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Inspection carried out on 12 November 2019

During a routine inspection

About the service

Gate House is a purpose-built residential care home providing accommodation and personal care to six people with a learning disability. The service can support up to seven people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning and physical disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

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 service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People appeared happy and relatives told us they were pleased with the care and support received. A relative told us, “I take my hat off to the staff, they work in a sometimes difficult environment and they always do it with kindness and a smile”. Staff were friendly and attentive to people’s needs and our observations showed there were enough staff to meet people’s needs. Staff were trained and felt supported.

People felt safe and staff were aware of how to promote people’s safety. Regular checks were in place to ensure staff worked in accordance with training and health and safety guidance adhered to.

The environment had plenty of communal space for people to enjoy. People enjoyed the activities that were provided, staff told us there were many opportunities for people to go out and people were living fuller lives. A relative told us, “[Registered manager] has even got [my relative] going to the gym regularly. I’m amazed, he’s never liked exercise. They really know how to motivate him”.

People were involved in planning their care and their views and preferences were acted upon. Feedback about the registered manager and staff team was positive. There was an open culture in the service and an expectation that people were supported in a person-centred way. Staff were clear about their roles and the management team engaged well with the team and other agencies.

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

The last rating for this service was Good (published 15 June 2017). At this inspection the service has remained rated as Good.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 12 May 2017

During a routine inspection

This inspection took place on 12 May 2017 and was unannounced.

The service is in the village of Eastry near to the main towns of Sandwich, Dover and Ramsgate. There was one person living at Gate House and two people who were about to move in. Each person had their own bedroom. The home is open plan in style with access to the garden at the front and back of the house. The house has one level and is set in the grounds with other houses owned by the company. The houses are separated by fencing and gates for privacy and security.

There was a registered manager at the service who was present on the day of the 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.

At our last inspection in January 2016, the service was in breach of some of the regulations and was rated ‘Requires Improvement’. The registered manager sent us an action plan outlining how they would rectify those breaches. The registered manager and team had worked hard to update policies, care planning, staff training and recruitment and develop communication support and person centred care. At this inspection improvements had been made and all the regulations were met.

The service had a clear direction and purpose that the staff team were signed up to. There was a person centred culture. Staff were enthusiastic in their roles and had received training to make sure they had the necessary skills to support people to keep them healthy and well minded.

A relative told us, “The main thing I look for is honesty and I feel confident in the leadership at Gate House.”

Thorough and detailed assessments were carried out with people and their representatives before they moved into the service. The registered manager made sure that people were compatible with each other and that sufficient preparation had been made to give people the best chance of success. The service went the extra mile to make sure people’s rooms were designed in the way they wanted and organised equipment and made adaptations with people’s preferences and individual needs in mind.

Staff were caring and people’s individuality was respected and nurtured. People’s confidence was growing and with this their communication skills had increased. Relatives and health and social care professionals told us that the service was really making a difference to people’s lives. People had more control over how they wanted to live their lives and were trying new experiences. People were more confident and incidents of anxious behaviour were reducing with the change of lifestyle. There were planned activities that people could choose from and the right number of staff to support them.

There was a system of risk assessment to protect people as much as possible without limiting their experiences. Each situation and opportunity was assessed for how it would enhance the person’s quality of life and what the potential risks were. Positive risks were taken to help people develop their independence.

People were learning new skills and living as active a lifestyle as they wanted. Staff respected peoples’ privacy and dignity and offered people choices in the way they could understand and respond to. Meetings were held regularly with people to plan and discuss their goals and aspirations so that the service was run in the way they wanted. People’s relationships with their families and other people who were important to them were encouraged and supported; this included regular phone calls and visits.

People were supported to maintain a healthy active lifestyle. Clear easy read plans were designed to help people manage health conditions that needed monitoring. The staff worked closely with health professionals to maintain peoples’ he

Inspection carried out on 7 January 2016

During a routine inspection

This inspection took place on 7 and 11 January 2016 and was unannounced.

The service is in the village of Eastry near to the main towns of Sandwich, Dover and Ramsgate. There were four people living at Gate House and one person who stayed for weekends. Each person had their own bedroom. The home is open plan in style with access to the garden at the front and back of the house. The house has one level and is set in the grounds with other houses owned by the company. The houses are separated by fencing and secure gates.

There was a registered manager at the service who supported both days of the 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.

