Archived: Three Gates

Three Gates is a five-bed residential home providing personal care to four people at the time of the inspection. The care home supports people in an adapted building.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible life outcomes for themselves that include control, choice and independence.

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

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.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, Right care, Right culture. The new service manager and support staff promoted a positive culture in the service. People had experienced significant changes to their routines during the pandemic period and people could not pursue many of the activities and learning opportunities they usually enjoyed. Staff have been proactive in supporting people with alternative in-house activities which ensured people’s behaviour continued to be calm and settled. This helped promote people’s choices and independence even during the pandemic period when normal routines were disrupted. Improvements were required to ensure all aspects of people's care was safe and information was consistently available in care planning documents.

People did not always receive consistent safe care.

We completed this inspection over two days. Though the provider had made some progress from the point of the last inspection, there were limited infection control checks in place which resulted in a heightened potential for cross infection and cross contamination of infections. Infection control checks were not completed thoroughly to ensure risks to people were minimised. We brought the infection control issues to the attention of the provider where we had immediate concerns to people’s safety. We required the provider to complete an urgent action plan to demonstrate how they would mitigate risk. We then returned to the home to see if the provider had done what they had told us in the action plan We saw the provider had made a number of improvements. However, information in the range of documents within the care plan were not summarised consistently and left a potential to cause people harm.

There was little consistent evidence that any quality monitoring had been used to make improvements highlighted in the September 2020 inspection. The audit systems that were in place were not operated effectively or overseen by the provider to ensure people received a quality service.

Medicines were stored and administered safely.

Staffing levels were adequate to provide acceptable levels of care. People were unable to communicate verbally, their views of the service staff provided were sought on a day to day basis by staff reading the body language and vocal sounds people used.

People were safeguarded by staff trained to recognise potential abuses. Where errors had been made, staff were involved in discussions about incidents and included in any shared learning.

The new service manager understood their roles and responsibilities and had applied to be a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

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 9 September 2020) and there were multiple 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 some improvement had been made, however, the provider was still in breach of some regulations.

Why we inspected

The inspection was prompted in part due to concerns received about infection control. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report. The provider has started to make changes to reduce risks, these will take some time to become fully embedded.

Enforcement

We have identified breaches in relation to the safety of people in the service and safety and monitoring of the environment they live in. Please see the action we have told the provider to take at the end of this report.

Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report. In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service.

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Three Gates is a five-bed residential home providing personal care to three people at the time of the inspection. The care home supports people in an adapted building.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible life outcomes for themselves that include control, choice and independence.

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

People did not always receive consistent safe care.

Information about people’s diets was inconsistent and left a potential to cause people harm.

There were limited infection control checks in place which resulted in a heightened potential for cross infection and cross contamination of infections. Infection control checks were not completed thoroughly to ensure risks to people were minimised. We brought the infection control issues to the attention of the registered manager where we had immediate concerns to people’s safety.

There was little consistent evidence that any quality monitoring had been undertaken. The audit systems that were in place were not operated or overseen by the provider to ensure people received a quality service.

The registered manager was unable to assure us at inspection that safe recruitment practices had been followed. We later received information which assured us there was a rigorous process in place which met national standards.

Medicines were stored and administered safely however, storage temperatures are not monitored, which allows for a degrading of medicines potency. We recommend the provider considers the national guidance on the safe storage of medicines.

Staffing levels were adequate to provide acceptable levels of care. People’s views of the service were sought on a day to day basis and through regular meetings though there was no information available from surveys. The registered manager understood their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

People were safeguarded by staff being trained and where errors had been made, staff were included in discussions around incidents and any shared learning.

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

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a potential criminal investigation. As a result, this inspection did not examine the circumstances of the incident. This incident is subject to a criminal investigation, as a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incident indicated concerns about the management of choking. This inspection examined those risks for those people left in the home.

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. The provider has started to make changes to reduce risks, these will take some time to fully be embedded.

Enforcement

We have identified breaches in relation to the safety of people in the service and safety and monitoring of the environment they live in. Please see the action we have told the provider to take at the end of this report.

Immediately after our inspection, we wrote to the provider and asked them to take urgent action to address the most serious risks outlined in this report. In response, the provider developed an action plan detailing actions taken and planned, to make improvements and reduce risk. Additional resources were also immediately deployed to the service. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service met the characteristics of good in all areas.

