Gate Cottage Rest Home

People’s experience of using this service: The service continued to meet the characteristics for a good service in each of the key areas, more information is in the full report.

• People were receiving a personalised service. Care records included details of people’s backgrounds and identified their needs and preferences. Staff knew people well and provided person centred care that was responsive to people’s needs and wishes. People were supported to follow their interests. Any concerns or complaints were responded to quickly. People were supported with end of life care.

•There were safe systems in place to protect people from harm or abuse. Risks to people were assessed and managed. There were enough staff to care for people safely and to administer their medicines. There were high standards of cleanliness throughout the home. Incidents and accidents were monitored and lessons were learned to prevent further occurrences.

• People spoke highly of the staff and described them as, “kind,” “really caring,” and “lovely, always calm.” Staff knew people well and had developed positive relationships with them. Relatives told us they felt welcomed and involved. People were supported to express their views about their care and support. One person told us, “I feel very much in control.” Staff respected people’s privacy and supported them to remain independent.

• Staff received the training and support they needed. One staff member said, “The managers are always available and work alongside us. It is a lovely place to work.” Assessments and care plans were holistic and provided clear guidance for staff. People were supported to have enough to eat and drink and spoke highly of the food on offer saying, “There’s a good choice,” and “It’s good home cooking.” Staff understood their responsibilities for seeking consent for care and treatment and people’s rights were respected. Staff supported people to access the healthcare services they needed.

• People, relatives and staff spoke highly of the management of the home. One person said, “We are so lucky to have found this place.” A relative told us, “People here are very happy, the staff are lovely and the management is very good.” Staff were clear about their roles and responsibilities and described clear leadership and involvement with developments at the service. There were systems in place to monitor the quality of care provided and any shortfalls were identified and addressed quickly. Staff had developed positive working relationships with health care professionals.

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

Rating at last inspection: Good- 31 May 2016

Why we inspected: This was a planned comprehensive inspection.

Follow up: Ongoing monitoring.

Gate Cottage Rest Home is a large detached house in the village of Rottingdean, close to Brighton. The home is the sole location owned by a family and run as Gate Cottage Rest Home Limited.

The home had a registered manager. A registered manager is a person who has registered with the 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 home is run.

People’s care records showed that some risks to people’s health and wellbeing had been identified. For example, risk assessments guided staff and promoted people’s comfort in such areas as nutrition and the prevention of pressure damage. However, some records were incomplete and their incompleteness did not demonstrate that care was person centred . We have identified this as an area of practice that needs improvement.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I have to have someone in the lift with me in case I fall and I feel safer like that. All I have to do is let them know and they’ll happily take me anywhere.” When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to make decisions in their best interests. The registered manager and staff had received training and were knowledgeable about the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People we spoke with were complimentary about the caring nature of staff. People told us care staff were kind and compassionate. People were treated with respect when they received care. We were told the following, “I’m constantly amazed at how thoughtful and attentive they are. Even if you want a cry, they’d hold your hand or put an arm round your shoulders, they wouldn’t leave you.”

People had access to appropriate healthcare professionals. Staff worked in cooperation with other

health and social care professionals to ensure that people received appropriate care and support. Staff told us how they had regular contact with the GP if they had concerns about people’s health. A person said, “I had to have the doctor when I had a fall once, you can see a doctor when you need to.”

Staff had received essential training and there were opportunities for additional training specific to the needs of the home. Arrangements for the supervision and appraisal of staff were in place. Staff told us they felt supported and recognised the part that regular scheduled supervision played. A staff member said, “I have regular supervision with [named supervisor]. They want to know how we are feeling and how we think we’re doing. It helps me to think about my role. They encourage me to think about going for a senior carer role.”

Systems were in place to monitor the quality of the service provided and regular checks were undertaken on all aspects of running the home. The registered manager had a range of tools that supported them to ensure the quality of the service being provided.

People, their relatives and staff told us it was well-run and organised home The phrase that was used several times throughout the inspections was that the atmosphere was homely, one person said, “It’s really cosy and homely. Just like a family home.”

Below is a summary of what we found. The summary describes what people who used the service, their relatives, visitors and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw care plans that reflected issues identified in the assessment. These were sufficiently detailed to allow care staff to deliver safe and responsive care. A care worker said, 'The care plans are drawn up by the senior care staff and allow us to work with that person with confidence that what we do is correct and safe.'

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

We spoke to staff about their understanding of safeguarding procedures. They had an awareness of the different types of abuse and what to do if they witnessed abuse.

Is the service effective?

We saw that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that people or their representatives had been involved in their care assessments and reviews.

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person who used the service told us, 'I really can't fault the care. It's a lovely, well kept home with friendly staff. I wouldn't want to be anywhere else.' Staff had obtained training to meet the needs of the people who received care.

All the staff we spoke with told us that they had been provided with support from other colleagues and from the manager. They all told us the management was always accessible and approachable.

Is the service caring?

People were supported by committed and attentive staff. We saw that care staff were patient and empathetic when supporting people. The relative of one person told us, 'We've never had any concerns. We really can't fault the care. I am full of praise for all the staff.'

Is the service responsive?

People's needs were continually assessed. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and treatment had been provided in accordance with people's wishes.

Is the service well-led?

Staff had a good understanding of the ethos of Gate Cottage Rest Home and its commitment to providing quality, personalised and individual care. Quality assurance processes were in place to support this. People told us they were asked for their feedback on the service they received and they confirmed they had felt listened to. Systems were in place to help the service develop and learn.

Comments on satisfaction questionnaires included 'Of all the care homes I've seen Gate Cottage is the best. Friendly, fresh and clean and good food.' Another person wrote 'Excellent the staff are extremely kind to residents and visitors.'

Two people we spoke with and a relative told us they were extremely happy with the care provided at the home and had no concerns.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Medicines were kept safely in locked cabinets in a locked room. Medication records were accurate and complete.

The environment was suitably designed and adequately maintained. Level access was provided throughout the home and adaptations had been made to meet the needs of the people who lived there.

There were enough qualified, skilled and experienced staff to meet people's needs. There were two care workers on duty at all times and management were on duty every day of the week.

People who lived at the home, their representatives and staff were asked for their views about their care and treatment and they were acted on.