Inspection on 25/10/07 for Gavin Astor House

This inspection was carried out on 25th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Gavin Astor House 09/01/07

Gavin Astor House 06/12/05

Gavin Astor House 05/08/05

Gavin Astor House 08/12/04

Gavin Astor House 03/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gavin Astor House Royal British Legion Village Aylesford Maidstone Kent ME20 7NL Lead Inspector Mrs Susan Hall Key Unannounced Inspection 25th October 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gavin Astor House Address Royal British Legion Village Aylesford Maidstone Kent ME20 7NL 01622 791056 01622 717273 gavinastor@rbli.co.uk www.rbli.co.uk Royal British Legion Industries Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Linda Alder Care Home 50 Category(ies) of Old age, not falling within any other category registration, with number (26), Physical disability (24) of places Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2007 Brief Description of the Service: Gavin Astor House is a purpose built care home for adults who have been assessed as needing nursing care. This includes two categories of care – older people with nursing needs; and adults aged 18-65 with physical disabilities who need nursing care. The report is written according to the format for older people, as the outcomes are the same for both categories of care. This was agreed with the manager prior to the inspection visit. The home is owned by the Royal British Legion Industries (RBLI), and is situated in their extensive and beautifully maintained grounds in the Royal British Legion Village at Aylesford. This is near to the M20 motorway, and within a short walk of a mainline railway station. There is ample car parking available in Gavin Astor House car park. The town of Maidstone is close by, providing shops and entertainment facilities. The home was opened in 1993 and provides 24 hour nursing care. Accommodation is provided on two floors, with a passenger lift providing easy access between floors. All rooms are large single rooms, with en-suite toilet and showers. Fees currently range from £680.00 - £892.00, depending on the assessed needs of individual residents. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, in which the inspector assessed all key national minimum standards, and most other standards as well. This enabled her to gain a comprehensive overview of how the home is operating. The inspection includes collating information gained about the service since the previous visit. This includes detailed pre-inspection documentation sent in by the manager (the “Annual Quality Assurance Assessment”); formal notifications to the CSCI office; monthly audits carried out by RBLI; and any complaints or concerns which have been forwarded to CSCI. Prior to the inspection visit, CSCI survey forms were sent to residents, relatives, care managers, staff, and health professionals. The inspector received 21 replies, and these were mostly very positive. Comments included: “The home provides a friendly, caring and professional service”. “My experiences of management and staff are of a positive, dedicated team of committed nurses and carers, who try very hard to build a warm and caring environment for a group of residents with complex medical and social needs.” No complaints about the home had been sent in directly to CSCI, but there have been some ongoing concerns (voiced by residents) about the variety and quality of the food. Catering is provided by an external catering company, Autograph Food Services. The inspector found that the registered manager for the home, and the chef manager for Autograph Food Services, are being proactive in dealing with this issue, and they had arranged a meeting with residents and relatives for the following week. What the service does well: The staff team work well together, and it is clear that the manager and nursing staff give a clear lead to other staff. There are good standards of nursing care, provided by a dedicated team of nurses and care staff. They relate well to other health professionals, and are proactive in inviting them into the home for advice and training. The manager and deputy carry out detailed pre-admission assessments, and prepare basic care planning prior to residents’ admission. Care staff are required to read these care plans, and this ensures that new residents are Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 6 admitted into a home where staff are already familiar with their basic individual care needs. The service ensures that staff receive a good induction and training programme, and mandatory training is reliably carried out. The manager has excellent auditing systems in place, and this provides effective oversight and management of the home. What has improved since the last inspection? What they could do better: The The one and main concern voiced by residents is in connection with food and menus. company are already in the process of addressing this situation. But - as resident said – it would be “really nice to be able to look forward to meals not to feel disappointed whenever food arrives”. Care planning documentation is generally good, but wound care documentation needs to be improved. There is no evidence of consent for taking photographs of residents, or their wounds/sore areas. Some small aspects of medication management need improving. There are currently low numbers of health care assistants who are trained to NVQ 2 or 3. