Gosberton House Care Home

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• 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

During our assessment of this key question, we found 3 breaches of regulation. People’s medicines were not safely managed and we found 9 tables under seat cushions and protocols for medicines prescribed to be taken as required lacked the information needed to support safe administration of these medicines. Staff were not following the provider’s policies of good infection control processes when cleaning the home and this increased the risk of infection for people. Some people needed restrictive practices such as bed rails, to keep them safe. When people were unable to consent to this restriction, best interest decision were not used to ensure the least restrictive method of maintaining the person’s safety was being used. There were enough staff available to meet people’s needs. However, staff had not received suitable comprehensive training to ensure they had the skills needed to provide safe care to people.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were happy with the care they received and felt that it was safe.

Staff confirmed the care plans had not supported them to provide safe care to minimize the risks to people. They told us care plans needed to be reviewed and rewritten. However, staff knew people’s needs and ensured the care provided was safe. Staff told us that at times the care they provided to people was not fully recorded. For example, where people were at nutritional risk their food and fluid charts were not fully completed. This meant the provider was unable to assess if they had received all for the care they needed. People were supported with positive risk taking where they had capacity to make decisions. For example, one person who was at risk of choking, chose not to have thickener in their drinks.

We observed care being delivered. Equipment was used safely. For example, staff ensured people had their feet on the footplates when using wheelchairs. However, some environmental risks were not managed. For example, the sluice room was left unlocked when there were cleaning chemicals in there. This was a risk for people living with dementia who would be unable to recognise the chemicals were dangerous.

We looked at 6 care plans. They lacked information on how to keep people safe from risks. Where people needed regular repositioning to keep their skin healthy the timing of turns was not recorded in their care plans. This increased the risk of people developing pressure ulcers. Where people needed equipment, such as a hoist, to help them move around the home, care plans did not fully describe the care needed to keep people safe. This increased the risk of people being hurt while using the hoist. Where people were living with diabetes there was no information on the risks of having a low blood sugar, or the actions staff needed to take to support a person. There was no guidance on when staff should call for emergency care. Where people had bed rails, the risk assessments completed did not cover all of the risk areas defined by the Health and Safety Executive. This meant there was an increased risk of bed rails not being safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were happy with the staffing levels in the home and told us staff were responsive when they used the call bell and they did not have to wait for long for care.

Staff raised concerns that at times, the level of care people received was impacted by them having to complete tasks like cleaning. Staff told us they received training. However, some concerns were raised about the quality of training provided and staff felt a more structured approach was needed. Registered nurses told us the training and support provided enabled them to retain their professional registration. Senior staff told us they monitored the care provided by new staff and they would ensure they were safe to work with people before allowing them to work independently.

During the inspection there were enough staff to meet people’s needs in a timely manner.

The training matrix showed there were gaps in staff knowledge. In addition, staff raised concerns about the quality of training provided. Competency checks had not been completed to ensure staff had understood and were able to work in line with their training. This meant the registered manager could not be confident about staff’s skills. The registered manager assessed the needs of people living at the home to understand how many staff were needed to meet people’s needs. Rotas showed that the appropriate number of staff had been working. The registered manager had ensured that staff were safe to work at the service and completed all necessary recruitment checks.

People told us they were happy with the levels of cleanliness in the home and staff protected them from the risk of infection by wearing protective equipment such as gloves and aprons.

Housekeeping staff told us how they worked to keep the home clean. However, the methods described did not support good infection control processes and increased the risk to people living at the home. Staff were correctly using protective equipment to keep people safe. They advised the changes they would make in an outbreak to keep people safe.

Where people needed hoisting we saw they were sharing hoist slings between people. This increased the risk of infection. We saw storage of some continence products increased the risk if infection for some people.

The provider’s policy supported good infection control practices. However, these were not being followed by housekeeping staff.

People were happy they received their medicines on time.

Staff told us they had their competency to administer medicines assessed yearly. Staff were concerned that medicines audits were not accurately completed, and this increased the risk of errors.

During the inspection we found 9 tablets under seat cushions in the communal areas. This meant staff had not ensured people had taken their medicines as prescribed. In addition, they were a risk for people living with dementia who may take them by mistake. When people who lacked capacity refused their medicines, staff sought advice from the GP. However, they did not follow the advice in a timely manner. Therefore, people who lacked capacity were able to refuse their medicines for a prolonged period. Where people had medicines prescribed to be taken as required, protocols in place did not always support staff to administer the medicines safely. For example, a person was prescribed a pain relief gel but their protocol was for pain relief tablets. Some people did not have header pages to clearly identify where medicines started in the folder. This increased the risk of staff making errors.