Cherrybrook Care Home

The Gateway Care Home is a residential care home providing personal and nursing care to older people, people living with dementia and people with physical disabilities. The service accommodates up to 92 people across three separate floors, each of which have separate adapted facilities. At the time of the inspection, two floors were being decorated and refurbished and not in use. Thirty four people were using the service and all were living on the first-floor unit.

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

Improvements had been made since the last inspection which had resulted in better outcomes for people using the service.

Systems for managing medicines had improved although we found some improvements were still needed and made a recommendation to support this.

People told us they received safe care. One person said, “The staff are very good and know how to use the equipment to get me in the bath and such. I am comfortable with them.” A relative said, “I feel (relative) is safe there and has always been cared for.” Risk assessments were in place to support staff in knowing how to manage any identified risks to people. Staff knew the processes to follow to manage any allegations of abuse.

Systems were in place to manage the risk of spread of infection within the home.

Care records reflected people’s needs and what staff needed to do to meet them, although records did not always reflect people’s involvement in making decisions about their care. People’s health care and nutritional needs were well managed.

People were complimentary of the care and support they, or their relatives received. One person said, “I have found the staff kind and caring they never raise a voice or anything.” A relative told us, “Without a doubt we are extremely happy with (person’s) care. The carers are very caring and are like friends to us. We are delighted. We observe a lot whilst we are there, and we think they support (person) really well".

Recruitment processes ensured staff were suitable to work in the care service. Staff were trained and said they felt supported in their roles. They had the required skills to meet people’s needs. People told us they thought there were enough staff and they didn’t have to wait for support.

There was a new registered manager in post. They were following action plans to continue to improve the service. People had confidence in the new manager.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 6 August 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since November 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 11 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The breaches were in relation to assessing and managing risks to individuals, managing medicines safely and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Gateway Care Home is a residential care home providing personal and nursing care to older people, people living with dementia and people with physical disabilities. The service accommodates up to 92 people across three separate floors, each of which have separate adapted facilities. At the time of the inspection, one floor was being decorated and not in use, 43 people were using the service.

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

People were not safe. Risks to people were not assessed and managed. Medicines were not managed safely. Lessons were not always learned when things went wrong. There were enough staff to keep people safe although there had been a high turnover of staff.

The service was not well-led. There were continued breaches at this inspection with similarities to issues found at the last inspection in relation to risk management and governance. Systems to monitor quality and safety were not effective.

The provider had strengthened how they managed accidents, incidents and safeguarding cases. People were generally positive about the staff who cared for them and their experience at the service. Staff said they felt supported and were complimentary about the management team who worked at the service on a day to day basis. Feedback varied about the overarching management arrangements and role of the provider. The service worked with other professionals to benefit people using the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 18 November 2020) and there were multiple breaches of regulation. The service remains rated inadequate.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in some areas, but not enough improvement had been made in other areas and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing and managing risks to individuals, managing medicines safely and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The Gateway Care Home is a residential care home providing personal and nursing care to older people, people living with dementia and people with physical disabilities. The service accommodates up to 92 people across three separate floors, each of which have separate adapted facilities. At the time of the inspection 65 people were using the service.

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

People were not safe. Risks to individuals were not appropriately assessed and managed. Medicines were not managed safely. Lessons were not learned when things went wrong. Safeguarding procedures were not consistently followed. There were sufficient staff to keep people safe and they usually worked in the same unit, so people received continuity of care. People lived in a safe, clean and pleasant environment.

The provider's quality management systems were not effective and did not identify areas where the service needed to improve. The provider and registered manager did not demonstrate they understood their legal responsibilities. People who used the service, relatives and staff provided consistent positive feedback about their experience. The management team were responsive to the inspection findings and shared plans to improve their systems and processes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 4 January 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about management of medicines and governance arrangements. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with assessing and managing risk to people who use the service, safeguarding people from abuse, failure to consistently report significant events to the relevant agencies, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We also looked at infection control and prevention measures the provider had in place. As part of CQC’s response to the coronavirus pandemic we are conducting a review of infection control and prevention measures in care homes.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to assessing and managing risks to individuals, management of medicines, governance, safeguarding people from abuse. Please see the action we have told the provider to take at the end of this report.

We have identified a breach in relation to failure to notify CQC about significant events at this inspection. We reviewed our regulatory response outside of the inspection process and decided not to take any further action. We took account of the exceptional circumstances arising as a result of the COVID-19 pandemic.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 quality assurance monitoring system in place that was designed to continually monitor and identify any shortfalls in service provision.

People who used the service and relatives were asked for their opinions about the way the service was managed through meetings and surveys.

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 available alongside the complaints procedure. Records showed that complaints received had been dealt with appropriately and the outcome communicated to the complainant.

People’s care files were well organised and care plans were personalised. We saw people had access to healthcare professionals such as GPs and district nurses.

People, relatives and staff praised the improvements that had been made since the last inspection. Everyone spoke highly of the registered manager who they described as a good person who led by example and was respectful, open and transparent. Effective quality assurance systems were in place and we saw actions had been taken when issues had been identified.

However, the Local Authority placed a restriction on admissions due to the findings from the previous two inspections in February and July 2016 when the service was rated Inadequate. This embargo remains in place. At this inspection the occupancy was low with only 26 people accommodated out of the 92 places which are registered and only two of the three floors were being used. We therefore need to be assured the improvements identified throughout this report will be sustained and developed further so that when occupancy levels increase people will continue to receive a consistently high standard of quality care.

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 induction or training they needed to carry out their roles. Systems were in place to ensure staff received supervision and the manager told us an appraisal system was being introduced.

People told us they enjoyed the food. We saw mealtimes had improved and were a pleasant and sociable occasion with staff providing people with the support they needed. A choice of meals, snacks and drinks were provided throughout the day.

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 available alongside the complaints procedure. However, the manager was unable to provide us with any records of complaints they had received.

The service had moved from an electronic care system to paper records which staff told us worked better as they could access the information more easily. We found the care files were well organised and care plans were personalised. We saw people had access to healthcare professionals such as GPs and district nurses.

People and staff told us improvements had been made since the last inspection. We found the home was more organised and the manager was open and transparent and had a calm demeanour. However, quality assurance systems were not fully embedded or robust which is evident from the continued breaches we found at this inspection.

We found continued shortfalls in the care and service provided to people. We identified four breaches in regulations – regulation 18 (staffing), regulation 19 (recruitment), regulation 12 (safe care and treatment) and regulation 17 (good governance). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

The overall rating for this service is ‘Inadequate’ and the service remains 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 still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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 still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can see what action we told the provider to take at the back of the full version of the report.