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 (Standard 6 does not apply to this home) People who use the service experience good quality outcomes in this area. The home provides detailed information for prospective residents to make a choice about moving into the home. Admission procedures ensure that residents have individualised care, and are sensitively assisted in settling in to the life of the home. EVIDENCE: The statement of purpose and service users’ guide have been reviewed and revised in the last few months. These documents are well prepared in an easy to read format and style of print. The home will produce them in other formats (e.g. different languages, larger print) if appropriate. Both documents contain all required information. The statement of purpose shows the structure of the organisation, clearly identifying that Gavin Astor House is owned and run by Royal British Legion Industries. Placements are not confined to Services’ personnel or their dependants, but these may have priority in placements if there is a shortage of vacancies. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 10 The Service Users’ (Residents) Guide shows what is/is not included in the fees, and each individual contract clearly shows the breakdown of costs, and how these have been assessed. There is a sample contract included in the Guide, and day to day information such as arrangements for choice of room, visiting, medication, pets, telephone and management of pocket monies. Prospective residents are invited to visit the home where possible, and to spend time in the home prior to making a decision to move in. The manager or one of the deputy managers carries out a pre-admission assessment. The inspector read 2 of these, and noted that they contained detailed information about all activities of daily living (e.g. personal and hygiene needs, skin care, mobility, nutrition, communication etc.) Additional information is obtained from relatives, hospital staff or other health professionals as appropriate. Residents move into the home for life, and emergency admissions would only rarely be considered. The manager ensures that the home has any necessary equipment in place prior to admission, and that the allocated room is suitable. Rooms are redecorated where possible between clients, and residents may make a choice on the décor. The home admits residents with long term illnesses and nursing needs. Staff are well informed about many illnesses associated with older people; and about nursing care for people with e.g. acquired brain injury, and physical disabilities. Admissions are on an individual personal basis, and only take place if the staff have the skills and qualifications to meet the assessed needs of the resident. A review is carried out after 4 weeks, and relatives/care managers are invited to attend these reviews to help to check the suitability of the placement. An individual member of staff is allocated to give the resident information, and special attention as they are settling in. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People who use the service experience good quality outcomes in this area. Residents’ health needs are met, and there is good liaison with relevant health care professionals. Some small improvements can be made with care planning and medication management. EVIDENCE: Basic care plans are developed prior to the resident’s admission, and nursing and care staff are encouraged to familiarise themselves with these details so that they are already aware of the resident’s assessed needs. Care plans are reviewed with the resident, and this is confirmed by their signature (or relative/advocate), showing their agreement to their plan of care. The home is divided into the McAllister Unit (on the first floor), and the Lewis Unit on the ground floor. Each unit has their own allocated nursing and care staff, who stay on that unit; this provides continuity of care. Residents have a named nurse and key worker, and know that these are the first people to ask if they have any questions/concerns. Named nurses are responsible for ensuring that these care plans are kept up to date. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 12 The inspector read 3 care plans on one floor, and two on the other. They are stored in nurses’ stations, and confidentiality is retained. Care plans have an overview of the resident’s life history at the front, showing the home’s concern to treat people as individuals. Sections include daily reports (completed by nursing and care staff), a social activities list, care plans for assessed needs, doctors’ notes, monthly observations, moving and handling assessments, and other medical data. Personal property is identified on a property list. Daily reports were seen to contain helpful information, and were appropriately detailed. Care plans are well written, reviewed monthly, and amended as needed. They contained suitable data such as: for nutrition “ liaise with the Speech and Language Therapist if swallowing difficulties recur”; and for mobility “ use the Arjo hoist with medium sling and 2 staff for all transfers”. Risk assessments are included for items such as the use of bedrails; safety when seated in an armchair; use of wheelchair; use of walking frame etc. Wound care plans show the state of any wounds/pressure