Gainsborough Care Home

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

At the previous inspection the home had demonstrated improvements in managing risks to people’s safety from unsecured furniture and auditing to identify and manage the risk. At this inspection we found evidence improvement in this area had been sustained and people were safe.

The registered manager had brought stability to the home and greater managerial oversight. People, relatives, staff and professionals were unanimous in their praise for the registered manager seeing them as pro-active, receptive and keen to encourage all to contribute ideas to drive further improvement.

People felt safe and happy living at Gainsborough Care Home. People were supported by staff who understood how to keep them safe from harm or abuse and knew their responsibility to raise concerns if they were to witness poor or abusive practice.

People and their relatives told us they felt there were sufficient staff to meet people’s needs in a timely and person-centred way. Our observations confirmed this.

People received their medicines on time and at the prescribed dose. Medicines were only administered by staff with the required training and competency assessments.

Staff felt recognised and told us management encouraged and supported them to progress. Staff and management told us they enjoyed working at Gainsborough Care Home and loved their jobs. Management told us they felt supported by the provider.

The home had a friendly, open and supportive atmosphere.

Good working relationships with other organisations such as local hospitals were helping the wider health and social care system at a time of significant pressures.

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

Rating at last inspection

The last rating for this service was requires improvement (published 15 October 2020).

Why we inspected

We inspected Gainsborough Care Home to support creating more capacity in the local adult social care system. We undertook a focused inspection to check improvements made at the previous inspection had been sustained. As a result, we did an inspection of the Safe and Well Led key questions and our report only covers our findings in relation to those areas. No areas of concern were identified in the Caring, Effective and Responsive key questions.

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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gainsborough Care Home 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.

Gainsborough Care Home is a residential care home providing personal and nursing care to 34 people aged 65 and over at the time of the inspection. The service can support up to 48 people in one building, which is adapted for the needs of people with mobility difficulties.

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

People were now protected from the risk of large furniture falling on them. Since the previous inspection risk assessments had been completed for each person. All large furniture in occupied and unoccupied rooms was now secured.

The provider had introduced improved oversight of the security of furniture in people’s rooms. This was now included in the home’s monthly health and safety audit. The maintenance person also carried out weekly checks to ensure this improved level of safety was sustained. The registered manager told us, “People here are definitely safer now.”

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 October 2020) when we identified two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Following our last inspection, we served a warning notice on the provider. We required them to be compliant with Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 30 October 2020.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

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.

Gainsborough Care Home is a residential care home providing personal care and accommodation for 35 people aged 65 and over at the time of the inspection. The home can accommodate up to 48 people in one building, which is adapted for the needs of people with mobility difficulties.

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

Although improvements had been made to safety at the home since the previous inspection and people told us they felt safe and well cared for, people were still at risk of avoidable harm. The provider’s quality assurance system and leadership had not identified the shortfall we found; 31 of 35 occupied rooms had unsecured wardrobes. None of the occupied rooms had risk assessments for the wardrobes.

There had been a period of management instability at the home since the previous inspection. The previous registered manager left in November 2019 and the home was then supported by peripatetic managers. A new manager and deputy manager started in March 2020. They have been supported by the provider’s senior management team. Despite this, and a previous action plan confirming the issue with wardrobes we had identified at two previous inspections had been resolved, and measures put in place to prevent a re-occurrence, the manager and provider had not identified the issue with the wardrobes that we found on this inspection.

Medicines were managed safely and stored securely. This included potentially hazardous denture tablets and topical creams. Each shift had a suitably trained and competent member of staff to administer people’s medicines.

Further improvements had been made to cleanliness around the home. Since the previous inspection the home had increased the number of domestic staff. This had also given care staff more time to spend with people.

There were enough appropriately trained staff to meet people’s needs. The home had a robust values-based recruitment process with all required pre-employment checks to ensure only suitable staff worked at the home. Staff received a comprehensive induction, which included shadowing more experienced staff.

Staff understood the signs and symptoms that may indicate a person is being harmed or abused and knew how to report this. They told us they would feel comfortable to whistle blow should they witness or hear about poor practice.

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 July 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced inspection of this service in April 2019. A breach of regulation was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings 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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service.

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

Gainsborough Care Home is a care home without nursing. It was providing personal care to 37 people aged 65 and over at the time of the inspection, many of whom were living with dementia.

Gainsborough Care Home accommodates up to 48 people in one building, which is adapted for the needs of people with mobility difficulties.

