Inspection on 05/08/05 for Gavin Astor House

This inspection was carried out on 5th August 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gavin Astor House 25/10/07

Gavin Astor House 09/01/07

Gavin Astor House 06/12/05

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Gavin Astor House Royal British Legion Village Aylesford Maidstone Kent ME20 7NL Lead Inspector Lynnette Gajjar Unannounced 05 August 2005 08:15am 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 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 and Care Homes for Adults 18 – 65*. 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 H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Gavin Astor House Address Royal British Legion Village Aylesford Maidstone Kent ME20 7NL 01622 791056 01792 717273 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Royal British Legion Industries Ltd Mrs Linda Alder CRH Care Home 50 Category(ies) of PD Physical Disability (24) registration, with number OP Old Age (26) of places Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16 February 2005 Brief Description of the Service: Gavin Astor House is a purpose built Care Home for adults over 18 years of age who have been assessed as needing “Nursing care”. The establishment opened in 1993 and now provides 24 hour nursing care for up to 50 people. The home provides accommodation over two floors; all rooms have en-suite facilities and are designated for single occupancy. All areas of the home have been designed to accommodate wheelchair users. The home has a patio courtyard in the centre that has seating and wheelchair access. The nearest public transport to Gavin Astor is approximately half a mile (1km). There is ample parking in the visitor’s car park. The aims and objectives of the home the care and range of services offered can be seen in detail in the “Statement of Purpose” and “Service Users Guide”. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 08:15am until 17:00pm. The home currently has 48 service users, with two vacancies. The visit was spent talking directly with both service users privately and collectively; care and nursing staff, kitchen staff, night RGN (on management day) and the registered manager. Judgements about quality of life and choices were taken from direct conversation with service users and observation followed by discussion with staff and evidencing records held at the home. A tour of the premises and gardens was undertaken. What the service does well: Gavin Astor provides a welcoming and homely environment, is decorated and furnished to a good standard and is clean, bright and airy. Personal health care needs are well supported. Service users are encouraged to maintain regular contact with external agencies and professionals to managed their health care and personal preferences. Service User’s spoke today of feeling safe, expressed confidence in the care and nursing staff and manager to listen to them and “feel good” in themselves. They are supported to explore and maintain contact with the local community and facilities. Staff promote service users personal choices and rights thus enabling them to feel confident within their daily lifestyle. Service users comments included: “I am very happy with the care Thank you” “Can’t fault the staff they are very good, I have everything I need here, no complaints” “On the whole I am very happy here” “The staff are very good, nothing is too much for them” Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Standards Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6-10 and 18–21) (Standards 11–17) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37–43) Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. 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. Prospective service users have an opportunity to “test drive” the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5, Service users and representatives are given all the information they need to be able to make an informed decision to live at Gavin Astor House. EVIDENCE: Service users have access to a statement of purpose and service users guide which give good representation of the service provided in the home. Service Users spoken with detailed family and friends involvement in visiting the home and the staff visiting them where they were living to assess their needs prior to deciding to move in. Many service users spoke of how they had left this to their relatives due to being in hospital at the time and not being well enough to visit. Files evidenced pre admission assessments taking place. Service users spoken with today felt staff had been very supportive and shared a lot of information at this time. Records seen showed individual contracts in place. “My daughter and sons sorted this out for me, they visited a number of places but said this was the one for me, all reports were good and I have to say I have been very pleased with their choice, they couldn’t have got better” Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6-10 and 18 –21 (Adults 18-65) 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. Including their physical and emotional health needs. 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. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. Service users receive personal support in the way they prefer and require. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 7, 9, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 Service users are treated with genuine respect and dignity by all staff. Individual health and social care needs are managed well. EVIDENCE: Care plan records seen were sufficiently up to date, detailed and contained clear information to support staff to meet the care needs of the individuals. Daily recordings varied in content from giving a good overall view of care and well-being of the service user to that only detailing the direct care given. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 10 Service users spoken with had varying understanding of their care plans, some with no interest at all. Those spoken with were aware of paperwork needing to be done but were happy to leave that to the staff. Care staff spoken with and observed were mindful of how to prevent risk of falls, taking action to ensure safety for individual service users and this is clearly recorded. Service users talked of regular contact with the GP ( or visiting VMO), chiropodists, opticians and consultant appointments. Records supported this and are stored securely. One professional a number of service users felt they did not get adequate support from was a trained physiotherapists, to assist with exercises and therapy due to their physical needs. Interaction between service users and staff is good showing genuine respect and appropriate familiarity with each other. Personal wishes in the event of illness and death, although a difficult subject, are discussed sensitively with service users and families to ensure appropriate levels of support are respected and personal dignity maintained at such times. All recommendations made from previous visits regarding medication administration have been implemented. Monthly monitoring audits have also been introduced and proving very useful to review practice. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 11 – 17 (Adults 18-65) are: 12. 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. Including opportunities for personal development. Service users engage in appropriate leisure activities. Service users maintain contact with family/ friends/ representatives and the local community as they wish. And have appropriate personal, family and sexual relationships. 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. 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15, 16 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users are encouraged to make choices about aspects of their daily lives, through the support of a range of activities, services and health care in the home and local area. EVIDENCE: The home has effective working relationship with the local health and social care professionals, supporting service users in their health and social care needs. Care plans seen recorded regular contact both at the home and their local practices/work place. Reviews with care managers take place. Discussion took place with service users regarding the food at the home. The majority of feedback was positive; some still feel there is room for improvement on personal preferences. Due to food hygiene standards service users are encouraged to have fridges in their rooms for personal stocks of food and ensure safe storage. Regular activities and events are booked to stimulate and encourage interaction with peers, such as the forthcoming 80 years RNBI summer fayre celebration, VE day tea and psychic event. A number of external outing have taken place. Other service users preferred to not join in and occupy themselves with TV, reading, listening to radio and personal Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 12 hobbies. There is three activity staff for the home providing activities Monday to Thursday. Currently Friday is not covered due to staff maternity leave. Service users expressed some frustration at this. There was a steady flow of visitors to the home, all received warmly by staff. Many service users access local supermarket and area using electric scooters and wheelchairs and found this independence satisfying. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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. Including neglect and selfharm. The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Service users feel confidant to raise concerns or complaints with the manager, as they know they will be listened to and action taken to resolve them. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: Service users spoken with knew who to talk to if they had a concern or wished to make a compliant; this included their relative, the manager, and their care manager. There is a complaint procedure are available in the home Staff who have been spoken shared a good understanding of how to protect and prevent abuse. Reporting under local procedures. There are no current adult protection alerts relating to this home. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) 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. Shared spaces complement and supplement service users’ individual rooms. Service users have sufficient and suitable lavatories and washing facilities. Provide sufficient privacy and meet their individual needs. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. And lifestyles. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,24,26 Service users live in a comfortable and purpose built home, which would be enhanced further by better equipment storage. Service users would feel safer and more independent with the fitting of automatic door closures. EVIDENCE: Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 15 The home was purpose built in 1993. The location of the home is off main road and bus routes within the Preston Hall grounds. Ongoing decoration is underway to all areas of the home. All rooms are single with en-suite facilities. Those visited were personalized and adequately meeting their needs. There are a variety of assisted bathing facilities in the home, including a sensory bathroom. Every corridor had alternative moving and handling equipment within easy access by staff. However, corridors although wide, have hoist and wheelchairs stored (all be it to one side) this does make them cluttered. The homes laundry covers all of the homes laundry no aspects are contracted out. The laundry is of good size with dedicated staff. There are small patio and gardens leading of various aspects of the home, all with seating and paths set to allow for resting. Service users were very complimentary of the gardens. . Due to the nature of the service and service users needs fire doors are heavy and difficult to manoeuvre and operate wheelchairs. Many doors were observed to be propped open with doors stops or chairs. This is unsafe practice and alternative automatic door closures linked to the fire alarm system and/or advice from the fire officer should be explored. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 36 (Adults 18-65) are: 27. 28. 29. 30. • • • Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. 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. Service users benefit from clarity of staff roles and responsibilities. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers standards 27, 29 and 30 (Older People) and Standards 34 and 35 (Adults 18-65) the key standards to be inspected at leat once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Service users have benefited from the support and care of competent, skilled staff. Resulting in good morale and commitment to improve their quality of life. EVIDENCE: Staff discussed attending a number of courses related to health and safety core training and nursing care, increasing their personal knowledge and understanding of individual care needs and their responsibilities. The home has 18 of the 41 care staff trained to NVQ 2 or 3. Both qualified nurses and care staff spoken with and directly observed evidenced clear and good understanding of different individual care needs. Service users talked fondly of individual staff and their kindness. Very few were aware of the named nurses or key workers. Service users shared that they did not always have the same staff and preferred this as they became familiar with their care and how to assist them, without having to explain again. One common theme expressed when talking with service users was, “we’d like more staff”, “it takes them along time to answer the call bell sometimes”. Staff were seen to support individuals respectfully but also with respectful familiarity resulting in some fun joking and banter from both parties. Staff files seen evidenced good Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 17 recruitment procedures to ensure safety of service users, staff training and competencies, including adaptation over seas nurses. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 37 – 43 (Adults 18-65) are: 31. 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 a well run home and from competent and accountable management of the service. 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. Service users are confident their views underpin all self-monitoring, review and development by the home. 32. 33. 34. 35. 36. 37. 38. • The Commission considers standards 33, 35 and 38 (Older People) and Standards 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,36,38 Service users personal preferences, support and care needs are encouraged through the registered managers open leadership and the promotion of a safe home and working environment. EVIDENCE: Service users and staff expressed a high regard for the management approach to the home. Service users feel the registered manager is approachable and all staff spoken with said they felt well supported by the manager and organisation. The registered manager and nurses demonstrated through discussion, a very clear understanding of the needs of current service users and current issues. Monitoring health and safety in the home is to a good standard through the maintenance staff. Equipment is serviced as required to Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 19 maintain a safe home and facilities. Risk assessments are completed for individuals and staff activities in the home and care duties. There is an evidenced of regulation 26 visit-taking place to monitor the service. Detailed financial recordings and storage is in place for small amounts of service users personal monies held by the home. Recorded formal supervision is in place with some minor tweaking to ensure regularity for some staff. Quality assurance systems have been implemented since the last inspection. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 20 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 3 2 3 3 3 4 3 5 3 6 x HEALTH AND PERSONAL CARE ENVIRONMENT Standard No 19 20 21 22 23 24 25 26 STAFFING Score 2 3 3 3 3 3 3 3 Score Standard No 7 8 9 10 11 Score 3 3 2 3 3 Standard No 27 28 29 30 3 3 x 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No 16 17 18 Score 3 x 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 x 32 3 33 3 34 x 35 3 36 3 37 x 38 2 Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 23(4)(a) Requirement Following consultation with the fire authority take adequate precautions against the risk of fire including suitable fire equipments:In that appropriate method of holding fire doors open and that will close safely if the fire alarms are activated. Timescale for action 30 November 2005 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 OP9 Good Practice Recommendations It is recommended that nursing and care staff familiarise themselves with the contradictions for service users on specific medication and the consumption of specific fruit juices.Service users are consulted and care plans amended as appropriate. It is recommended that staff induction core training is booked or undertaken within recommended timescales. It is recommended that summaries of Quality Assurance audits be submitted to the commission now they are starting to be implemented. It is recommended that all care staff preparing and serving breakfast undertake basic food hygiene training It is recommended that staff have access to the guidance H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 22 2. 3. 4. 5. OP30 OP33 OP38 OP38 Gavin Astor House published by the commssion to assist them and completing Regulation 37 notices appropriately. Gavin Astor House H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 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 H56-H06 S26172 Gavin Astor V231607 050805 Stage 4.doc Version 1.30 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!