The DurhamGate Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

​Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. ​

This is the first inspection of this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Any incidents about people's safety were discussed with staff in a timely way, with action taken to mitigate further risks. A staff member commented, “We discuss incidents and lessons learned at staff meetings.”

Staff at the service worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. Staff made sure there was always continuity of care, including when people moved between different services. A relative commented, “Staff took all the information when [Name] came, we looked around before they came in. We asked lots of questions and there was a transition meeting with the previous home.” Detailed information was collected before people started to use the service, and passports were available with information to take when attending hospital or other health appointments. A person commented, “My admission was all very good, I was welcomed.”

Staff at the service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.A staff member told us, “We are always encouraged to report any concerns especially safeguarding’s.” People and relatives told us they felt safe, they would speak with staff if they were worried, and they always felt listened to. A person commented, “I feel safe, staff pop in during the night to check on me.” Deprivation of Liberty Safeguards (DoLS) authorisations were sought when needed and any conditions imposed by them were followed.

Staff always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.Risks were assessed to ensure people were safe and staff took action to mitigate any identified risks. A relative commented, “There are always 2 staff when [Name] is hoisted from their wheelchair or chair.” Risks were identified and transferred to care plans, including for the management of distress and agitation to mitigate risks and help to keep people safe. Staff supported people safely and appropriate equipment was available if people needed assistance.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care. Equipment was regularly serviced to maintain safety. The environment was very well-designed to meet peoples’ needs in a comfortable and luxurious way. A relative commented, “The environment is high quality and it is amazing everyone has their own wet room.”

Improvements were needed to staffing levels and staff deployment across the home to ensure people received safe and timely care. Observations at inspection and people and relatives’ comments showed improvements were needed. People told us they felt safe with staff support, however we received mixed feedback about staffing levels. Some people thought there were sufficient staff other people and relatives’ comments included, “More staffing would make all the difference”, “Staff are caring, but they don’t have a lot of time” and “Staff looked rushed, they never ask if you want anything.” We discussed this with the registered manager who said more staff were being recruited and they would look at staff deployment.

Staff were skilled and experience and they received effective support, supervision and development. Staff members confirmed they received opportunities for training and development. A staff member commented, “There is plenty of training, online and we get practical training” and “Training is good it gives us the knowledge that is needed.” Staff were recruited safely.

Staff assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. They confirmed they had received infection control training. There was a very good standard of hygiene. A person commented, “Staff clean my room very well, they come in every day. They change the bedding and take the wastepaper, they clean the bathroom every day and change the towels.” A relative told us, “The cleanliness is fabulous.”

Whilst people, relatives and staff raised no concerns about medicines management. We identified some improvements were needed to medicine management to ensure medicines and treatments met people’s needs, capacities and preferences.

Records did not always evidence that an effective system was in place to ensure medicines were safely managed and administered.

Medicine records were not always clear. Records of regular medicines followed national guidance including recording people’s allergies. However, managers had identified that stock did not balance with records and stock adjustments had been made on the electronic medicine record for several peoples’ medicines.

Some people were prescribed medicines to be taken on a ‘when required’ basis or with a variable dose. Guidance for how these medicines should be administered need to have more person-centred information and include information on variable dose directions and linked if more than one medicine for a condition.

Records were not in place for all creams applied by care staff as part of personal care. Patch application records were available but not fully completed to demonstrate rotation in line with manufacturers guidance to prevent side effects.Care plans for medicines needed further updating when changes occurred and to make them more person centred.

Medicines were stored securely and safely. Staff who administered medicines had the appropriate training and competency checks.Management completed audits, these had identified some of the issues we found at inspection. Following our inspection the registered manager sent a detailed action plan to show how the issues had been addressed.