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Gateway Care Services Requires improvement

This service was previously registered at a different address - see old profile

We are carrying out a review of quality at Gateway Care Services. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 9 January 2019

During a routine inspection

This inspection took place on 9 and 11 January and 15 February 2019. We gave the provider two days’ notice of the inspection as we needed to make sure the registered manager and or staff would be available at the location. This inspection was partly prompted by safeguarding concerns which had impact on people using the service and this indicated potential concerns about the management of risk in the service. While we did not look at the circumstances of specific incidents, we did look at associated risks. At the time of our inspection there were 40 people using the service, however only 38 people were receiving the regulated activity; personal care.

Gateway Care Services is a domiciliary care agency. It provides personal care and support to people in their own homes. Not everyone using the service may receive the regulated activity; personal care. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of our inspection the service did not have a registered manager in post. 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 this inspection we found breaches of legal requirements because risks to people's health and well-being were not always managed safely and the provider did not have comprehensive robust systems in place to monitor the quality and safety of the service provided to people. You can see the action we have told the provider to take at the back of the full version of the report.

We have also made a recommendation to the provider about the correct completion of mental capacity assessments in line with the codes of practice and principles of the Mental Capacity Act 2005.

Assessments were conducted to identify, assess and manage risks to people’s health and well-being. However, assessments were not always detailed or provided guidance for staff on how to support people to manage identified risks and this required improvement. There were no systems in place to check when a call was recorded as being missed or late, that staff had attended the call and people had received the support they needed. Medicines were not always managed safely. Staff reported accidents and incidents when they occurred, and these were recorded on the provider’s electronic care planning and monitoring system. However, there was no system of oversight regarding accidents and incidents when they occurred. This meant that trends were not identified so that appropriate action could be taken to reduce the reoccurrence of risk.

Care staff were aware to seek consent from people when offering them support and demonstrated a good understanding of the Mental Capacity Act 2005. However mental capacity assessments were not completed in line with the codes of practice and principles of the Mental Capacity Act 2005. Although the provider did offer new staff the opportunity to shadow more experienced staff members before starting to work with people, they had not yet introduced best practice induction training, in line with the Care Certificate and this required some improvement. Some people were living with diabetes, Parkinson’s or a learning disability and staff had not received training in these areas and this required some improvement.

Although complaints received were recorded and responded to, there were no documented outcomes or learning going forward regarding complaints and this required improvement. Care plans were not always reflective of individuals physical, mental, emotional or diverse needs in line with the protected characteristics of the Equality Act 2010.

There were policies and p

Inspection carried out on 10 May 2018

During a routine inspection

This announced inspection took place on 10 and 14 May 2017. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. At the time of the inspection 56 people were using the service.

At our last comprehensive inspection on 28 February and 1 March 2017 we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not always managed staff rostering and call monitoring effectively. At this inspection we found that the provider had made some improvements. However, the systems for monitoring and improving the quality and safety of the services provided to people required further improvement to ensure these were effective.

The service had a registered manager in post. 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.

People told us they felt safe with the staff. The service had clear procedures to recognise and respond to abuse. All staff had completed safeguarding training. Risk assessments for people were in place, which provided sufficient guidance for staff to minimise identified risks. The service had a system to manage accidents and incidents to reduce recurrences. People were protected from the risk of infection.

The service had enough staff to support people and satisfactory background checks were carried out for staff before they started working. The service had an on-call system to make sure staff had support outside office working hours. Staff supported people so to take their medicines safely. The service provided an induction and training, and supported staff through regular supervision, appraisal and spot checks to help them undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People consented to their care before it was delivered. The provider and staff understood their responsibilities within the Mental Capacity Act 2005.

Staff supported people with food preparation. People’s relatives coordinated healthcare appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

Staff supported people in a way which was caring, respectful, and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date.

The service had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. The service sought the views of people who used the services. Staff felt supported by the provider. The provider worked in partnership with health and social care professionals.

Inspection carried out on 28 February 2017

During a routine inspection

This announced inspection took place on 28 February and 01 March 2017. Gateway Care Services is a domiciliary care service providing personal care to people living in their homes. At the time of the inspection 46 people were using the service.

We had carried out an announced comprehensive inspection of this service on 05 and 06 October 2016, at which breaches of legal requirements were found. This was because medicines were not safely managed and risks to people had not always been adequately assessed. These issues placed people at risk of unsafe care. We also found that the provider did not have effective systems in place to monitor and improve the quality of the service. The provider had failed to submit notifications to Care Quality Commission (CQC) as required by the regulations.

After the comprehensive inspection, we took enforcement action and served a warning notice and requirement notices on the provider and registered manager requiring them to comply with the regulations. We also asked the provider for an action plan to address the less significant breaches found.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Gateway Care Services' on our website at www.cqc.org.uk.

At this inspection we found that the provider had taken appropriate actions to ensure compliance with the regulations. Medicines were safely managed and people's records contained full medicines lists and appropriate guidance on how to support people. Risks to people had been adequately assessed and reviewed, with appropriate risk management plans in place to mitigate future risks. The provider had made appropriate notifications to the CQC since the last inspection, and the registered manager understood when notifications should be made.

We noted the service had made improvements in the systems used by the provider to assess and monitor the quality of the care people received. This included unannounced spot checks at people’s homes and audits covering areas such as accidents and incidents, care plans, risk assessments, management of medicines, and staff training. The service sought the views of people who used the services.

