Gain Healthcare Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to Inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to people’s safe care, governance and consent.

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider failed to ensure the person's care and treatment were effective. They did not routinely assess, review or discuss health, care, or wellbeing, with the person which meant care was not consistently planned or delivered in line with the person's current needs.

The care plan did not accurately reflect the person's needs and were not kept up to date. Although staff were able to verbally describe the person's individual needs during the inspection, this information was not consistently recorded within care planning documentation. As a result, staff did not have access to reliable, accurate or current information to guide their practice. This placed the person at risk of receiving ineffective or inconsistent care.

The care plan lacked essential information to support safe and effective care delivery. Guidance for staff relating to moving and handling was not included, staff told us care plans were often not a true representation of the person or their current needs. This demonstrated a fundamental weakness in care planning systems and increased the risk of inappropriate or unsafe support.

Care records did not consistently evidence that the person received appropriate support with personal care, or their support needs. The care plan did not clearly state the level or type of support required.

Some positive information was included within the care plan, such as details about what was important to the person, activities they enjoyed and how to offer choice. However, these isolated examples did not mitigate the overall failure to ensure assessments and care planning were accurate, sufficient or effective.

We found no evidence that people or their relatives were consistently involved in reviewing their care needs. Although the registered manager told us they spoke with people daily, there was no documentary evidence to support this or to demonstrate that feedback from people or relatives was used to review or update care plans. This meant the provider could not demonstrate that care was planned or reviewed in partnership with people.

The provider did not always plan and deliver people’s care and treatment with them, including what mattered to them and what was important for their wellbeing.

The care plan did not provide the guidance staff required to safely support the person. There was no information explaining why they required the level of supervision indicated or how staff should carry out the support in practice.

The care plan did not specify what texture food was appropriate for the person.The supporting professional guidance was not available for staff to follow. We requested the recommendations from the provider, we were informed this was in the person’s home. Which meant new staff did not have access to this prior to shadowing staff to support the person, and the provider was unable to monitor the persons care and treatment as they did not have access to their care and support needs.

Staff did not have access to the information needed to deliver safe, effective and consistent support in line with evidence based practice. The care plan referred to strategies to protect the persons skin such as barrier creams to support with continence care, however there were no creams listed.

The provider did not always work well across teams and services to support people. They did not consistently share their assessment of people’s needs when people moved between different services.

Where professionals were involved in the person’s care, information from clinical assessments, including guidance and recommendations provided, was not included within the person’s care planning. This meant staff did not have access to essential information needed to deliver safe and consistent support.

Staff we spoke with felt that due to high number of staff changes, they often felt staff were not adequately trained to provide support and staff felt they had to train staff to support the person and their needs which was challenging when providing people with support.

The provider did not always ensure staff, teams or external professionals had access to accurate assessments when people required support from other services. As a result, people were sometimes required to repeat information, and important details about their relatives’ needs were not always communicated, which increased the risk of inconsistent or unsafe care.

The provider did not always support people to manage their health and wellbeing, which meant people were not always able to maximise their independence, choice and control. Staff did not consistently support people to live healthier lives or, where possible, reduce their future needs for care and support.

Risk assessments included information about known triggers and strategies to support the person. However, additional relevant information recorded in daily notes had not been incorporated into the care plan. There were incidents where inconsistent and reactive approaches reduced the effectiveness of support provided, as staff did not have the information or training required to predict outcomes. The training matrix did not demonstrate that staff supporting the person had received training as outlined within their care plan. These further limited opportunities to take a preventative, health-promoting approach to care.

Relatives told us they had been given clear expectations that the service would provide specialist support to maximise the person’s independence and development. However, this level of support was not delivered in practice. The service confirmed that certain specialist professionals advertised were not in place. As a result, the person’s potential to build confidence, develop coping strategies and achieve greater autonomy was not fully realised. This had a direct impact on health promotion, as the support provided did not consistently enable the person to thrive, maintain wellbeing or reach their full potential.

The provider did not always routinely monitor people’s care and treatment to drive continuous improvement. They did not always ensure that outcomes were positive or consistent, or that they met both clinical expectations and the expectations of people using the service.

The care records made reference to specific strategies intended to support the person. However, these were not clearly defined or supported by sufficient guidance. Key supporting documentation referred to within the records was not available during the inspection. Although this was later provided, it had been created after the inspection and did not contain clear or practical guidance for staff.

There was no evidence to demonstrate staff had received the relevant training linked to these approaches. This meant staff did not have consistent access to the information or competencies required to apply agreed strategies in a safe and reliable way. This reduced effectiveness in achieving intended outcomes.

Records did not always contain enough detail to provide a clear and comprehensive framework for staff to follow. While general approaches were outlined, there was a lack of clarity around how these should be interpreted or implemented in practice. This limited the provider’s ability to ensure consistency, review effectiveness, and make meaningful improvements.

The provider failed to ensure that people were supported in line with their rights around consent. They did not consistently inform people of their rights, nor did they respect or lawfully apply these rights when delivering care and treatment. These failures placed people at risk of receiving care that was not lawful or in their best interests.

The registered manager told us about how decisions were made, this was not consistent with the records reviewed. Documentation indicated that formal assessments and structured decision-making processes were required, however, these had not been completed.

There were no mental capacity assessments in place to support decisions relating to medicines management, personal care, or the use of restrictive practices. As a result, the provider could not demonstrate that decisions about the person’s care were lawful, necessary or made in their best interests. This indicated a fundamental lack of understanding of responsibilities under the Mental Capacity Act (2005).

The training matrix did not evidence that staff had completed training in the Mental Capacity Act. Without appropriate training, staff did not have the knowledge or understanding required to assess capacity, seek valid consent, or make lawful best‑interest decisions. This further increased the risk that people’s rights were not recognised or protected.