Archived: Old Gates Care Home

Updated 7 December 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team:

The inspection was carried out by two adult social care inspectors, a medicines inspector, an assistant inspector, a specialist advisor (nurse) and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission (CQC). The manager had been in post for six weeks at the time of the inspection and had applied to CQC to become the home’s registered manager.

Notice of inspection:

This inspection was unannounced.

What we did

Before the inspection we reviewed information we had received about the service from the provider since the last inspection, such as details of serious injuries and safeguarding concerns. We sought feedback from the local authority quality, safeguarding and infection prevention teams and the local clinical commissioning group. We contacted Healthwatch Blackburn with Darwen for feedback about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection we spoke with 14 people who lived at the home and nine visiting relatives about their experience of the care provided. We spoke with sixteen staff, including care staff, nursing staff, unit managers, the clinical services manager, the manager and the area director. We also spoke with a community professional who was visiting the home.

We reviewed a range of records. These included seven people’s care records and multiple medicines records. We looked at a variety of records relating to the management and monitoring of the service and a selection of policies and procedures.

After the inspection we received further information from the manager about improvements that had been made, including changes in medicines processes and practices and additional staff training that had been completed.

Updated 7 December 2019

About the service:

Old Gates Care Home is a nursing and residential care home which provides nursing and personal care to up to 90 people, including older people, people with a physical disability and people living with dementia. Accommodation is provided over three units, with one unit specifically for people living with dementia. At the time of the inspection, 63 people were living at the home.

People’s experience of using this service:

Some improvements were needed to how people’s medicines were managed to ensure they were safe. Shortly after the inspection, the manager provided evidence that these had been addressed. People felt safe at the home and were happy with staffing levels. Staff understood how to protect people from the risk of abuse or avoidable harm. The provider followed safe processes when recruiting staff to ensure they were suitable to support people living at the home. Staff followed appropriate infection control procedures and we found the home clean. The provider ensured safety checks of the home environment were completed regularly.

Staff supported people in a way which met their needs. People felt staff were skilled and knowledgeable. Staff were happy with the induction they received when they joined the service and received regular supervision. Some staff training updates were overdue and the manager addressed this shortly after the inspection. We have made a recommendation about this. 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; the policies and systems in the service supported this practice. Staff completed capacity assessments in line with the Mental Capacity Act 2005 and applied to the local authority for authorisation when people needed to be deprived of their liberty to keep them safe. Staff supported people with their dietary and healthcare needs and contacted community professionals when they needed extra support. The environment was suitable for people’s needs.

People liked the staff who supported them and told us staff were kind and respectful. Staff considered people’s diversity and respected their right to privacy and dignity. They encouraged people to be as independent as they could be and involved them in decisions about their care. The service provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

Staff provided people with care that reflected their needs and preferences. They reviewed people’s care needs regularly and updated documentation when people’s needs changed. People told us staff knew how they liked to be supported and offered them choices. The provider managed people's concerns and complaints appropriately. Most people were happy with the activities and entertainment provided at the home.

The manager and senior staff completed a variety of audits to check appropriate levels of safety and quality were maintained at the home. The manager told us medicines practices would be monitored more closely in the future to ensure they remained safe. The provider had effective oversight of the service. Staff worked in partnership with a variety of community agencies to ensure people received the support they needed. People and relatives were happy with the management of the service. Staff felt well supported and told us care standards and the management of the home had improved since the last inspection.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 25 April 2019) and there were three breaches of regulations. 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. However, the service remains requires improvement, as further improvements were needed to medicines processes and practices at the home.

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

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will request an action plan from the provider to understand what they will do to ensure medicines processes and practices remain safe. We will monitor the progress of improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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