Care Home: Gavin Astor House

What the care home does well The environment is purpose built, safe, clean and well maintained. This provides a pleasant and homely place in which to live where the residents can maintain as much independence as possible. The home provides excellent health and personal care. Staff are well trained and up-todate. This means that the residents benefit from best practice in nursing and care. There is a stable, friendly and caring staff team. Residents confirmed that the staff are kind and caring. One said, "The staff are always polite and helpful". The home is well managed both on a local and organisations level. Residents and staff praised the registered manager for her openness and enthusiasm. There is a three year business plan that identifies areas for improvement and there is clear evidence that the service is committed to self regulation and improvement. The home values equality and diversity and offers a wide range of activities that are tailored to individual choices and need. Two social care co-ordinators work hard to ensure that the activities programme includes one-to-one sessions; entertainment in the home; physical activities such as gardening and exercises; creative activities such as art and craft work; and outings to places of the residents` choice. There are excellent quality assurance measures in place. These include regular clinical audits; frequent visits by the responsible individual and other representatives of the registered provider; regular residents` meetings and formal questionnaires. The nursing and care staff are very well supported by the hotel services team. The domestic, laundry, maintenance and catering staff all work hard to support the smooth and efficient running of the home. What has improved since the last inspection? More money has been invested in food services. A new contract for food services has been arranged and a catering manager has a high profile in the home. This has resulted in meals in the home improving significantly. Residents told us that they enjoy their meals and are given the portion size that they want. Staff training has improved a great deal. There is a significant improvement in the percentage of care staff with the National Vocational Qualification in care at level two or above and qualified nursing staff have undertaken a good level of specialist training in areas such as end of life care and Mentorship. There have been a number of environmental improvements, including redecoration of some bedrooms, improvements to the dining areas and the creation of an accessible and interesting woodland walk. What the care home could do better: There were no recommendations or requirements placed as a result of this visit. Key inspection report Care homes for older people Name: Address: Gavin Astor House Royal British Legion Village Aylesford Maidstone Kent ME20 7NL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Wendy Mills     Date: 1 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Gavin Astor House Royal British Legion Village Aylesford Maidstone Kent ME20 7NL 01622791056 01622717273 linda.alderr@rbli.co.uk www.rbli.co.uk Royal British Legion Industries Ltd care home 50 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 50 The registered person may provide the following category of service: Care home with Nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Physical disability (PD) Date of last inspection Brief description of the care home 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. Care Homes for Older People Page 4 of 30 Over 65 50 0 0 50 Brief description of the care home 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 twenty-four hour nursing care. Accommodation is provided on two floors, with two passenger lifts providing easy access between floors. All bedrooms are large single rooms, with en-suite toilet and showers. The current weekly fees range from £750 - £1,000. Fees are based the assessed needs of each resident. Further information about the home can be obtained by contacting the registered manager, Ms Linda Alder. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit formed part of the annual regulatory process of the Care Quality Commission (CQC)under the Care Standards Act. This report is based on information that we have gathered both during this visit and information we have received over the past twelve months. This includes the information that the home has given us in their Annual Quality Assurance Assessment (AQAA) and in notifications that are required under the Act; things other people have told us about the home as a result of surveys; and views that we have received about the home from other sources such as visiting health and social care professionals. The evidence we have gathered is then used to make a judgement about the quality rating for the home. This visit was made by a CQC Regulatory Inspector who was accompanied by an Expert by Experience. An Expert by Experience is someone who has experience of care in the relevant sectors, either by their own experience of receiving care or by being involved in the care of people close to them. They receive training through one of the voluntary Care Homes for Older People Page 6 of 30 agencies such as Help the Aged, so that they can provide an independent opinion about the care given by the service. During this visit we spoke to fifteen of the people who use this service, some in the privacy of their own rooms and some