• Mental Health
  • Independent mental health service

Gateway Recovery Centre

Overall: Requires improvement read more about inspection ratings

Bennetts Lane, Widnes, Cheshire, WA8 0GT (0151) 422 2140

Provided and run by:
Elysium Healthcare No.2 Limited

Important: The provider of this service changed. See old profile

All Inspections

5, 6 and 7 December 2023

During a routine inspection

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 Out of date medication was not always disposed of in a timely manner.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.

12th and 13th June 2018

During a routine inspection

We rated Gateway Recovery Centre as good because:

  • Concave mirrors situated in the ceiling allowed full view of the corridors, thereby allowing staff to observe all parts of the wards. Ligature points were noted during the inspection, and the environmental risk and assessment plan showed that these points were considered and action was in place to address issues. Staff had personal alarms and all rooms had wall-mounted call buttons. The key security system used biometric readings to issue and accept keys. Outside areas were well maintained, and had exercise equipment in good repair for all four wards. Staff, including bank and agency staff, completed induction training.
  • Staff completed comprehensive risk assessments and these were updated regularly. Advance statements and crisis plans were in place for patients.
  • Patient care plans were comprehensive, personalised, holistic and recovery orientated. Each patient had signed to show they agreed with their care plan and had received a copy. There was evidence of patient involvement in all aspects of their care.
  • Patients had good access to physical health interventions. Staff completed physical health monitoring including the use of a tracker system by a practice nurse to ensure all relevant tests were undertaken. There was a service level agreement with a local GP, and evidence of their involvement in patient care. Multi-disciplinary meetings were attended by relevant staff including the consultant psychiatrist, a qualified nurse, an occupational therapist, and other staff as required ensuring patient needs were met. Work on diabetes monitoring with patients with a history of self-harming was really good practice. There were a range of mental health disciplines employed at the service, including consultant psychiatrists, qualified nurses and support workers, occupational therapists and psychologists.
  • Staff were regularly supervised and appraised, with plans for monitoring and continual improvement. Mandatory training was being completed and monitored. Staff received training in the Mental Health Act as part of their mandatory training, as well as training in the Mental Capacity Act.
  • Discharge planning was evident in care records and case files, as well as being actively monitored on the hospital electronic dashboard system.
  • We observed kind, caring and positive interactions between staff and patients. Patients said that staff were respectful, approachable and were clearly interested in patient well-being. Staff were knowledgeable about their patients, and this was reflected in their interaction and notes on case files. Minutes of community meetings that involved the patients were reviewed and shown to reflect the feelings and demands of patients. Patients commented favourably on the available activities. Multi-disciplinary team reviews showed participation and consideration over all aspects of care. Carers said that they had been involved in meetings with their relatives and the multi-disciplinary team, and felt that their opinions had been taken into consideration.
  • Patients who were on leave did not have their beds filled in their absence, ensuring the bed was available on return. Patients had access to a range of rooms and equipment to support treatment and care.
  • There was access to telephone rooms, as well as patients having their own mobile telephones. Patients had access to a range of meaningful activities for patients, available seven days per week.
  • The service could make adjustments to meet the needs of patients with physical disabilities as well as mental health problems. Patients had been involved in menu choice developments and smoking cessation initiatives.
  • Complaints were fully investigated, and there were a low number of complaints in the 12-months prior to inspection.
  • Staff knew senior managers; both qualified staff and support workers said that senior managers and executives visited the hospital. Staff used performance indicators to gauge and improve performance by ‘ward to board assurance’, and these were available live on the service electronic dashboard.
  • Clinical audit was being carried out with full staff involvement; the audit and assurance framework showing comprehensive auditing across the service, with indications of positive impact on the service.
  • Staff felt they could raise concerns without fear of victimisation, and morale was high among staff.

However, some of the care plans reviewed did contain jargon or language that might be confusing to patients.