Gain Healthcare Ltd

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to Requires improvement. This meant people’s needs were not always met.

The service was in breach of legal regulation in relation to person-centred care.

This service scored 46 (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 did not always make sure people were at the centre of their care and treatment choices, and they did not always work in partnership with people to respond to changes in their needs.

There was no evidence that people had been actively involved in the development of their care plans or given meaningful opportunities to express their views about their care and support. Care planning documentation did not consistently reflect people’s current needs, preferences or lived experiences. This increased the risk of fragmented, inconsistent or inappropriate care and meant the provider could not demonstrate that care was shaped around what mattered to people.

Relatives told us they were not always involved in care planning, and changes agreed during meetings were not consistently reflected in care plans or followed through by the service. For example, staff had identified the need for a structured bedtime routine to support the person, however, this had not been incorporated into the care plan. As a result, staff did not have access to accurate or up‑to‑date information, which increased the risk of inconsistent care and unmet needs.

The care plan on some occasions used insensitive language and included information that was not always relevant to the person. For example, the care plan stated that staff should be trained to recognise early signs of allergic reactions, including the administration of emergency medication if prescribed. However, information about any known allergies or sensitivities was unclear, and no information was provided on what symptoms staff should look for, or whether any emergency medication had been prescribed.

This meant staff did not always have clear or accurate information about the person’s individual needs.

There was some good guidance about some aspects of the person’s personal care; however, other aspects of their care needs were not clearly described to ensure they received appropriate, person-centred care.

Daily notes did not reflect what support had been provided with personal care and did not align with the relatives account of the person’s needs.

Daily notes documented the use of ‘defensive techniques’ to support the person during a period of heightened distress. However, there was no positive behaviour support plan to monitor triggers, guide staff on how to appropriately respond, or support learning from incidents. This limited the provider’s ability to ensure the person’s care was adapted to their needs.

The provider failed to consistently understand and respond to the diverse health and care needs of people and their local communities. As a result, care was not always joined‑up, flexible or supportive of people’s choices or continuity of care. These failures had a negative impact on the safety, predictability and effectiveness of care delivered.

Although the care and support plan for the person contained some detailed information about their needs and known triggers, the information was inconsistent and contradictory. This significantly undermined the continuity and safety of care. There was no clear explanation, risk assessment or professional guidance to reconcile these conflicting approaches.

There was no evidence that staff had received training or guidance on the safe use of calming techniques, nor was there any instruction describing what the intervention should look like in practice for this individual. As a result, staff did not have the information, skills or confidence required to deliver care in a consistent, safe or person-centred way, particularly during periods of distress or crisis.

The lack of clear, consistent guidance increased the risk of inappropriate or potentially harmful interventions being used and meant care was not delivered in a predictable or therapeutic manner.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. This meant people were not always supported to understand or express their needs effectively, which negatively impacted the delivery of personalised and responsive care.

The care plan included some information about how the person preferred to communicate and identified their primary methods of communication. However, this information lacked sufficient detail to be meaningful or effective in practice as there was no information about how the person was involved within their care planning, and how the service discussed the persons care with the person in a way that met their individual needs.

The provider did not ensure information was shared in a way that enabled all staff to understand and respond to people’s communication needs consistently, particularly where staff were new or unfamiliar. This meant information shared about the person was less likely to be shared in a way that they could understand and could impact their ability to participate in discussions about their care or express their views.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

There was no formal process in place to collect people’s views of the service. Relatives were not involved in care planning, and where professionals had provided guidance on how to support the person, this was not updated in people’s care plans.

Relatives we spoke with told us they had raised concerns. They felt they did not always receive adequate responses or embedded change in response to their concerns.

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

There was a lack of clear guidance to support staff in assisting the person to access external services for assessment, treatment or ongoing support. Care planning documentation did not explain how staff should support the person to engage with services or respond to known barriers, which meant access to care and treatment was not effectively planned or coordinated.

Where incidents had occurred in relation to accessing services, these were not used as learning opportunities to improve care delivery. The provider did not update care plans to include clear guidance on how best to support the person following these incidents. As a result, staff continued to lack direction on how to facilitate access to services safely, consistently and in a way that met the person’s needs.

Staff training and induction was ineffective, which meant staff were not equipped to understand people’s care and support needs, or when to escalate concerns to ensure people had access to the support they needed.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

We found no evidence that people were routinely asked to provide feedback about their experiences of care, nor were there systems in place to gather, analyse or act on feedback, and no process to support those less able to verbalise their views. The absence of feedback mechanisms prevented the provider from identifying inequality in experience or outcomes and from making improvements to promote fairness, inclusion or better quality of care.

In addition, there was no evidence that staff supporting the person had received training in equality, diversity and inclusion, or in recognising and addressing discrimination and inequality. Without this training, staff lacked the knowledge and awareness required to identify how people’s backgrounds, protected characteristics or differing needs could impact their experience of care. This reduced assurance that people were supported in an inclusive, respectful and equitable way.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Care plans included some reference to the person being supported with goal setting. However, these goals had not been reviewed and were not supported by clear guidance explaining how staff should help people achieve them. As a result, people’s goals were not actively pursued, monitored or progressed. This increased the risk that people’s preferences, aspirations, values and priorities were not understood, respected or reflected in the care they received.

There was no evidence that the persons future wishes, advance decisions or preferences about important life changes had been discussed or recorded as part of care planning. Advance care planning was not embedded within the service, and discussions about future needs had not taken place.

Although there was no one receiving end‑of‑life care at the time of the inspection, the provider told us this was support they were able to offer. However, there was no evidence that staff had received training in end‑of‑life care, advance care planning, or supporting people through significant life changes. This meant the provider could not demonstrate they had the skills, knowledge or systems in place to safely or compassionately provide this support if required.