Gainsborough Hall Care Home

Gainsborough Hall is registered to provide accommodation, nursing and personal care for up to 74 people, including younger people, older people, people living with dementia and people with a physical disability.

At the time of our inspection visit there were 33 people living at the home. Care is provided across 3 floors that include a residential and nursing unit. A communal lounge and dining area are located on each floor. People’s bedrooms are ensuite and there are further communal bathroom facilities located on each floor.

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

Relatives felt involved in care planning for their family member. Relatives told us their family members choices were accommodated and considered.

Relatives told us staff knew what to do and staff were trained which gave them confidence their relatives received the right level of support. Training refreshers were held to make sure staff received training to maintain staff skill and knowledge.

People and relatives were pleased with their meal choices, and they could have additional choices if requested. People received their food and fluids in line with personal preferences. People who were at risk of weight loss were regularly checked by staff to ensure any further support was provided to help maintain their health and welfare.

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 management team and provider completed regular audits and checks, including clinical and checks that supported a quality service.

There was no registered manager at the time of our visit but the senior management team remained consistent and they supported temporary managers at the home. A new manager was being appointed and would make an application to be registered with us.

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 good (published 07 October 2022).

Why we inspected

The inspection was prompted in part due to concerns received about a lack of important health information being known by and available to staff. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern.

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. In Safe, we did not look at the entire key question, only the part of the key question related to infection prevention and control. This does not change the rating from the previous inspection.

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 stayed the same. 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 Hall on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gainsborough Hall Care Home is a care home providing accommodation with personal and nursing care for up to 74 people. It is a new, purpose-built home in which care is provided across four floors. Residential care was being provided on the ground floor and dementia nursing care was being provided on the first floor. The second and third floor were unoccupied. At the time of our inspection visit there were 28 people living at the home.

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

There were enough staff to keep people safe. However, the provider had experienced difficulties recruiting and retaining staff and as a result, staffing numbers were maintained by using temporary staff supplied through an agency. Whilst temporary staff understood people’s support needs, they had little knowledge of their people’s background and interests. Some people expressed distress through their behaviour. This was not always responded to promptly or consistently in line with their care plan. There were missed opportunities to engage people in meaningful activities within the home and people were not always supported to try new things or maintain or develop their skills. The provider was responsive to our feedback and had made some improvements by the second day of our inspection.

Following our last inspection, improvements had been made to the management of risks related to people’s health and well-being. People’s needs had been assessed and plans were in place to mitigate any risks posed to people’s health. Environmental risks were also managed safely.

People told us they felt safe and relatives felt people were protected from the risk of abuse. Staff understood their safeguarding responsibilities and knew to report concerns to keep people safe. Records confirmed safeguarding referrals had been made as appropriate and required action had been taken to manage any risks to people's safety, health and wellbeing.

Improvements had also been made to the safe management of medicines. People now received their medicines as prescribed. Staff who administered medication were appropriately trained and their competency had been assessed.

People and relatives gave positive feedback about the care provided at home. Staff were friendly, and people were seen to be comfortable in the presence of staff who were supporting them. People were encouraged to make decisions about the way their care was delivered. These care preferences were recorded in peoples care plans. Staff were appropriately trained and felt able to speak up, if things went wrong. 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 this practice.

People’s needs were assessed before they moved into the home so their care could be planned based on their needs, wishes and choices. People had access to external healthcare professionals to ensure they remained well. People had a choice and were supported to eat and drink enough to maintain a balanced diet. Where people had been identified as losing weight, records showed timely action had been taken to mitigate the risk of further weight loss.

At our last inspection, systems and processes failed to assess and mitigate the concerns we related to diabetes management, catheter care and medicines management. Improvements had been made and quality assurance processes were effective. People, relatives and staff provided positive feedback about the leadership at the home and told us the new manager had already made improvements. Communication had improved and people, relatives and staff felt listened to. Improvements had been made to the management of complaints.

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 22 February 2022) and there were breaches of the regulations. 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

The inspection was prompted in part due to concerns received about safeguarding concerns, poor personal hygiene practices and record keeping. A decision was made for us to inspect and examine those risks.

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 overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Gainsborough Hall is a care home providing accommodation with personal and nursing care for up to 74 people. Gainsborough Hall is a purpose-built home where care is provided across four floors. Residential care was being provided on the ground floor and nursing care was being provided on the first floor. The second and third floor were unoccupied at the time of our visit. The home supported people living with dementia on both occupied floors. At the time of our inspection visit there were 29 people living at the home.

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

Although the providers assessed staffing numbers had been maintained, people, staff and relatives told us there were not enough staff to meet people's needs. People reported long waits for care and staff told us current staffing numbers prevented them from providing high-quality care.

