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

This inspection took place on 20, 24 and 31 July 2017. The first day was unannounced and the second two days were announced.

Gainsborough care home provides accommodation and personal care for up to 45 people. At the start of the inspection there were 33 people living in the home. The service is located in a residential area of Swanage and is a large detached building set over two floors. The home had two communal lounges and dining areas and an accessible garden. The majority of people living in the home had complex needs relating to the impact of their dementia.

There was a registered manager in post. 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.

When we last inspected the service on 27 April 2016 we had concerns about how people’s risks were managed and people were not provided with the necessary support to eat or drink. The provider sent us an action plan which detailed how they would meet the regulations and be compliant by August 2016. At this inspection we found that improvements had been made.

Staff were aware of the risks people faced and their role in managing these. Care plans provided information about risk but were not individualised.

Audits were completed regularly and covered a range of topics. They were used to drive improvements but did not consistently identify gaps where improvements were needed.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

People had care plans which provided detail about how to support people but needed more information to be person centred and reflect the histories of people and what was important to them. Care plans were regularly reviewed with people and their loved ones where appropriate.

There were enough staff available and people did not have to wait for support. People had support and care from staff who were familiar to them and knew them well. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs.

The home had good links with health professionals and regular visits and discussions meant that people were able to access appropriate healthcare input promptly when required.

People were supported by staff who had the necessary training and skills to support them. Training was provided in a number of areas the service considered essential and other learning offered was relevant to the conditions that people faced.

Staff understood and supported people to make choices about their care. People's legal rights were protected because staff knew about and used appropriate legislation. Where people had decisions made in their best interests, these included the views of those important to the person and considered whether options were the least restrictive for the person.

People spoke positively about the food and had choices about what they ate and drank. The kitchen were aware of people’s dietary needs and where people required a special diet or assistance to be able to eat and drink safely this was in place.

Staff knew people well and interactions were relaxed and caring. People were comfortable with staff and we observed people being supported in a respectful way. People were encouraged to make choices about their support and staff were able to communicate with people in ways which were meaningful to them.

People were supported by staff who respected their privacy and dignity and told us that they were encouraged to be independent.

People were supported by staff who knew their likes, di

The inspection visits took place on 10 and 16 March and we spoke with relatives by phone over the following week.

Gainsborough Care Home is a purpose built home registered to provide care for up to 45 people in a residential area of Swanage. At the start of our inspection there were 42 people living in the home. The majority of people living in the home had complex care needs related to the impact of their dementia.

The service did not have a registered manager at the time of our inspection but the manager was in the process of applying to take on this role. The last registered manager had left the service in December 2015 and the current manager had started in post at this time. 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.

Gainsborough Care home had been through a sustained period of management change when we inspected. The new manager had been in post for three months and was applying to become the registered manager. We found a number of areas that required improvement during our inspection. The manager was aware of most of these issues and had started work on plans to make improvements.

People did not always receive the support they needed to eat and drink in ways that met their needs and preferences. We observed that for some people meal times were an opportunity for choice and socialising but this was not the experience for people with more complex needs.

We heard some mixed opinions from relatives as to whether there were always enough staff available and we observed times when staff were not deployed in ways that met people’s identified needs. The staffing had been reviewed and increased since the manager came into post and remained under review. Changes to deployment were made immediately following our inspection.

People were protected from harm because staff understood the risks they faced and knew how to identify and respond to abuse. Care and treatment was delivered in a way that met people’s individual needs but there was some discrepancy about staff understanding of how to mitigate risks and records were not always accurate. This increased the risk that people could receive inappropriate care. Where people needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this Deprivation of Liberty Safeguards had been applied for.

Some people were engaged with a wide range of activities that reflected individual preferences, including individual and group activities. Activities were being developed further with a focus on people who spent more time upstairs.

Health professionals were confident that people received support for their health related needs in a timely and appropriate manner.

People and their relatives were positive about the care they received from the home and told us the staff were compassionate, kind and attentive. Staff treated people, relatives, other staff and visitors with respect and kindness throughout our inspection. Relatives told us they felt able to raise concerns and that the new manager had made themselves available.

There was a breach of regulation relating to how people received care and support that met their needs. You can see the action we asked the provider to take at the back of the full report.

We looked at the management of medicines to follow up on some issues found at a previous inspection. We checked the arrangements for handling, and giving medicines in the home. We talked with staff and watched some medicines being given to people. We checked storage arrangements, and medicines records.

When we inspect we gather evidence to answer the below questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This inspection was to follow up some issues with the management of medicines, and so we only looked at whether the service is safe on this occasion. Below is a summary of the inspection and what we found.

Is the service safe?

We found that there were appropriate arrangements in place in relation to the obtaining, recording, handling, safe keeping and administration of medicines. We saw that improvements have been made recently to the way medicines were managed in the home. We found that a warning notice that we had issued has now been met.

The home had not made appropriate arrangements to ensure people’s medicines were administered safely.

Staff sought people’s permission before providing care or treatment. One person’s relative told us, “They ask them what they want and seek their permission.”

People’s needs were assessed and care was planned and delivered to meet people’s needs. We found that people’s care records contained assessment of people’s needs and a plan as to how these needs were to be met. Staff were aware how to meet people’s needs.

The home was clean and smelt fresh and staff were aware of how to protect people from the risks of infection. One person told us, They clean my room pretty regularly.”

There were sufficient numbers of staff to meet people’s needs. One person told us, “The staff are pretty good.” We spoke with staff who considered there were enough staff to perform their duties effectively.

The provider assessed the quality of the service provider and made changes as necessary.

We spoke with three people and three people’s relatives. People’s privacy was respected and people were treated with consideration. One person told us, “They generally knock on the door before they enter. They have a polite approach.”

People’s care needs were assessed and care was planned and delivered to meet their needs. One person told us, “I get all the help I need, the staff meet my needs.”

The provider had a process in place to report allegations of abuse and staff were aware of this process. Staff had received appropriate training and were supported in their roles.

The provider had not protected people against the risks of infection as they had not conducted an adequate assessment of the risks of cross infection.

Records were accurate and contained appropriate information. There was a process in place for secure storage and destruction of records which were no longer needed.

In this report, the name of the registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.