over the lunchtime period. We spoke to four relatives and eight members of staff. Important documentation, such as care plans, staff files and medication records were examined and a tour of the home was made. Direct and indirect observations were made throughout the time we spent in the home. Prior to this visit we reviewed the AQAA and the notifications the service has sent us in the last twelve months; we reviewed the service file to see if there had been any significant concerns raised; and we sent out twenty surveys to the people who use this service and their relatives to seek their views. We received nineteen completed surveys which we reviewed and analysed. The people who use live in this home told us that they are very satisfied with the service they receive. Comment such as, Gavin Astor has a good reputation and lives up to it very well; The home provides a fresh, homely atmosphere in good surroundings and good medical care; and, The home gives us excellent care, were received. The Expert by Experience concluded her report, saying, I found this to be an excellent, well maintained home with caring and efficient staff. The home is very clean, light, well furnished and odour free. All the residents I spoke to were extremely happy there. We asked the people who use this service how they would like us to refer to them throughout this report. They overwhelmingly told us that they like to be referred to as, Residents. Therefore, we have used this term throughout this report to refer to the people who use this service. The residents, their supporters, the staff and the registered manager are all thanked for the friendly welcome they gave and for their help throughout this inspection. Based on all the evidence we have gathered, the quality rating for this service is 3 Stars. This means that the residents experience excellent outcomes in all aspects of their care in the home. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: There were no recommendations or requirements placed as a result of this visit. Care Homes for Older People Page 8 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home gives prospective service users and their supporters good information about the home so that they can make an informed decision about moving into the home. There are robust admissions policies and procedures to ensure that only those people whose needs can be met and who are suited to the home are offered a place in the home. Evidence: There is plenty of information about the home and the provider organisation in the entrance hall of the home. The information includes the last inspection report, the latest newsletter and homes brochure. In addition there is interesting information about the local history and attractions. The home has a comprehensive Statement of Purpose and Service User Guide. This documentation is regularly reviewed and updated as necessary. Residents spoken to Care Homes for Older People Page 11 of 30 Evidence: were clear about their rights and what to expect whilst living in the home. Six care plans, three from each floor were examined. There is clear evidence that good pre-admission information is sought, pre-admission assessment visits made and thorough assessments carried out, before a place is offered in the home. Residents spoke of the visits they had received from the manager before they were offered a place. Pre-admission assessments are carried out by the registered manager or one of the deputy managers. Prospective residents are invited to visit the home although this is not always possible, particularly when a resident is admitted directly from a hospital bed. The pre-admission assessments contain good information about health and personal care needs, cultural and religious needs, dietary requirements and likes and dislikes, as well as other areas such as past histories and family contacts, if appropriate. The residents in the home all have long term nursing and continuing care needs. Many have complex disorders that require skilled nursing and care. No person is offered a place unless the staff have the skill and competencies to meet their assessed needs. The home does not offer intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home positively promotes the health and well being of the residents in a way that respects their privacy and dignity. This enables them to enjoy as healthy a life as possible. Evidence: The home has a strong ethos of involving residents in all aspects of life in the home. All residents have a robust care plan and a named nurse with input from a named night nurse, Keyworker, senior healthcare assistant and the care team. Care plans are important documents because they are one of the ways that residents and their supporters can tell that the way they wish to receive their care has been recorded. In addition they provide an important source of reference for the staff so that they can ensure that care and support is given in a consistent and professional manner. Further, they can provide a basis for best interest decision making in cases where there is failing mental capacity. The care plans are reviewed on a monthly basis. Recently the home has introduced an Care Homes for Older People Page 13 of 30 Evidence: audit tool for ensuring care plans are maintained in a consistent way and contain sufficient information. The expert by experience observed that the staff were caring and efficient and that the residents were treated with respect, dignity and