Gravesham Place Integrated Care Centre

We found the following examples of good practice.

People were well supported by staff to have telephone and internet contact with their family and friends. People had been given individual tablet computers providing a video phone to make it easier to keep in touch with friends and family and reduce social isolation during the pandemic. The service facilitated in person visits in a manner which minimised the risk of infection spread, including outside visits, and visits using a separate door through to the day centre facility.

Staff ensured people’s welfare had been maintained and they had sufficient stimulation, such as crafts and games. Residents had been given individual tablet computers providing a video phone to make it easier to keep in touch with friends and family and reduce social isolation during the pandemic.

Plans were in place to isolate people with COVID-19 to minimise transmission. The provider had reduced the occupancy of the home during the pandemic to facilitate isolation and social distancing arrangements. The service had good supplies of personal protective equipment (PPE) that were readily available at stations throughout the service.

The provider had measures in place to prevent visitors from catching and spreading infections. On arrival to the service visitors were asked health screening questions; temperature checks were performed; facilities were provided to wash hands and lateral flow tests were carried out to check the COVID status of visitors.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and residents were regularly tested for COVID-19. The building was clean and free from clutter. There were social distancing signs throughout the home to remind people of the distancing requirements.

Staff ensured people’s welfare had been maintained by facilitating socially distanced activities, such as crafts and games.

•People told us they experienced and exceptional service. People and their relatives said of the service, “Very well run, staff are so obliging.” “I couldn’t have wished to be in a better place. I feel like a queen being waited on.” “The level of care and attention I see people receiving from the staff team is first class.” “Excellent care.”

•The registered manager had worked innovatively to engage with people in their recovery pathway. For example, weekly multi-disciplinary meetings were led by Gravesham Place staff to review and adjust people’s care pathway. People who had been very poorly on admission had received exceptional care to enable them to recover. One person said, “The service is excellent.” Another person said, “Staff are very helpful and go over the top with their care and kindness.”

•Incidents and accidents were recorded and checked or investigated by the registered manager to see what steps could be taken to prevent these happening again. People’s safety was protected through a culture of incident analyses and responses. For example, the levels of falls in the service had reduced by half. People told us they felt safe with staff. One person said, “I Feel very safe, staff are great I like them all.” Another person said, “I feel safe here, I just don’t want to go home now.” People received their medicines as prescribed to protect their health and wellbeing. One person said, “I always have my medication at breakfast time.” Another person said, “Staff always check with me if I am in pain and need some extra painkillers.”

•We observed and people told us that staff met their needs with exceptional care and compassion. This happened because the registered manager recognised the value of having staff on site trained to mentor others in delivering consistent compassionate care. For example, dementia and dignity champions. One person said, “I feel they are my friends, I can have a joke with staff.” A relative said, “Staff have a caring attitude, when staff come in for their shift they go round everyone saying hello using their first names, asking them how they are.”

•The values of the organisation matched the high standards of care people experienced in the service to meet their needs. For example, the service was dependency driven rather than numbers led so that staffing levels were consistently matched to people’s needs. One person said, “There are enough staff to help me, they always have time for you.” Staff were deployed with the skills and training needed to meet people's needs and choices. People and their relatives told us that the staff were good at their jobs, that staff had the right skills and knowledge to meet their need. A relative said, “Staff appear skilled, they are proactive and very aware of who they are talking to.”

•Staff at Gravesham place utilised planned and emergency specialised health and social care colleagues such as occupational therapy and community nursing exceptionally well. People and their relatives told us their health care needs were met and that health care staff were proactive at getting medical assistance. One person said, “I have regular district nurse visits to check my wounds are healing correctly.” A relative said, “When (family member) was not too good recently they called the doctor straight away.”

•People felt included in planning their care. A relative said, “We have been kept fully informed about the assessment (care plan) by the staff.” People’s rights and their dignity and privacy were respected. One person said, “Staff always knock before they come in, when having a shower they leave me to do as much as I can, always there to give me my towel to dry myself.” People told us they were listened to by the management of the service. One person said, “I would recommend this place to anyone, everyone treated the same, they treat you as a person.”

•The care offered was inclusive and based on policies about Equality, Diversity and Human Rights. Equality champions offered support and advice to people and staff. Innovative ways were being used to encourage people to speak about their sexuality. For example, the rainbow flag, commonly known as the gay pride flag or LGBT pride flag, had been discreetly added to paperwork headings, information displayed on notice broads and placed around the service.

•People were often asked if they were happy with the care they received. People, their relatives and health care professionals had the opportunity to share their views about the service.

•Care plans had been developed to assist staff to meet people’s needs. One person said, “There’s a folder with my care plan in it, staff always record what I have eaten and been drinking along with what I have done for the day.” The care plans were consistently reviewed and updated. Care plans told people’s life story, recorded who the important relatives and friends were in people’s lives and explained what lifestyle choices people had made. Care planning informed staff what people could do independently, what skills people wanted to develop and what staff needed to help people to do.

•Health and safety policies and management plans were implemented by staff to protect people from harm. The provider trained staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have.

•Complaints made by people or their relatives were taken seriously and thoroughly investigated.

•Safe recruitment practices had been followed before staff started working at the service.

•New staff and existing staff were given an induction and on-going training which included information specific to the people’s needs in the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

•There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

•Staff supported people to maintain a balanced diet and monitor their nutritional health. People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health.

•Management systems were in use to minimise the risks from the spread of infection. One person said, “The home is well managed and kept spotlessly clean.”

•The service could continue to run in the event of emergencies arising so that people’s care would continue.

The registered manager and staff were working with a clear vision for the service.

Rating at last inspection: At our last inspection on 13 July 2016, (The last inspection report was published on 24 August 2016), we gave the service a Good rating. At this inspection we found the evidence of continued development which had moved the service to an Outstanding rating.

Why we inspected: This was a comprehensive inspection scheduled based on the previous rating.

Follow up: We will continue to monitor the service through the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 approach. They placed emphasis on continuous improvement of the service.

There was a thorough system of monitoring checks and audits to identify any improvements that needed to be made. The management team acted on the results of these checks to improve the quality of the service and care.

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.

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.