St Mary's Gate is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, both of which we looked at during this inspection supporting four people living with profound learning disabilities and complex needs. At the time of this inspection, there were three people living at the home.

St Mary's Gate is located in a residential area of Euxton near Chorley. The home is within easy reach of the town centre and transport links can be accessed without restrictions. The home has living accommodation, a large dining area, a domestic kitchen and utility room used as a laundry. The home has four suitably adapted bedrooms and a bathroom. The home is a bungalow so access is only required to the ground floor level.

There was a registered manager for the home. 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 the last inspection on 22 December 2016, we found that the provider needed to take action to ensure the people in the home were protected in the event of a fire, and that the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection in March 2018 we found that following a visit from the Lancashire Fire and Rescue Service and discussions with the housing landlord, improvements to the fire safety system had been made, and the service was no longer in breach of the regulation.

At the last inspection on 22 December 2016, we found that the provider needed to take action to ensure the people in the home were protected at night as there was only one member of staff on duty. Immediately after the inspection, the night time staffing arrangements increased. This ensured people were now better supported as some of the care they received requires two members of staff.

People who used the service received an excellent personalised service that met their individual needs and preferences. People were at the centre of how their service was run and were fully involved in the planning and developing of the service. Staff used innovative ideas and actions to improve people's quality of life and to give them outstanding opportunities in daily life. People were supported with meaningful activities which supported their well-being and encouraged them to access the local community.

The provider had effective systems in place to ensure there was always the correct amount of staff with the appropriate skills and training needed to provide safe care for people. There was a structured induction program to ensure staff developed the skills needed to work for the provider and on-going training was in place that ensured staffs skills remained up to date. Staff were provided with support from their line manager to ensure they were working in line with best practice. Recruitment processes ensured staff were safe to work with people at the home.

Risks to people were managed and care was planned to keep people safe. The registered manager had submitted appropriate applications under the Deprivation of Liberty Safeguards (DoLS) to ensure people's human rights were protected. People's abilities to make choices were respected and where needed decisions were made in people's best interests. Risks to people were identified and appropriate action taken to keep people safe.

People's medicines were available to them when needed and stored safely. Appropriate support was provided, and advice taken to ensure that people's nutritional and hydration needs were met.

Staff were kind, caring and knew how to personalise care to meet people's i

We inspected this home on the 6 and 7 of October 2016. The provider was told 24 hours before we visited that we would be inspecting the home. This was so that we could ensure staff and people who lived there would be available during our inspection.

St Mary’s Gate is a residential care home supporting four ladies living with complex needs. St Mary’s Gate is located in a residential area of Euxton near Chorley. The home is within easy reach of the town centre and transport links can be accessed without restrictions. The home has living accommodation, a large dining area, a domestic kitchen and utility room used as a laundry. The home has four suitably adapted bedrooms and a bathroom. The home is a bungalow so access is only required to the ground floor level.

The home was last inspected in January 2014 under the Care Quality Commission’s old methodology. This is the first comprehensive inspection looking at all 16 regulations. The home met the standards of the five regulations inspected in 2014.

At this inspection we found staff approached their job with enthusiasm and optimism. People they supported were treated with kindness and respect. Staff were mostly of a similar age to the current ladies who lived in the home, which allowed for a mutual sharing of age related culture, fashion and interests.

We found the home managed people’s medicines safely and undertook risk assessments to ensure people were safe day to day and whilst they undertook the varied activities people were involved with. However, we found that more action was needed to ensure people and staff were safe in the event of an emergency. This included better systems to manage the safe evacuation of the building.

The home assessed people’s needs and any associated risks and managed these safely. However we found that assessments and decisions required under the Mental Capacity Act (2005) were not consistently completed.

We had some concerns around the staffing compliment at the home. This was specifically when people were left with just one carer. We did not think the risks of this had been appropriately assessed. Risks included people potentially having to wait to receive care and support which required two staff, risks in the event of an emergency and also risks associated to a situation happening through the night. Incidents could occur through the night which would result in more than one staff member being required. This could include someone form the home having to attend hospital or someone could need additional support. We have recommended the provider completes a thorough risk assessment on the current staffing deployment and ensures these risks are managed appropriately.

Staff were recruited safely to their role and peoples’ circumstances were considered when making appointments. The provider took steps to ensure staff were suitable for the role including sourcing appropriate references and checking potential staff criminal histories. However, we have recommended the provider develops procedures to assess the ongoing suitability of staff. This will help ensure people are always kept safe and supported by suitable staff.

Information was available for staff on how to support people in the home. We found for one person this information was easily accessible and included all assessments and plans to support the individual in one place. For others information was in different places. We acknowledged this was due to the recent implementation of an electronic support planning system; however we have recommended the provider spends some time to ensure the support plans include all the required information about the person to be supported. This would ensure all staff have easy access to the information they need to support people.

People who lived in St Mary’s Gate were supported to engage with all aspects of managing their day to day lives, including accompanying staff when completing domestic chores, to shopping for groceries and completing bankin

People who lived at the home did not give us specific feedback but we saw they appeared content and comfortable in their surroundings and obviously got along very well with their support staff. Each resident was engaged in activities of their own choosing, which included pamper sessions and various activities.

We heard staff constantly offering choices to residents such as what to eat and where to sit. We noted staff approached residents in a kind and respectful way and residents responded positively.

The environment was very homely and comfortable. Some residents allowed us to have a look in their bedrooms and we saw these were very nicely decorated and personalised with pictures, posters and other such personal possessions.

During this inspection we assessed standards relating to people’s care, welfare and medication management. We also looked at arrangements for staff training and processes used by the provider for monitoring quality within the service. We found evidence that the home was compliant in all the areas we inspected.

At the time of our Inspection there were four people living at St Mary's Gate of which only one was present during our visit. None of the people living there were able to express their views on the service but we were able to speak to a number of relatives, speak to staff and capture people's experiences through observing practices and looking at care records.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. Staff were observed to be patient, calm and treated people with dignity at all times. One relative described the service as follows, "_____ is very happy, everyone is treated with respect. Staff are very good, if a little loopy at times, which is great"! Another said, "Nothing gets unchecked or unresolved. We looked at a lot of places, this is by far the best from our point of view, it is fantastic".

From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop. At all times during our visit staff were seen to be treating people with dignity and in a person centred way that ensured users of the service were happy with the care and support received.

At the time of the inspection there were three people living at the home. Whilst they were not able to comment specifically on standards at the home we saw that they appeared content and comfortable in their surroundings.

Residents clearly got along well with their support staff and appeared relaxed in their presence.

We spoke with some parents of people who live at the home and received some very positive feedback. People expressed satisfaction with all aspects of the service provided and told us they felt the standards at the home were extremely high.

People felt that the staff fully understood their loves ones’ needs and were able to meet them. One parent said, ‘’They (the staff) have taken an awful lot of time to get to know (name removed). They take time to listen and always ask me what I think.’’

Parents were fully aware of care plans and one parent went through her daughter’s care plan with us, showing us the different areas and explaining how she had been involved throughout the care planning process.

People spoke very highly of staff, describing them as professional, competent, kind and caring. One person commented, ‘’You could not choose better people, they are everything you would want them to be.’’ Another parent said, ‘’I am so impressed with everything at this home, but the one thing that really stands out is the attitude of the staff – they are excellent.’’