The Gatehouse

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.

The Gatehouse is registered to provide residential care for up to 31 older people. Thirty people were using the service when we inspected.

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

People received exceptionally caring support from staff who were kind, compassionate and thoughtful. There was an extremely strong person-centred culture within the service. Staff consistently recognised what was important to people and provided outstanding, caring support to help them meet their needs. People felt empowered to express their wishes and views knowing staff would respond with compassion and kindness. Staff consistently treated people with dignity and respect.

Staff were safely recruited and enough staff were deployed to meet people’s needs. People were supported by staff who understand their needs and how to safely support them. Care plans and risk assessments were regularly reviewed and updated to make sure staff had up-to-date information about people’s needs. People received safe support to take their prescribed medicines.

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. We made a recommendation about reviewing how people's mental capacity, consent to care and the need for DoLS were explored and recorded.

Staff provided effective care to meet people’s needs. They received an induction, regular training and had supervisions, appraisals and competency checks to support them to provide effective care. Staff felt supported by management and encouraged to learn and develop in the role. Staff worked closely with healthcare professionals to make sure people received effective care if they were unwell.

People praised the variety and quality of food provided. Drinks and snacks were readily available and staff provided effective care to monitor and make sure people ate and drank enough.

The environment was very warm, welcoming, clean and safely maintained. We spoke with the registered manager about regularly checking window opening restrictors were in safe working order and they acted to address this.

Staff understood people’s communication needs and used accessible information to help people be involved in decisions.

People were supported to take part in a wide range of activities and there were regular opportunities for meaningful stimulation. The provider was responsive to feedback and had systems in place to manage and respond to any complaints.

There was strong organisation and leadership within the service which promoted a person-centred culture and focussed on providing high-quality care to meet people’s needs and improve their quality of life. People told us management were approachable and supportive. Regular audits helped management monitor the quality and safety of the service and to identify where improvements could be made. There was a strong focus on continually learning and improving the service.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

At the last inspection service was rated good (report published 24 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

This inspection took place on 14 March 2017 and was unannounced, which meant the registered provider did not know we would be visiting the service.

The Gatehouse is registered to provide personal care and support for up to 31 older people. It is a large converted and extended, detached property, previously a private residence and is located in a residential area of Harrogate. The home is set in attractive grounds. A range of local amenities are a short walk away, including the Valley Gardens. The Gatehouse is approximately one mile from the town centre. All of the bedrooms are equipped with en-suite facilities. There is a passenger lift.

The home provides accommodation over three floors. There are bedrooms and bathrooms on the first and second floors, with a hairdressing area on the second floor. People have access to a communal dining room, lounge and various seating areas on the ground floor. There was also access to an enclosed garden area which people and their relatives enjoyed. At the time of our inspection there were 30 people living at the home.

There was a registered manager in post. 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.

There was an open welcoming atmosphere on entering the premises. All areas within the home had been designed for the needs of the people and planned works to some of the bathroom areas will enhance the facilities available. We observed that this was a safe home with a well-designed system enabling staff and visitors to move freely within the home.

The registered manager and registered provider were inspiring and committed to providing care, which met the highest of standards. They strived for excellence through consultation; they were passionate and dedicated to providing an excellent service for people. They led with a dynamic approach and continually reflected on how to improve the service further. They demonstrated a strong and supportive leadership style, seeking feedback in order to further improve what was offered. The registered provider's vision and values were understood and shared across the staff team, and they were fully supportive of development plans. The culture of the service was open, transparent and progressive. All the staff were committed to continuous improvement of the service and individual care.

People's care plans were tailored for them as individuals with the involvement of their families at all stages. People were cared for by staff that knew them well and understood how to support them to maximise their potential. People's progress was monitored and any changes in their circumstances or health were promptly acted upon. Staff looked for opportunities to offer to people that would help them retain their independence.

People, staff, relatives and a healthcare professional gave us positive comments about the service and what it provided. Staffing levels were adequate to meet people’s needs. New staff were recruited in a safe way; all checks were in place before they started work and they received an induction. A programme of training was in place to make sure staff were competent in their work.

Activities were meaningful to people and designed around people's own interests. Staff ensured people received a nutritious, balanced diet. People who required it were supported to eat their meals. People told us they were given enough to eat and drink.

Staff made sure risk assessments were carried out and took steps to minimise risks without taking away people’s right to make decisions. There was a system of audits, checks and analysis to identify shortfalls and to rectify them so as to continually improve and develop.

Staff demonstrated an in-depth awareness of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DOLS).

Medicines were administered safely.

There was a procedure in place to deal with complaints. However, there had been no complaints in the last two years.

We found people looked well cared for and relatives told us they thought people were treated well and their experiences in the home were positive. We observed the care staff being kind and respectful to people. One visitor said 'My relative has not been here very long,but I have only seen kindness and respect,towards the people who live here.'

We looked at people's care records and saw arrangements were in place to identify those people at a greater risk of poor nutrition and dehydration.

Medicines were prescribed and given to people appropriately; we saw people were given the right medicine, in the right way and at the right time on the day of our inspection.

Staff we spoke with told us they received training which helped them to deliver care and support safely.

The provider had systems in place to identify, assess and manage risks to the health, safety and welfare of people using the service. This meant people who lived and staff who worked here were protected from potential risks to their well-being.

People told us they received the care and support they wanted to receive and could live the life they chose. People said 'The staff are very good they are here when needed.' And 'The staff listen to you and deal with my needs.' People's needs were being met.

We were told by everyone we spoke with that they could raise any issues and felt these would be dealt with. People said they felt safe. One person said 'If I were abused verbally I would say.' Another person said 'I feel safe here.'

People said they were supported by staff in a timely way because there was enough staff on duty to look after them. One person said 'Staff are available when I press my buzzer.' Another said 'I am very sure the staff know what they are doing.'

The quality of the service was being monitored by the manager. Any issues found were acted upon to ensure people living at the home remained happy with the service they received. People said 'On the whole I am happy here. This is the place to be. We get an excellent quality of service. They are wonderful from the bottom to the top.'