We carried out a comprehensive inspection on 13 September 2018. At the last inspection in December 2016, the service was rated good. At this inspection we found, overall, the service requires improvement.

Gate Lodge is a care home. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Gate Lodge is located in a quiet residential road in Purley close to good transport links. Gate Lodge provides accommodation and personal care for up to 21 people. At the time of our inspection 18 people were living in the home.

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.

Staff demonstrated a good understanding of safeguarding and whistleblowing procedures and knew how to report concerns. Incidents and accidents were recorded and the records showed that actions were taken to minimise the risk of recurrence.

Improvements were required to ensure that people were protected from the risk and spread of infection. People received their medicines as prescribed. However, the arrangements in place for storage of people’s medicines were not always safe.

We were concerned that there were insufficient staff at mealtimes and at night particularly in the event of an emergency. Staff performance was effectively monitored. Staff received supervision and training to ensure they had the skills to meet people’s needs.

The premises were not adequately maintained to ensure people's safety. We have made a recommendation that the provider seeks guidance on good practice in meeting the needs of people living with dementia.

People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes. People had a sufficient amount to eat and drink. Staff were kind and caring. We found people were being treated with dignity and respect and people’s privacy was maintained.

Systems were in place for monitoring the quality and safety of the service. However, they were not always as effective as they needed to be and when areas were identified as requiring improvement, the provider did not always take prompt action.

We found a breach of the of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 in relation to the provider's failure to provide safe care and treatment. You can see the action we have asked the provider to take at the back of this report.

Gate Lodge is a residential care home that provides accommodation and personal support for up to 21 older people living with dementia. There were 20 people living at the home at the time of our inspection.

At a previous inspection in July 2014 a breach of legal requirements was found relating to the safe management of medicines. We undertook a focused inspection of the service in May 2016 to check that they met legal requirements which they had. We undertook an unannounced inspection to the home on 14 and 19 December 2016. The service met all the standards we inspected it against.

A registered manager was in post and was present during our inspection. 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 using the service and their representatives told us they felt safe and well cared for at Gate Lodge. There were clear procedures in place to recognise and respond to abuse and staff understood how to follow these. Medicines were managed safely and people received their medicines on time. Staff had the appropriate training to be able to administer medicines competently. Staffing numbers on each shift were sufficient to help make sure people were kept safe.

Staff were caring and treated people with dignity and respect. They received training and support to help them carry out their role effectively. Staff were familiar with people living in the home and understood people’s needs and preferences for the way they wished their care to be delivered.

People and relatives told us staff were kind, attentive and caring. Staff were very respectful in their interactions and engagement with people. Staff sought permission from people before any care or support was offered and personal care was carried out in the privacy of the person’s room. The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA). Staff respected people’s right to make their own decisions and supported them to do so.

Staff supported people to eat and drink in an inclusive way and which enabled the person to have a positive experience at meal time. People were supported to take part in activities and to continue to be part of their community. People were supported to maintain relationships with family and friends who were important to them.

There was a positive culture at Gate Lodge where people using the service, their relatives or friends and staff were included with their views listened to and acted upon.

We carried out an unannounced comprehensive inspection of this service in November 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Gate Lodge on our website at www.cqc.org.uk.

We found improvements had been made around the management of medicines and in keeping up to date auditable administration records. There were now appropriate arrangements in place for the storage, administration, recording and disposal of medicines. Medicines kept on behalf of people using the service were being administered correctly with up to date records kept. This meant that the provider could check that people had received their medicines correctly

During our inspection we spoke with five people who lived at Gate Lodge. They all told us they were happy with the care and support they received at the care home and that staff who worked there were kind and caring. People also said they felt safe living at Gate Lodge and able to talk to the management and other members of staff if they felt concerned or unhappy about anything. One person told us “It’s been lovely living here. The staff are all great”, and another said “I like the people I live with, and the food is gorgeous here”.

We saw staff treated people who used the service with respect and dignity. We found staff were suitably trained and were familiar with the individual needs, abilities, preferences and daily routines of the people they supported.

The provider also had effective systems in place to ascertain the views of people who used the service and their representatives, as well as routinely assess and monitor the quality of the care and support they received.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People we spoke told us they were happy with the overall standard of the care and support provided at the care home. They felt the staff that worked at the home always treated people with respect and dignity. Typical comments we received, included, “staff are very caring and always take their time when helping the people who live at Gate Lodge”, “staff always call people by their preferred names”, and “people are looked after well here”.

Two people we spoke with said they were ‘happy’ with the food they were offered at Gate Lodge.

Comments from people using the service were generally positive, with indication that staff are kind and helpful in meeting their care needs. People were observed to be treated with respect by staff and to have their privacy and dignity respected.

This inspection took place on 19 and 21 November 2014 and was unannounced.

Gate Lodge is a residential care home that provides accommodation and personal support for up to 21 older people living with dementia. There were 19 people using the service at the time of our inspection.

We last inspected Gate Lodge in April 2013. At that inspection we found the service was meeting all the regulations that we assessed.

There was a registered manager in post at the time of our inspection. 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 using the service and their representatives told us they felt safe and well cared for at Gate Lodge. They were encouraged to take part in activities and to continue to be part of their community. People were supported to maintain relationships with family and friends who were important to them.

There were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these. Staffing numbers on each shift were sufficient to help make sure people were kept safe.

Medicines were stored securely and safely. However, safe practice was not always being followed around the management of medicines and in keeping up to date auditable records. You can see what action we told the provider to take at the back of the full version of this report

Staff were caring and treated people using the service with dignity and respect. They received training and support to help them carry out their role effectively.

A positive culture was evident at Gate Lodge where people using the service, their relatives or friends and staff were included with their views listened to and acted upon.