Gateholme

Gateholme is a residential care home providing accommodation and personal care for up to 48 people. The service supports adult with a learning disability, autistic people, people with a mental health need and people living with dementia.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Right Support

Risks associated with people’s care and support were not always assessed, monitored or managed to ensure people were safe. Most staff were aware of risks associated with people’s care; therefore, this minimised the risk. However, more guidance and documentation was required to keep people safe.

We found concerns in relation to infection prevention and control, particularly in the kitchenettes and bathroom areas. The provider took appropriate actions to ensure these concerns were resolved and mitigated in the future.

People’s medicines were predominantly managed safely, and medicines were administered as prescribed. However, we found areas which required improvement. The registered manager took immediate actions to address these concerns, however we have made a recommendation that medicine audits are reviewed and updated to ensure issues can be identified and resolved in a timely way.

Accidents and incidents were recorded and analysed to ensure risks were identified and mitigated. However, this process could be improved to include environmental factors.

There were enough staff available to support people in a timely way. The provider ensured staff were recruited safely.

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.

Right Care

People told us they enjoyed living at the service and felt staff supported them well. Relatives told us they were satisfied with the care and support offered to their relatives.

Right Culture

A person centred culture was not always promoted within the service. For example, staff were not always quick to respond when people required support with personal hygiene. We also saw people’s dignity was not always promoted.

Systems in place to monitor the service were not always effective. Audits had not been instrumental in identifying or resolving concerns we identified during the inspection process. Confidential and sensitive information was not always stored in line with the Data Protection Act. Care documentation was often left in communal areas. The registered manager took action to address these concerns, however new systems and processes require embedding into practice to ensure effectiveness.

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 12 June 2018).

Why we inspected

We received concerns in relation to management of risks and staff training. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 good to requires improvement, based on the findings of this inspection.

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

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 ‘Gateholme’ on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to infection prevention and control, risks associated with people’s care and management.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Staff had opportunities to update their skills and professional development. Staff demonstrated an understanding of the Mental Capacity Act (MCA) 2005. 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 and their relatives told us they felt safe and supported. We saw staffing levels were appropriate for people’s needs and staff received training, supervision and appraisals to support their role.

Care records contained clear information covering all aspects of people's individualised care and support. Staff had a caring approach to working with the people who used the service. We spoke to the registered manager about clearer information for people with epilepsy this was completed by the second day of inspection.

We saw people had access to a wide range of activities/hobbies which they chose to do in and outside the service.

Staff were confident in supporting people with medicines and knew people very well. We spoke to the registered manager about ensuring staff were aware and could support people with their preferred communication.

There was a clear management structure and staff clearly understood their roles and responsibilities. There was an open and transparent culture in which staff felt valued and able to approach the registered manager. Staff told us they felt valued and really enjoyed their role and received support by their team. The management team continued to improve and work as much as possible with relatives at the home if they had any concerns or complaints. Accidents and incidents were analysed and any lessons learnt were filtered through to working practices.

Further information is in the detailed findings below

Gateholme is registered to provide accommodation and personal care for up to 48 people. There were 48 people living at the home at the time of the inspection. There are six self contained units within Gateholme which have their own lounge, dining and kitchen areas.

The service had a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe living at Gateholme. Staff were able to recognise potential signs of abuse and had received safeguarding training so they understood the appropriate policies and procedures in order to help keep people safe.

We found that staff were recruited safely and there were enough staff to meet people’s needs.

Medicines were managed appropriately and staff who were responsible for administering medication had been trained to do so.

Staff performance was monitored and staff received regular supervision and support in their roles.

Where people lacked capacity to make specific decisions, a mental capacity assessment had been undertaken and decisions were made in people’s best interest, in accordance with the principles of the Mental Capacity Act 2005.

Support was provided so people had their nutritional and hydration needs met. Referrals were made to other health care professionals where appropriate.

People told us staff were caring and we observed this. Staff and the registered manager knew people well. People’s privacy and dignity were respected.

Care and support was provided to people in a personalised way and this was reviewed regularly. People were involved in developing and reviewing their care and support.

People were enabled to develop life skills and to become more independent through work, education and training both within the home and the community.

The service was led by a registered manager that people and staff spoke highly of. We found the registered manager to be open and responsive during the inspection.

