Gateway Recovery Centre

Our overall rating of this location went down. We rated it as requires improvement because:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

• Patient care and support was not always provided in environments which were well-maintained and allowed them access to space to meet their mental health, sensory, physical and recovery needs.

• Staff did not follow policies on infection control.

• In the autism and learning disability service staff did not lessen risks within communal areas where there was not a clear line of sight.
• The provider did not have sufficient, appropriately skilled staff to meet patient needs and keep them safe. Agency staff were not effectively inducted into the ward or show how best to support patients.
• Medicines administration was not completed at a safe time (during lunch) or in private, as medicines were administered in the dining room on one ward. Medicines policies were not followed, and medicines risk assessments were not completed. Staff had not always accurately recorded patient allergies on prescription charts. Out of date medication was not always disposed of in a timely manner.
• Governance processes did not meet the requirements for fit and proper recruitment of staff. Information prior to December 2023 had been sent for storage and archiving, including observation records, cleaning records, community meeting minutes and complaints, this meant the information was not easily accessible.
• When restrictive practices were used, there were inconsistent approaches from staff and unclear rationales in adhering to the policy. Patients where unclear how decisions were made to try and reduce the use of restrictive practices and improve their recovery. There were not always comprehensive reviews to try and reduce the use of these practices.
• Patient care, risk management, treatment, and support plans, did not always reflect patients own words and experiences and used medical language and not plain English. In the In the autism and learning disability service care records did not always reflect patient’s sensory, cognitive and functioning needs. There was not any accessible, easy to understand information for each patient setting out how best to support them.
• Staff supported patients through a model of care which was under review and needed additional benchmarking and refinement to provide clarity on the level of restriction and security being proportionate to the service being delivered.

However:

• Patients were protected from abuse and poor care.
• Patient risks were assessed regularly and managed safely. Patients were involved in managing their own risks whenever possible.
• Patients made choices and took part in activities which were part of their planned care and support. Staff supported them to achieve their goals.
• Patients received care, support and treatment that met their needs and aspirations. Care focused on patient quality of life and followed best practice. Staff used clinical and quality audits to evaluate the quality of care.
• Patients were provided with care, support and treatment from the providers trained regular staff and specialists able to meet patient needs. These staff were not irregular agency staff.
• Managers usually made sure staff had relevant training, regular supervision, and appraisal except for agency staff. In the In the autism and learning disability service and low secure services managers made sure staff received training, supervision and appraisal.
• Patients and those important to them, including advocates, were actively involved in planning their care. A multidisciplinary team worked well together to provide the planned care.
• Staff understood their roles and responsibilities under the Human Rights Act 1998, Equality Act 2010, Mental Health Act 1983, and the Mental Capacity Act 2005.
• Patients were in hospital to receive active, goal-oriented treatment. Patients had clear plans in place to support them to return home, back to services they were admitted from, or move to alternate community living. Staff worked well with services that provided aftercare to ensure patients received the right care and support when they went home. As a result, discharge was rarely delayed for other than a clinical reason.
• Patients received kind and compassionate care from staff who protected and respected their privacy and dignity and understood each person’s individual needs. Patients had their communication needs met and information was shared in a way that could be understood.
• In the low secure the ward environments were safe and clean. The ward had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
• The service had programmes of audit and assurance in place. Managers had access to up-to-date information and performance data.