We carried out a review of the data available to us about London and Manchester Healthcare Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about London and Manchester Healthcare Limited, you can give feedback on this service.
London and Manchester Healthcare Limited, Gainsborough House is a residential care home providing personal and nursing care to up to 72 people. At the time of our inspection there were 68 people using the service across three separate wings, each of which has separate adapted facilities.
People’s experience of using this service and what we found
The service had addressed some of the issues from the last inspection, and we found medicines were managed safely across the home, however we made some recommendations about medicines management.
There were a range of effective provider and manager quality assurance processes in place, the provider had learnt lessons from the previous inspection and improved services.
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.
Risk assessments held appropriate information. Care plans and risk assessments were person centred and detailed how people wished and needed to be cared for; these were regularly reviewed and updated as required. We saw evidence of how the registered manager and staff ensured people beliefs, choices and rights were respected. This was supported in feedback we received from people and their relatives.
The recruitment of staff was safe and there were enough staff on duty on the day of inspection to meet people's needs. Risks to people's health and safety had been assessed and mitigated and equipment had been serviced and maintained. Accidents and incidents were recorded and reviewed in order to minimise the risk of reoccurrence.
We observed support being provided in the home and saw this was done in a caring, responsive, and patient manner. We saw people were comfortable in the presence of staff and positive relationships had developed between people receiving support and staff. A visitor told us “There are always plenty of staff about and they always seem patient and kind with the residents. There seems to be more permanent staff about lately, they do use some agency staff, but they also seem genuinely nice. The home is always spotless with no nasty odours. I have no concerns about any other residents or the way anyone is treated. There is always a very pleasant friendly atmosphere when I visit.”
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 03 December 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service. 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. 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 requires improvement to good based on the findings of this inspection.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
London and Manchester Healthcare Limited, Gainsborough House is a care home providing personal and nursing care to 57 people. The service can support up to 72 people across three separate wings, each of which has separate adapted facilities.
People’s experience of using this service and what we found
Improvements had been made in infection control and identification of risk. However, improvements were still needed regarding medicines management, monitoring and quality assurance.
There were a range of provider and manager audits in place. However some audits were in need of improvement due to the issues we found.
Feedback we received from staff, people and relatives was mainly positive, and some comments made from families indicated that communication from the home had improved.
The recruitment of staff was safe and there were enough staff on duty to meet people's needs. However, comments we received from families indicated that there was a slight concern regarding the changes to the management team and staff and how this impacted continuity of care.
Risks to people's health and safety had been assessed and mitigated and equipment had been serviced and maintained. Accidents and incidents were recorded and reviewed in order to minimise the risk of reoccurrence. Safeguarding and complaints were also managed appropriately and monitored by the management.
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 inadequate (published 18 May 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had been made and the provider was no longer in breach of regulation 17. However, enough improvement had not been made in regulation 12 and the provider was still in breach of regulations.
This service has been in Special Measures since 7 April 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last 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.
We have found evidence that the provider needs to continue to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
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. The overall rating for the service has changed from inadequate to requires improvement. 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 London and Manchester Healthcare Limited on our website at www.cqc.org.uk.
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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so. We have identified a continued breach in relation to medicines management at this inspection.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
London and Manchester Healthcare Limited, Gainsborough House is a residential care home providing personal and nursing care to 62 people requiring nursing and personal care. The service can support up to 72 people across three separate units, each of which has separate adapted facilities. Two of the units specialise in providing care to people living with dementia who have additional nursing needs, the third unit provides care to people only needing nursing support.
People’s experience of using this service and what we found
At this inspection, we found concerns with the management of risk, medicines, record keeping, infection control and governance.
Staff did not have sufficient guidance to provide safe and appropriate care. Medication management was unsafe and placed people at risk of avoidable harm. Infection control standards were not being followed to protect people from the risk of infection such as COVID-19.
We identified that a lack of cohesive working and poor communication within the home had led to risks not being recognised and acted on. Some audits of the service were ineffective and, in some cases, not carried out.
Record keeping in relation to people’s ongoing care needs were not always properly maintained. However, accidents and incidents were kept in order and there was evidence of monthly scrutiny of incidents and falls looking for patterns.
There were enough staff on duty to support people, and staff were recruited safely. Care staff were friendly, and treated people kindly. People’s relatives confirmed this and felt their loved ones were well looked after.
Rating at last inspection
The last rating for this service was good (published 01 March 2018).
Why we inspected
We received concerns in relation to injury sustained through moving and handling, infection control, care delivery and governance. As a result, we undertook a focused inspection to review the key questions of safe 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.
The overall rating for the service has changed from good to inadequate. 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 COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London and Manchester Healthcare Limited, Gainsborough House on our website at www.cqc.org.uk.
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.
We have identified breaches in relation to medicines, safe care and treatment, infection control and governance at this inspection.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
London and Manchester Healthcare Limited (known locally as Gainsborough House) is a residential nursing home near the centre of Warrington and is registered to provide accommodation with care for up to 72 people. Rooms are over three floors, single occupancy and all have en-suite facilities. Assisted bathrooms are also available on each level of the home. There are a range of public areas including lounges and dining rooms on each floor. There are communal secure gardens with good access from the building.
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.
There was lots of positive feedback about the home and caring nature of staff from people who used the service and their relatives.