ulcers on admission to the home, and photographs are taken. These care plans had been evaluated each month, but did not show the progress of wound healing/deterioration. The inspector recommended that wound care is charted, so that it clearly shows the state of the wound at each dressing change; a written description would also increase clarity, and each wound should be documented separately so that there is no confusion. It should be possible to follow the pathway of the wound progress, and there is a requirement to review how wound care is documented. There was no written evidence that consent is obtained for taking photographs of residents, or for showing wound development, and consent should be evidenced. The home is fortunate to have a visiting medical officer, who usually visits the home twice per week, as well as in emergencies. Residents are enabled to have the GP of their choice, but most prefer to take up the opportunity for this service. This doctor is easily available for relatives to discuss concerns regarding their resident (e.g. end of life care, possible hospital admission), and also carries out routine medication reviews, blood tests etc. The home has excellent access to support from other health professionals, such as dietician, speech and language therapist, and occupational therapist. Medication is stored in a separate clinical room on each floor. These are large rooms with plenty of storage and hand washing facilities. There is one controlled drugs cupboard, and controlled drugs are checked by the 2 nurses from each floor working together. The amounts of controlled drugs are checked by 2 nurses twice per day, and this is good practice. The inspector checked the medication procedures on the first floor. There was evidence of stock rotation, and cupboards were in good order. Medication is supplied via a monitored dosage system. Oxygen is stored in the clinical rooms, and a hazard warning Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 13 sign is displayed wherever oxygen is in use. The home has a homely remedies policy signed by the visiting medical officer, for medication which can be used for residents on his list. Medication administration records (MAR charts) show evidence of medication checked in, and those viewed on the first floor were reasonably well completed. However, handwritten entries had not been signed, and a sticky label was seen on one chart, which is not good practice. The inspector discussed the importance of these issues with the manager and other nursing staff. Residents who wish to self medicate have a detailed assessment to check that they fully understand their medication; that they can open the packaging; and know the times to take it. Residents have a lockable facility in their room. These medication assessments are reviewed each month. Accommodation is provided in large single rooms, with en-suite facilities. This assists the staff to carry out care with attention to privacy and dignity. The inspector observed that staff respond sensitively to residents, recognise that this is their home, and knock on doors etc. before entering their rooms. The home is committed to carrying out end of life care with sensitivity and respect for individual wishes. This is discussed with the resident or relatives as appropriate, and details entered on to a form at the front of the care plan. The home has an ethos of enabling residents who are dying to stay in their own room wherever possible, and to be cared for by staff who know them. Pain assessments are carried out, and additional pain relief sought if indicated. One of the staff has completed a degree course in palliative care, and all nursing staff are trained in using syringe drivers for pain relief. Relatives can visit as wished. The manager is currently overseeing all nursing staff being trained in the “Liverpool Care Pathway” – a multi-professional document/model, which describes the best model of nursing care for each individual person at the end of life. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People who use the service experience adequate quality outcomes in this area. There are a good variety of activities available, and the home enables residents to take part in community life. Concerns regarding the menus and the nutritional value of food, are being reliably addressed by the management. EVIDENCE: The home provides a variety of communal areas for residents and visitors to meet. The largest area is the dining room, and this is usually used for social entertainment occasions. There is also an activities room. Residents can take part in joint activities such as bingo; dominoes/board games/jigsaws; arts and crafts; and an exercise class; and can have individual hand massage or aromatherapy; outings to shops etc. One of the bathrooms is set up as a sensory therapy bathroom, and this can help residents to relax. A “trolley” shop is provided in the home and is taken round at regular intervals. Church services are held in the home; entertainment such as singers, BBQ lunch, and themed days (e.g. Hallowe’en); and the home was currently preparing for fireworks night. Relatives and visitors are always made welcome in the home, and invited to join in with activities. There is an activities planner on the residents/relatives Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 15 notice board, and staff remind residents each