Gatwick House

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

Gatwick House accommodates 14 people in 1 shared house for 3 people and has 11 individual units known as bungalows, each of which have separate entrances and adapted facilities. At the time of our inspection visit there were 11 people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People’s experience of using this service and what we found

Based on our review of safe and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

Right Support

People were supported to have choice about their living environment and were being encouraged to personalise their accommodation. Refurbishment was being carried out to improve Gatwick House, this included creating bespoke accommodation for people. People, their relatives and professionals were being involved in these decisions.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. People were receiving their medicines as prescribed; however the provider did not always have effective systems to manage people’s prescribed medicines.

Right Care

People's care, treatment and support plans had been updated and reviewed since our last inspection. Each person had a detailed positive behaviour support plan.

Staff understood people’s needs and the support they required and knew how to support people when they were anxious.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

The provider did not always operate effective systems to monitor the quality of the service they provide, including in relation to fire safety, legionella’s and general maintenance.

The registered manager and representative of the provider had a clear plan of improvement for Gatwick House. They had arranged for support from an external consultant to help drive a positive and empowering culture.

People’s relatives and staff spoke positively about changes at Gatwick House and discussed the positive impact these changes had on people who lived at Gatwick House.

Rating at last inspection

The last rating for this service was Requires Improvement (published 11 November 2022). At this inspection the rating has remained the same.

Why we inspected

We carried out an unannounced inspection of this service on 4 October 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when, to improve people’s care records and their good governance systems.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have identified breaches in relation to safe care and treatment, good governance and notification of other incidents at this inspection.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gatwick House on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service

Gatwick House is a care home. People in care homes receive accommodation and nursing or 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.

Gatwick House accommodates 14 people in one shared house and a number of individual units known as bungalows, each of which have separate adapted facilities. At the time of our inspection visit there were 11 people using the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People’s experience of using this service and what we found

Based on our review of safe and well-led the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

Right Support

People had not always been protected from the risk of infection, including COVID-19. Staff were not wearing face masks in accordance with current government guidance.

People were supported to have choice about their living environment and were being encouraged to personalise their accommodation.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. People were receiving their medicines as prescribed.

Right Care

People's care, treatment and support plans covered their range of needs, however people’s support plans had not been fully updated in 2022. People’s care records sometimes provided conflicting information, however staff understood people’s needs and the support they required.

People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

The provider did not always operate effective systems to monitor the quality of the service they provide, including in relation to fire safety, legionella’s and general maintenance.

The provider had not always operated robust recruitment procedures in accordance with government legislation.

There was no a registered manager in post. The last registered manager left in February 2022. Staff told us they felt supported, however expressed some difficulties due to changes in management and management being stretched. A new manager had been recruited, however, had only been in post for a couple of weeks.

The manager and representative of the provider recognised improvements were needed at the service and were positive about improving the service.

The provider had sought support from an social care consultant who was planning to implement new audit systems to help improve the support people received at Gatwick House.

Rating at last inspection

The last rating for this service was Good (published 17 December 2021).

Why we inspected

We received concerns in relation to the management of Gatwick House and the quality of care people living at Gatwick House received, including supporting people with behaviours of distress that others might find challenging. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Good to Requires Improvement.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have identified breaches in relation to good governance, safe care and treatment and safe recruitment practices at this inspection.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gatwick House on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gatwick House is a care home. People in care homes receive accommodation and nursing or 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.

Gatwick House accommodates 14 people in one shared house and a number of individual units known as bungalows, each of which have separate adapted facilities. At the time of our inspection visit there were thirteen people using the service.

People’s experience of using this service and what we found

People were supported by staff who understood how to keep them safe from the risk of abuse. Appropriate safeguarding procedures were in place and staff had been trained in how to protect people from abuse.

Risks to people were assessed and managed safely. Risks were monitored regularly, and routine checks were made to ensure people were receiving the care they needed to mitigate risk. Risks associated with premises safety were managed but there were some areas of the home which required development, investment and modernisation. The registered manager told us that they were working with the provider to develop the environment in accordance with people’s needs and preferences.

At the time of our inspection there were staffing vacancies which had been managed by block booking agency staff. The registered manger had already identified staffing as a high priority. They were putting measures in place to reduce the risk whilst developing systems to reduce staff turnover and retention, and provide greater consistency for people.

The provider had infection control procedures in place to protect people and prevent the spread of infection. Staff accessed personal protective equipment (PPE) and staff followed the providers guidance and expectation.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The home was well led by a management team who were committed to improving care at Gatwick House and delivering a good service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe, Responsive and Well Led, the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Care was person centred and staff understood people’s preferences.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

We received concerns in relation to the management of medicine and finance, staff conduct, IPC practice, supporting people with choice, and supporting people with behaviours of distress that others might find challenging. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has remained the same. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, responsive and well led sections of this full report. The provider had taken action to mitigate the risks identified. They were developing their systems through their internal quality assurance process.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gatwick House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gatwick House accommodates 14 people in one shared house and a number of individual units known as bungalows, each of which have separate adapted facilities. At the time of our inspection visit there were thirteen people using the service.