People’s experience of using this service:

People received the care they needed. Individual people’s risks were assessed and managed.

There was one instance of a person being lifted in a different sling to that specified in their care plan. The registered manager ensured the person’s care plan was updated. However, we have made a recommendation regarding always having people’s correct slings available.

Staff treated people with dignity and respect, promptly assisting people who showed signs of distress. People told us they liked the staff. A person commented, “If you’re worried, they [staff] will help you.”

People were supported 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 and where appropriate their relatives were involved in decisions about their care.

Safety certification for gas, electricity and the fire warning system was up to date. Precautions were taken against legionella (bacteria that can cause serious illness) colonising the water system.

Improvements had been made to cleanliness around the building. However, there were some localised instances of unpleasant smells and staining, which staff attended to when we highlighted these.

The building was overall accessible to people with impaired mobility. Some aspects of the décor did not follow recognised guidance on dementia-friendly design.

Activities were provided.

There were enough safely recruited and trained staff to provide for people’s essential needs, but additional responsibilities for laundry and washing up made it hard for staff to spend time with people other than during care. The provider was in the process of recruiting further domestic staff who would be able to cover additional kitchen and laundry duties.

For four nights a week, there were no staff on duty who were trained to administer medicines. The provider was in the process of addressing this.

Staff worked in a confident and organised manner. They were supported through training and supervision to perform their roles effectively.

Medicines were managed safely and stored securely, apart from some prescribed skin creams that were loose in some people’s rooms.

The provider’s quality assurance system had not identified or remedied shortfalls we found, such as unsecured furniture and denture cleaning tablets that had not been stowed away. You can see what action we told the provider to take at the back of the full version of the report.

Staff had up-to-date training in safeguarding adults and knew how to report suspected abuse.

The registered manager and provider had worked openly and cooperatively with health and social care professionals who were investigating safeguarding concerns. Accidents and incidents were reviewed to ensure necessary action had been taken to keep people safe.

Concerns about people’s health were referred to the appropriate health professionals.

Dietary needs and preferences were catered for. Staff discreetly and attentively assisted people who needed support with eating and drinking.

Rating at the last inspection:

At the last inspection the service was rated requires improvement (15 January 2019).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to meet the regulations in relation to safe care and treatment and good governance.

Why we inspected:

This inspection was brought forward due to information of concern relating to people’s care and safety. There was an ongoing safeguarding enquiry overseen by the local authority in relation to this.

Improvement action:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We continue to work with partner agencies in our ongoing monitoring of the service.

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

Gainsborough Care Home 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.

Gainsborough Care Home accommodates up to 48 people on the ground and first floors of one building. Nursing care is not provided. There were 33 people living or staying there when we inspected, most of whom were living with dementia.

A new manager had started working at the service in July 2018. Their application to register as manager was being assessed by a Care Quality Commission registrations inspector. This was completed shortly after 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.

There were usually enough staff on duty. There were checks before new staff started work so only staff who were suitable to work in care were recruited. We have made a recommendation about references from previous care employers. However, staff were not all skilled and competent to care for people safely. We observed a new member of staff assisting a person to eat in an unsafe and undignified manner, placing the person at risk of choking. They did not have a good understanding of fire safety. This was a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.

There were also shortfalls in the cleanliness of the service, which the manager was addressing. Staff did not always use disposable gloves properly, which increased the risk of spreading infection. This was a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.

The premises were accessible to people with restricted mobility. Much of the décor was tired and scuffed. There was limited signage suitable for people who were living with dementia and had lost the ability to read, to help them find their way around the building. A programme was in place for redecoration. We have made a recommendation about the redecoration considering good practice guidance about decoration that meets the needs of people who live with dementia.

The provider told us doors across the upstairs corridor were locked to prevent access to the stairs, as instructed by the local authority safeguarding and quality teams. The manager and provider had identified that this was potentially unduly restrictive for people. They were considering what action to take, in consultation with the local authority.

The manager had a good understanding of the Mental Capacity Act 2005 and the service worked within its principles. They understood when people should be viewed as deprived of their liberty and had ensured DoLS applications had been made to the appropriate local authority.

There were regular health and safety checks. The provider and manager were aware of repairs and redecoration that were needed, and a programme was under way to address this. Risks in relation to individual people were assessed and managed.

Staff followed safe procedures when administering medicines. Eye and ear drops, and medicines taken by mouth or injected by district nurses were stored securely. Quantities of medicines in stock were accounted for in people’s medicines records and there were procedures to ensure there were always sufficient amounts on hand. However, prescribed creams and ointments were not stored safely, and some were overstocked. The manager had already identified this was an issue and was acting to address it.

