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Inspection carried out on 22 November 2017

During a routine inspection

This inspection took place on 22 November 2017 and was unannounced.

When we inspected the service in June 2016 we identified four regulatory breaches which related to staffing, recruitment, safe care and good governance. At the next inspection in November 2016 we found improvements had been made in all these areas and no regulatory breaches were identified. The quality rating at that time was ‘Requires Improvement’ as we needed to be assured improvements were consistently sustained over time. At this inspection we found improvements had been sustained and further developments made.

The Gateway Care Home 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 Gateway can accommodate up to 92 people across three separate floors, each of which have separate adapted facilities. The service provides care and support to older people, people living with dementia and people with physical disabilities. There were 46 people using the service when we inspected. The home was purpose built in 2015 and provides single bedroom with en-suite toilet and shower facilities over three floors. There are a good range of communal areas on each floor and a bar/café and hairdressing salon in the foyer.

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. 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 staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their various roles. Staff told us they felt supported by the registered manager and deputy manager and were receiving formal supervision where they could discuss their on-going development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion. They also told us they felt safe with the care they were provided with. We found there were appropriate systems in place to protect people from risk of harm.

We found the service was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS). 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 supported this practice.

Staff knew about people’s dietary needs and preferences. People told us there was a choice of meals and said the food was very good. We also saw there were plenty of drinks and snacks available for people in between meals.

Care plans were up to date and detailed exactly what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified. People who used the service and relatives told us they were happy with the care and support being provided. We saw people looked well-groomed and well cared for.

People’s healthcare needs were being met and medicines were being managed safely.

Activities were on offer to keep people occupied both on a group and individual basis. Trips out were also available.

The service was well decorated, well maintained, comfortable, clean, tidy and odour free.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager provided staff with leadership and direction and was described as being very approachable and understanding.

There was a q

Inspection carried out on 10 November 2016

During a routine inspection

This inspection took place on 10 November 2016 and was unannounced.

At the last inspection on 20 June 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We identified four regulatory breaches which related to staffing, recruitment, safe care and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The Gateway Care Home is registered to provide accommodation and personal care for up to 92 people some of who are living with dementia. There were 26 people using the service when we inspected. The home was purpose built in 2015 and provides single en-suite bedrooms over three floors with communal areas on each floor.

The home has a registered manager. 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.

Although we judged the provider to be inadequate on our last inspection, we did note some areas where improvements had been made in relation to care

planning, activities, the cleanliness of the environment, nutrition and leadership. During this inspection we found the provider, registered manager and staff had worked hard to sustain and build on these improvements. People told us there were enough staff and this was confirmed in our observations which showed staff were available and responded promptly to people. The turnover of staff had reduced which had resulted in a more stable staff team who knew people well and how to meet their needs.

People told us they felt safe and this was echoed by relatives we met. Staff understood safeguarding procedures and how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the Commission. Risks to people were assessed and managed to ensure people’s safety and well-being.

Medicines management systems had improved and were being monitored through regular audits. This helped to ensure people received their medicines when they needed them. Robust recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA).

People told us they enjoyed the food. Lunchtime was a pleasant experience with people offered choices and given the support they required from staff. A choice of meals, snacks and drinks were provided throughout the day. People's weights were monitored to ensure they received enough to eat and drink.

The environment was clean and well maintained. People told us they liked their rooms. People told us they enjoyed living at the home and described staff as kind, caring and helpful. People told us they were treated with respect and this was confirmed in our observations. People looked clean, comfortable and well groomed. We saw people enjoyed activities taking place during the inspection and people told us of other activities they had taken part in.

People were aware of how to make a complaint and we saw complaints forms were freely

Inspection carried out on 21 June 2016

During a routine inspection

This inspection took place on 21 June 2016 and was unannounced.

At the last inspection on 16 and 17 February and 17 March 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We identified seven regulatory breaches which related to safeguarding, staffing, consent, dignity and respect, safe care and treatment including medicines, complaints and good governance. We issued warning notices for the breaches of safe care and treatment and staffing with a compliance date of 31 March 2016 and for good governance with a compliance date of 15 April 2016. We issued requirement notices for the breaches relating to complaints, consent, safeguarding and dignity and respect. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

The Gateway Care Home is registered to provide accommodation and personal care for up to 92 people some of who are living with dementia. There were 31 people using the service when we inspected. The home was purpose built in 2015 and provides single en-suite bedrooms over three floors with communal areas on each floor.

