All inspections: Old Gates Care Home - Care Quality Commission

This was an unannounced inspection which took place on 12 and 13 December 2016. The service had previously been inspected in January 2016 when we found it to be in breach of one of the regulations we reviewed; this was because the management of medicines needed to be improved.

This inspection was prompted in part by anonymous information we had received which alleged people who used the service were receiving poor care, particularly those on the unit for people living with dementia.

Old Gates Care Home provides accommodation in three units, for up to 90 people who need either nursing or personal care and support. These units are Cherry, Holly and Rowan. Care and support for people living with a dementia is provided in Rowan. There were a total of 79 people using the service on the days of our inspection.

Although the service had a registered manager in place at the time of this inspection they were absent from work. 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. We were told the registered manager would not be returning to the service as they had gained a different position within the organisation. A new manager had been recruited to the service and was due to start in January 2017.

During this inspection we found five breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. These related to staffing arrangements in the home, a lack of regular supervision for staff, recruitment processes which were not sufficiently robust, a lack of effective systems to ensure the safe handling of medicines and quality assurance processes which did not drive forward improvements in the service. You can see what action we have told the provider to take at the back of the full version of the report.

Staffing levels had recently increased on Rowan unit following a number of safeguarding alerts raised with the local authority. However we found there was no robust system in place to determine what staffing levels were required and the skill mix needed on each unit to meet the needs of people who used the service.

Although most staff told us they enjoyed working in the home and felt they received good support from senior staff, we found staff were not provided with regular supervision which was a forum to discuss their learning and development needs.

The recruitment process in the service needed to be improved. Additional checks had not always been undertaken when staff had worked previously with vulnerable adults or children to ascertain why their employment in that service had ended. Records did not show that gaps in applicant’s employment history had been explored.

A number of audits had been completed by the provider and internally within the home. These audits had shown that improvements needed to be made to the way the service was run in order to ensure people who used the service always received high quality care. Our findings during the inspection showed necessary actions had not always been completed in a timely manner.

Improvements needed to be made to the way medicines were handled in the service. However, we did not find any evidence that people had not received their medicines as prescribed.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. Staff were able to tell us of the correct action to take should they witness or suspect abuse.

People who used the service told us they felt safe in Old Gates and that staff were always kind and caring. The staff we spoke with had a good understanding of the care and support that people required. They told us, wherever possible, they would support people to maintain their independence.

Care records showed that risks to people's health and well-being had been identified, such as the risk of falls, pressure sores and poor nutrition. Where necessary we saw that people had charts in their rooms to confirm they had received the care they required to reduce the risk of pressure ulcers and poor nutrition. We saw that on Rowan unit these charts had not always been fully completed by care staff or signed by a senior member of staff; this meant we could not be certain people had always received the care they needed.

People were cared for in a safe and clean environment. Procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the premises and the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

Staff received the induction and training they required to be able to deliver effective care. We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. Where necessary applications had been made to the local authority to authorise any restrictions necessary to ensure people received the care they required.

Systems were in place to help ensure people’s health and nutritional needs were met, although one person’s relatives were concerned that a number of health appointments had been missed due to a lack of communication by staff. Records we reviewed showed referrals had been made to specialist services such as dieticians when any concerns were identified. People who used the service told us the quality of the food was good.

Although care records had been regularly reviewed and updated, there was limited evidence that people who used the service or, where appropriate their relatives, had been involved in formal review meetings. However, none of the relatives we spoke with had any major concerns about the care and treatment their family member received.

We saw that concerns had been raised in a number of different forums regarding the lack of meaningful and individualised activities in the service, particularly on Rowan unit. During the inspection we observed a number of activities taking place on Holly and Cherry units. However staff on Rowan were mainly focused on task related interventions with limited 1-1 attention given to people outside of these.

Systems were in place for receiving, investigating and responding to complaints. The provider kept a central record of all complaints in order that any themes and trends could be identified. The two most recent complaints in the service related to staffing levels and communication within the service. All the people we spoke with during the inspection told us they would be confident that any concerns they reported would be listened to and action taken by senior staff to resolve the matter.

This was an unannounced inspection which took place on 6 and 8 January 2016. The service was last inspected in July 2015 when we found it to be in breach of three of the regulations we reviewed; these related to consent to care and treatment, the management of medicines and staffing levels in the service. Following the inspection in July 2015 we issued warning notices in relation to the management of medicines and consent to care and treatment. We also issued a requirement notice in relation to staffing levels in the service. The provider sent us an action plan telling us what they intended to do make the improvements needed. This inspection was undertaken to check whether the required improvements had been made.