People were protected from abuse. Staff understood their responsibilities to report safeguarding concerns within their organisation and knew how to blow the whistle about poor practice.

Staff reported accidents and incidents and the management team took appropriate action.

Food was not all appetising or presented in a way that would encourage people to eat. A member of staff usually employed in a different role was covering until the new chef started work. The dining environment was not always pleasant and conducive to people enjoying their meal. People mostly made meal choices in advance of the meal when staff asked them. This method of choosing a meal can be difficult for people who live with dementia, who may have difficulty remembering or understanding the alternatives. We have made a recommendation about reviewing dining environments, method of offering choices and food presentation to encourage people to eat.

Staff generally treated people kindly and with respect but were largely focused on tasks. When they spoke with people it was with warmth and kindness but mostly about whatever needed doing. People’s dignity and privacy was not consistently promoted.

People were encouraged to make choices about their life at Gainsborough Care Home and these were respected, for example what time they got up or where they wanted to eat their meal. People were encouraged to personalise their rooms as they wished. Mostly, care staff explained to people what was going to happen and kept them informed of what they were doing.

Staff generally had a good understanding of the care people needed. Preadmission assessments had been undertaken before people moved into the service, so the service could be sure it would be able to provide the care and support they needed. Care records did not all contain detail about people’s backgrounds and preferences to help staff view people for who they were. The manager had identified that care plans were not all up to date and person centred and was in the process of reviewing and rewriting them to make them more detailed and relevant to the person. People were supported to access healthcare as they needed. They were supported at the end of their life to have a dignified and comfortable death.

An activities coordinator had recently been appointed and there were visiting entertainers and trips out locally. However, people often sat withdrawn or asleep in the lounges with the television playing and little interaction from staff, who were busy with other things. Activities were not clearly publicised.

Information was displayed in the reception area about how to raise a concern or complaint. No formal complaints had been received since the manager had been in post. However, people living at the service and relatives expressed ongoing frustrations about lost clothing. The manager was trying to address this.

The manager worked closely with staff and sought to cultivate a positive, open culture. They set out clear expectations regarding what staff were responsible for and how things should be done. Staff were supported through supervision meetings and received coaching where necessary to improve their performance.

Quality assurance systems were in place to monitor the quality of the service but had not identified all the issues found at inspection. The manager responded promptly and constructively to issues we raised. Not all concerns identified through audits were addressed with an action plan and audits were not all sufficiently comprehensive. There had been multiple demands on the manager’s time since they started in post, which limited their time to oversee all aspects of the service. You can see what action we told the provider to take at the back of the full version of the report.

The service and provider sought to foster community links and work in partnership with other agencies.

Gainsborough care home provides accommodation and personal care for up to 45 people. At the start of the inspection there were 33 people living in the home. The service is located in a residential area of Swanage and is a large detached building set over two floors. The home had two communal lounges and dining areas and an accessible garden. The majority of people living in the home had complex needs relating to the impact of their dementia.

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.

When we last inspected the service on 27 April 2016 we had concerns about how people’s risks were managed and people were not provided with the necessary support to eat or drink. The provider sent us an action plan which detailed how they would meet the regulations and be compliant by August 2016. At this inspection we found that improvements had been made.

Staff were aware of the risks people faced and their role in managing these. Care plans provided information about risk but were not individualised.

Audits were completed regularly and covered a range of topics. They were used to drive improvements but did not consistently identify gaps where improvements were needed.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

People had care plans which provided detail about how to support people but needed more information to be person centred and reflect the histories of people and what was important to them. Care plans were regularly reviewed with people and their loved ones where appropriate.

There were enough staff available and people did not have to wait for support. People had support and care from staff who were familiar to them and knew them well. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs.

The home had good links with health professionals and regular visits and discussions meant that people were able to access appropriate healthcare input promptly when required.

People were supported by staff who had the necessary training and skills to support them. Training was provided in a number of areas the service considered essential and other learning offered was relevant to the conditions that people faced.

Staff understood and supported people to make choices about their care. People's legal rights were protected because staff knew about and used appropriate legislation. Where people had decisions made in their best interests, these included the views of those important to the person and considered whether options were the least restrictive for the person.

People spoke positively about the food and had choices about what they ate and drank. The kitchen were aware of people’s dietary needs and where people required a special diet or assistance to be able to eat and drink safely this was in place.