kindness. Relatives told her that they are very happy with the standards of care at the home. She noted only one concern in that those residents with visual impairment do not always have their belongings put back in exactly the same place. The home should ensure that all staff understand the importance of this to someone who is visually impaired so that they can locate items with ease. All the residents are registered with local General Practitioners (GPs). Where possible residents choose their GP but this is dependent on the location of the practice and the capacity of the GP to take on more patients. We found good evidence to show that the home seeks the advice of other health care professionals such as physiotherapists, occupational therapists, speech and language therapists and dietitians. The home has been very proactive in accessing these services on behalf of the residents. The home has improved the way it works to prevent pressure sores developing. There are sound policies and procedures for pressure sore management. At the previous inspection it was found that some photographs of pressure areas had been taken without written consent. There are now robust procedures to ensure that informed consent is sought and that each photograph is correctly dated. The home has a good stock of pressure relieving equipment and pressure area assessments and risk assessments are in place. The responses in the surveys to the questions about health and personal care were very positive. They stated that the staff are always available when needed, always listen to and act on concerns, and always ensure that the medical care needed is given. However, there was one negative comment that suggested staff are sometimes delayed in answering buzzers. The Annual Quality Assurance Assessment gave good information about health and personal care. It confirmed that staff are kept up-to-date with training, professional research and literature in both clinical and social care fields. The home ensures that this learning is used to inform the care plans so that they contain relevant social and clinical guidance. Since the last inspection the two deputy house managers have embarked on Mentorship Modules with Christ Church University. One nurse has completed a Degree Care Homes for Older People Page 14 of 30 Evidence: in Palliative care and there is commitment to implement the Liverpool Care Pathway in the home to improve palliative care for the end stages of life. The Heart of Kent Hospice is situated opposite the home. Over the past year there has been good collaborative working between the home and the hospice. This has benefited staff at both places and enabled the staff at Gavin Astor House to learn more about end of life care. Medicines in the home are well managed. There are sound systems for the ordering and disposal of medicines. Storage of medicines is safe and secure. Each floor of the home has a clinical room where medicines are stored. There is plenty of cupboard space in these rooms and we were told that there are plans to upgrade them over the next year. Where possible, residents are encouraged and supported to self medicate. Risk assessment are in place for this and lockable facilities are provided in each room. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home values equality and diversity. There is a wide ranges of activities on offer. Dedicated staff support activities so everyone can take part in activities that interest them and help maintain their independence. Evidence: Activities in the home have improved significantly since the last inspection. Two social care co-ordinators work in the home and, along with the manager plan activities on a two week rolling programme. The routines of the home are planned around the needs and wishes of the residents. One of the social care co-ordinators told us how the programme works and spoke of the flexibility in the programme. Where possible, activities are seasonal. For example, if out door activities are planned and the weather is poor, indoor activities are carried out instead. Similarly, if indoor activities are planned and the weather is nice, these activities may be moved outside. The home has a room set aside for activities and this room houses a variety of games, arts and craft materials and other things to enable the residents to take part in interesting activities. Activities take place on a one to one basis and in groups. The groups often use the dining rooms as a base for activities. Care Homes for Older People Page 16 of 30 Evidence: The expert by experience talked to several of the residents about the activities they enjoy. She was told of the wide variety of activities available. These include arts and crafts, barbeques, keep fit, bingo, quizzes and knitting as well as a recent Summer Fayre and outings. Residents told her that they enjoy the activities but do not have to join in if they dont feel like doing so. Some residents really enjoy taking part in activities. Others said that they prefer to spent time in their rooms either watching television, reading or listening to music. Some residents take a particular interest in gardening and this year they have been growing vegetables as well as tending the raised flower beds. The gardens are very well maintained and were full of colourful flowers on the day of this visit. It was good to see that the vegetable plot has also done very well and runner beans, leeks and tomatoes were nearly ready for