This inspection was carried out on 28 March and 5 April 2018. The inspection was unannounced.

Gavin Astor House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Gavin Astor House is a purpose built care home registered to provide accommodation and nursing care to up to 50 adults. The service provides nursing care to adults over age 18 with physical disabilities as well as to older people. Gavin Astor House is owned by the Royal British Legion Industries. The home is situated in grounds within the Royal British Legion village, there is ample parking. All rooms are single with en-suite facilities. There were 42 people living there at the time of our inspection; 40 people on a permanent basis and two people staying for a period of respite.

At the last inspection on 7 and 8 December 2016, the service was rated Requires Improvement. At this inspection the service was rated Good.

At our last inspection in December 2016, we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to the people’s care plans not being updated to ensure they contained the relevant information to inform staff how to meet people’s assessed needs, in particular information pertaining to nutrition and hydration. This inspection took place to check that the registered provider had made improvements to meet the regulation. We found that improvements had been made and the breach had been met.

The service had a registered manager in post who had worked for the organisation for a number of years. The registered manager was moving to a new role within the organisation and a new manager had been recruited. At the time of our inspection the new manager was working alongside the registered manager whilst they were in the process of completing the provider’s induction. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were mixed views regarding the deployment of staff. Some people told us their calls bells took a long time to be answered by staff whereas relatives told us they felt there were enough staff. People’s needs had been assessed and recorded; the registered manager used an assessment tool to monitor the number of staff required to meet people’s assessed needs. Observations and records showed there were enough staff to meet people's needs.

People felt safe and were protected from the potential risk of harm and abuse. Staff understood their responsibilities for safeguarding people and followed the provider’s policy and procedure. Potential risks to people had been assessed and steps were taken to reduce any risks. The premises were well maintained and equipment had been regularly serviced to ensure it was in good working order.

The provider operated safe and robust recruitment and selection procedures to make sure staff were suitable and safe to work with people.

People received their medicines safely as prescribed by their GP. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed regularly. People were protected by the prevention and control of infection where possible, with systems in place to ensure the risks of contamination were minimised. Accidents and incidents were monitored and managed effectively.

People received a personalised service which was responsive to their needs. People and/or their relatives were involved in the development and review of their care plan. Guidance was in place to inform staff of how to meet people’s needs whilst

This inspection was carried out on 07 and 08 December 2016. The inspection was unannounced.

Gavin Astor House is a purpose built care home registered to provide accommodation and nursing care to up to 50 adults. The service provides nursing care to adults over age 18 with physical disabilities as well as to older people. Gavin Astor House is owned by the Royal British Legion Industries. The home is situated in grounds within the Royal British Legion village. All bedrooms are single with en-suite facilities. There was a passenger lift to assist people to move between floors. At the time of our inspection 42 people lived at the service.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection on 28 July 2015, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people had not received their medicines as required or as prescribed. The provider had systems in place to make sure there were enough staff employed and rostered. However, the way staff were deployed needed to be reviewed to ensure there were sufficient staff available at key time during the day. We made a recommendation about this. Safe recruitment procedures were being followed to make sure staff were suitable to work with people. Staff members past employment history was not being explored when there were gaps in their employment. We made a recommendation about this. Quality assurance systems were in place to assess the level of quality provision with the service but they had not identified the issues we found at the inspection. We made a recommendation about this. We asked the provider to take action to meet the regulations.

We received an action plan on 27 November 2015 which stated that the provider had met the regulation on 20 November 2015.

People and their relatives told us that they received safe, effective, caring and responsive care and the service was well led.

Some people received their nutrition and hydration through percutaneous endoscopic gastrostomy (PEG). Records did not always evidence that they had received the right amount of food and fluid to maintain good health.

Medicines had been generally well managed, stored securely and records showed that tablets had been administered as they had been prescribed. Medicines records in relation to pain patches were not clear or consistent with the manufacturer’s information. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made and how to submit one when required. However, robust systems were not in place to track, monitor and report DoLS authorisations. We made a recommendation about this.

People did not all have care plans that detailed how staff should meet their care needs in all of the areas they had been assessed as requiring help and assistance. The registered manager had introduced a new care planning system in June 2016 which was still being embedded.

Records were not always complete or accurate. We made a recommendation about this.

Staff had received training about protecting people from abuse and showed a good understanding of what their roles and responsibilities were in preventing abuse.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity.

The service was suitably decorated, adequately heated and was clean. There was a relaxed atmosphere.

There were enough staff o

This inspection was carried out on 28 July 2015. The inspection was unannounced.