People and their families described the care as safe. Staff had been trained to recognise signs of abuse and knew the actions they needed to take if abuse was suspected. People were protected from avoidable harm as risk assessments had been carried out, were regularly reviewed and staff understood the actions needed to minimise identified risks. People were involved in decisions about how their risks were managed and had their freedoms and choices respected.
There were enough staff to meet people's needs and they had been recruited safely. The recruitment process included obtaining employment references and carrying out a criminal record check. Staff were well trained to enable them to carry out their roles effectively.
Staff felt valued and supported by management and by each other and made sure that people's needs and preferences were at the forefront of what they did. Staff received regular on-going training and supervision and had opportunities for professional development. Nurses received training that kept their clinical skills up to date.
People had been involved in decisions about how they would like their care needs met and these were regularly reviewed. Care and support plans provided clear information about people's care needs and staff understood the actions needed to support people and had been kept updated with any changes. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in place supported this practice.
People and their families described staff as caring, kind and patient and we observed relaxed, friendly interactions between people and the staff. Staff demonstrated a good understanding of people's individual communication needs and supported people in ways that enabled them to be involved in decisions and express their wishes. People had their independence, privacy and dignity respected.
People were offered choices of meals and snacks throughout the day and information about likes, dislikes, allergies and special diets had been shared with the catering team.
People had opportunities to maintain hobbies and interests and keep in touch with family and friends. Numerous activities took place both within the home and in the local community.
The service was extremely well managed by an accomplished, experienced and highly motivated registered manager. The registered manager and staff were proud of where they worked and committed to delivering a high standard of care. Staff spoke positively about their roles and the teamwork and described how they had embraced the organisation's values.
The culture of the home was open and transparent and people who used the service, their families and the staff team felt able to raise any issues with the management team. Communication was effective and ensured people were kept up to date and felt included.
There was an excellent quality assurance system in place that was effective in gathering information that captured the experiences of people using the service and this information was used to improve outcomes for people.
The inspection was unannounced and took place on the 12 January 2015. An arranged visit to complete the inspection was then undertaken on the 20 January 2015.
This home is actually registered as London and Manchester Healthcare Ltd and the first line of the address is Gainsborough House Nursing Home. This is an administrative issue that occurred when the home was first registered in August 2011. Everyone refers to the service as Gainsborough House so this is the name used throughout this report.
The last inspection took place on the 11 February 2014 when Gainsborough House Nursing Home was found to be meeting all the regulatory requirements looked at and which applied to this kind of home.
The home is required to have 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. The current registered manager is due to retire and the provider has appointed a new manager who had applied for registration with the CQC. They will take over the day to day management of the home when the current manager retires.
Gainsborough House is a privately owned care home. It is located on the corner of Chester Road/Gainsborough Road in Lower Walton which is on the outskirts of Warrington. The home provides accommodation with nursing for up to 72 people. It is divided in to three 24 bedded units arranged over three floors. The ground floor accommodates people who need nursing care [Picasso] and the first and second floors cater for people living with some degree of dementia Matisse and Renoir]. On the day of our inspection visit there were 72 people living in the home.
We saw that the service had a safeguarding procedure in place. This was designed to ensure that any possible problems that arose were dealt with openly and people were protected from possible harm.
We looked at the recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.
The provider had their own induction training programme that was designed to ensure any new staff members had the skills they needed to do their jobs effectively and competently.
We asked staff members about training and they all confirmed that they received regular training throughout the year and that it was up to date.
The service had a range of policies and procedures which helped staff refer to good practice and included guidance on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.
There was a flexible menu in place which provided a good variety of food to the people using the service.
The care plans were reviewed monthly so staff knew what changes in care provision, if any, had been made. The files we looked at all explained what each person’s care needs were. This helped to ensure that people’s needs continued to be met.
Staff members we spoke with were positive about how the home was being managed. Throughout the inspection we observed them interacting with each other in a professional manner. All of the staff members we spoke with were positive about the service and the quality of the support being provided.
There was an internal quality assurance system in place. This included audits on care plans, medication, weight losses, accidents, incidents and complaints.
In addition to the above there were also a number of maintenance checks being carried out weekly and monthly. These included the water temperature, the proper operation of window restrictors as well as safety checks on the fire alarm system and emergency lighting. Individual fire safety risk assessments were also completed for each person and these were kept in the care files.
People felt that they were consulted and involved in their care.One relative said "They communicate with me very well."
The home worked cooperatively with a range of healthcare providers. One relative said "When my mother had a fall they called someone in very appropriately."
During our visit the home was clean and tidy and had clear systems in place to reduce the risk of infection.
The staffing levels we observed were appropriate to the needs of the people living in the home. The staff we spoke to commented that they only had to ask the manager if they felt they were short staffed and bank staff would be brought in. One member of staff said "I'm proud to say I work here."
There was a complaints procedure in place which staff felt confident to follow. One person said "I've got no complaints" and another "If I had any concerns they are very accessible."
The people using the service who were able to tell us said that they were happy living in the home. Comments included; 'I am fine and being looked after well' and 'I have no complaints at all, the staff are really kind.' Visiting relatives told us; 'The staff are very friendly and keep you informed' and 'The staff are really good.'
We asked a visiting relative and her relation who lived in the home about the staff working there, they told us, 'Lovely here, love the people, wonderful. There are little touches.' Another relative said; 'The staff are brilliant.'
The manager and deputy both 'walk the floor' on a regular basis to make sure everything is going well. Residents and relatives forums are held regularly and there is also a 'spouse group' who meet regularly [This is a support group for the partners of people using the service who have dementia].