Gateway Care Services

Gateway Care Services is a domiciliary care service that provides care and support to people living in their own houses or flats in the community. At the time of our inspection, 33 people were using the service. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Risks to people’s health and safety were not effectively assessed or guidance available to reduce possible risks and maintain people’s safety. Medicines were not always managed safely. Aspects of people’s care records were not person centred and did not reflect the appropriate support in accordance to people’s needs. The current systems in place were not effective enough to assess and monitor the quality and safety of the services being provided to people.

The service had safeguarding procedures in place. Appropriate recruitment checks had taken place before staff started work; however, some improvement was needed to ensure references obtained for staff were robust. There were enough staff available to meet people’s care and support needs. The service had procedures in place to reduce the risk of infections.

People’s care and support needs were assessed before they started using the service. Staff were supported and received training. We have made a recommendation about staff performance and development. People were supported to maintain a healthy balanced diet and had access to health care professionals when they needed them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's privacy, dignity and independence was promoted. People and relatives told us staff were kind and caring.

People and relatives spoke positively about the service and said they felt safe. The service had a complaints procedure in place. No one at the service was receiving end of life care.

The service sought the views of people and their relatives. The service worked in partnership with health and social care providers to plan and deliver an effective service.

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 12 October 2021).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gateway Care Services on our website at www.cqc.org.uk.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to assessing risk, medicines management and good governance.

Please see the action we have told the provider to take at the end of this report.

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.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is to help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People received care and support which was safe and personalised to their needs. Staff understood their responsibility to protect people from the risk of abuse and to report any concerns to their line managers. Risks to people had been identified, assessed and managed and staff protected people from the risk of infectious diseases. People were supported to take their medicines safely and there were enough staff deployed to support people’s needs. The service carried out appropriate pre-employment checks before staff began working and lessons were learnt from accidents and incidents to prevent repeat occurrences.

Before people started using the service, their needs were assessed to ensure they could be met. People received care and support from staff who had been supported through induction, training, supervision and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to maintain good health; eat healthily and access healthcare services when required.

People knew how to make a complaint if they were not satisfied with the quality of care provided. People's communication needs had been assessed and met and people were involved in making decisions about their care and support needs.

People spoke positively about the service and told us it was well led. The service had effective systems in place to assess and monitor the quality and safety of the service. People, their relatives' and staff views were sought to improve on the quality of care and support provided. The service worked in partnership with key organisations to plan and deliver an effective service.

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 requires improvement (published 10 May 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out an announced comprehensive inspection of this service on 9 and 11 January and 15 February 2019, where breaches of legal requirements were found. We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gateway Care Services on our website at www.cqc.org.uk.

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.

Gateway Care Services is a domiciliary care agency. It provides personal care and support to people in their own homes. Not everyone using the service may receive the regulated activity; personal care. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the time of our inspection the service did not have a registered manager in post. 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.

At this inspection we found breaches of legal requirements because risks to people's health and well-being were not always managed safely and the provider did not have comprehensive robust systems in place to monitor the quality and safety of the service provided to people. You can see the action we have told the provider to take at the back of the full version of the report.

We have also made a recommendation to the provider about the correct completion of mental capacity assessments in line with the codes of practice and principles of the Mental Capacity Act 2005.

Assessments were conducted to identify, assess and manage risks to people’s health and well-being. However, assessments were not always detailed or provided guidance for staff on how to support people to manage identified risks and this required improvement. There were no systems in place to check when a call was recorded as being missed or late, that staff had attended the call and people had received the support they needed. Medicines were not always managed safely. Staff reported accidents and incidents when they occurred, and these were recorded on the provider’s electronic care planning and monitoring system. However, there was no system of oversight regarding accidents and incidents when they occurred. This meant that trends were not identified so that appropriate action could be taken to reduce the reoccurrence of risk.

