Gatwick Rise

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us the service was actively learning from past experiences and making improvements.

Events within the service were recorded and learning was discussed in staff supervisions and team meetings. Staff told us about the provider’s electronic texting platform used by managers to cascade information to staff. This system helped to ensure essential information was received by staff.

The manager analysed accidents and incidents for trends. They sought input from the rest of the management team to agree on action plans to reduce the risk of recurrences.

People and their relatives told us the manager and staff members contacted health and social care professionals to ensure people had the care and equipment they needed to be safe.

Staff completed ‘antecedent, behaviour, consequence’ (ABC) forms for each person, for each shift. Improved ABC forms had been implemented for staff to read and complete. The new forms clearly outlined what had triggered people to become upset and their behaviours during an incident, and any actions taken afterwards.

Health and social care professionals were confident in the care delivered at the service and told us after a safeguarding concern was raised by relatives, “Gatwick were responsive straight away” and “I am confident the staff know all the people well.”

We saw records were up to date and staff were updating them. Each person had a Hospital Passport and Health Action Plan that detailed their communication needs and the reasonable adjustments they needed to ensure they could safely and effectively access health services. For example, one person was being supported to visit the dentist’s surgery with a gradual desensitisation programme, records showed this process had been mostly effective. Systematic desensitization therapy is a type of behavioural therapy used to treat disorders, phobias, and fears. The aim of this therapy was to change the way people responded to objects, people, or situations that triggered feelings of fear and anxiety. People learnt ways to support them to remain relaxed and calm. Desensitisation involved a person exposing themselves to their fear in stages, so they became increasingly comfortable dealing with it.

People were protected from discrimination and bullying. People benefited from having their own living space and individual staff support which enabled staff to manage minor interpersonal conflicts safely and effectively. One person told us, “I can talk to staff if I have a problem. They help me.” Relatives told us “[Person] is safe there, I’m confident that staff keep [person] safe.”

A staff member told us, “As we are 1:1 we rarely have to deal with interpersonal conflicts between the service users. We are always around to defuse situations before they blow up.” Members of the management team were responsible for having oversight of specific areas and tasks, such as medicines, ordering food and training.

We observed safe interactions throughout our inspection. Staff maintained safety standards when supporting people to move and transfer from place to place.

Safeguarding information was available for people in easy read format. Whilst staff had told us ABC forms had improved, they were unclear of whether these were to be used in conjunction with accident and incident forms or not. We discussed this with the manager who was responsive to our feedback and produced a flowchart to assist staff.

Relatives told us “[Person] has lost weight recently. They are monitoring it well. They’ve now referred [person] to a dietitian and are waiting for the appointment.” People experienced inequalities in managing their risks depending on whether the staff member supporting them was an agency staff member or a permanent staff member. For example, permanent staff were seen actively engaging with people while some agency staff were seen not actively engaging with people.

Staff told us how important it was to - understand people and how they communicated, to reduce risks and improve people’s quality of life. One staff member told us, “You have to get to know people very well to support them safely. Knowing people well gives you the confidence to anticipate their needs which reduces their distress and then you can take positive risks together.” The manager told us how they worked with other health professionals to ensure any restrictions imposed on people were carried out in their best interest. For example, staff provided examples of when they had considered alternative and less restrictive ways to support people.

We observed that some agency staff did not know people very well and therefore were not able to confidently and meaningfully engage with people and anticipate their needs. This left people feeling distressed which significantly impacted on some people’s quality of life.

We saw information on risks was presented to people in ways that met their communication needs, such as easy read format, using Makaton signs, using pictures and objects of reference. Some people had guidelines and social stories to support them to learn more community-appropriate behaviours. We saw evidence of appropriate referrals being made to the dietitian and speech and language therapist.

Relatives gave positive feedback about the service’s environment. One relative told us “[Person] has a nice room. It’s reasonably spacious and has an ensuite. In fairness to the owners, they are going to do a complete refurb, but they’ve already done an uplift on the ensuite. They felt it was not up to standard so it’s been done, even though there will also be a refurb. The owner said the bathroom wasn’t going to last until the refurb of the whole house. The bungalows will be first.” Another relative told us “It’s cleaner than before.”

Staff told us “The refurbishments will improve the level of care we can provide.” The manager shared with us the time frame for the refurbishment plans including the laundry room, which at the time of the inspection was not safe for the people living at the service to use.