picking. One resident said that they had already been able to eat some of the vegetables that they have grown. One of the bathrooms in the home has been made into a therapy bathroom, with attractive lighting, gentle music and a jacuzzi bath. This is very popular with residents who enjoy taking a relaxing bath. The home produces a quarterly newsletter to which residents, relatives, the Friends of Gavin Astor House, the manager and others all contribute. The newsletter is very informative and has interesting articles. There is information about entertainment, outings, religious service and health care provision as well as some light-hearted quizzes and thought provoking articles. The home celebrates special festivals such as Christmas, St Patricks day, Halloween and Divali as well as birthdays. Many of these events are reported in the Newsletter. The home has safe grounds with plenty of sitting areas both in sun and shade. A woodland walk that snakes around the trees close to the home has been created since the last inspection. The path is wide and wheelchair friendly and is lite by solar powered lights along its length. The walk has proved very popular with the residents since its construction. The home arranges a variety of outings. Some residents enjoy visiting garden centres and going out for tea whilst others prefer going out for meals or to see places of interest. Some residents told us that they had enjoyed a pub lunch followed by a boat trip on the River Medway the week before this visit. Other residents we spoke to were looking forward to making the same trip the week following the visit. Care Homes for Older People Page 17 of 30 Evidence: The home has a number of volunteers who visit the home and is supported by the Friends of Gavin Astor House, a voluntary group who support the residents by fund raising to helping provide entertainments, subsidise outings and support purchasing equipment. The Friends also run the Trolley Shop and there are are plans to set up a support group for relatives and friends in the near future. Relatives and friends told us that they are always made very welcome when they visit. They said they are supported to help the care of their loved one of this is mutually agreed. Food services in the home have improved significantly since the last inspection. More money has been invested and the contract for catering has been changed. We took lunch with the residents. It was a good opportunity to chat with them and find out what life is like in the home. The residents were very positive about the home and their care. They said that the food is really good for the most part of the time. One said, The food here is really nice, of course there will occasionally be something we dont like as much as others but you can please everyone all the time, on the whole its very good indeed. The catering manager told us that there are a number of special diets prepared daily and that the home caters for a variety of special dietary needs. This might include gluten free, diabetic, vegan and vegetarian menus as well as diets to meet religious and cultural needs. The home has two dining rooms, one upstairs and one down, both are light and airy. Residents can choose where they eat. They can take their meals in their rooms if they wish and some residents, who need a lot of help to eat, take their meals in the privacy of a quiet lounge. On the day of this visit there were two main choices of starter, main meal, one meat and one vegetarian, and pudding. The residents we spoke to said that they enjoyed their meals and that there is plenty to eat. The catering supervisor ensures that residents are given the portion size they wish. Some said that if they are given a portion that is too large it puts them off their meals whilst others said they have a good appetite and enjoys larger meals. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home listens to concerns and acts positively to address them so residents can be assured that their concerns and complaints will be taken seriously. Evidence: The registered provider, Royal British Legion Industries Ltd, and the home have robust policies and procedures in place for handling concerns, complaints and protection. The complaints procedure is contained in the Statement of Purpose and the Service User Guide. It is available in a number of different formats including easy read and audio versions. It can be supplied in other languages if needed. The home is very good at recording all complaints, however small. Complaints are made on behalf of the resident if this is deemed appropriate. For example, we found evidence that the registered manager had written to a local health care trust on behalf of a resident, to raise concerns about their treatment whilst in hospital. The complaints records for the last year were examined and the complaints made were tracked and discussed with the registered manager. The few formal complaints that were made were all dealt with in the standard times and to the satisfaction of the complainants. The home demonstrates a commitment to learning from complaints and there is good evidence that changes are made to ensure that concerns are addressed. Care Homes for Older People Page 19 of 30 Evidence: All staff receive safeguarding training as part of their induction. There are regular updates of this training. Those spoken to were clear about their roles and responsibilities in protecting the residents from all forms of abuse. They said that they would have no hesitation in reporting any concerns and felt comfortable in reporting directly to the registered manager if they felt this necessary. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very clean, safe, accessible and well maintained. It has a relaxed and friendly atmosphere that gives the resident a pleasant and homely place in which to live. Evidence: The home was purpose built some fifteen years ago. It is set in the grounds of Preston Hall Hospital and surrounded by well maintained gardens and woodland. The accommodation is arranged on two floors and each floor has a lounge and dining room. As well as the woodland walk, the home has a courtyard garden with raised flower beds. Several of the residents take and interest in gardening and help maintain this area. They are commended for the way they have created a calm and attractive space full of colourful flowers for everyone to enjoy. This year they have also grown vegetables, including leeks, tomatoes and runner beans. All bedroom accommodation is for single use and each bedroom has an en suite toilet and shower facility. Bedrooms have ceiling tracking for hoists and are well furnished. Despite the need for a significant amount of specialist equipment, residents have been able to personalise their own rooms. There are specialised bathrooms on each floor, including spa baths and one bathroom that has been made into a therapy bathroom Care Homes for Older People Page 21 of 30 Evidence: for relaxation. This bathroom has sensory lighting, gentle music and a visual display. Residents said that they particularly enjoy taking their baths here. There are additional accessible toilets through out the home. As mentioned, the people who use this service require a lot of specialist equipment. This includes very specialised wheelchairs and beds, hoists and pressure relieving equipment. All equipment was seen to be stored safely and records show that this equipment is regularly checked and serviced. The deputy manager for each floor showed us around the home. The home was very clean and odour free on the day of our visit and there was a friendly and relaxed atmosphere throughout. The expert by experience commented on the excellent standards of cleanliness and welcoming atmosphere of the home. The home has a well equipped laundry room and there are strict infection control policies and procedures in place. The Homes Annual Quality Assurance Assessment confirmed that there is a written plan for maintaining and improving the environment. Since the last inspection a woodland walk that weaves in and out of the trees near the home has been created. The walk is wheelchair friendly and lit by solar powered lamps along its length. There is a team of housekeeping staff including domestic assistants, laundry assistants and maintenance staff. This team is commended for the way they maintain the home. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels, staff training, staff recruitment procedures and staff morale are all excellent. This means that the residents are supported and cared for by a well qualified, enthusiastic and cheerful staff team. Evidence: The home is well staffed. Management and staffing structures give clear lines of responsibility. The registered manager has overall responsibility for the running of the home. There are two deputy managers who each take responsibility for the nursing care on each of the two floors of the home. Each floor also has a Registered General Nurse (RGN) on each shift. The qualified staff are supported by a team of well trained carers and two activity co-ordinators. In addition there is a strong and dedicated group, The Friends of Gavin Astor House, who provide volunteers who work in the home, providing befriending, gardening and other assistance, such as accompanying residents on outings, help at mealtimes and the trolley shop. The home has a team of housekeeping staff that includes domestic assistants, laundry assistants and maintenance staff. Catering services in the home are contracted out to an independent provider who provides the catering manager and the kitchen staff. We spoke to eight members of staff, some in private and some during a tour of the home. They all spoke very positively about their work and told us that there are Care Homes for Older People Page 23 of 30 Evidence: excellent training opportunities. They said that there is good team working and that they are clear about their job roles and responsibilities. Since the last inspection a new role of senior carer has been created. This role was designed to support the work of the RGN and gives more responsibility for clinical decision making. For example, the senior carer can now make a decision about whether simple dressings need changing and carry out this task; take part in Care Assessments and monitor carers tasks and documentation. The staff spoken to said that this had enhanced the carer role and made their jobs much more interesting. The home has a very low staff turnover with many staff having worked at the home for several years. Several of those staff that have left the home have been care staff who have gone on to train as RGNs following their positive experiences at the home. The residents we spoke to were all very positive in their comments about the staff. One said, The staff here are wonderful, they have a lot on heir hands looking after us all and yet they are always kind and cheery. Another said, The staff are