We found the following examples of good practice.

Staff had received training in the use of Personal Protective Equipment (PPE).

Staff and people had been tested for COVID-19 in accordance with national guidance.

The layout of the accommodation enabled most people using the service to effectively isolate from other people during an outbreak.

The provider had a contingency plan to follow in the event of staff shortages caused by COVID-19.

Arrangements had been made for visitors to enter the care home through a designated entrance and to be screened and tested to ensure visits to people were safe.

People had been supported to keep in touch with relatives through electronic means when visits were not possible.

Staff told us they felt supported by the registered manager and received regular updates about working through the pandemic.

The registered manager had not followed current guidance about overnight visits out of the care home for people using the service. As part of the inspection process we signposted the service to current guidance at the time of our visit. Following this the registered manager cancelled overnight visits until guidance allowed.

Gatwick House is a ‘care home’. People in care homes receive accommodation and nursing or 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. Gatwick House accommodates 14 people in one shared house and a number of individual units known as bungalows, each of which have separate adapted facilities. At the time of our inspection visit there were twelve people using the service.

At our previous inspection in September 2017 the service was rated ‘Requires Improvement’. We found three breaches of regulation and took enforcement action. To support the provider to make the necessary improvements we imposed two conditions on their registration. The provider was required to undertake regular audits to monitor quality and risks in relation to the management of the service and staff, and support of people. They had to send a monthly report to CQC detailing the audit dates, the outcomes of these and any actions taken or to be taken as a result. The provider had complied with the conditions on their registration.

Following the last inspection, we also met with the provider to confirm what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good. At this inspection we found the service had made and sustained the required improvements to meet the requirements of the regulations and was rated ‘Good’ overall.

At the time of our inspection Gatwick House had 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We heard positive comments from people’s representatives about the care and support they received at Gatwick House such as, “I feel that they support each individual well and are very proactive in their approach to each person”, “We would like to, on record, thank the staff at Gatwick House for their hard work and patience with (the person), the staff do a great job!” and “(The person) has never had as good a placement as this”.

We found improvements to the investigation of incidents, guidance on how to support people at risk of choking and the recording and auditing of the support people were given to take their medicines. We found the environment of the care home was clean and had been well maintained. Improvements had been put in place to ensure thorough checks were made when recruiting staff.

We also found improved training and supervision for staff to enable them to effectively support people at Gatwick House. People were assisted to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with kindness; their privacy and dignity was respected and they were supported to develop their independence and keep in contact with relatives. People were enabled to be actively involved in the planning and review of their care and support.

Detailed records enabled staff to have the right information to support people. People were supported to take part in a range of activities. Concerns and complaints were investigated and improvements made to the service.

Quality monitoring systems had improved with the introduction of regular monthly reports to provide the management with oversight of the results of audits and other important aspects of the service provided. In addition, a system was in place to ensure required notifications about events effecting people and the service were sent to CQC.

Gatwick House is a residential care home and provides accommodation and personal care for up to 14 people with learning and physical disabilities. At Gatwick House there is one main house with three people living there and ten individual bungalows with their own outside space. At the time of our inspection there were 13 people living at the home. The service had a large geographical area with many different and separate buildings. If there was an incident or altercation staff used radios to communicate with each other.

The inspection was prompted in part by notification of an incident. This incident is subject to a separate process and as a result this inspection did not examine the circumstances of that incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk in relation to people’s agitation and associated behaviour. This inspection examined those risks.

People did not always receive a service that was safe. People received enough to eat and drink. One person’s Speech and Language therapy (SALT) guidelines for safe eating and drinking could not be found during our inspection. This meant that staff would not have the documentation or guidelines to follow to ensure this person was safe when eating and drinking. Improvements were needed to ensure the night time safety arrangements would be reviewed regularly. This would ensure they remained effective in enabling people to request staff support in the event of an emergency or if they felt unwell.

Staff had not received suitable training and supervision to enable them to effectively support the people living at Gatwick House such as people living with autism or with behaviours that may challenge. Some staff still needed to attend mandatory training courses such as adult safeguarding, manual handling, MCA and DoLS, and infection control.

The service was not always responsive to people’s needs. We found some people’s daily notes lacked detail on what care was being provided or needed. If people were feeling anxious or upset this was not always clearly documented. This meant that staff and the registered manager would not know from people’s records whether they had been supported to meet their aspirations and had received their care as required.

The service was not well led. The registered manager and provider had governance systems in place to monitor and improve the quality of the service provided. However, these systems had not identified the concerns we found around recording of information, identifying staff training needs, staff supervision and appraisals and assessing risks. Some relatives and staff we spoke with stated communication between management and themselves was poor.

There were some positive comments from relatives and health professionals about the care provided and the staff members who cared for their family members.

People had sufficient activities to support them to lead an active and fulfilling life. Complaints had been dealt with appropriately

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations have been concluded.

Gatwick House provides care for up to 14 people with learning disabilities. At the time of our inspection visit there were 13 people using the service.

