CQC report explained · a residential care home
What the CQC found at The Gatehouse
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Medicines were not always managed safely, and some risk assessments, care records and safety monitoring were incomplete. Recruitment checks for some younger staff were also not always in place.
- Effective?
- Good
- This question was not inspected during this visit, so its previous rating was carried forward for the overall rating.
- Caring?
- Good
- People were treated with kindness, dignity and respect. Staff knew people well and involved people and relatives in decisions about care.
- Responsive?
- Good
- This question was not inspected during this visit, so its previous rating was carried forward for the overall rating.
- Well-led?
- Requires improvement
- Audits and management systems did not consistently identify or address medicines, incident and risk concerns. There was no registered manager in post at the time of the inspection.
What inspectors found, December 2022
The Gatehouse rated Requires Improvement; inspectors found kind care, but medicines, risk records, recruitment checks and oversight were not always safe.
Inspectors visited on 10 and 17 October 2022. They spoke with people, relatives and staff, and checked care records, medicines records, recruitment files, training records and management checks. The first visit was unannounced and the second was announced.
People were treated with kindness and respect. Relatives said people felt safe and well cared for. There were enough staff, infection control arrangements were suitable, and staff understood the people they supported.
However, medicines were not always stored, given or recorded safely. Risk assessments and care plans were sometimes missing or inaccurate. Recruitment checks for younger staff were not always complete, and management audits had not found or dealt with important problems.
The overall rating changed from Good to Requires Improvement. Safe and Well-led were rated Requires Improvement, while Caring was rated Good. The provider took immediate action, and CQC requested an action plan and said it would continue to monitor the home.
Kind and respectful care
Inspectors saw people being treated with kindness and compassion. Staff spent time getting to know people and supported their dignity and independence.
“People were treated with kindness and compassion by staff that knew them well.” from the report
Enough staff
Inspectors found there were enough staff to meet people's needs safely and with care.
“There were enough staff to meet the needs of the people living at the service.” from the report
Infection control
Inspectors were assured that the home had suitable arrangements for preventing and managing infections, including safe visiting and the use of protective equipment.
“We were assured the provider was responding effectively to risks and signs of infection.” from the report
Staff support
Staff said managers and colleagues supported them, and that lessons from incidents were shared with staff through training and support.
“The provider shared information on lessons learnt with staff.” from the report
Medicines were not always safe
seriousMedicines were not always stored, administered or recorded correctly. Checks found discrepancies in tablet numbers, and some creams were not recorded properly.
“Medicines were not always stored, administered or recorded in line with best practice guidance.” from the report
Risk information was incomplete
seriousSome care plans and risk assessments were missing or did not give staff enough guidance. Safety records such as repositioning and weight records were inconsistent.
“Care plans and risk assessment were not always in place to assess risk and provide guidance where there was a known risk.” from the report
Recruitment checks
seriousRequired checks and processes were not always in place for staff under 18, including some staff under 16. The recruitment policy did not include all relevant requirements.
“Safe recruitment checks such as DBS checks were not always in place for staff under the age of 18 as required.” from the report
Weak management checks
seriousAudits had identified some medicine-counting problems but the home had not shown that these were investigated or fixed. Incident and risk oversight was also not reliable.
“Audits and checks in place had not identified or addressed the concerns found on this inspection.” from the report
No registered manager
needs fixingThere was no registered manager in post during the inspection. Directors and other managers were running the service while recruitment continued.
“At the time of the inspection there was not a registered manager in position.” from the report
- 01What changes have you made to ensure medicines, including creams and self-administered medicines, are stored, given and recorded safely?
- 02How do you now check that every person has accurate risk assessments and care plans, including guidance for behaviour, epilepsy, repositioning and weight monitoring?
- 03Have all required DBS checks, work permits and risk assessments been completed for younger staff?
- 04Who is currently managing the home, and when do you expect to have a registered manager in post?
- 05How do your audits now identify and fix medicine, incident and safeguarding concerns promptly?