At the time of our inspection there were 2 people living in the main house and 7 people living in the bungalows within the care home grounds. The bungalows were in the process of being refurbished at the time of our inspection. The bungalows which had been refurbished were cleaner and safer environments for people to live. When the building work is completed there will be indoor and outdoor facilities to meet people’s needs. Before the inspection, we had received information anonymously about out of date food being left in people’s fridges and cupboards. On inspecting people’s cupboards and fridges, we mainly found food was within the best before dates. However, we found a small number of items out of date. This was raised with the manager who took action.

There was an emergency grab bag kept in the foyer in the main house. This included people’s Personal Emergency Evacuation Plans (PEEPs), a first aid kit in which all supplies were in date, and other emergency equipment such as foil blankets and important phone numbers. Safety certificates for gas, Legionella and fire safety equipment were seen and were in date.

People told us, and we observed, they felt comfortable and safe with the staff who knew them well. One person told us, “The staff help me.” One relative told us “There was a massive exodus of staff this year, due to changes in management. There are very few staff that I know well.” Another relative told us “The staff speak kindly with [person] and they are caring.”

Staff told us there were enough staff, consideration was given to staff’s skills and experience when staff were allocated to work with specific people. One staff member told us, “We really support each other, everyone will chip in if needed even the managers.” A team leader told us, “It’s much less chaotic now. I didn’t used to feel safe here at work, but I do now. We really give a lot of thought to allocating specific staff to work with people depending on what they’re doing, and we have the space to do that.” The manager told us about their priorities when recruiting staff. They said, “When I’m interviewing, I have a specific person [we support] in mind. I look for their values, not necessarily their experience and I’m always thinking are you going to get on with [person we support]? Will you be right for them?’”

We observed there were enough staff to support people safely. There was at least a team leader each shift as well as a floating staff member, the deputy manager, assistant manager and manager in addition to people’s 1:1 staff member. Staffing levels were flexible to allow people to have the support they needed for activities and appointments. We observed staff accompanying people to and from activities outside of the service.

We reviewed 3 staff recruitment files and found staff were recruited safely. We saw staff had received appropriate training in crises prevention and learning disability. The manager had booked in future training courses for Makaton training, which is a way of communicating with people who are non-verbal. We saw evidence where staff had failed an online training course, and they were given extra support to understand the course content. We saw evidence staff competency was assessed, and the forms used were robust and specific to the area being observed.

People and their relatives told us the home was clean and tidy. This included people’s own bedrooms.

Prior to the inspection we had received feedback from staff who told us there was an issue with having access to personal protective equipment (PPE) and cleaning products. During the inspection, we spoke to several staff members who did not corroborate these views. The manager told us a system was in place for staff to alert a team leader via the walkie talkie additional system if PPE and cleaning products were needed. These would be delivered to the staff member.

We observed the old bungalows were not able to be cleaned to the same standard as the newer bungalows, however this was being addressed through the refurbishment. We observed within the bungalows there was PPE available, as well as cleaning products kept securely in kitchen cupboards away from where people could access them.

The service had not reported any recent infectious outbreaks. We reviewed the provider’s outbreak and infection control policy and found these were clear and in line with guidance. We reviewed the audits in place for control of substances hazardous to health (COSHH) and infection control and found these were up to date. Staff training records showed there was a high compliance in COSHH and infection control training.

People received their medicines in a safe and caring way and were given the appropriate level of support, as per their individual needs. Records were kept on an online system centrally. People’s individual preferences for how they liked to take their medicines were considered and tailored to the individual. People’s medicines were seen to be given in a safe and caring way. Medicines were administered in a timely manner and recorded on people’s medicines administration record (MAR) charts. However, in some cases topical administration of medications were not recorded, for example medicated shampoos. People had information recorded to guide staff on when to administer ‘as required’ medicines. Effective systems were in place to ensure people received their prescribed medicines. People were supported to access their GP as needed and received an annual GP review of their medicine and medical needs.

Staff told us they felt well supported regarding medicines management. Staff told us they were trained in medicines administration and had regular competency assessments. Staff we spoke with told us medicines administration systems worked well.

There were policies and processes in place to ensure people received their medicines safely. Medicines were stored securely and there were suitable arrangements for controlled drugs. However, the provider’s audits did not identify some medicines discrepancies, for example, administration records were missing for topical medications and end dates were missing for 2 medicines.