Gateway Care Services was rated Requires Improvement overall following an April 2023 inspection, with breaches identified in safe care and treatment (Regulation 12), person-centred care (Regulation 9) and good governance (Regulation 17). Key concerns included inadequate risk assessment guidance, unsafe medicines management, task-focused care plans lacking personalisation, and quality monitoring systems failing to detect these shortfalls.
Concerns (9)
criticalCare planning: “Care plans were mainly task focused and the language used was often a list of instructions... there was contradictory information about people's care needs.”
criticalMedication management: “For a person who required 'as and when required' (PRN) medicines, there was no clear guidance and/or PRN protocols in place for staff.”
criticalGovernance: “The current systems in place were not robust enough to assess and monitor the service. This was a breach of regulation 17 (Good governance).”
criticalPerson-centred care: “Aspects of people's care were not person centred and did not reflect how people should be supported safely in accordance to their specific needs. Breach of regulation 9.”
moderateRecord keeping: “A person was prescribed a barrier cream in March 2023, however the MAR sheet and care records had not been updated to reflect this.”
moderateSupervision / appraisal: “Staff received some formal supervision and appraisals... however records showed these were not done on a regular and consistent basis.”
moderateStaff competency: “Medicine competency assessments for staff had been completed, however these covered generic areas and did not focus on people's individual needs.”
minorCultural competency: “In one person's care plan, it stated they were a devout Muslim... there was no information for staff on whether the person needed support to practice their faith.”
minorCommunication with families: “For one person, English was not their first language... there was no further information detailing how staff should communicate with them.”
Strengths
· Safeguarding procedures were in place and staff understood their responsibilities; people and relatives reported feeling safe.
· Sufficient staffing levels were maintained and a new electronic care planning system was implemented in February 2023 to monitor staffing and timekeeping.
· Staff completed induction based on the Care Certificate and mandatory training including safeguarding, infection control and moving and handling.
· People were supported to access healthcare professionals promptly and the service worked in partnership with district nurses and GPs.
· People and relatives spoke positively about staff being kind, caring and respectful, with positive relationships developed.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service; promoting a positive culture; continuous learning and improving careGood