The inspection took place on the 18,19 and 20 July 2018 and was unannounced.

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 introducti

This inspection was unannounced and took place on 1 and 4 September2017. The last comprehensive inspection of the service was on 5 May 2016 and there were no breaches of regulations at that time.

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.

The inspection took place on the 10 May 2016 and was unannounced. The home was last inspected on 24 June 2015 to check on breaches of regulation found at a previous inspection on 19 and 20 November 2014.

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.

We carried out an unannounced comprehensive inspection of this service on 19 and 20 November 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These were the regulations in force at the time. We now inspect registered services under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 (location's name) on our website at www.cqc.org.uk

There had been improvements to the laundry enabling a clean environment to be maintained and improving staff access to hand washing facilities.

Peoples’ rights were protected by the use of the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards (DoLS).

Gatwick House had a registered manager. 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.

A relative we spoke with told us how they worked with the service to get the basics right for their relative. They told us that the service had been a “godsend” for them and said, “for us the pressure has come off”. They felt secure in the knowledge that their relative was safe, well cared for and was treated with respect and dignity.

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.

Although we spoke with some people using the service, we haven't been able to get feedback about concerns raised because we visited the home early in the morning. We gathered evidence of people's experiences of the service by reviewing care records and other documents. We contacted fifteen members of staff and received feedback from ten staff. We also had feedback from other stakeholders.

The people we spoke with said they made choices about how they spent their time and they felt able to express their wishes. They felt safe at Gatwick House and said they could go to staff with any concerns they had. We observed that residents benefited from calm home environments where their individual needs were well understood by staff. A relative of one resident told us that their son was less likely to be unsettled by what was happening around them because of this.

We observed that people’s needs were attended to promptly and in accordance with their planned care.

This inspection took place on the 19 and 20 November 2014 and was unannounced. The home was last inspected in May 2014 and at this time all standards inspected were being met.

Gatwick House provides accommodation and personal care for 14 people with autism and learning disabilities. At the time of our inspection there were 14 people living in the home.

The home had a registered manager. 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 were protected by staff and management who understood safeguarding and staff recruitment procedures were generally robust. However people were at risk of infection because of the condition of the laundry in the main house. Wall surfaces were in need of remedial work.

People were supported by staff that were suitably trained to carry out their role. There were sufficient numbers of skilled staff to meet the needs of the people they supported. Staff were supported in their work and could raise any concerns with the management team.

Care was not always provided in people’s best interests. Staff were not always following the Mental Capacity Act 2005 (MCA) for people who lacked capacity to make certain decisions. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant

People’s privacy, dignity and their choices about daily activities were respected by staff. People benefited from access to a range of activities both at the home and in the wider community. The approach to managing any risk from activities ensured safety but also supported people’s independence and choice.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.