People continued to receive safe care. There were enough staff to support them and they were recruited to ensure that they were safe to work with people. People were protected from the risk of harm and received their prescribed medicines safely. Lessons were learnt from when mistakes happened.

The care that people received continued to be effective. They 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 received training and support to be able to care for people well. They ensured that people were supported to maintain good health and nutrition; including partnerships with other organisations when needed. The environment was adapted to meet people’s needs.

People continued to have positive relationships with the staff who were caring and treated people with respect and kindness. They could get involved in activities and pursue their interests. Staff knew them well and understood how to care for them in a personalised way. There were plans in place which detailed people’s likes and dislikes and these were regularly reviewed. People knew how to raise a concern or make a complaint and the registered manager managed any complaints in line with the provider’s procedure.

The registered manager was approachable and there were systems which encouraged people to give their feedback. There were quality structures in place which were effective in continually developing the quality of the care that was provided to people.

More information is in the full report.

Rating at last inspection: Good: report published on 3 August 2016.

About the service: Three Gates is a residential care home registered to provide personal care for up to five people with learning disabilities or autistic spectrum disorder. There were four people living there at the time of the inspection. The accommodation is an accessible bungalow with large gardens

Why we inspected: This was a scheduled inspection based on previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Three Gates is a small home which offers personal and social care for five adults with a learning disability (including autistic spectrum disorder). At the time of our inspection, four people were using the service.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People were protected from the risk of abuse and avoidable harm. Their needs and risks associated with care were assessed and staff had clear guidance about how to meet people’s individual needs. Care plans were regularly reviewed and updated to meet people’s changing needs and preferences.

People were happy, comfortable and relaxed with staff. They were cared for by sufficient numbers of staff who were suitably skilled, experienced and knowledgeable about people’s needs.

The provider took steps to ensure checks were undertaken to ensure that potential staff were suitable to work with people needing care. Staff received one-to-one supervision and had regular checks on their knowledge and skills. They also received regular training in a range of skills the provider felt necessary to meet the needs of people at the service.

The systems for managing medicines were safe, and staff worked in cooperation with health and social care professionals to ensure that people received appropriate care and treatment in a timely manner.

Appropriate arrangements were in place to assess whether people were able to consent to their care. The provider was meeting the legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DOLS). This ensured that legal safeguards were in place to protect people who could not consent to aspects of their care.

People were supported to be as involved as possible in their care planning and delivery. The support people received was tailored to meet their individual needs, wishes and aspirations.

Systems were in place to monitor the quality of the service provided and ensure people received safe and effective care. These included seeking and responding to feedback from people and their relatives in relation to the standard of care. Regular checks were undertaken on all aspects of care provision and actions were taken to improve people’s experience of care.

As people using the service were unable to give us their views of the service, we contacted people's family members and friends to get feedback from them. People's family members and friends were happy with the support their relatives received. One family member talking about their relative told us, 'moving to Three Gates was the best thing that's ever happened, she is so happy there and if there are any concerns the staff always let us know. I think the place is fantastic.'

People were supported to undertake activities of their choice and to develop their skills and independence. On the day of our visit three people using the service left for a two day trip to London with staff support and staff supported the two other people using the service to access the local community.

People's preferences and the level of support they needed was delivered in line with their individual support plans.

People were supported to access health care services as needed to maintain their health and were supported to take their medication as prescribed.

Sufficient numbers of staff were on duty to ensure people's needs were met effectively.

Discussions with staff and observations during our visit demonstrated that staff had a good understanding of people's support needs.

People's family members and representatives were positive about the support and services provided by the staff team. Comments included, 'I have only positive things to say about the support provided by the staff, they have encouraged my relative to try different experiences, I think they do a marvellous job.'

People's method of communication was recorded in their support plans. This ensured staff could support people according to their preference and choice. Information in records demonstrated that staff were committed to promoting independence and choice by working with and involving individuals in decisions on a day to day basis.

Staff were provided with ongoing training and support, to enable them to carry out their work effectively.

Systems were in place to monitor the care and services provided, and to identify and manage risks to ensure the service was run safely.