This was a focused inspection of Safe, Caring and Well-led, including infection prevention and control; Effective and Responsive were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 14 December 2022 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 2020
Rated Good overall, with Outstanding caring; inspectors found kind, safe care, but records about mental capacity and liberty safeguards needed review.
Inspectors visited on 17 and 23 October 2019. The first visit was unannounced and the second was announced. They spoke with people, relatives, professionals, managers and staff, and checked care records, medicines, recruitment files and management records.
People were safe and received effective care. Staff were safely recruited, staffing levels met people's needs, medicines were managed safely and the home was clean and welcoming. Staff were well trained and worked with healthcare professionals when people's health changed.
The strongest area was caring, rated Outstanding. Inspectors found exceptionally kind and respectful staff who understood people as individuals and supported their choices and independence. Responsive care was rated Good, down from Outstanding at the previous inspection, while the other ratings stayed Good.
The overall Good rating means the home was meeting the regulations and providing good-quality care. Inspectors recommended clearer recording of mental capacity assessments, consent and applications under the Deprivation of Liberty Safeguards.
Exceptionally caring staff
Staff were consistently kind, compassionate and respectful. They took time to understand what mattered to people and supported their wellbeing and independence.
“People received exceptionally caring support from staff who were kind, compassionate and thoughtful.” from the report
Choice and independence
People had control over their care and were supported to express their wishes. Staff adapted communication and used creative ways to help people make choices.
“People had choice and control over all aspects of their care and support; they were empowered to confidently express their wishes and views” from the report
Safe staffing and medicines
The home used recruitment checks, staffing reviews and trained staff to support people safely. Medicines were administered safely and checked through audits.
“People were supported by staff who understand their needs and how to safely support them.” from the report
Good food and activities
People praised the quality and variety of food. They could join group and individual activities, pursue hobbies and maintain relationships with visitors.
“People had the opportunity to take part in a wide range of activities.” from the report
Strong leadership
Inspectors found good organisation, teamwork and regular checks on quality and safety. Staff felt supported by managers.
“There was strong organisation and leadership within the service which promoted a person-centred culture” from the report
Mental capacity records
needs fixingInspectors found that records did not always clearly explain mental capacity assessments, consent to care or applications to restrict liberty. They recommended a review of the relevant guidance.
“clear information had not always been documented about how people's mental capacity had been assessed or in relation to applications to deprive people of their liberty.” from the report
Window safety checks
minorInspectors asked the manager to check window opening restrictors regularly. The manager acted immediately to address this.
“we spoke with the registered manager about regularly checking window opening restrictors to make sure they worked safely and they immediately addressed this.” from the report
Agency staff training records
minorThe report says the home used agency staff when needed, but inspectors asked for more information about their training to be retained.
“We spoke with the registered manager about retaining more information about agency staff's training.” from the report
- 01How do you now record mental capacity assessments and decisions made in a person's best interests?
- 02How do you record consent to care and applications under the Deprivation of Liberty Safeguards?
- 03How do you check and record the training of agency staff before they work in the home?
- 04How often are window opening restrictors checked, and where are those checks recorded?
- 05How do you make sure each person's activities, hobbies and relationships continue to reflect their wishes?
This was a planned inspection covering all five key questions, and the report says both the premises and the care provided were looked at. This explanation was written from the published report of 4 January 2020 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 The Gatehouse
5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- December 2022Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2020Goodstayed GoodSafe: GoodCaring: OutstandingWell-led: Good
- April 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: OutstandingWell-led: Good
- October 2015Goodstayed GoodEffective: Good
- March 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: OutstandingWell-led: Good
- November 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- April 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
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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28 live-in carers within about an hour of North Yorkshire
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,010 to £1,290 a week. 27 can care for a couple. 12 years' experience on average.
“Carla has been a god send with the implementation of bringing mum back home from respite care.”
“She was always 'just present enough': attentive, available, kind and engaging, but without ever over-stepping any boundary”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.