Cherrybrook House

The Gateway Respite is a residential care home providing personal care to older people, people living with dementia and people with physical disabilities. The service provides short term and long-term care and accommodates up to 28 people in one adapted building. At the time of the inspection 12 people were using the service.

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

We have made recommendations about the safe administration of medicines and the effective recording of risk within care plans. We have made a recommendation about reviewing care plans to remove historical information.

There were enough staff to meet people's needs and keep them safe. Staff had a good understanding of safeguarding processes. Infection control practice was robust, and staff wore appropriate personal protective equipment (PPE).

Care plans were personalised and showed the care and support people wanted and needed. People and relatives knew how to raise concerns and were confident these would be dealt with appropriately.

The registered manager had a clear focus on quality and worked alongside staff. Staff worked well with other services and appropriate referrals were made in a timely manner. Quality assurance systems were in place to enable robust governance of responsibilities and regulatory requirements; this supported the continuous improvement of the service through the sharing of lessons learned.

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 requires improvement (published 13 August 2021) and there were breaches of regulation. 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 8 December 2020. During this inspection the provider demonstrated 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 comprehensive inspection of this service on 15 June 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 safe care and treatment, person-centred care, good governance, and staffing.

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, responsive 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 requires improvement to good. 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 Respite on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about the safe management of some medicines and about improvements in care plan records.

Follow up

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

The Gateway Respite is a residential care home providing personal and nursing care to older people, people living with dementia and people with physical disabilities. The service provides short term and long-term care and accommodates up to 28 people in one adapted building. At the time of the inspection 14 people were using the service.

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

People were not always safe. Risks to people were assessed but care was not always delivered as detailed in their risk assessments and care plans. There were not enough staff available to meet people’s needs and keep them safe. Improvements had been made in relation to managing medicines and safe systems were in place. The manager and staff understood safeguarding procedures and reports to the local authority were made as needed. Systems were in place to make sure people lived in a safe and comfortable environment.

Some people told us their relatives were at risk of social isolation due to spending long periods of time alone in their rooms. People were not always supported to engage in meaningful activities. One person who used the service told us there was not anything to do during the day. People were not able to access the enclosed garden area independently and one family member told us their relative was very rarely supported to go into the garden. People gave us mixed responses in relation to how the service communicates with them. Some felt there had been improvements whilst others felt they were not responded to.

Systems for auditing quality and safety within the service had been improved but had not identified issues we found during the inspection. People had mixed views about the management team. Some expressed confidence in the manager and felt they had been effective in making improvements whilst others had concerns about the management team.

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 found the service had robust systems in place.

Care plans had been improved. They contained more detail and had been reviewed monthly. End of life plans had also been introduced.

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 inadequate (published 5 December 2020).

Why we inspected

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

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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, staffing, person centred care and governance.

At this inspection, not enough improvement had not been made and the provider was still in breach of regulations 12 (Safe Care and treatment), regulation 9 (Person centred care), regulation 18 (staffing) and regulation 17 (Good governance). Please see the action we have told the provider to take at the end of this report in relation to regulations 9, 18,and 17.

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.

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

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 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 ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place or keep services 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, 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.

We found the following examples of good practice.

The service was creating a visiting pod at one of the patio doors on the ground floor. It was due to be ready by 18 November 2020. The pod will include an intercom system to make it easier for people and relatives to talk with each other. Visiting will be be appointment only with intervals for cleaning between visits.

The provider used a fogging system to clean and sanitise communal areas. This is done using a machine which produces a mist of antiviral disinfectant to cover covers all surfaces.

Further information is in the detailed findings below.

The Gateway Respite is a residential care home providing personal and nursing care to older people, people living with dementia and people with physical disabilities. The service provides short term and long-term care and accommodates up to 28 people in one adapted building. At the time of the inspection 18 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 always assessed and appropriately managed. Some staff were not up to date in safety related training. Medicines were not managed safely. There were insufficient staff with the appropriate skills and knowledge to meet people’s needs and keep them safe. Lessons were not learned when things went wrong. The manager was familiar with safeguarding and fully understood reporting procedures. People lived in a safe and pleasant environment. The service had infection prevention and control systems in place although additional measures were being introduced to ensure staff fully understood how to prevent the transmission of infection.

The service did not have effective systems in place to involve people in making decisions about their care. Care plans did not reflect people’s needs and wishes. The management team had started to improve the care planning system. Relatives were concerned because they had been unable to find out about their relatives’ wellbeing; this was during the COVID-19 pandemic when everyone was feeling anxious and visiting restrictions were imposed. The service was developing social activities, but concerns were raised that people did not have opportunity to go outside even though there was an enclosed garden. When concerns and complaints were raised there was little evidence to show improvements were made.

The provider's quality management systems were not effective and did not drive improvement. Record keeping was unreliable which meant it was not always possible to monitor service delivery. People’s opportunities to share their views about the service were limited. The manager who had been in post less than three weeks had started to make changes. Feedback about the manager from staff, people who used the service and relatives was positive.

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 good (published 8 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about management of risk, staffing arrangements, communication, poor quality care and leadership. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led. We inspected and found there was also concerns around care planning and complaints, so we widened the scope of the inspection and included the key question responsive.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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, staffing, person centred care and governance.

Please see the action we have told the provider to take at the end of this report.

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

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 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 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.

The Gateway Respite 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 care home can accommodate up to 28 older people and older people living with dementia in one purpose built building. Accommodation is provided over three floors.

This was the first inspection of the service since it opened in August 2017. When The Gateway Respite home was open the intention was to provide short or long term respite care, however, some people had decided to make it their long term home. On the day of inspection there were 10 people who were living permanently at the service and three people receiving respite care.

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.

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 role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing 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.

Care plans were up to date and detailed 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 felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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.

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

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

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The home was spacious, well decorated, clean and tidy. All of the bedrooms were single occupancy with en-suite toilets and showers.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they took action to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.