Care staff were aware to seek consent from people when offering them support and demonstrated a good understanding of the Mental Capacity Act 2005. However mental capacity assessments were not completed in line with the codes of practice and principles of the Mental Capacity Act 2005. Although the provider did offer new staff the opportunity to shadow more experienced staff members before starting to work with people, they had not yet introduced best practice induction training, in line with the Care Certificate and this required some improvement. Some people were living with diabetes, Parkinson’s or a learning disability and staff had not received training in these areas and this required some improvement.

Although complaints received were recorded and responded to, there were no documented outcomes or learning going forward regarding complaints and this required improvement. Care plans were not always reflective of individuals physical, mental, emotional or diverse needs in line with the protected characteristics of the Equality Act 2010.

There were policies and procedures in place to safeguard people from possible harm or abuse. Staff understood their responsibilities to safeguard people and knew how to report any concerns. There were arrangements in place to deal with emergencies and infection control. There were consistent levels of staff who provided regular care to people. There were robust staff recruitment practices in place.

Staff told us they felt supported in their roles and received regular supervision. Assessments of peoples’ care and support needs were conducted before they started using the service and peoples’ nutritional needs were met where this was part of their plan of care.

People told us that staff treated them with respect, supported their independence and maintained their privacy and dignity. Staff were knowledgeable about people's needs and understood how best to support them to meet their needs. People told us they were involved in planning and reviewing their care and support and were provided with information. Care plans were reviewed on a regular basis. People and staff told us they had access to equipment to meet their needs when required.

People and staff spoke positively about the management of the service. Staff confirmed that they attended regular team meetings and had the opportunity to discuss areas which effected their work and the service. There were systems in place to gather feedback from staff, people and their relatives where appropriate. The service worked with external organisations including health and social care professionals to ensure people’s needs were met.

At our last comprehensive inspection on 28 February and 1 March 2017 we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not always managed staff rostering and call monitoring effectively. At this inspection we found that the provider had made some improvements. However, the systems for monitoring and improving the quality and safety of the services provided to people required further improvement to ensure these were effective.

The service had a registered manager in post. 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.

People told us they felt safe with the staff. The service had clear procedures to recognise and respond to abuse. All staff had completed safeguarding training. Risk assessments for people were in place, which provided sufficient guidance for staff to minimise identified risks. The service had a system to manage accidents and incidents to reduce recurrences. People were protected from the risk of infection.

The service had enough staff to support people and satisfactory background checks were carried out for staff before they started working. The service had an on-call system to make sure staff had support outside office working hours. Staff supported people so to take their medicines safely. The service provided an induction and training, and supported staff through regular supervision, appraisal and spot checks to help them undertake their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. People consented to their care before it was delivered. The provider and staff understood their responsibilities within the Mental Capacity Act 2005.

Staff supported people with food preparation. People’s relatives coordinated healthcare appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

Staff supported people in a way which was caring, respectful, and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date.

The service had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. The service sought the views of people who used the services. Staff felt supported by the provider. The provider worked in partnership with health and social care professionals.

We had carried out an announced comprehensive inspection of this service on 05 and 06 October 2016, at which breaches of legal requirements were found. This was because medicines were not safely managed and risks to people had not always been adequately assessed. These issues placed people at risk of unsafe care. We also found that the provider did not have effective systems in place to monitor and improve the quality of the service. The provider had failed to submit notifications to Care Quality Commission (CQC) as required by the regulations.

After the comprehensive inspection, we took enforcement action and served a warning notice and requirement notices on the provider and registered manager requiring them to comply with the regulations. We also asked the provider for an action plan to address the less significant breaches found.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Gateway Care Services' on our website at www.cqc.org.uk.

At this inspection we found that the provider had taken appropriate actions to ensure compliance with the regulations. Medicines were safely managed and people's records contained full medicines lists and appropriate guidance on how to support people. Risks to people had been adequately assessed and reviewed, with appropriate risk management plans in place to mitigate future risks. The provider had made appropriate notifications to the CQC since the last inspection, and the registered manager understood when notifications should be made.