The home does not have a registered manager. A manager was appointed in February 2016 and is the process of applying for registration. 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.

Overall we found some improvements had been made to the care people received and areas such as care planning, activities, the cleanliness of the environment, nutrition and leadership were better than we had found at the last inspection. However, we found a number of breaches remained and we were concerned about the continued turnover of staff and the impact this has on the stability of the staff team, including the management of the service.

People and staff raised concerns about staffing levels, in particular the high turnover of staff and use of agency staff. People told us agency staff did not know them as people or how to meet their needs. They said there were sometimes not enough staff. There was no staffing tool and the manager was unable to explain how the staffing levels had been determined. We found people’s dependencies and the layout of the building had not been taken into consideration.

The majority of people told us they felt safe although two people raised concerns about other people coming into their bedrooms. Safeguarding processes had improved and incidents had been investigated and reported to the Local Authority safeguarding team. Although this was not consistent as one person told us of a recent incident which had happened to them. Our discussions with the manager showed they had taken action to keep this person safe, but there were no records relating to this incident and a safeguarding referral had not been made.

We found some aspects of medicine management had improved, however inconsistencies remained which meant we could not be assured people always received their medicines safely or when they needed them.

Systems were in place to manage risk although records were not always reviewed and updated when people’s needs changed. We found not all staff had received fire training and some staff we spoke with were not aware of the correct procedures to follow in the event of the fire alarms sounding which placed people at risk.

The environment was clean and well maintained. People told us they liked their rooms.

Safe recruitment procedures were not always followed as we found some staff had started work before references had been obtained. Although some staff training had taken place we found there were still gaps where staff had not received the induct

Inspection carried out on 17 February 2016

During a routine inspection

This inspection took place on 16 and 17 February 2016. A further visit was made as part of the inspection on 17 March 2016 after we received information of concern about the service. The evidence from the additional visit has been included at the end of each relevant domain within this report. All visits were unannounced. This was the first inspection of this service since it’s registration with the Care Quality Commission in October 2015.

The Gateway Care Home provides personal care for up to 92 older people, some of who may be living with dementia or have a physical disability. Accommodation is provided in single en-suite bedrooms over three floors. There are passenger lifts to all floors. Each floor has its own dining room, lounge areas and bathrooms. The main kitchen is situated on the ground floor.

The home does not have a registered manager. 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.

Staff had an understanding of safeguarding and told us about events in the home which they understood should be reported. However we found safeguarding incidents had not been referred to the local authority safeguarding team. Risks to people were not well managed which meant people were at risk of harm and poor standards of care. Staff failed to answer call bells.

Medicines were not managed safely and some people had not received their medicines as prescribed.

There was a lack of appropriate personal protective equipment such as gloves and aprons for staff to maintain effective infection control procedures. Staff hand washing facilities were not in place as required.

Staffing levels often fell short of those the provider’s representative had told us were in place and were often insufficient to meet the needs of the people living at the home. Staff had not received the training and support they needed to fulfil their roles. Staff recruitment processes were safe but staff turnover levels were very high.

The legal framework relating to the Mental Capacity Act 2015 (MCA) and Deprivation of Liberty Safeguards (DoLS) was not understood by all staff and was not being followed, although some applications had been made for DoLS authorisations these were not being prioritised based on need or risk.

Food at the home was good and choice was available. However people were losing weight and were not receiving the diet and fluids they needed to maintain their health.

People said staff were good and we witnessed some caring interventions. However, we found some practices undermined people’s privacy and dignity and showed a lack of respect.

Care records were not sufficient to make sure people’s needs were met. Care was not planned or delivered with a person centred approach.

Some activities were provided but were not research based to make sure they were appropriate. Some activities involved using toys designed for very young children which could be demeaning to people living at the home.

We found management systems were not robust.

We identified 12 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is