About the service London and Manchester Healthcare Limited, Gainsborough House is a residential care home providing personal and nursing care to 62 people requiring nursing and personal care. The service can support up to 72 people across three separate units, each of which has separate adapted facilities. Two of the units specialise in providing care to people living with dementia who have additional nursing needs, the third unit provides care to people only needing nursing support.
People’s experience of using this service and what we found
At this inspection, we found concerns with the management of risk, medicines, record keeping, infection control and governance.
Staff did not have sufficient guidance to provide safe and appropriate care. Medication management was unsafe and placed people at risk of avoidable harm. Infection control standards were not being followed to protect people from the risk of infection such as COVID-19.
We identified that a lack of cohesive working and poor communication within the home had led to risks not being recognised and acted on. Some audits of the service were ineffective and, in some cases, not carried out.
Record keeping in relation to people’s ongoing care needs were not always properly maintained. However, accidents and incidents were kept in order and there was evidence of monthly scrutiny of incidents and falls looking for patterns.
There were enough staff on duty to support people, and staff were recruited safely. Care staff were friendly, and treated people kindly. People’s relatives confirmed this and felt their loved ones were well looked after.
Rating at last inspection
The last rating for this service was good (published 01 March 2018).
Why we inspected
We received concerns in relation to injury sustained through moving and handling, infection control, care delivery and governance. As a result, we undertook a focused 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 changed from good to inadequate. 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 sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London and Manchester Healthcare Limited, Gainsborough House 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 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 breaches in relation to medicines, safe care and treatment, infection control and governance at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.