Old Gates Residential and Nursing provides accommodation in three units, for up to 90 people who need either nursing or personal care and support. These units are Cherry, Holly and Rowan. Care and support for people living with a dementia is provided in Rowan. There were a total of 64 people using the service on the days of our inspection.

We were aware that, as a result of difficulties in recruiting qualified nursing staff, following the last inspection the provider had reached the decision to suspend admissions to both Rowan and Holly units. During this inspection the registered manager informed us, following a successful recruitment programme for nursing staff, a plan of staggered admissions to these units was now in place.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we found some improvements had been made. However we found a continuing breach of regulations in relation to the management of medicines. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe in Old Gates Residential and Nursing Home. Staff had received training in safeguarding adults. They were able to tell us of the correct action to take should they witness or suspect any abuse had occurred. Staff also told us they would feel confident to use the whistle blowing procedure in the service to report any poor practice they observed.

Staff had been safely recruited. Records we reviewed showed staff had received the induction, training and supervision they required to be able to deliver effective care. Staff told us they enjoyed working in the service and received good support from the registered manager and senior staff. Although we received conflicting information regarding staffing levels in the service, our observations during the inspection showed staff responded to people’s requests for support in a timely manner.

People told us staff were always kind and caring. They told us staff respected their dignity and privacy and promoted their independence as much as possible.

Although improvements had been made to the way medicines were managed in the service, some aspects needed further attention to ensure people always received their medicines as prescribed.

All areas of the home were clean and well maintained. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply. Regular checks were also in place to ensure staff were aware of the action they should take in the event of a fire at the service.

People’s care records contained information to guide staff on the care and support required. The care records showed that risks to people’s health and well-being had been identified and plans were in place to help reduce or eliminate the risk. However, risk assessments for three people on Rowan unit lacked detail about the action staff should take to deal with behaviour which might challenge others. We saw that staff had made referrals to health professionals to help ensure people received effective care.

We saw that arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was aware of the action to take to ensure any restrictions in place were legally authorised under the Deprivation of Liberty Safeguards (DoLS).

We received mixed views regarding the variety and quality of the food in Old Gates Residential and Nursing Home. However, all the people we spoke with who used the service told us they could always request an alternative if they did not like what was on the menu. We observed people received the individual assistance they needed to eat their meals.

A programme of activities was in place to help promote the well-being of people who used the service. Records we reviewed showed people were supported to access activities on both a group and individual basis.

There were effective systems in place to investigate and respond to any complaints received by Old Gates Residential and Nursing Home. All the people we spoke with told us they would feel confident to raise any concerns they might have with senior staff or the registered manager. Results from the provider’s 2015 staff survey showed staff had increased confidence in the leadership of their manager.

There were a number of quality assurance processes in place. These were used to help drive forward improvements in the service.

This was an unannounced inspection which took place on 1 and 7 July 2015. The service was last inspected in July 2014 when we found it to be in breach of three of the regulations we reviewed; these related to consent to care and treatment, the management of medicines and staffing levels in the service. Following the inspection in July 2014 the provider sent us an action plan telling us what they intended to do make the improvements needed. During this inspection we found the required improvements had not been made. You can see what action we told the provider to take at the back of the full version of the report.

Old Gates Residential and Nursing provides accommodation in three units, for up to 90 people who need either nursing or personal care and support. These units are Cherry, Holly and Rowan. Care and support for people living with a dementia is provided in Rowan. There were a total of 70 people using the service on the day of our inspection.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The systems for managing medicines in the service needed to be improved to ensure that people always received their medicines as prescribed. Appropriate action had not been taken to ensure that, where people were unable to consent to take their medicines as prescribed, any decisions made were in line with the Mental Capacity Act (MCA) 2005. This meant there was a risk people’s rights might not be upheld.

Although most staff told us they had completed training in the Mental Capacity Act, care records did not include information about the specific decisions people who used the service were able to make for themselves. Where people were unable to consent to their care and treatment in Old Gates, the legal requirement to ensure any restrictions were legally authorised had not always been adhered to.

Recruitment processes were sufficiently robust to help protect people who used the service from the risks of unsuitable staff. During the inspection people gave positive feedback about the caring nature of staff. However, people also told us there were not always enough staff on duty to provide the care people required. Relatives of people on Rowan unit also raised concerns about the skills and abilities of staff to deal with the needs of people who were living with a dementia. Two staff we spoke with who were deployed to work on Rowan unit confirmed they had not completed training in how best to support people living with a dementia. The registered manager told they would ensure all staff on Rowan unit received this training as a matter of urgency.

