Gate House provides care and accommodation to seven adults with mental health problems. At the time of our inspection there were five people using the service.

This unannounced inspection was carried out on 08 August 2017. The last inspection of the service took place on 22 May 2015 at which time they were rated ‘Good’. At this inspection the rating remained ‘Good’.

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. 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 felt safe living at the home. Staff were knowledgeable on the types of abuse and the signs to identify them. They also knew how to report any concerns in order to protect people they supported. Staff told us they were confident that concerns reported would be promptly addressed; but were aware to whistle blow if not. There were sufficient numbers of staff available on duty to meet people’s needs. Risk management plans were in place to respond to identified risks to people. These ensured people’s health and well-being were promoted. People received their medicines safely. Medicines were managed safely in line with good practice including receiving, storage, administration, recording and disposal.

Staff received up to date training to do their jobs effectively. Staff told us they received support and supervision to meet the needs of people. These took place in the form of team meetings, handovers, and formal and informal conversations. However, we saw that regular structured one-to-one supervisions did not take place regularly.

The service worked well with other health and social care professionals, including the community mental health team (CMHT). Professionals we spoke with told us staff understood the needs of people and how to support them in accordance with their needs. People were supported to go for their medical appointments to ensure any changes in health care were managed. People had access to food and drink throughout the day and staff supported them to prepare food to meet their requirements.

People consented to their care and support before it was delivered. Staff respected people’s day-to-day choices and decisions about their lives. People were not restricted or deprived of their liberty. We saw people go out and return from the service as they wished. The registered manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People continued to be treated well and respected by staff. People told us staff were kind and polite towards them. Staff supported and cared for people in a way that maintained their dignity and independence. People were supported to keep in contact with relatives and friends. They were also supported in their religious and cultural beliefs.

People were encouraged to maintain their independence. They were supported to engage in meaningful activities of their choice, and took part in educational occupational activities to develop their skills and keep them occupied.

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People’s individual needs had been assessed, planned and delivered in accordance with their wishes. Staff understood people’s needs and preferences, and provided appropriate support accordingly. People’s needs were reviewed regularly with them and their care coordinator to ensure it reflected their present situation.

The provider held regular meetings with people and staff to listen to their views and to consult with them about various matters affecting the service. People knew how to complain if they were unhappy with the service. There were systems in place to monitor and assess the quality of service provided.

This unannounced inspection took place 22 May 2015. The service provides care and accommodation to seven adults who have experienced mental health problems. At the time of our inspection there were five people living at the home.

The service did not have a registered manager. The manager had submitted their application to be registered as the manager of the home with the Care Quality Commission. 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 last inspection of the service was on 3 October 2013. We found the service met all the regulations we looked at.

At this inspection we found there were tools used to monitor and assess the quality of service provided. However, these had not been used for over one year.

People told us that the home was a comfortable place to live. They said staff treated them with respect and dignity. Care records confirmed that people had been given the support and care they required to meet their needs. Safeguarding adults from abuse procedures was in place and staff understood how to safeguard the people they supported from the risk of abuse. Staff told us they were supported to do their jobs effectively. There were sufficient numbers of staff on duty to meet people’s needs.

People’s individual care needs had been assessed and their support planned and delivered in accordance to their wishes. People and their relatives were involved in reviewing their support to ensure it was effective to meet their needs. Risks to people were assessed and a management plan put in place to ensure that they were protected from risks associated with their support and care.

People received their medicines safely and medicines were managed in line with the provider’s medicines policy and procedure. The service worked effectively with other health and social care professionals including the community mental health team (CMHT). People were supported to attend their health appointments and to maintain their health.

People’s choices and decisions were respected. People consented to their care and support before it was delivered. People told us they had the freedom to do whatever they wished without restrictions. The registered manager understood their responsibility under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to ensure that best interests’ decisions were made for those who lacked the mental capacity to make such decisions; to ensure people were not unlawfully deprived of their liberty.

People were provided with a choice of food, and were supported to eat their meals when required.

People were encouraged to follow their interests and develop new skills. There were a range of activities which took place within and outside the home. People were encouraged to be as independent as possible.

The home was clean and well maintained. Health and safety checks were carried out regularly to ensure the home was safe.

The service held regular meetings with people to gather their views about the service provided and to consult with them about various matters. People knew how to make a complaint if they were unhappy with the service or the care they received

We completed a follow up inspection to the service by unannounced visits to the service on 1st and 10th October 2013. This was because at the previous inspection on the 14th May 2013 we found that medicines storage arrangements were not safe and secure, and the environment was not always suitably and adequately maintained. At this inspection, we saw new locks were supplied on the medicine cabinet which made them secure. We saw that new flooring was supplied to replace old and worn carpets and the environment was clean and maintained to a satisfactory standard.

On 14th May we also found that people were not fully protected from the risks of unsafe or inappropriate care and treatment because there were some inconsistencies in recording. On this inspection we examined records, and spoke with external mental health professionals. The professionals we spoke with told us people using the service progressed well from the support received and that documentation presented was generally satisfactory. On this inspection we saw that record keeping had improved and become more consistent.

During our inspection we met with five people living at Gate House; all of them told us they saw Gate House as their home. We saw friendly, professional and personal interactions between staff and people using the service, and there was a relaxed atmosphere at the home.

We found that people’s needs were assessed and that their care was planned and delivered in line with their individual care plans. People told us they were supported to understand their health needs; to maintain their health and take their medications. People said there were always staff available if they needed help or support, and that they met with their key workers regularly. One person told us, “my key worker is very good, she helps me”.

At our previous inspection on the 16 and 17 January 2013 we found that appropriate medicines storage arrangements were not in place which fully protected people against the risks associated with medicines and that the environment was not always suitably and adequately maintained. At this inspection, we found that some, but not all, improvements to the safety and suitability of the premises and to medicine storage had been made, and that further improvements were required.

We also found that people were not fully protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

Gate House had a friendly and relaxed atmosphere. We saw positive professional and personal interactions between staff and people using the service. People told us that they saw Gate House as their home.

People expressed their views and were involved in making decisions about their care and treatment. Their personal needs and preferences were respected.

People using the service and family members had been asked for their feedback on the quality of the services provided at Gate House. One family member said, “the staff are always kindly and respectful…. People get all the help they need”.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

A person using the service told us, “the staff here are lovely. They got me well.” Another said, “I’ve got no problems with staff support for my medication and health”.

However, during our inspection we found that appropriate medicines storage arrangements were not in place to protect people against the risks associated with medicines.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises. There was a problem with the electrical installations, and no evidence of in-date electrical or gas installation or safety tests.