The Gatehouse

Updated 14 December 2022

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. We checked 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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector on the first day and two inspectors on the second day. An Expert by Experience made phone calls to relatives remotely. 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 Gatehouse is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Gatehouse is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The service was being managed by the directors and other support managers at the time of our inspection whilst recruitment was on-going.

Notice of inspection

This inspection was unannounced on the first day and announced on the second day.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who used the service and 5 relatives about their experience of the care provided. We spoke with 9 members of staff including the director, managers, senior carers, care assistants, support workers and domestic assistants.

We reviewed a range of records including 5 people’s care records. We reviewed 6 people’s medication records. We looked at 2 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, policies and procedures were reviewed. We also reviewed training records, meeting minutes and other documents remotely.

Updated 14 December 2022

About the service

The Gatehouse is a residential care home providing personal and nursing care to up to 31 people. The service provides support to older people, some of who may be living with dementia. At the time of our inspection there were 22 people using the service.

The Gatehouse is a large detached building with bedrooms across three floors which is accessible via a lift. The home also has an accessible garden area.

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

Recruitment processes were not always robust and safety checks such as DBS checks were not always in place where needed. There were enough staff to meet people’s needs in a safe and caring way.

Medicines were not always safely managed. Systems in place did not identify and address these in a timely and effective way to manage risk.

Staff knew the people they supported well, however care plans and risk assessments were not always in place or accurate. Incidents were not consistently recorded or managed as we would expect to communicate concerns and reduce risk.

Audits and checks in place were not always effective at identifying and addressing concerns found at this inspection.

Lessons learnt were shared with staff and additional training provided to reduce reoccurrence. Staff told us they were well supported by the management team and their colleagues. Staff described the service as, “like family”.

The provider sought and acted on feedback from people, relatives and staff to improve their experience. People and their relatives told us they felt safe and well cared for. People were observed to be treated with respect, dignity and kindness.

The provider was passionate about the service and providing a welcoming and homely environment for people. Staff and family members told us they could approach managers with any concerns, and they were confident they would be acted upon.

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.

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 4 January 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 in relation to the safe and well-led domains. Please see the safe, caring and well-led sections of this full report

Enforcement

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, staffing and good governance.

Please see the action we have told the provider to take at the end of this report. The provider took immediate action to address the concerns raised and to mitigate risk.

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.