The inspection took place on 13 and 14 July 2016 and was unannounced. Gravesham Place Integrated Care Centre is run by Kent County Council, and is split in four distinct units in one building owned by the NHS. They provide short term respite and an assessment and enablement service for a period of three weeks to six weeks, before discharging people to the community with a domiciliary care package to suit their needs. ‘Diamond’ Unit accommodates people living with mild effects of dementia; ‘Topaz’ Unit, and ‘Opal’ Unit accommodate older people; ‘Emerald’ Unit accommodates people with low nursing needs. Each unit accommodates up to 20 people. There were 60 people living in Gravesham Place Integrated Care Centre on the days of our inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place which included the checking of references.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect. People were able to spend private time in quiet areas when they chose to.

Staff were well supported in their role; they received all essential training and regular one to one supervision sessions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them.

People’s mental capacity was assessed when necessary about particular decisions. When necessary, meetings were held to make decisions in people’s best interest, as per the requirements of the Mental Capacity Act 2005.

The meals that were provided were in sufficient quantity and met people’s dietary needs and choices. People were complimentary about the food they received.

People’s individual assessments and care plans were reviewed at several stages during their stay in the service or when their needs changed. Clear information about the service, the facilities, and how to complain was provided to people and visitors.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff focused on enabling people and promoted their independence before they returned to their homes.

People were involved in the planning of activities that responded to their individual needs. People and relatives’ feedback was actively sought at meetings and through satisfaction surveys. Action was taken as a result to improve their experience of the service.

Staff told us they felt valued by the new registered manager and they had confidence in her leadership. The registered manager was open and transparent in their

Assessments were undertaken on admission to the home and the care plans had been developed and drawn up with the individual, where possible, and their families had been consulted on every aspect of the care plan. We saw staff interacting with people in a positive and encouraging way.

We talked with eleven people who used the service or their relatives and they told us that the service was good. One said “The home is relaxed and there are good staff” another said “It’s like a hotel we get good food and the staff are excellent”. We talked with seven members of staff including team leaders and nursing staff. Staff told us that people get good care and they have no concerns about raising any issues they may have at meetings.

The staff we spoke with were able to explain to us what should be done if they suspected abuse was happening.

Staff we talked with were able to describe how they protected the vulnerable people they look after using procedures called safeguarding procedures. They were also able to describe the diverse needs of people and how they met people’s needs. .

We found that the premises and grounds were well maintained and clean. We saw that cleaning schedules were being adhered to and that the standard of cleanliness in the home was good.

We looked at staff files and saw that they included completed application forms, which had staff members' educational and work histories. We saw interview notes in the staff files. Staff told us that they had been interviewed as part of the recruitment process. This ensured that staff had the qualifications, skills and experience to undertake their work.

Records were kept securely and could be located promptly when needed. We saw that all information that related to the running of the service was readily available for all staff.

The provider had a quality assurance system in place to monitor the quality of the service provided that covered all the main aspects of the service.

The service had four units which are Topaz, which provided an enablement service to support people back into the community. Emerald unit provides nursing care. Opal 1 provides residential care for the elderly and Opal 2 provides residential care for people living with Dementia. We examined the care plans of 12 people; we spoke with 10 people and five relatives of people at the service 10 members of staff across all four units.

People in each unit told us that they received good care. On Topaz one person told us, “The staff here are so kind and they make me laugh.” On Emerald one person told us, “The staff work so hard, they are absolute gems.” On Opal 1, one person told us, “I cannot fault the service here, ten out of ten.” On Opal 2 one person who could talk to us, “The staff are so kind, wonderful.”

We found that the service was meeting people's care needs and so supporting their health and wellbeing. The service had interpreted the implications of the mental capacity act and applied them locally. People had benefited from regular access to other healthcare professionals including district nurses.

People were cared for by a sufficient number of staff and by staff who are supported to deliver care and treatment safely and to an appropriate standard in all four units.

People were not always protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained on each of the four units.

We visited each of the four units and talked with people having either short-term or long-term care. We had conversations with eleven people, and talked briefly with many others, including people in the dementia care unit.

Everyone we talked with spoke positively about the staff and the standards of care. Comments included:

“The staff are all very good, very caring, and very helpful.”

“The staff are lovely. I can’t fault them. They do a really good job.”

“The staff come to help me when I ring my bell.”

“The staff are always kind and friendly.”

People from different units voiced the same concern that they “didn’t have enough to do." Two people said they “couldn’t wait to get home” because they were used to doing everything for themselves, and they were bored by having nothing to do. Two people said that they enjoyed the entertainment that was arranged but said it “didn’t happen very often." Another person said that there was sometimes bingo, but she didn’t like that. She also said that “all people do all day is watch television.”