Gatwick House had 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 and management understood how to protect people from harm and abuse. Risks to people’s safety were identified, assessed and appropriate action taken and their medicines were safely managed. People’s individual needs and were known to staff who had achieved positive relationships with them. People were treated with kindness, their privacy and dignity was respected and they were supported to develop their independence and keep in contact with relatives. People were enabled to be actively involved in the planning and review of their care and support.

Staff received support in the form of training and supervision to develop knowledge and skills for their role. Staff described good effective team working. The management were accessible to people, their visitors and staff. They aimed to provide a quality service to people through engagement with them and their representatives. People and their representatives were asked for their views about Gatwick House. Where areas were identified for improvement, appropriate action was taken.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe as risks were assessed and managed effectively. When people displayed behaviour which challenged others, staff dealt with the person safely, respected their dignity and protected their rights. Clear strategies were in place describing the situations that may cause distress to people and what staff needed to do to help them become calmer. Advice had been sought from external health professionals to manage people's specialist needs and recommendations were followed. Staff acted to protect people from the risk of abuse by responding appropriately to incidents and allegations, notifying external agencies and carrying out investigations.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff were trained to understand when an application should be made, and how to submit one.

People were protected from healthcare associated infections because the home was kept clean and hygienic. Systems were in place to assess and prevent the spread of infections which made sure people stayed healthy and well.

Is the service effective?

The service people received was effective because their individual needs, choices and preferences were reflected in their care plans. It was clear from speaking with staff that they knew the people they supported well and understood what was important to them. Our observations showed that staff communicated well with people and understood their needs and wishes. For example, to check what they wanted to eat and that they agreed to the care or activity planned for them. Some people had been supported to apply for bus passes, to increase their independence and opportunities to access their local community.

People were supported to access a range of health professionals and their advice was taken into account when planning and delivering care. When people had been assessed as unable to make health related decisions for themselves, the service worked with their family and health professionals to act in people's best interests

Is the service caring?

People were supported by staff that cared about their well-being. One person showed us a birthday present which a staff member had bought for them. The staff member told us how difficult it had been to find exactly what they had wanted and how pleased were to have managed this. Another staff member said, there were 'lots of good staff here, who are willing to go above and beyond and give their own time'. We observed one person laughing openly with the staff member supporting them and could see genuine pleasure and enjoyment in their facial expression. Two other people were particularly relaxed and comfortable with the staff member supporting them. These staff members demonstrated real understanding of how to work with these two people, to achieve the best outcomes for them.

Is the service responsive?

People's needs had been assessed before they moved into the home. Activities were timetabled and routines adapted to suit people's needs. For example, one person went horse riding first thing in the morning when less people were around. This meant they could enjoy the activity safely as they were not likely to be distressed or distracted by others. Another staff member saved part of one person's lunch for later, as they knew the individual was anxious to mow the lawn before this was done by maintenance staff. Staff were working with another person to integrate them into life in the main house as they had expressed a wish to live there with others. People were supported to maintain relationships with family and friends though email, letters and hand held device facilities such as 'FaceTime'.

Referrals to health professionals had been made quickly when needed and people's care and support were adapted accordingly. For example, one person was less able to walk comfortably than usual, due to a sore toe. A GP appointment had been arranged, they received medicine to manage their pain and chose to relax at home rather than assist at the local stables that morning as planned.

Is the service well-led?

The former registered manager left Gatwick House in October 2013. The deputy manager had been 'acting manager' at the home since this time. They were supported by the provider and other members of the management team who had taken on additional responsibilities until a new manager was in post. We monitored action taken by the provider and were informed that a new manager had been appointed and a start date had been agreed.

Quality assurance processes were in place and where the need for improvement had been identified, action had been taken. Staff were clear about their roles and responsibilities. They felt supported by the management team and were confident that if they raised any issues or concerns, these would be dealt with effectively and in confidence. People, or their representatives, met with staff regularly to give feedback about the service provided.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us about their experiences. While we were able to have limited communication with seven people who used the service, we also observed how people were being supported, reviewed records, comments and complaints.

We found that overall the service was providing a good standard of care to people who used the service. The majority of whom had complex and challenging needs. However, the systems and processes in place were not sufficiently robust to ensure that the expected standards were met in all areas we checked. The service was meeting requirements in recruitment, staffing and supporting staff. Shortfalls were found in obtaining consent, planning care, safeguarding and quality assurance processes.

In this report the name of a Registered Manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Appropriate arrangements were in place for management of medicines and staff felt confident and well supported in managing this aspect of their role.

Systems were in place to assist the provider in monitoring the quality of the service. This included involvement and feedback from families through the family forum and regular care reviews. One relative told us, 'You can have a difference of opinion; they are good at taking what you say on board and working through it together. They are so committed they really do go that extra mile'. A member of staff said, 'I'm very passionate, if I have any issues I come and talk with the managers, they sort it out pretty quickly'.

A responsive review was carried out at this service in May 2012 where the service was found to be compliant in the three outcome areas we checked at this visit. This included respecting and involving people who use services, staffing and supporting workers. The report from this inspection is available on our website.