All the staff we spoke with during the inspection told us they had received training in safeguarding adults and were aware of the action they should take if they witnessed or suspected abuse. However, from our review of care records we noted a person who used the service had made an allegation of abuse which had not been reported by staff. This meant there was a risk people who used the service might not be adequately protected.

We saw there was a system in place to record the risks people might experience including those relating to falls, poor nutrition and skin integrity. However, we found it difficult to find the most recent assessments on the electronic care records as out of date assessments had not been archived. This meant there was a risk staff might not be aware of the most up to date information relating to people who used the service.

We saw there were risk assessments in place for the safety of the premises and the equipment used by staff. All areas of the home were clean and well maintained. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply to the premises.

There were systems in place to assess people’s health and nutritional needs. However, we found a lack of communication in the service had led to one person not receiving the care and treatment they required in relation to their health care needs.

People who used the service told us staff were kind and always treated them with dignity and respect. This was confirmed by our observations during the inspection. Relatives told us staff would always support people who used the service to be as independent as possible.

Care records had not always been regularly reviewed and updated to ensure they accurately reflected people’s needs. This meant there was a risk staff might not have access to the most up to date information about the care people required.

People told us there were not enough activities in place, particularly for those people living with a dementia. However, we noted the recent recruitment of two activity coordinators should help to ensure a range of activities were provided throughout the service.

There were some opportunities for people who used the service and their relatives to comment on the service provided. However, we found people were not routinely included in reviewing the care they received.

We received conflicting opinions about the leadership in the service. All the people we spoke with who used the service and their relatives were aware of the manager responsible for the unit on which they or their relative lived and were confident to raise any issues with them. However some people were less sure about the identity of the registered manager and one person told us they did not always feel timely action had been taken to address any issues raised.

Most staff we spoke with told us they enjoyed working at Old Gates. However, other staff raised concerns about the culture in the service and told us they did not always feel that their views were listened to or respected.

There were a number of quality assurance measures in place in the service, including audits relating to care plans and medication records. However, these had not been sufficiently robust to identify the shortfalls we found during the inspection.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. During the visit we spoke with 12 people who used the service, four relatives, nine staff, a visiting health professional, the registered manager and the area manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Following the visit we contacted a further three relatives by telephone to ask them their opinion of the home.

Old Gates Residential and Nursing provides accommodation, in three units, for up to 90 people who need either nursing or personal care and support. These units are Cherry, Rowan and Holly. Care and support is also provided for people who have a dementia. There were 82 people living at the home on the day of our inspection.

We received mainly positive feedback about the home from people who used the service, relatives and health professionals. During our inspection we observed good interactions between staff and people who used the service.

People who used the service told us they felt safe and well cared for in the home. We saw evidence of training provided to staff in safeguarding adults. Staff we spoke with were able to tell us appropriate procedures to take if they suspected abuse was taking place and they were aware of the whistleblowing policy for the home.

On the day of our visit we noted standards of cleanliness in parts of the home required improvement, in particular some of the communal bathrooms. However, the home was in a good state of decoration and its layout supported people to maintain their independence and well-being as much as possible as all areas were on the same level.

One person who used the service and their relatives told us there were not always enough staff to meet their needs in a timely way. This view was confirmed by staff on both Cherry and Holly units. There were no issues raised about staffing levels on Rowan unit.

Staff had received training in the Mental Capacity Act 2005. However, not all staff understood the implications of people being subject to the Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS provide legal safeguards for people who may be unable to make certain decisions for themselves.

We looked at nine care records and found, on all of these records, assessments of people’s capacity to make particular decisions were not completed in line with the requirements of the Mental Capacity Act. This is a breach of the regulations as the provider did not act in accordance with legal requirements where people may lack the capacity to make decisions about their own care and support.

Medication risk assessments were not in place on three of the records we looked at in order to provide staff with information as to what they should do if a person refused to take their medicines. Policies and procedures had not been followed to ensure appropriate safeguards were in place when medicines needed to be given in food or drink. This is a breach of the regulations as the provider did not have appropriate arrangements in place for the safe administration of medication.

There were systems in place to provide staff with support, induction, supervision and training. Staff told us they enjoyed working at Old Gates and considered they received the training and support they needed to effectively carry out their role.

People’s health needs were assessed and staff ensured appropriate services were in place to meet these needs, including speech and language therapy and palliative care services. Where necessary, staff provided support to ensure people’s nutritional needs were met.

