Background to this inspection
Updated
27 October 2021
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 Care Act 2014.
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 two inspectors.
Service and service type
Gate House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with seven members of staff including the nominated individual, registered manager, operations manager, senior care workers and care workers. We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
27 October 2021
About the service
Gate House is a residential care home providing accommodation and personal care to four people with a learning disability at the time of the inspection. The service can support up to seven people.
People’s experience of using this service and what we found
People were not protected from harm and were at risk of abuse from other people and staff. People had been unlawfully restrained by staff. Staff did not have the skills or competencies to support people when they were distressed or to support them proactively to manage their behaviours. Incidents were not reported to the relevant professional stakeholders. The provider had failed to introduce additional measures to reduce repeated incidents or learn lessons. The registered manager and provider had poor oversight of incidents and had allowed people to be harmed by one another and staff.
There was a poor culture within the service which was not person centred. People were restricted in their home, for example they were not allowed in certain areas of their home and could only have snacks at specific times of the day. Staff, the registered manager and provider were not open, honest or transparent when things went wrong. The registered manager and nominated individual failed to meet their regulatory requirements.
People’s views had not been sought since they moved into the service, they were not encouraged to plan their care or make decisions about the service. The providers systems for overseeing the service were ineffective and not robust.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
The model of care setting did not maximise people’s choice, control and Independence.
Right care:
Care was not person-centred and did not promote people’s dignity, privacy and human Rights.
Right culture:
Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services could lead confident, inclusive and empowered lives.
This meant people were placed at harm; had unnecessary restrictions placed on them and did not receive person centred care. The provider had not acted or taken any measures to mitigate the risk of harm to people or support people to live with choice or independence.
Following this inspection we worked closely with Local Authorities to ensure people were safeguarded from on-going harm. Three people were supported to move out of Gate House. There is currently no one living at Gate House.
Immediately following this inspection the nominated individual of this service changed.
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 13 December 2019).
Why we inspected
We received concerns in relation to incidents and allegations of abuse. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gate House on our website at www.cqc.org.uk.
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 coronavirus and other infection outbreaks effectively.
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, safeguarding, staffing, good governance, and notifications of other incidents at this inspection.
Following the inspection, we took immediate action to restrict admissions to the service. We took action against the provider and cancelled their registration at Gate House. Everyone moved out of the service and Gate House is now closed.