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Gainsborough Care Home Requires improvement

We are carrying out a review of quality at Gainsborough Care Home. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 15 January 2019

This comprehensive inspection took place on 22 and 23 October 2018. The first day was unannounced.

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 a

Inspection areas

Safe

Requires improvement

Updated 15 January 2019

The service was not safe in all respects.

Staff were not all skilled and competent and up to date with safety-related training.

Medicines were not all stored safely, although the manager was addressing this.

There were lapses in cleaning and in good infection control and food hygiene practice.

Effective

Requires improvement

Updated 15 January 2019

The service was not wholly effective.

Signage around the building was not all suited to the needs of people who live with dementia.

The dining environment was not always pleasant, and food was not always well presented.

The manager had a good understanding of the requirements of the Mental Capacity Act 2005.

Caring

Requires improvement

Updated 15 January 2019

Some aspects of the service were not caring.

Staff mostly, but not always, treated people kindly and respectfully. On occasion some staff did not uphold people’s privacy and dignity.

Staff were at times more focused on tasks than people and their wellbeing. Support was inconsistent and not always respectful.

People were encouraged to make choices, and these were respected.

Responsive

Requires improvement

Updated 15 January 2019

The service was not wholly responsive.

Care was often task-focused. Activities were provided but people often lacked enough stimulation.

People knew how to raise any concerns or issues.

The service worked with healthcare professionals when people were at the end of life to provide a dignified and pain-free death. Families felt involved and supported during the final days of a person’s life.

Well-led

Requires improvement

Updated 15 January 2019

The service was not wholly well led.

There was a new manager in post.

Governance was not always reliable and effective, as the provider’s quality assurance systems had not identified all the issues we found at inspection. The manager’s time for oversight of the service was limited.

The manager fostered an open, positive culture.