well cared for and relatives told us they thought people were treated well and their experiences in the home were positive. We observed the care staff being kind and respectful to people. One visitor said �My relative has not been here very long,but I have only seen kindness and respect,towards the people who live here.�

We looked at people's care records and saw arrangements were in place to identify those people at a greater risk of poor nutrition and dehydration.

Medicines were prescribed and given to people appropriately; we saw people were given the right medicine, in the right way and at the right time on the day of our inspection.

Staff we spoke with told us they received training which helped them to deliver care and support safely.

The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service. This meant people who lived and staff who worked here were protected from potential risks to their well-being.

Inspection carried out on 24 October 2012

During a routine inspection

People who use the service told us that they knew what the service could offer them and said they consented to their care and support. We observed that staff respected people�s privacy and dignity. One person said �No one makes me do anything.� Another person said �It is your home. You can have what you want when you want. There are no rules and regulations.�

People told us they received the care and support they wanted to receive and could live the life they chose. People said �The staff are very good they are here when needed.� And �The staff listen to you and deal with my needs.� People�s needs were being met.

We were told by everyone we spoke with that they could raise any issues and felt these would be dealt with. People said they felt safe. One person said �If I were abused verbally I would say.� Another person said �I feel safe here.�

People said they were supported by staff in a timely way because there was enough staff on duty to look after them. One person said �Staff are available when I press my buzzer.� Another said �I am very sure the staff know what they are doing.�

The quality of the service was being monitored by the manager. Any issues found were acted upon to ensure people living at the home remained happy with the service they received. People said �On the whole I am happy here. This is the place to be. We get an excellent quality of service. They are wonderful from the bottom to the top.�

Inspection carried out on 13 March 2012

During an inspection looking at part of the service

We did not speak with people using the service at this inspection due to the nature of the compliance action we were reviewing. Instead we spoke with the manager and staff working at The Gatehouse.

Inspection carried out on 1 December 2011

During a routine inspection

People told us they were very happy at The Gatehouse. One person said "I like it here" and another commented "It's very nice". They also said their views and preferences are listened to and these are taken into consideration.

People said they were pleased with the care they were receiving. One person said "I've never been happier" and another told us they felt "looked after." They also said they felt safe and trusted the staff that work there.

People said they were happy with the staff and the care that they provided. One person said "The staff look after me very well." We also spoke with peoples relatives who were visiting and they gave positive feedback on the staff.

People told us they were happy with the service and knew how to raise issues, should they have any. They also said that the manager is prepared to see people at any time and operates an open door policy.

Reports under our old system of regulation (including those from before CQC was created)