People’s views were regularly sought and acted upon, through meetings and questionnaires.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We reviewed a random sample of six people's Medicine Administration Record (MAR) sheets which recorded the medication being prescribed for them. There were clear instructions to staff when medication needed to be administered and MAR sheets were completed correctly. People's known drug allergies were clearly documented in care plans and replicated on individual MAR sheets and blister packs. When 'as required' medication had been prescribed, we saw staff had recorded on the MAR sheets whether the medication had been given or not. Also the dosage which had been administered had been recorded. This helped to ensure medicines were given safely and at the appropriate time.

We looked at a sample of staff training records and found staff had access to a programme of training. Mandatory training was provided on a number of topics such as: safeguarding vulnerable adults, manual handling, food hygiene, first aid and fire safety. Additional training was provided on specialist topics such as autism and suicide prevention.

The service used a computerised method of recording training needs and when these needs had been met. The provider referred to this system as 'e-compliance'. The system prompted supervisory staff when refresher training was due. This ensured there was a means of maintaining the knowledge base and competency of staff which secured a safe environment in which to care for vulnerable people.

Is the service effective?

People told us they were happy with the care they received. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We saw daily menus were available on the tables in the dining areas and these were in picture form so people could choose easily. We saw the weekly menus in the kitchen areas. People told us they had their favourite meals on the menus because they had helped with menu planning and shopping.

Is the service caring?

We spoke with ten people who used the service. They all gave positive comments about living there. One person said: 'I can look after myself but sometimes I need some help and that's why I live here.' Another person said: 'I love it here. I love being in the fresh air and working outside.'

We observed staff supporting people in a positive way. Some people living at the home had Autistic Spectrum Disorders (ASD). We saw staff interacted with people with ASD with a structured and therapeutic approach. Staff were helping people to develop social skills and manage stress.

Is the service responsive?

Staff we spoke with demonstrated a clear understanding of people's individual dietary needs. They told us information about each person's nutritional requirements was contained in their care records. We found this information was contained in the four care records we looked at. They also said they knew each person well and understood their likes and dislikes. Staff said where they had concerns about people's food or fluid intake they were referred to the dietician to ensure their health needs were met.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw evidence that annual feedback questionnaires were completed by people who lived at Gateholme in order to seek their views about the running of their home. People were also consulted in the running of the home through 'Your Voice' resident meetings.

We looked at a sample of staff meeting minutes. Topics such as the recent staff survey were discussed. This demonstrated staff views were taken into account in relation to the running of the service.

Is the service well-led?

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. The manager carried out audits on areas such as: medication, supervision and training. The regional manager attended the home on a regular basis to carry out an internal quality monitoring report on areas such as: the environment, complaints, care records and incidents. This information was fed into an action plan if areas for improvement were identified.

Through 'Your Voice' resident meetings and monthly keyworker meetings, we found people's views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

We looked at four care records and found there was conflicting information within them. This meant it was not clear what people's current needs were and whether the risk assessments were appropriate. We found care and treatment was not always planned and delivered in a way that ensured people's safety and welfare.

We saw the provider had safeguarding and whistleblowing policies in place to provide staff with guidance about protecting people from abuse. The staff we spoke with had an awareness of the different types of abuse and described how they would respond if abuse was suspected or happening.

Staff received regular training in mandatory areas which included: safeguarding, infection control and fire safety. Staff received regular supervisions and attended regular team meetings.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

One relative commented; '[Relative] is really happy here. It's her home and she refers to it as her home.' The relative told us she knew how to make a complaint and had confidence that the manager would address any issues.

The people we spoke with told us they liked living at Gateholme. One person said; 'I'm happy here.' Other comments included:

'I'm getting ready to go to the local public house with a friend at lunch time. I like going out and meeting other people.'

'I'm going to Spain for my holidays this year.'

We spoke with four members of staff who all had a good knowledge of the people they cared for. We saw staff interacted with people in a polite and respectful way. We observed staff being kind, patient and explaining things to people at a pace they could understand.

We looked at four care records and found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

At the last inspection it was identified that an improvement to the environment could be made by completing decoration in the lounges and kitchen areas. We saw that improvements had been made by the provider and a number of new kitchens and bathrooms had been fitted.

We looked at three staff records and found that effective recruitment processes were in place and appropriate checks were undertaken before staff began work.