very professional - theyre very well trained and know their jobs but still manage to be friendly and we can have a joke with them as well. Throughout the time we spent in the home we observed the staff to be professional but kind in their approach. They were respectful at all times but also joined in with friendly banter with the residents. Staff training has significantly improved since the last inspection. The home now has more than fifty percent of its care staff who hold the National Vocational Qualification (NVQ) at level two or above. In all, thirty-two care staff hold the NVQ at level two, six have NVQ at level three and four care staff have just embarked on the NVQ process. In addition, two domestic staff have achieved the first level NVQ in cleaning. All the staff who have achieved these qualifications are commended for their hard work. The organisation is very good at supporting staff training. Nearly all training is carried out on site so staff do not have to travel. They are paid for the time they spend training and there are arrangements for on the job support for continuous learning. The two deputy home managers have embarked on a Degree Mentorship Module with Christ Church University College. This qualification will allow them to assess the clinical practice of nurses and student nurses. The Annual Quality Assurance Assessment(AQAA) provided good evidence that staff have undertaken a great deal of specialist training in areas such as Tissue Viability, Care Homes for Older People Page 24 of 30 Evidence: Spirituality, the Mental Capacity Act and the Liverpool Care Pathway for terminal care. The home provides placements for student nurses. In order to be able to do this, the home must be able to demonstrate and maintain the rigorous standards of nursing care demanded by the University. Staff recruitment at the home has been encouraging over the last year. A new deputy manager and night sister have been appointed recently. The AQAA confirmed that the home has rigorous policies and procedures for recruitment to ensure that all those working in the home have been carefully vetted. These procedures include seeking written references, Criminal Records Bureau checks and conducting in-depth interviews. There are regular staff meetings and the home has a Staff Council Committee. This council, along with a working party group and team meetings constantly look at ways of improving the working arrangements, environment and job satisfaction for staff. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is excellent both at local and organisational level and the home is run in the best interests of the residents and their supporters. Evidence: The registered manager is a Registered General Nurse who has maintained her continuing professional development. She has over thirty years experience in Health and Community Care and has provided consistent and effective management for the home for the past seven years. In depth discussion with the registered manager showed her to be very knowledgeable about best nursing and care practices. She demonstrated an excellent awareness of current legislation and the recent changes in the Care Quality Commission. The residents and staff all spoke highly of the managers ability and said that she is very approachable and has an open and friendly personality. The registered Provider is Royal British Legion Industries(RBLI). RBLI is a registered Care Homes for Older People Page 26 of 30 Evidence: charity. It has a sound organisational structure that makes management responsibilities transparent and an excellent track record of service provision. There is a detailed three-year business plan that gives a clear indicator of the success and efficiency of the business arrangements. The financial accountant, the director of operations and the human resource department of RBLI all give regular support to the home. There are excellent quality assurance systems in place. Regular visits are made to the home by representatives of RBLI; there is a monthly clinical audit that includes regular checks of the care plans and staff training records; spot checks; regular residents meetings; good arrangements for receiving staff feedback; a robust system for handing concerns and complaints; and a formal annual survey of residents and their supporters. Residents who wish, and are able, are actively encouraged to manage their own money. The home ensures that there are safe and secure arrangements for this by providing lockable facilities and sound record keeping systems. The home accesses outside agencies, such as Age Concern and Kent County Council, on behalf of residents, to make arrangements for the provision of advocates and/or appointees. The home has a good record of meeting relevant health and safety standards. All staff are given a copy of the health and Safety policy during their induction period and there are regular, random checks to ensure staff are following procedures. Records are of a good standard and risk assessments are in place. There is good written evidence to show that any identified risks are minimised. The AQAA confirmed that staff undertake Health and Safety, fire safety and moving and handling training. There is a strong commitment to the health, welfare and safety of residents, visitors and staff. No health and safety hazards were noted on the day of this visit. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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