All the records we looked at showed people’s care plans and risk assessments were updated to reflect their changing needs. Although people who used the service told us they could not recall being involved in reviewing their care plan, they felt the care they received was appropriate to meet their needs.

Staff on two of the units in the home told us they did not always have enough time to respond to people’s needs in a timely manner. We were told that this meant people were not always able to have a bath or shower when they requested it. This is a breach of the regulations as the provider did not ensure that, at all times, there were enough qualified and experienced staff to meet the needs of people who used the service.

Although group activities were provided regularly at the home, we found there was a lack of attention paid to people’s individual social needs.

The registered manager investigated and responded to people’s complaints in line with the provider’s complaints procedure. All the people we spoke with knew how to make a complaint and were confident their concerns would be taken seriously.

There were a number of quality assurance processes in place at the home. The registered manager had also introduced initiatives to develop best practice and consistency in caring for people at Old Gates.

Staff told us they enjoyed working in the home and were always able to approach senior staff for advice or support.

We have identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take in the full version of this report.

During this inspection we spoke with five people living in the home and one visitor. We also spoke with one visiting professional and seven members of staff.

People told us they were happy with the care and support they received. One person said, "They are very good here; they look after me". A visitor said, "I can go home and know they are safe and being looked after; I have confidence in the staff".

We found the service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

Everyone that we spoke with said they enjoyed the food. Comments included, "There is a very good choice of food", "If it's something I don't like they will get me something else without any fuss", "I'm sure I can have anything I like" and "The food is very good; always very tasty". The catering team were aware of people's dietary needs and preferences and were able to provide specialist diets as needed.

All areas of the home were clean and free from offensive odours and there were effective systems in place to reduce the risk and spread of infection. People had access to a range of appropriate equipment to safely meet their needs and to promote their independence and comfort.

We found records were accurately maintained, were held securely and were kept in a way that allowed them to be located quickly when required. There were effective systems to ensure all records were accurate and fit for purpose.

During our inspection visit we spoke with six people living in the home and seven visitors. They told us they were happy with the care and support they received. Comments included, "I generally look after myself but they always ask if they can do anything to help me" and "It's alright here". We observed staff treating people in a friendly and respectful way and people being offered choices and being supported in a way that respected their privacy and encouraged their independence.

People told us there were sufficient numbers of staff on Cherry House and Rowan House (residential and dementia). However there were differing opinions about the availability of staff on Holly House (nursing). Comments included, "The care is good; I can't complain. But the staff are very busy, particularly at mealtimes, which means people have to wait until staff are free" and "There seem to be enough staff around if help is needed". We spoke with the manager who had already taken action to improve staffing levels and would keep them under review.

We spoke with four staff. We found all staff received a range of appropriate training to keep them up to date and to give them the necessary skills and knowledge to look after people safely and properly.

Staff told us that they were aware of safeguarding issues and the process for reporting any concerns. Staff said they were supported and able to communicate with management on a regular basis to help meet the needs of people who used the service. Staff said their numbers had increased and were able to meet the needs of people who used the service and felt less under pressure to carry out their tasks.

The person in charge said the new management team were conducting good quality assurance audits to ensure the better standards attained could be maintained.

People who used the service said they had choices to help retain some individuality. People said personal care was undertaken privately to help maintain their dignity. People said they felt safe and felt able to voice any concerns they may have. People thought staff were good and provided in sufficient numbers to meet their needs. People who used the service said they were consulted about care and life at the home to provide a suitable service.

People told us they received the care they wished. Staff were described as nice and caring. People were treated with privacy and dignity and therefore felt comfortable with the personal care they received. Plans of care informed staff of the care needs of each person but needed to include the end of life wishes to ensure they recieved the care they required at this difficult time.

Staffing was appreciated but sometimes people had to wait for the care they needed. People told us they felt safe and were confident to raise any concerns they may have.

Staff told us they felt supported but they would provide a better service if there were more to meet the needs of service users.

Management had devised a plan and this told us how they intended to improve the service over the next few weeks.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Old Gates Care Home

All Inspections

12 December 2016

During a routine inspection

6 and 8 January 2016

During a routine inspection

1 and 7 July 2015

During a routine inspection

17 and 18 July 2014

During a routine inspection

14 November 2013

During a routine inspection

15 February 2013

During a routine inspection

26 October 2011

During an inspection looking at part of the service

7 July 2011

During an inspection in response to concerns

Reports under our old system of regulation