day of any specific items. The home currently has a part-time activities co-ordinator available, and is in the process of recruiting someone for a full time post. Outings are carried out using the home’s 2 minibuses, or their small van. These are adapted for wheelchair users. Staff and relatives can be authorised to drive these providing they have the necessary documentation for insurance purposes. It is excellent that the home provides a vehicle which relatives can use to take their residents out in. Outings used to be on a set day, but are now carried out according to individual arrangements. The home produces a quarterly newsletter for everyone to keep in touch, and the “Friends of Gavin Astor House” are very active in planning and organising events, and in fund raising. Some funds were put towards a new woodland walkway – currently being landscaped. The RBLI have taken this on as a project by the estate. There are very pleasant areas for sitting outside – currently 3, (apart from the new walkway). Routines are planned around resident’s needs and wishes, and there is flexibility on a day to day basis to meet individual wishes. Residents are actively encouraged to be involved in the running of the home, and to be involved in the life of the local community. Visitors are always welcome, and they can stay and have a drink or meal with residents. There is a kitchenette on the first floor where relatives and visitors can prepare their own hot drinks or snacks. Residents are encouraged to take responsibility for their own financial affairs. The home has lists available for advocacy services, for anyone who prefers the help of an independent service. The management are fully aware that some residents have been unhappy with aspects of the food and menu planning, and have been actively discussing their concerns. Food management is contracted in via another company, and the manager has set up a meeting with the chef manager, and Gavin Astor staff and residents (due to happen the next week). Menus looked varied, and with suitable nutritious value. The contracting company have been willing to take suggestions and advice from the visiting dietician, and have been working together to improve the quality of food and service. Particular attention is being paid to pureed foods, to ensure that these meals retain a high nutritious value. The kitchen is well organised, and the same chefs are supplied to the home on a rota basis. This ensures that they know the residents, their specific diets, and their likes/dislikes. There is a choice of main meals, and the chefs are willing to prepare additional dishes for residents on request. A cooked breakfast is offered once per week, or residents can have this more often if they wish. Soups and cooked dishes are home made. The chefs have completed City and Guilds intermediate training. There is provision for residents to have snacks during the day or night if wanted. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 -18 People who use the service experience good quality outcomes in this area. Residents are supported in making their views known. Concerns and complaints are taken seriously, and responded to appropriately. Residents are protected from abuse. EVIDENCE: The complaints procedure is included in the residents’ guide – and each resident is given a copy of this on admission. It is also displayed on the residents/relatives notice board. It contained the correct information, but the inspector pointed out some ways in which it could be simplified for easier reading. She also suggested adding a line to remind residents/relatives that they can contact Social Services/their own care managers where appropriate Each complaint is recorded separately, with clear details of the action taken, and with copies of letters and meetings concerned. The record showed that all concerns are taken seriously and dealt with appropriately. Residents are supported by key workers/named nurses if they have poor communication skills and wish to make a complaint, and there was evidence regarding one of these. There are effective systems in place to make sure all residents have the opportunity to vote in elections. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 17 There are good records in place to show that staff have initial POVA training during their induction, and this is updated on a yearly basis. The manager is currently arranging for line managers to become trainers, so that they can ensure that each level of staff keeps up to date in prevention of abuse. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 People who use the service experience good quality outcomes in this area. The premises provide a well maintained and homely environment, and are suitable to meet the needs of the residents. EVIDENCE: The premises are a purpose built home, built in 1993, and adhering to the correct regulations for door widths etc. One person commented that door ways are sometimes too narrow for wheelchair users to navigate easily, but this is due to the development of better wheelchairs – many of those used in this home are wide wheelchairs, and are electric, so that residents can make their own way around. There is an ongoing maintenance plan, ensuring that different areas are upgraded as needed. Most bedrooms are redecorated when vacant, and carpets are cleaned or replaced as required. The home is well equipped with