Staff knew people well and interactions were relaxed and caring. People were comfortable with staff and we observed people being supported in a respectful way. People were encouraged to make choices about their support and staff were able to communicate with people in ways which were meaningful to them.

People were supported by staff who respected their privacy and dignity and told us that they were encouraged to be independent.

People were supported by staff who knew their likes, dislikes and preferences. Staff told us that they communicated well and there were regular handovers. There were clear processes in place for each shift and staff knew their roles and responsibilities.

People were able to engage with a range of activities including one to one time with staff. People told us that they had enough to do at the home and enjoyed the activities on offer.

Relatives spoke positively about the staff and management of the home. They told us that they were always welcomed and visited when they wished. Both relatives and people told us that they would be confident to complain if they needed to.

Feedback was gathered both formally and informally and used to drive improvements at the home. Quality assurance measures were regular and also used to identify gaps and trends which were then used to plan actions to drive high quality care.

The inspection visits took place on 10 and 16 March and we spoke with relatives by phone over the following week.

Gainsborough Care Home is a purpose built home registered to provide care for up to 45 people in a residential area of Swanage. At the start of our inspection there were 42 people living in the home. The majority of people living in the home had complex care needs related to the impact of their dementia.

The service did not have a registered manager at the time of our inspection but the manager was in the process of applying to take on this role. The last registered manager had left the service in December 2015 and the current manager had started in post at this time. 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.

Gainsborough Care home had been through a sustained period of management change when we inspected. The new manager had been in post for three months and was applying to become the registered manager. We found a number of areas that required improvement during our inspection. The manager was aware of most of these issues and had started work on plans to make improvements.

People did not always receive the support they needed to eat and drink in ways that met their needs and preferences. We observed that for some people meal times were an opportunity for choice and socialising but this was not the experience for people with more complex needs.

We heard some mixed opinions from relatives as to whether there were always enough staff available and we observed times when staff were not deployed in ways that met people’s identified needs. The staffing had been reviewed and increased since the manager came into post and remained under review. Changes to deployment were made immediately following our inspection.

People were protected from harm because staff understood the risks they faced and knew how to identify and respond to abuse. Care and treatment was delivered in a way that met people’s individual needs but there was some discrepancy about staff understanding of how to mitigate risks and records were not always accurate. This increased the risk that people could receive inappropriate care. Where people needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this Deprivation of Liberty Safeguards had been applied for.

Some people were engaged with a wide range of activities that reflected individual preferences, including individual and group activities. Activities were being developed further with a focus on people who spent more time upstairs.

Health professionals were confident that people received support for their health related needs in a timely and appropriate manner.

People and their relatives were positive about the care they received from the home and told us the staff were compassionate, kind and attentive. Staff treated people, relatives, other staff and visitors with respect and kindness throughout our inspection. Relatives told us they felt able to raise concerns and that the new manager had made themselves available.

There was a breach of regulation relating to how people received care and support that met their needs. You can see the action we asked the provider to take at the back of the full report.

When we inspect we gather evidence to answer the below questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This inspection was to follow up some issues with the management of medicines, and so we only looked at whether the service is safe on this occasion. Below is a summary of the inspection and what we found.

Is the service safe?

We found that there were appropriate arrangements in place in relation to the obtaining, recording, handling, safe keeping and administration of medicines. We saw that improvements have been made recently to the way medicines were managed in the home. We found that a warning notice that we had issued has now been met.

People's needs were assessed and care was planned and delivered to meet people's needs. We found that people's care records contained assessment of people's needs and a plan as to how these needs were to be met. Staff were aware how to meet people's needs.

The home was clean and smelt fresh and staff were aware of how to protect people from the risks of infection. One person told us, They clean my room pretty regularly.'

There were sufficient numbers of staff to meet people's needs. One person told us, 'The staff are pretty good.' We spoke with staff who considered there were enough staff to perform their duties effectively.

The provider assessed the quality of the service provider and made changes as necessary.

People’s care needs were assessed and care was planned and delivered to meet their needs. One person told us, “I get all the help I need, the staff meet my needs.”

The provider had a process in place to report allegations of abuse and staff were aware of this process. Staff had received appropriate training and were supported in their roles.

The provider had not protected people against the risks of infection as they had not conducted an adequate assessment of the risks of cross infection.

Records were accurate and contained appropriate information. There was a process in place for secure storage and destruction of records which were no longer needed.

In this report, the name of the registered manager appears who was not in post and not managing the regulated activity 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.