We noted the service had made improvements in the systems used by the provider to assess and monitor the quality of the care people received. This included unannounced spot checks at people’s homes and audits covering areas such as accidents and incidents, care plans, risk assessments, management of medicines, and staff training. The service sought the views of people who used the services.

However, we found the system for monitoring visits to people to ensure they received visits at the correct times was not robust. The scheduling of staff to visit people’s homes was not well managed and feedback from people following a survey carried out in December 2016, the provider had analysed the findings but had not taken action to resolve the identified concerns.

These issues were a continuous breach of Regulation 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

You can see the action we have asked the provider to take in respect of the above breach of regulations at the back of the full version of this report.

The deployment of staff to meet people needs required improvement. Staff rostering records showed that the provider had not always allowed enough time for staff to travel between calls. The service had an on call system to make sure staff had support outside the office working hours. However, a relative told us the weekend out of office service was not robust.

The service had a registered manager in post. 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.

People and their relatives told us they felt safe with the staff. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. The service had a system to manage accidents and incidents to reduce reoccurrence.

The service provided induction and training, and supported staff through regular supervision and annual appraisals to help them undertake their role. The service carried out satisfactory background checks of staff before they started working.

People’s consent was sought before care was provided. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and acted according to this legislation.

Staff supported people with food preparation. People’s relatives coordinated health care appointments to meet people’s needs, and staff were available to support people to access health care appointments if needed.

The service involved people about their care and support needs. Staff supported people in a way which was caring, respectful, and protected their privacy and dignity. Staff developed people’s care plans that were tailored to meet their individual needs. Care plans were reviewed regularly and were up to date.

The service had a clear policy and procedure for managing complaints. People knew how to complain and would do so if necessary. Staff felt supported by the registered manager.

At our inspection on 24 and 25 September 2015, we found the arrangements for the safe management of medicines for people using the service were not robust. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The provider sent us an action plan telling us how they would address these issues and when they would complete the action needed to remedy the concerns.

At this inspection we checked to see if these actions had been completed. We found that staff had received appropriate medicines training; however staff had not been assessed to ensure their competence to administer medicines. There was no medicine plan or list of prescribed medicines in people’s care plan’s relating to the period covered by the MAR charts. The service had not carried out assessments of people who were self-medicating in line with the provider’s medication policy, to ensure that medicines were safely managed.

The provider had identified potential risks to people but had not put in place risk management plans to mitigate the risk for people using the service.

These issues were a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

We took enforcement action following this inspection and served a warning notice on the provider in respect of the most serious breach requiring them to become compliant with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also asked the provider for an action plan to address the less significant breaches found.

You can see what action we took at the back of the full version of this report.

The provider had not notified the Care Quality Commission (CQC) of safeguarding allegations as required.

This was a breach of Regulation 18 of the Registration Regulations 2009.

The service did not have an effective system in place to regularly assess and monitor the quality of services people received or the improvements required.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

The service had not carried out satisfactory background checks for all staff before they started working, and this required improvement.

There were sufficient numbers of staff to meet the needs of people.

There was a registered manager in post. 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. 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.

People and their relatives felt safe using the service. The service had clear procedures to recognise and respond to abuse. All staff completed safeguarding training. The service had a system to manage accidents and incidents to reduce reoccurrence.

Staff were supported through regular supervision, annual appraisal and training programmes.

People’s consent was sought before care was provided. Where the provider considered people did not have capacity they had followed best interest decision making processes.

Staff supported people to eat and drink sufficient amounts to meet their needs. People’s relatives coordinated health care appointments and health care needs, and staff were available to support people to access health care appointments if needed.

Staff supported people in a way which was caring, respectful, and protected their privacy, dignity, and human rights.

The provider had carried out, collaboratively with the relevant person, an assessment of the needs and preferences for the care and treatment of people. People and their relatives, where appropriate were involved in the assessments and development of people’s care plans.

The service had a clear policy and procedure about managing complaints. People knew how to complain and would do so if necessary.

People and their relatives commented positively about staff and the service. The service had some good practices in relation to quality assurance of the service.