different communal areas – including different sized lounges, and different outdoor spaces. As already mentioned, a woodland walkway is being developed Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 19 in the grounds. This will enable residents to have more opportunity to feel a sense of privacy and independence. The home is situated on the Royal British Legion Estate, which is very well maintained, and with spacious grass and woodland areas between buildings. Bedrooms are all for single use, and are above the recommended size. Each one is equipped with an en-suite toilet and shower facility. Additional fitments are put in on the recommendation of the manager to the Estates Management. This includes overhead tracking for hoisting in one room, and shows that individual needs are taken into account. Residents are offered the key for their door, and for the lockable facility in their room. Bedrooms and communal areas were seen to contain good quality furniture and furnishings, and in line with residents’ choice. Bedrooms are personalised with residents’ own belongings and choice of soft furnishings. The home is equipped with specialised bathrooms, including spa bath facilities, and shower trays. There are additional disabled toilets throughout the building. Other equipment includes profiling beds for assistance with nursing care; bed rails (with padded bumpers); handrails; over toilet commode chairs, shower chairs, and pressure-relieving equipment. There is a hairdressing salon with 2 backwash sinks, on the first floor. The call bell system is radio controlled, and enables residents to take their call alarms with them in their wheelchairs. Some of the staff and residents reported this system as not being “user friendly” as there are fairly frequent episodes of broken units, or numbers coming up on the monitors, which are incorrect. The manager said that she will be discussing this in the next year, in line with the home’s budget. Bedroom radiators have an individual thermostat control, and are low surface temperature. Water temperatures are checked weekly by the maintenance man, to ensure that they do not exceed levels of safety. The home was clean in all areas, and is light and airy. There are usually 2 housekeeping staff on duty on each floor, and one laundry assistant. The housekeeping staff have a system for spring-cleaning rooms every month. The laundry has new ironing equipment, and is fitted with 2 commercial washing machines and 2 tumble dryers. A red alginate bag system is used for soiled items, and this promotes good infection control. There are also sluice rooms on each floor, which have sluicing disinfectors. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People who use the service experience good quality outcomes in this area. The home maintains good staffing levels, and has effective training programmes in place. EVIDENCE: Nursing and care staffing levels are maintained independently on the separate floors, so that residents are well acquainted with the staff who look after them. The home is registered with 2 agencies for times when there may be a shortfall of staff – usually due to sickness. They also have their own “bank” staff. There is a nurse on duty for each floor 24 hours per day. This enables trained staff to check specific data together, or to give each other support and advice where applicable. Each floor has a team of care staff comprising 7 care staff per day, per floor. These are divided into 3 groups of 2 staff, with one other carer to “float”, and carry out additional tasks if all the other 6 are involved in personal care. Care staffing levels include extra health care assistants at peak times – mid-morning and twilight – which are the busiest times. They try to ensure that residents can get up/go to bed/go out as they like, but this is still difficult at times, if all want to get up or go to bed around the same times. They do not carry out a set routine, but try to ensure fairness so that particular residents are not always left until last. Care staff are assisted by good numbers of housekeeping, laundry, maintenance, and administration staff. Kitchen staff are contracted in. There Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 21 are also 2 volunteers, one of whom works in the home every morning, and carries out tasks such as laying the tables etc. With high numbers of health care staff, the home is struggling to meet the recommended percentage of 50 of care staff with NVQ 2 training. The percentage is currently only 9.6 , but there are another 7 staff currently completing NVQ training, and this will bring the percentage up to an increased rate of 21 . Staff are keen to accept training, and mandatory training is well carried out and well evidenced by staff, and by their individual staff folders. All staff carry out all mandatory training during their initial probationary period. The home has a good induction programme, and staff said that this had helped them to settle quickly in to their posts. After the initial induction days, staff are required to shadow an experienced staff member for several shifts, so that they get to know the residents and their needs. The inspector saw good evidence of training for moving and handling, basic food hygiene, fire awareness and POVA. The inspector viewed 4 staff recruitment files, and these were in good order, and with good procedures in place. They did not specify clearly that applicants are requested to provide a full employment history, and it is recommended that this is clarified on the application form. Nurses’ PIN numbers are checked every year. POVA First and CRB checks are carried out prior to confirmation of employment. Nurses said that they are given excellent opportunities to keep their own training skills updated. This includes items such as taking blood, tissue viability, and updating knowledge of illnesses such as Parkinson’s Disease, Multiple Sclerosis, and Diabetes. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-33, 35-38 People who use the service experience good quality outcomes in this area. The home has effective and professional management in place; and residents are confident that the home is well managed and safe. EVIDENCE: The home is led by a highly competent and experienced manager, who is a trained nurse, and who has completed relevant training such as a Diploma in care home practice and management, and the Registered Managers’ Award. Her nursing experience and training has included nursing older people, intensive care, orthopaedic nursing and accident and emergency. She has sound knowledge of the national minimum standards, and is familiar with other relevant legislation. Staff throughout the home spoke highly of her competence, and her ability to lead the staff team effectively and sensitively. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 23 She has implemented improved quality assurance procedures, which include an open and transparent ethos in the home; regular questionnaires to seek residents and relatives’ views; excellent monthly auditing systems; and meetings with residents, relatives and staff. Residents are actively encouraged to take part in the running and life of the home. The “Friends of Gavin Astor House” also provides another opportunity for residents to share their views, and to attend meetings. The home has monthly audits carried out by the RBLI Quality Assurance Manager, and these are very detailed. The home has good systems in place to protect residents’ money. The staff do not act as appointees for anyone. The manager has a list of advocates/appointees available for those who need this service. Some residents are able to continue managing their own finances. Small amounts of money are kept in a suitable safe place, and debits and credits for each person are clearly itemised and recorded, with receipts retained. Authorised persons can view these records at any time. Residents or their appointees are invoiced at the end of the month for costs such as hairdressing and chiropody. Staff and volunteers have formal supervision and support to enable them to carry out their tasks effectively and to identify training needs. Supervision may be more often that the recommended 6 times per year, depending on the assessed support required by individual staff. Detailed yearly appraisals are carried out for all staff, and were seen in staff files. Records are generally well maintained, up to date, and are stored with regard to retaining confidentiality. Policies and procedures are reviewed every year, and are amended as necessary. A requirement given at the last inspection regarding some health and safety issues has been met. The kitchenette was clean and tidy, although still worn and waiting for upgrading. The costing and plans have been completed for this, and purpose built units are in the process of being made. The kitchenette is due to be fully upgraded during the next month. A new fire risk assessment has been carried out by a fire consultant. All doors are now linked into the fire system. The manager had already identified the need for more fire drills that involve night staff as well as day staff. The home works to a health and safety policy drawn up by RLBI, and all staff are required to keep up to date with this. Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 4 3 3 4 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 3 3 3 Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12 (1) (a) and (2) Requirement To review how wound care is documented; so that a clear pathway can be seen for the progress of the wound or pressure ulcer. And: To ensure that written evidence is in place to show that residents (or their representatives) have consented to have photographs taken of wounds/ulcers. 2 OP9 13 (2) Any hand written entries on medication administration records (MAR charts), must be signed by 2 nursing staff. (This was being put into place with immediate effect). Sticky labels must not be used on MAR charts. 3 OP29 19 (1) and Schedule 2. To ensure that application forms specify that a full employment history is requested. 31/12/07 30/11/07 Timescale for action 30/11/07 Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations To ensure that discussions continue in regards to the food and menus; and that issues that affect residents’ satisfaction with food are satisfactorily resolved. To review the effectiveness of the call alarm system. To continue to take all possible measures to increase the numbers of health care assistants with NVQ (2) training; so that the percentage is increased to 50 . 2 3. OP22 OP28 Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gavin Astor House DS0000026172.V353884.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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