The provider used a large number of temporary staff, supplied through an agency. At the time of our inspection the provider did not have a system in place to check the COVID-19 vaccination status of temporary staff working in the home as required by law since 11 November 2021.

Despite this, we observed effective partnership working between temporary staff and the staff employed by the provider. People and relatives spoke positively about the caring nature of staff and staff understood their responsibility to keep people protected from abuse and avoidable harm.

Risks to people's health had been identified and assessed. However, these risks were not always managed safely.

People did not always receive their medicines as prescribed because the medication ordering procedures were ineffective. Further improvements were required with the management of some medicines.

The provider's systems and processes were not used effectively to review and maintain oversight of the quality of care being provided. Concerns and complaints were not always managed effectively.

Although systems and processes were in place to drive improvements within the service, these did not always assess and mitigate concerns related to diabetes management, catheter care and medicines management.

Staff and the management team were committed to the people living at the home and feedback from our inspection was welcomed. The provider told us action would be taken to address all of the areas which required improvement.

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 16 March 2021) and we found a breach of regulation. 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 not 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 two consecutive inspections.

Why we inspected

We received concerns in relation to safe staffing numbers, safeguarding, wound care, medicines management and ineffective governance. As a result, we undertook a focussed 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 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 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 key question sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Gainsborough Hall 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 breaches in relation to regulation 12 safe care and treatment, regulation 16 receiving and acting on complaints and regulation 17 good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 also request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Gainsborough Hall is a care home providing accommodation with personal and nursing care for up to 74 people. It is a purpose-built home in which care is provided across four floors. Residential care was being provided on the ground floor and nursing care was being provided on the first floor. The second and third floor were unoccupied at the time of our visit. The home supported people living with dementia on both occupied floors. At the time of our inspection visit there were 19 people living there.

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

Systems and processes were not used effectively to review and assess the quality of service provision which meant previously demonstrated good standards had not been maintained. Relatives told us changes in managers and a lack of communication meant their concerns and complaints when raised, were not acknowledged or addressed. People’s experiences of care quality were inconsistent.

There were enough staff on the day of our visit to provide safe care. However, external pressures caused by the COVID-19 pandemic meant there had been a reliance on agency staff who did not always know people well.

More information was needed in care plans for people living in the home on a temporary basis to ensure staff were able to provide consistent care and manage known risks.

An 'infection prevention control' audit was carried out by CQC during the inspection. Overall, we found the provider was following government guidelines, but improvements were required to ensure staff followed good practice when wearing PPE and carrying out housekeeping responsibilities.

Effective processes were in place for the timely ordering, supply and safe disposal of medicines. Records demonstrated people received their medicines as prescribed.

The provider welcomed our inspection feedback. They assured us they were committed to providing high quality care and improving communication systems to support the new manager and improve the governance and leadership of the home.

Rating at last inspection

The last rating for this service was good. (Report published 24 July 2019).

Why we inspected

The inspection was prompted by concerns we had received about standards of care within the home, a failure to respond to concerns and complaints and the overall governance of the service. As a result, a decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of 'Safe' and 'Well-led' only.

The overall rating for the service has deteriorated to requires improvement. This is based on the findings at this inspection.

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 one breach of the regulations in relation to the management of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Gainsborough Hall is a care home providing accommodation with personal and nursing care for up to 74 people. It is a new, purpose-built home in which care is provided across four floors. Residential care was being provided on the ground floor and nursing care was being provided on the first floor. The second and third floor were unoccupied. The home supported people living with dementia on both occupied floors. The home opened in August 2018 and at the time of our inspection visit there were 19 people living there.

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

People told us they felt safe at Gainsborough Hall and were supported by staff who were caring and kind.

Staff respected people’s rights to privacy and dignity.

Staff understood how to keep people safe and how to act on any concerns they may have.

Risks to people’s health and well-being had been identified, assessed and monitored to ensure they received safe care and treatment.

Assistive technology was used to promote safety within the environment.

There were enough staff to meet people’s clinical and emotional needs.

Staff were recruited safely, and processes checked the background of potential new staff.

People received their medicines as prescribed.

The home was exceptionally clean, tidy and well-maintained.

Accidents and incidents had been recorded and evaluated to prevent re-occurrence. Lessons had been learned when things went wrong.

People’s capacity to make important decisions had been assessed where required.

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.

People’s needs were assessed before being supported by the service. This meant the service could be sure they could meet people’s needs.

Staff received an induction and had access to the training and guidance they needed to undertake their role well.

People received personalised care and records supported this practice.

Systems were in place to manage and respond to any complaints or concerns raised.

Robust systems and processes were in place to monitor the quality within the home.

The registered manager understood their regulatory responsibilities and had informed us of significant events at the service since taking on the management role.

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

Rating at last inspection

This service was registered with us on 17 August 2018 and this was the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

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.