Inspection on 09/01/07 for Gavin Astor House

This inspection was carried out on 9th January 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 25/10/07

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 HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Gavin Astor House Royal British Legion Village Aylesford Maidstone Kent ME20 7NL Lead Inspector Gary Bartlett Key Unannounced Inspection 9th January 2007 09:45 X10029.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.V326891.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 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 DS0000026172.V326891.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 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) Royal British Legion Industries Limited 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.V326891.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 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 visitors car park. Current charges range from £503.41 to £986.67 per week. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Gavin Astor House from 9.45 a.m. until 5.45 pm. During that time the Inspector spoke with some residents, visitors and some staff. Parts of the Home and some records were inspected and care practices observed. A large number of comment cards were received prior to the inspection. Residents and their relatives generally responded that they liked the home and staff. Responses from health professionals also indicated good standards of care. Statements on comment cards included: • “If one can not be in one’s own home G.A.H. is a good alternative and staff replace the loss of your relatives”. • “The care my mother receives is excellent. I could not ask for more…….the safe and loving care at Gavin Astor”. • “Residents in Gavin Astor are very well looked after and every effort is made to provide a sociable and caring environment”. • “It is an excellent nursing home and very well run”. Further statements are quoted in the text of the report. The Manager and staff gave their full co-operation throughout the inspection. What the service does well: Gavin Astor House provides a comfortable environment that was bright and airy. The standard of cleanliness around the Home is very good. Information about the Home is easily accessible. Staff are good at helping residents to settle in. The Home enjoys good relationships with other health care professionals. There is an open and friendly atmosphere with good interaction between residents, staff and visitors. Personal health care needs are generally well supported and residents’ individual preferences are catered for where practicable. Staff are well supported in their training. There are good procedures to protect residents from abuse. The Manager is approachable and has high expectations of the standards of care for residents. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 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 Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 7 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 8 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 Outcomes 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, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 9 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. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) 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. (YA NMS 4) 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1(OP), 3(OP), 5(OP) and 6(OP) 1(YA), 2(YA), 3(YA), 4(YA) and 5(YA) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they are appropriately placed due to good preadmission assessments and benefited from being able to visit the Home prior to admission. The Home does not provide intermediate care. EVIDENCE: Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 10 The Manager said the Statement of Purpose was accurately descriptive of the aims, objectives, philosophy of care, services and facilities and terms and conditions of Gavin Astor House and copies of the Service Users Guide were provided for each service users or their representative. These were not inspected on this occasion. The Manager described how a pre-admission assessment was made of each prospective resident using an aide-memoir. These included a medical history, activities of daily living, usual reliance on medical services, and any existing care manager or nursing assessments. Prospective residents, their families, advocates, and relevant health care professionals were involved in the assessment process. Specialist advice was sought from external sources where required. Residents said they or their families had been able to visit the Home before moving in. This was confirmed by a relative present. Residents also said staff had been very helpful in assisting them to settle in. Intermediate care was not offered at Gavin Astor House. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7(OP), 8(OP), 9(OP) and 10(OP) 6(YA), 9(YA), 16(YA), 18(YA), 19(YA) and 20(YA) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Records of care being more consistently maintained would better promote residents’ health and welfare. More consistent adherence to the procedures for the administration of medicines would better protect residents. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 12 Staff treated residents with respect and maintained their privacy and dignity. EVIDENCE: Four care plans were inspected in detail, two from each unit. They were generally reflective of the resident’s current needs and were being regularly reviewed. There were separate daily record sheets to be completed by the care staff and by the qualified nurses. The standard of daily record keeping was not consistent. It was not always evident that health care had been continuously monitored or that appropriate advice or action had been taken in response to recorded conditions or symptoms. The residents or their representative had not signed the care plans inspected, therefore it was not evident if they had involvement in the writing of the plan or agreed to its contents A notice in each bedroom informed the occupant of their named Nurse and key-worker. Staff spoken with had a good understanding of residents’ individual needs. The clinical rooms were clean and well maintained. The first floor clinical room had been equipped with a new drugs refrigerator. The Medication Record Administration Record (MAR) sheets that were inspected had been completed appropriately. The temperature of the rooms had been monitored and recorded. Records were available to indicate that all staff administering medications had been trained and signed off as being competent to do so. However, statements taken during a recent investigation of a complaint indicated some staff might not be adhering to the procedures for the administration of medications, thereby placing residents at potential risk. When the Manager was told of this, she immediately issued a memorandum to all staff reminding them of their responsibilities. This negated the need for the Commission to issue an Immediate Requirement Notice but a strong recommendation was given for the administration of medicines to be more closely monitored. During the inspection, medicines were seen to be given in accordance with good practice guidelines. The Home continued to have a good working relationship with the specialist and local health care professionals. This greatly assisted in supporting residents in their health care needs. Discussion with residents and records seen clearly showed they had access to appropriate health care services such as G.P.s, dentists, chiropodists, opticians, dieticians, etc. Residents felt that staff were kind and gentle, this was confirmed by observation. Staff were seen to be very considerate of the age and dignity of residents and to treat them with courtesy. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 13 Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 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. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12(OP), 13(OP), 14(OP) and 15(OP) 12(YA), 13(YA), 15(YA) and 17(YA) Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to this service Residents could generally enjoy a fulfilling lifestyle although some wanted more activities. Some residents could be given greater choice and control over all aspects of their lives as their individual abilities allowed. Dietary needs of resident were met with improvements being made to providing a varied selection of food that met their tastes and choices. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 15 EVIDENCE: Residents spoken with were happy with the flexibility the Home offered in regard to meeting personal preferences where practicable, for example what time they got up, went to bed etc. The Home operated a named nurse/ key worker system, which enabled closer resident/staff relationships where likes, dislikes and needs were shared. Some residents mentioned they would like more activities and outings. The Manager explained they would like to be able to offer a wider range of activities especially arts, crafts and other hobbies. There were two part time Activities Co-ordinators working at Gavin Astor House and this was supplemented by some of the Housekeeping Team volunteering additional activities support approximately once a month. The Manager was trying to recruit a suitable person to fill the 14 hours that were vacant. This was particularly important in view of some comments made by residents that they became bored at weekends as no formal organised activities were on offer then. A visiting hairdresser was at the Home on the day of inspection. Family and friends felt welcome and knew they could visit the Home at any reasonable time, although one comment card received from relatives indicated they did not think staff welcomed their children. The design of the Home provided seating areas within the communal areas of the Home where residents could entertain their visitors, in addition to the privacy of their own room. The Home encouraged individuals and groups from the community to visit the home. The Home had a contract with a catering company for the provision of meals. Feedback from residents and relatives was variable. Some said the food was very good, others did not think so. A comment card completed by a community dietician included the statement: • “I feel that the home has a very proactive approach to patient care and they communicate well asking for advice where necessary”. Statements on comment cards completed by residents included: • “Sunday roasts are always good, but weekday meals are repetitive. Too much processed food sausages, meat-balls etc. Not enough in season fresh fruit, tinned fruits get used instead”. • “Limited vegetable selection”. • “Could be better on occasions”. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 16 A comment card completed by a relative included the statement: • “Poor food choice. Lack of fresh vegetables”. It was recognised within the Home that there had been problems in the past and whilst some improvements had been made, more were needed to attain the expected standards. Records of feedback about meals were kept and these were discussed by the Home and the catering company. The process would be aided by a more formalised system of consultation between the catering staff and residents. The dining rooms would have been more congenial had the stained tablecloths been replaced with clean ones. Food was served to meet the needs of all residents including those who had swallowing or chewing difficulty. Staff gave assistance to those residents who needed help to eat, in a discreet and sensitive manner. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 17 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16(OP) and 18(OP) 22(YA) and 23(YA) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives knew their complaints would be listened to and acted on. There were systems to ensure residents were protected from abuse. EVIDENCE: The complaints procedure was readily available to residents and their relatives and visitors. The Manager was aware that it needed to be revised to show complainants can approach the Commission at any time during the process. Residents described how they knew of the complaints procedure but had not had cause to use it. Records of complaints were kept and these included details of investigation and action taken. The Manager stated that complaints were used to improve practice where required. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 18 There were procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with demonstrated a sound understanding of adult protection procedures and stated that any allegation of abuse would be referred to the concerned agencies without delay. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 19 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 live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18(OP), 19(OP), 20(OP), 21(OP), 22(OP), 23(OP), 24(OP), 25(OP) and 26(OP) 24(YA) and 30(YA) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the Home was good providing residents with an attractive, homely and safe place to live. EVIDENCE: Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 20 The Home was purpose built in 1993. All rooms were for single occupancy and had en-suite facilities. Those seen were well decorated and adequately furnished for the occupants’ purposes. The Manager said there was an ongoing process of redecorating and/or refurnishing bedrooms when the occupancy changed. Residents said they were happy with their rooms and welcomed the opportunity to personalise them and had ready access to all parts of the Home they needed. The dining room had been equipped with new furniture and curtains and the staff room had been refurbished. Hoists and wheelchairs were provided where there was assessed need and assisted bathing and toilet facilities were available to residents. Storage space was at a premium and staff were having to be very careful that wheelchairs and hoists did not cause obstruction when not in use. Residents said the current toilet and bathing facilities were adequate to meet their needs. The temperature of the hot water was tested at several outlets and was at a safe temperature. The Manager described how there were regular tests for Legionella and safety measures were taken as required. Since the last inspection, most fire doors had been fitted with appropriate automatic closing devices. There were still a few to be done. The Manager was aware of the need for this to be completed to ensure residents and staff safety. Commendably, the “courtyard” and “balcony” had been adapted to enable interested residents to do some gardening. Unfortunately the “balcony” had been poorly maintained recently and was unsightly with overfull cigarette bins and discarded litter. The laundry was small for the needs of the Home but the staff member responsible kept it well maintained and had a good system for keeping the soiled and clean items well separated. The room was still not fitted with a dedicated hand wash basin that potentially compromised infection control. There were sluicing facilities on both floors and these were well maintained. Except for the kitchenette on the first floor (as detailed later in this report), the standard of cleanliness around the Home was very good. A comment card completed by a resident included the statement: • “Housekeeping Team do a good job”. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27(OP), 28(OP), 29(OP) and 30(OP) 32(YA), 34(YA) and 35(YA) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment processes offered protection to people living at the Home. The Home provided ongoing training for staff so they had the skills to meet the needs of the residents. EVIDENCE: Residents and visitors spoke highly of staff and thought they worked hard. One resident described staff as “lovely”. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 22 Records seen indicated that robust recruitment procedures were used and ensured the Home employed only staff that had been properly vetted. The Home was reliant on the occasional use of agency staff to maintain adequate staffing levels and, when practicable, used the same agency staff so there was continuity. There was some discussion as to whether the number care staff at peak times was adequate. Statements on comments card completed by residents included: • “Staff have great demands on their time, so sometimes have to juggle residents requirements to fit them all in”. • Pressure of work on the staff sometimes involves waiting time for residents”. • “Although staffing levels are good, there is still room for increased levels as many of the residents now require more care”. Observations and discussions during the inspection confirmed these views. Whilst there were generally enough staff available, they were clearly under pressure at peak times of activity. The Manager described how they monitored staffing levels remained appropriate as residents’ dependency levels increased. The staff rosters inspected did not show any staff to be working long consecutive shift patterns that could compromise staff competency through fatigue and thereby put residents at risk. Staff were required to undertake a comprehensive induction programme and there was ongoing training for them that was monitored to identify individual staff training requirements. Data provided by the Manager showed that 33 of staff were trained in NVQ. The Manager described how the NVQ training had been disrupted by the demise of a training organisation but alternative trainers had been identified and NVQ training was recommencing. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 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. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31(OP), 32(OP), 33(OP), 35(OP), 36(OP), 37(OP) and 38(OP) 37(YA), 39(YA) and 42(YA) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 24 The Home benefited from a Manager who was accessible and had high expectations of the service to be delivered. The Home regularly reviewed aspects of its performance through a programme of self-review and consultations, which included the opinions of residents and relatives. EVIDENCE: Residents benefited from the support of a Manager who was competent and experienced. She was a registered nurse and had completed the Diploma in Care Home Management. The management approach to Gavin Astor House created an open, positive and inclusive atmosphere in which people who lived there were able to influence the way in which the Home was run. The Manager described how residents and their representatives or relatives were regularly asked for their views about the service. Relatives/residents’ meetings were held regularly and questionnaires were distributed. The Home encouraged residents to manage their own financial affairs or to have assistance from their families / representatives. There was a sound system of holding and recording residents’ cash, which facilitated ease of monitoring. The Manager described a system of ongoing environmental risk assessments. An environmental Health Officer had inspected the kitchen on 29th June 2006 and the Catering Manager said there had not been any resultant recommendations. The standard of cleanliness in the kitchen was good but this did not extend to the kitchenette on the first floor. Here the standard of cleanliness was very poor, potentially placing residents at risk. Staff spoken with had a sound understanding of emergency procedures. The Manager described how they were intended to introduce a different method of recording staff attendance of fire drills/training to make it easier to monitor that all staff attended at periods recommended by the Fire Safety Officer. Staff spoken with had a sound understanding of emergency procedures. Staff spoke of regular supervision and appraisals. The Manager stated that all records of maintenance and safety checks were up to date and that policies and procedures were regularly reviewed by a Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 25 competent individual to ensure they complied with current legislation and good practice advice. These were not inspected on this occasion. Records seen were kept in a manner that preserved confidentiality. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 26 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 X 3 3 4 X 5 3 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 2 20 3 21 3 22 2 23 3 24 3 25 3 26 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 3 33 3 34 X 35 3 36 3 37 2 38 2 Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15(2)17 Schedules 3 and 4 Requirement Timescale for action 16/02/07 2. OP19 23(4)(a) 3. OP26 13(3) 16(2)(j) “The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review” in that care plans must be accurately reflective of service users current needs. This must be completed by the given timescale and maintained thereafter. 30/03/07 “The registered person shall after consultation with the fire and rescue authority take adequate precautions against the risk of fire, including the provision of suitable fire equipment” in that appropriate methods of holding all fire doors open must be used. This requirement is repeated from the last inspection. This must be completed by the given timescale and maintained thereafter. “The registered person shall 30/03/07 make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home” in DS0000026172.V326891.R01.S.doc Version 5.2 Gavin Astor House Page 28 4. OP38 13(3) 16(2)(j) that: 1. More appropriate hand washing facilities are provided in the laundry for the control of infection. 2. The tiling around the sink must be made good. This must be completed by the given timescale. “The registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home” in that: 1. The kitchenette on the first floor and all associated equipment must be kept clean. 2. Washed crockery must be dried in such a manner that complies with food hygiene standards To be completed by the given timescale, if not sooner, and maintained thereafter. 23/02/07 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 OP7 Good Practice Recommendations It is recommended that service users or their representative sign their care plans as evidence of their involvement in the writing of the plan and their agreement to its contents. It is strongly recommended that the staff adherence to the procedures for the administration of medicines is more closely monitored. It is strongly recommended the Manager continue their efforts to make more meaningful activities available to residents throughout the week. It is recommended the consultation process between the DS0000026172.V326891.R01.S.doc Version 5.2 Page 29 2. 3. 4. OP9 OP12 OP15 Gavin Astor House 5. 6. 7. 8. 9. 10. 11. OP15 OP16 OP19 OP22 OP27 OP28 OP38 catering team and residents be formalised. It is strongly recommended stained tablecloths are not used. It is recommended the complaints procedure be revised to show complainants can approach the Commission at any time during the process. It is recommended the “balcony” be better maintained so as to provide a better outlook from the Balcony Room. It is recommended that additional storage space be provided for equipment such as lifting hoists etc It is strongly recommended that a review be undertaken of staffing levels at peak times of activity to ensure they are adequate to meet residents’ needs in a timely fashion. It is recommended that more staff are trained to at least NVQ level 2 or equivalent It is recommended the Home implements the proposed method of recording staff attendance of fire drills to facilitate easier monitoring. Gavin Astor House DS0000026172.V326891.R01.S.doc Version 5.2 Page 30 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.V326891.R01.S.doc Version 5.2 Page 31 - 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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