Gainsborough Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider recorded and investigated accidents, incidents and near misses and. Reports were made to professional bodies and to the local authority, should a safeguarding alert need to be made.

A monthly audit of accidents and incidents was completed and themes and trends identified so the registered manager could act to prevent a recurrence.

We saw actions had been taken to reduce the risk of medicines errors. The provider had identified medicines for some people had been overstocked in the medicines store. They returned the overstocked medicines to the pharmacy and added additional checks to ensure stock was not already available before ordering. In the future this should not only reduce risks but will reduce waste.

Additionally, a senior staff member was responsible for completing monthly audits, checking the environment and premises, clinical and care practice and governance. The audits were in depth and included any actions needed to improve the service. For example, following up maintenance works that had been requested, but not completed.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Prior to admission to Gainsborough Care Home, the registered manager assessed people to ensure their needs could be met. Pre-assessments took place in people’s homes, care homes and in hospitals and could be completed in person or by telephone.
Areas assessed included medical conditions, both physical and mental health conditions, communication, mobility, nighttime needs and sleeping, social needs and advance planning. Information included whether the person had a current do not attempt cardiopulmonary resuscitation (DNACPR), if there was a Deprivation of Liberties Safeguarding (DoLS) in place and if they had appointed power of attorneys.
The electronic care record produced a care plan that could be shared should a person need to be admitted to hospital. It held an overview of all completed care plans to ensure people could receive the correct support from hospital staff.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider identified safeguarding concerns and made alerts to the local authority safeguarding team as needed. Records we reviewed confirmed the provider responded to potential safeguarding concerns, for example through increased welfare checks. When we inspected there were no open safeguarding cases.
The provider had a robust safeguarding policy which had clear flow charts explaining to staff what they should do in different situations should they suspect abuse had occurred.
Incidents were recorded in a safeguarding log which was updated with details of outcomes once investigations were completed. Information and investigations required by the local authority were submitted as requested.

The provider had not always fully understood and managed risks. Systems were in place to identify assess and mitigate risks however this had not identified all risks associated with providing care to people using the service. This meant care was not always delivered in the safest or most person-centred way.

A range of risk assessments were completed by the provider to mitigate risks associated with peoples care needs. Risk assessments were part of electronic care plans. At the end of each section of the care plan, risks were listed with brief actions staff should take to reduce them. For example, in a person’s continence and elimination care plan, risk of skin breakdown was identified, then mitigated by staff ensuring they were supported to stay clean and dry, continence aids were changed promptly, and any concerns were reported to the district nursing team. A nutrition and hydration care plan identified malnutrition as a possible risk, mitigated by staff encouraging and prompting them to eat and drink and recording consumption to ensure sufficient calories were taken and to support referrals to healthcare professionals should they deteriorate.

While some risk assessments were brief, they included sufficient information for staff to manage the most significant risks to people. However not all care plans were fully completed. We found some care records had several sections that were incomplete. For example, a person who had ‘tissue thin skin that was intact’ had no tissue viability care plan or risk assessment in place. Tissue thin or ‘fragile’ skin can breakdown quickly causing pain and potentially infection to the person. At the time of the inspection, the person had no wounds, however the risk of developing wounds because of tissue thin skin had neither been assessed nor mitigate.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
The provider had completed some refurbishment and decoration while the premises had been closed. Other maintenance took place as required and regular checks and servicing of equipment took place as scheduled.

A fire risk assessment and water hygiene management assessment had been completed by external contractors and the provider completed actions as recommended.

Health and safety audits ensured all servicing and testing was current and noted actions that were required to maintain the premises safely.

The health and safety audit had identified some shortfalls in fire equipment test recording. We also noted records were unclear and held some confusing information. Each week they stated automatic detectors were not satisfactory and each week no remedial action was taken. The registered manager had arranged for staff from another service to support their staff in becoming familiar with the system and procedures. We have shared details of our findings with the provider so they could take additional remedial actions and further improve their records.

We saw flooring that needed to be replaced in a bathroom and the kitchen, though it had the highest food safety rating of 5, also needed flooring replaced. The provider agreed funding for both floors during our inspection, one has been completed and the second is due to be completed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The registered manager used a staffing dependency tool to ensure there were sufficient numbers of suitably qualified staff to meet people’s care needs. When we inspected, there were 21 people using the service; the registered manager expected this to increase to 25 within the next 2 weeks. When numbers were at 25, staffing would increase to 5 care staff on each shift.
People and their relatives were complimentary about staff, a relative told us, “I always find them to be welcoming and professional, which gives me great confidence in their care for my [relative]. Speaking as an ex nurse myself, I am very impressed by the quality of the care staff at Gainsborough, who all seem competent and well trained.”

Staff were safely recruited, and all pre-employment checks had been carried out prior to staff commencing in their posts. Disclosure and Barring Service (DBS) checks were completed when people commenced in post, and at appraisal staff were asked to update as to whether there had been any change to this. Staff were supported with skill development and career progression through an annual appraisal and supervision session.

Staff received training in a wide range of areas to enable them to complete their job roles. Courses included, infection prevention and control, moving and handling, food safety and information governance. A staff member told us, “Yes, I have received training such as mandatory care modules including, dementia, diabetes, first aid and online and face to face training. It was very informative, and face to face training such as CPR has also been helpful, especially for complex needs”. A relative commented, “The staff are very consistent and part of why we like Gainsborough, they are very friendly, kind and caring. Yes they appear well-trained”.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider maintained a clean and uncluttered environment. There were no malodours and housekeeping staff worked to a schedule to ensure all areas of the service were regularly cleaned.
Staff wore personal protective equipment appropriate to the task they were performing. For example, aprons and gloves when serving meals, and there were supplies of hand cleaning gel throughout the premises.
The housekeeping staff completed records of their cleaning and tasks were scheduled to ensure all areas of the premises were regularly cleaned.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medicines were not always safely managed at Gainsborough Care Home, however though we found some examples of practice that needed to be improved, no one came to any harm as a result.
Medicines, when given were recorded on medicines administration records (MAR). These should be double signed by staff members when either handwritten or if changes are made to them. MARs were not routinely double signed by staff meaning the second check for accuracy was not being completed.
We saw a person who had been prescribed Co-codamol had also received paracetamol as a homely, or ‘over the counter’ remedy. This is a risk as both contain paracetamol and when taken together, this can lead to a paracetamol overdose.

Topical medicines administration was recorded on TMARs. These had not been fully completed. A person had been prescribed a barrier type cream for use twice daily. The TMAR showed 2 1/2 days when either no cream was applied, or no record was maintained of the application. A second person had an antifungal treatment that should be applied 2 to 3 times daily. Some days had a single application and others none was applied at all. Another TMAR simply had the instruction, ‘use as directed’. Topical medicines labels wear away quickly, so having suitable detail about dosage and application on TMARs is vital to ensure safe management.

At the start of our inspection, we found drink thickeners were being stored on top of people’s wardrobes. We told the registered manager who moved them to locked storage as ingestion of the product that has not been added to fluid poses a serious safety risk to people.
There was a medicines policy in place reflecting current good practice guidance and each person had a printed copy of a medicines care plan in their medicines record.

The medicines room was cleaned regularly, and controlled medicines were audited weekly by the registered manager. Medicines such as antipsychotics were reviewed monthly with GPs and in addition, an advanced practitioner attended the service weekly to see people.