The registered manager started working at the service in August 2015. He had identified lots of areas where improvements were needed and had written an action plan. An acting deputy manager had been supporting the manager and a new deputy manager had just started and was going to be based in Gate House.

At the time of the inspection the home provided an unpredictable and unsettled environment for people. There was an inconsistent approach to supporting people that sometimes put people’s wellbeing at risk. There had been some changes in the service provided and some new people had moved into Gate House. People did not all get along and they had conflicting needs that made it difficult for staff to manage and support people effectively. The registered manager and deputies were trying to sort the service out, but were managing various situations that occurred in order to protect people, rather than being able to manage the service and prevent the situations from occurring in the first place. The registered manager and deputies had lots of ideas to improve the service and were working through the action plan, which meant that some of their ideas had not yet been implemented.

Risk assessments had been carried out for general areas of risk and were in people’s care plan folders. These covered areas like slipping in the bath or needing support to go out due to a lack of understanding of road safety. Risk assessments for the current difficulties and needs were being assessed on an almost day to day basis, so they were not all recorded clearly in people’s plans. In these circumstances, staff were reliant on senior staff and management to direct them to protect people.

Staff we spoke with knew about different types of abuse but not all of the staff had attended training in safeguarding people from harm and abuse. Recruitment checks on staff were not as thorough as they should be. Some staff did not have the right number of references and gaps in their employment history and this had not been followed up. Staff had not declared that they were healthy and fit for the role and provided proof of their qualifications.

There were sufficient staff to meet people’s basic care needs. People’s unpredictable behaviours meant that at times a higher staffing level was needed. Recently the staff had been organised so that they supported people with individual activities to minimise the risk of behaviour that may harm others.

Staff attended basic training courses; subjects related to peoples’ needs were limited. Staff had not had training in person centred planning, learning disability awareness and positive behaviour support. Staff had not had the opportunity for regular one to one meetings. The registered manager agreed that the training for staff could be improved and he would talk to the provider about this. Staff we spoke to were motivated, enthusiastic and willing to learn. There had been some recent staff meetings and staff said they felt supported by the new manager and deputies.

Staff respecte

Inspection carried out on 3, 4 October 2013

During a routine inspection

Some of the people who lived in the home were not able to tell us about their experiences, so we observed the interactions between people and staff. People lived active lifestyles and could choose how they spent their time.

People were assisted to attend health care checks and community health professionals were involved to provide advice and support when needed.

We saw people looked comfortable and at ease in the home and with staff. There were procedures in place for staff to follow to protect people from abuse.

The home was maintained and checks were in place to make sure it provided a safe environment for the people who lived there. There was a maintenance and refurbishment plan in place. Some redecorating had commenced and work to refurbish the kitchen had been organised.

There had been some staff changes but there were sufficient staff to support the people who lived at the home. Training that the manager had identified the team needed was being organised. Staff were being supported and directed by a new manager to develop their confidence and skills to effectively meet the needs of the people using the service.

At the time of our inspection the provider did not have a registered manager in post.

Inspection carried out on 18 December 2012

During a routine inspection

We spoke to and spent time with all the people living in Gate House. Not everyone living in the home was able to talk about their lifestyle with us so we observed the interactions between the people and staff. People said or expressed that they were happy with the service. People were laughing and interacting with each other.

People received support to maintain a healthy, active lifestyle. They were able to pursue a variety of hobbies and interests in the home, at the day centre and out in the community. People were assisted to attend health care checks and community health professionals were involved to provide advice and support when needed. A healthy balanced diet was offered to people who were able to choose the food they ate from photos or food packets if they did not understand the menu. People were supported to develop their independence skills, including making snacks and drinks.

People were assisted to express their views and make important decisions because the staff helped them with their communication and spent time with them.

There were a clear recruitment process and staff said they received the training they needed and were well supported when starting work in the service.

Inspection carried out on 23 November 2011

During a routine inspection

Not all the people living in the home were able to tell us about their experiences so we observed the interactions between the people living in the home and the staff.

People said they liked the home and the staff were supportive. They talked about their lifestyle and interests. They explained that they were able to get out and pursue their interests.

We observed people looking comfortable and at ease in the home and with staff. People smiled and laughed when participating in various activities with the staff.

People were given the opportunity to tell staff how they wanted to be supported.

Reports under our old system of regulation (including those from before CQC was created)