Gavin Astor House provides accommodation, nursing and personal care for up to 50 people. People had a variety of complex needs including people with mental and physical health needs. Accommodation was provided over 2 floors. There was a passenger lift to assist people to move between floors.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our inspection, people made complimentary comments about the service they received. People told us they felt safe and well looked after and they were part of the community within the home. Relatives told us they were very satisfied with the service.

Systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service, and identify and manage risks to people’s safety. However there were shortfalls identified in the administration and recording of medicines which could have had an impact on people’s welfare. Some people may not have received their medicines as prescribed. Suitable arrangements were in the homes policy and procedure for managing medicines. However the administration and recording of medicines did not follow this guidance or the guidance issued by the National Institute for Health and Clinical Excellence.

People felt there were usually enough staff, however staff had mixed views of whether there were sufficient staff, some saying more were needed. We found that at lunch time staff were stretched trying to assist people who needed assistance to eat and drink. Improvement was required with the organisation of mealtimes to ensure that people who required support to eat did not receive their food cold. We have made a recommendation about this.

People were complimentary about the food although they did say it depended who was cooking. People told us they were provided with enough to eat and drink. Choices of menu were offered each day.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. People with certain conditions such as dementia had been assessed as lacking capacity to make decisions for themselves. Staff were supporting people to make choices and made sure their best interests were taken into account. Staff received training in the Mental Capacity Act 2015 and DoLS to enable them to make a referral if it was needed.

Care plans for people focussed on their care, health and physical needs. They related to people’s emotional, spiritual, mental, social or recreational needs. There was information about people’s likes, dislikes and lifestyle choices. People’s care was planned with them in a personalised way.

Staff felt well supported by the provider and the management team. New staff received induction training. Staff had an annual appraisal to assess their performance and regular supervision sessions.

There was a system for managing complaints about the service. People were listened to and knew who to talk to if they were unhappy about any aspect of the service. People knew about the procedure for making a complaint.

Staff were kind and caring in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed and there were lots of smiles and laughter. Safe recruitment procedures were followed to make sure staff were suitable. People were safeguarded from abuse.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and were complimentary about the care their relatives received. People were consulted through resident’s meetings and their views taken into account in the way that the service was run.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the administration and recording of medicines. You can see what action we told the provider to take at the back of the full version of this report.

At the inspection conducted 29 April 2013 we had concerns that people’s privacy and dignity were not always respected. The manager wrote to us following our inspection to tell us how people’s privacy and dignity would be better respected in future and how this would be monitored. We visited the service and found that the manager had completed the action plan and that processes for protecting privacy and dignity were in place.

People said they were happy living at the service and that they were supported and encouraged to be involved in their care. People said they were supported with accessing the community and staying as independent as possible. We found that the privacy and dignity of some people were not always respected because confidential information about some people could be seen by people visiting the home. We found that the dignity of one person was not respected as judgemental language and staffs individual opinions had been written in the care plan.

People experienced person centred care which met their individual needs. People said that they received the help they needed when they needed it. One person said “They are very good, you never have to wait long for help”. One person told us “I like to get up late and stay up late, and they let me do what I want”.

Medication was managed appropriately and people received the medication they needed at the times they needed them.

The premises were safe and well maintained.

People using the service benefited from equipment that was comfortable and met their needs.

Peoples complaints and comments were listened to, and action was taken to resolve any complaints made.

We spoke with four people living at the home and the two deputy managers, catering and care staff.

People living at the home spoke very positively about life at the home. They said the staff were excellent and that they enjoyed the friendships they had made with other residents and the staff. One person said “The staff are excellent, very good”

People said that the food was very good, and that the appointment of the new chef 6 weeks previously had dramatically improved the quality of the cooking. One person commented “The new chef is much more hands on, he comes around to chat to us about our likes and dislikes, and takes on board what you’ve said”.

People said their privacy and dignity were respected, and that they felt involved in the running of the home. They told us that they were asked about how they wanted to spend their days and what they wanted to get involved in. One person said “they understand my needs and care for me very well”.

People said they enjoyed the variety of activities going on at the home and that their clothes and belongings were taken care of well. One person told us that they were looking forward to a trip to Herne Bay which was planned for the next week. Another told us that they had recently attended a garden party at Buckingham Palace, having been nominated by the staff through the Not Forgotten Society.

People said they liked their rooms and that the home was always clean and tidy.

One person commented about the well maintained gardens, “It was the garden that decided me to move in”

Staff told us that the home was a good place to work, with plenty of support and training and good communication.