However, we found the system for monitoring visits to people to ensure they received visits at the correct times was not robust. The scheduling of staff to visit people’s homes was not well managed and feedback from people following a survey carried out in December 2016, the provider had analysed the findings but had not taken action to resolve the identified concerns.

These issues were a continuous breach of Regulation 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

You can see the action we have asked the provider to take in respect of the above breach of regulations at the back of the full version of this report.

The deployment of staff to meet people needs required improvement. Staff rostering records showed that the provider had not always allowed enough time for staff to travel between calls. The service had an on call system to make sure staff had support outside the office working hours. However, a relative told us the weekend out of office service was not robust.

The service had a registered manager in post. 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.

People and their relatives told us they felt safe with the staff. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. The service had a system to manage accidents and incidents to reduce reoccurrence.

The service provided induction and training, and supported staff through regular supervision and annual appraisals to help th

Inspection carried out on 5 October 2016

During a routine inspection

This announced inspection took place on 05 and 06 October 2016. Gateway Care Services is a domiciliary care service providing support to people living in their homes. At the time of our inspection 48 people were using the service.

At our inspection on 24 and 25 September 2015, we found the arrangements for the safe management of medicines for people using the service were not robust. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The provider sent us an action plan telling us how they would address these issues and when they would complete the action needed to remedy the concerns.

At this inspection we checked to see if these actions had been completed. We found that staff had received appropriate medicines training; however staff had not been assessed to ensure their competence to administer medicines. There was no medicine plan or list of prescribed medicines in people’s care plan’s relating to the period covered by the MAR charts. The service had not carried out assessments of people who were self-medicating in line with the provider’s medication policy, to ensure that medicines were safely managed.

The provider had identified potential risks to people but had not put in place risk management plans to mitigate the risk for people using the service.

These issues were a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

We took enforcement action following this inspection and served a warning notice on the provider in respect of the most serious breach requiring them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also asked the provider for an action plan to address the less significant breaches found.

You can see what action we took at the back of the full version of this report.

The provider had not notified the Care Quality Commission (CQC) of safeguarding allegations as required.

This was a breach of Regulation 18 of the Registration Regulations 2009.

The service did not have an effective system in place to regularly assess and monitor the quality of services people received or the improvements required.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

The service had not carried out satisfactory background checks for all staff before they started working, and this required improvement.

There were sufficient numbers of staff to meet the needs of people.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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.

People and their relatives felt safe using the service. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. The service had a system to manage accidents and incidents to reduce reoccurrence.

Staff were supported through regular supervision, annual appraisal and training programmes.

People’s consent was sought before care was provided. Where the provider considered people did not have capacity they had followed best interest decision making processes.

Staff supported people to eat and drink sufficient amounts to meet their needs. People’s relatives coordinated health care appointments and health care needs, and staff were available to support people to access health care appointments if needed.

Staff supported people in a way which was caring, respectful, and protected their privacy, dignity, and human rights.

The provider had carried out, collaboratively with the relevant person, an assessment of the needs and preferenc

Inspection carried out on 24 & 25 September 2015

During a routine inspection

This announced inspection took place on 24 and 25 September 2015. Time was spent inspecting at the provider’s office, making visits to people in their homes and telephone calls were made to people who used the service and their relatives. .

Gateway Care Services provides personal care for people in their homes in Essex.. There were 50 people receiving personal care at the time of our inspection visit.

At our inspection on 23 July 2014, we found several breaches of legal requirements. Suitable arrangements were not in place concerning safeguarding of people, care workers had not received appropriate training, and there were no effective systems to monitor accidents, incidents and complaints and Care Quality Commission (CQC) was not notified of change of manager as required by law. We asked the provider to make improvements in these areas. Following that inspection the provider sent us an action plan telling how and when they were going to make these improvements. They kept CQC informed of the improvements that had been made.

At this inspection we found that significant improvements had been made in relation to the breaches. We found that action had been taken to reduce the risk of abuse from happening and timely reporting to relevant authorities. Care workers had received appropriate training that enabled them to meet people’s needs. There were arrangements in place to deal with accidents, incidents, complaints and notification to CQC as required.

A registered manager was in post. They took over as manager in January 2015 and registered with Care Quality Commission in August 2015. 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.

There were clear procedures in place to recognise and respond to abuse and care workers had been trained in how to follow these. Riskassessments were in place and reflected current risks for people who used the service and ways to try and reduce these. Care workers had received training in administering medicines. However, appropriate arrangements for the management of people’s medicines were not in place.

Care workers received appropriate training to help them undertake their role and were supported through supervision and appraisal. We saw care workers had received training in the Mental Capacity Act (MCA) 2005. However, when people did not have capacity to consent, the provider had not followed the best interest decision making process in accordance with legal requirements.

Care plans were in place and were reviewed with people and or their relatives to ensure the care provided was appropriate for people.

Care workers knew people’s needs and preferences well and treated people in a kind and dignified manner. People and their relatives told us they were happy and well looked after. They felt confident they could share any concerns and these would be acted upon as appropriate.

The provider took into account the views of people using the service and their relatives through questionnaires. The results were analysed and action was taken to make improvements. . Care workers said they enjoyed working at the service and received appropriate training and good support from the manager. The supervisor conducted spot checks to make sure people were receiving appropriate care and support.

People using the service, their relatives and staff we spoke with during this inspection told us there had been improvements made since the new manager arrived.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.You can see what action we took at the back of the full version of this report.