CQC report explained · a residential care home
What the CQC found at Pathway House
Rated Outstanding: inspectors found the home performing exceptionally well.
What inspectors found, October 2021
Requires Improvement; inspectors found kind staff and safe medicines support, but short staffing, poor cleanliness and weak checks limited people's choices and dignity.
This was an unannounced focused inspection on 16 August and 1 September 2021. Inspectors spoke with people, relatives, staff and other professionals. They reviewed care, medicine, recruitment, incident and management records.
The home was rated Requires Improvement overall. Safe, Responsive and Well-led were each rated Requires Improvement. Inspectors found that staffing shortages sometimes stopped people going out or taking part in activities they preferred. Communication methods in support plans were not always used in practice.
Some areas were dirty and mouldy food was found in a kitchen. Checks had not identified these problems or other shortfalls. Incident records, including records about physical restraint, did not always explain what had happened or what had been learned.
Inspectors found positive relationships between staff and the people living there. People felt safe, staff knew them well, medicines were managed safely and infection control measures for COVID-19 were in place. The rating had fallen from Good at the previous inspection, published on 31 January 2018.
Kind relationships
People appeared happy and relaxed with staff. Staff knew people's likes, dislikes and individual needs.
“People were relaxed and appeared happy being supported by the staff team.” from the report
Detailed support plans
Support plans gave staff clear information about people's preferences and how to support them.
“Support plans were very detailed and gave a clear overview of how to support people in line with their preferences.” from the report
Medicines support
Staff who supported people with medicines were trained and had their competence checked. Medication protocols were in place.
“People were supported with their medicines by staff who had received training and regular competency checks to help ensure that this was done safely.” from the report
Short staffing reduced choice
needs fixingThe home regularly ran short of staff. Although inspectors found staffing levels were safe, people could not always go out or take part in activities they preferred.
“Staffing levels at the service prevented people from having maximum choice and control in their lives.” from the report
Cleanliness problems
seriousSeveral areas were dirty and mouldy food was found in a kitchen. The checks in place had not identified these issues, creating possible infection control risks.
“There was a build-up of dirt and dust on skirting boards and we also found some mouldy food items in one of the kitchens.” from the report
Dignity and homeliness
seriousSome areas needed cleaning or repair and notices made the home feel institutional. Records also used language about people that did not treat them as adults.
“This did not respect people's home environment and made the service feel institutionalised.” from the report
Incident reviews
seriousRecords of physical restraint did not always explain why it was used, and staff debriefs were not completed. This limited opportunities to learn from incidents.
“The way in which incidents were being reviewed limited the opportunities to learn lessons and did not show openness and transparency at all times.” from the report
Weak quality checks
seriousAudits did not identify problems with cleanliness, staffing, person-centred care, incidents or dignity. Some audits were unclear or incomplete.
“Some audits completed by the provider were unclear as to what they were looking at and what actions were going to be taken to improve the service.” from the report
- 01What staffing arrangements are now in place, and how do you make sure people can go out and follow their preferred activities?
- 02How are communication methods from each person's support plan used in everyday conversations and decisions?
- 03What has been done to improve cleaning, remove mouldy food and keep the home environment dignified and homely?
- 04How are incidents involving physical restraint now recorded, reviewed and discussed with staff and external professionals?
- 05What progress has been made on the action plan, and can we see how people and relatives are now being asked for feedback?
This was an unannounced focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 8 October 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2018
Rated Good; inspectors found caring, personalised support, with medicine errors corrected during the inspection.
The CQC made two visits, one unannounced and one announced, in November and December 2017. Inspectors spoke with people living there, relatives, staff and healthcare professionals. They observed care and checked care records, medicine records, meeting minutes and quality checks.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People said they felt safe and supported. Inspectors found enough staff, suitable risk assessments, personalised support plans and staff who knew people well.
Inspectors found medicine management errors during the first visit. The registered manager investigated these, arranged more training and checks, improved records and increased supervision. At the second visit, the medicines checked were being managed safely and given as prescribed.
The home supported people to become more independent and move towards living in less supported settings. Inspectors noted some areas to improve, including healthier meals, more opportunities to prepare food independently, some damaged decoration and limited healthy activities.
Personalised support
Support plans were tailored to each person and included their goals, preferences and guidance for staff.
“Each person's support plan was fully personalised, agreed with the person and gave staff sufficient guidance to support the person in the way that would help them attain their goals.” from the report
Caring staff
People, relatives and professionals spoke positively about staff. Inspectors found that staff knew people's needs and preferences well.
“People were supported by caring, supportive and professional staff who knew each person and their individual needs well.” from the report
Support for independence
The home helped people develop skills, take suitable risks and work towards moving to more independent accommodation.
“The service had been effective in supporting a number of people to achieve what they wanted to achieve and move on to more independent living.” from the report
Good leadership and monitoring
The manager was approachable and staff understood the home's aims. The home used feedback, audits and action plans to identify improvements.
“A quality assurance system was in place, including a number of ways in which people, their relatives, staff and other stakeholders were asked to give their views about the service and how it could be improved.” from the report
Medicine errors at first visit
seriousInspectors found that medicine records did not allow them to check whether stock matched the medicines recorded as given. The manager took corrective action before the second visit.
“Staff had not followed the provider's policy nor carried out this task in line with their training.” from the report
Healthy food and cooking
needs fixingPeople could choose to cook, but the food observed was not always healthy and there was little food available for people who wanted to prepare meals. Inspectors also felt people were not always being supported to build independence with food.
“We noted that what people cooked was not always a particularly healthy meal and we also noted that there was very little food in the refrigerator if people had wanted to cook a meal for themselves.” from the report
Environment needed repair
minorMost areas were clean, but some decoration was damaged and the shower room needed refurbishment.
“We noted that most areas of the house were clean, even though some areas, such as the shower room, were in need of refurbishment to fully eliminate any risks from damaged decoration.” from the report
Limited healthy activities
minorPeople had access to outings and activities, but inspectors saw little organised healthy activity such as regular swimming or gym visits.
“We noted that there was a lot of walking to local cafes and a fast food restaurant, but little healthy activity, such as regular swimming or visits to the gym had been organised.” from the report
- 01What medicine checks and staff competency assessments are now used, following the errors found at the first inspection visit?
- 02How will my relative be supported to plan and prepare healthier meals and develop cooking independence?
- 03Has the shower room decoration been repaired or refurbished since the inspection?
- 04What regular physical activities, such as swimming or gym sessions, are currently available?
- 05How will my relative's progress towards more independent living be reviewed and shared with them and the family?
This was a comprehensive inspection covering all five key questions, with one unannounced visit and one announced follow-up visit. This explanation was written from the published report of 31 January 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Pathway House
3 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- October 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2018Goodstayed GoodSafe: GoodResponsive: GoodWell-led: Good
- December 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2014
Registered with the Care Quality Commission on 28 April 2014.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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