Inspection on 04/03/09 for Agape Annexe

This inspection was carried out on 4th March 2009.

CSCI found this care home to be providing an Good service.

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

Agape Annexe 12/03/07

Agape Annexe 30/01/06

Agape Annexe 02/09/05

Agape Annexe 06/01/05

Agape Annexe 23/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Agape Annexe 191 Havelock Street Kettering Northants NN1 8QR two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rajshree Mistry Date: 0 4 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. They reflect the things that people have said are important to them: 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 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Agape Annexe 191 Havelock Street Kettering Northants NN1 8QR 01536510808 01536390608 enquiries@agapehomes.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Julia Rosemary Hamilton, Mr Michael Hamilton Name of registered manager (if applicable) Mrs J Hamilton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The Home will limit its services to the following service user categories: No person falling within the category LD can be admitted where there are already 3 persons of category LD in the home. No person under the age of 18 years or of/over the age of 65 years may be admitted to the home. The total number of service users in the Home must not exceed 3. Date of last inspection A bit about the care home Agape Annexe is a care home providing personal care and support to three people with learning disabilities. The service is aimed at adults with low levels of dependency who may be working towards a move into greater independent living in the future. Agape Annexe is one of two care homes within walking distance of each other, owned by Mr and Mrs Hamilton. The home is situated on the outskirts of Kettering close to shops, other local facilities and the bus route to the town centre. The property is a terraced house offering 3 single bedrooms for people and one staff bedroom, one bathroom and shower facilities, a kitchen and living / dining room. The Registered Provider gave us the details of the average fees charged, which is £500.00 per week. There are additional charges for personal expenditure such as toiletries. People considering using Agape Annexe are encouraged to contact the home directly. The full details of the home and any specific requirements can be obtained from the home in the form of the Statement of Purpose and the Service User Guide. The latest Inspection Report from the Commission for Social Care Inspection is available at the home. 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We as written in this inspection report means, The Commission for Social Care Inspection. As part of this inspection, we looked at the Annual Quality Assurance Assessment (AQAA) completed by the Registered Manager and sent to us. This information is sent each year and tells us what they think of the service they provide. We also looked at the other information sent to us. We sent out Have You Say About Agape Annexe to the people who use the service, their relatives, care staff and health care professionals. We received two surveys back from the people using Agape Annexe. We did this key (main) inspection by visiting Agape Annexe on 4th March 2009. The visit started at 3.30pm. The visit lasted 4 hours and we found out about the service given to people using Agape Annexe. We talked with the three people who live at the home and we looked at how people live. We asked staff about how they help people to make sure their needs are met. We also looked at the care plans, medication records and other records that told us how people are supported. This is called case tracking. We also saw records showing people have their health care needs met. This includes seeing the General Practitioner when needed. We looked at some of the policies and procedures in the home. Policies are rules about how to do things. Procedures tell people how to follow the rules. We spoke with staff and looked at their records. This tells us what skills and training the staff have to support the people who live at the home. What we have written is based on what we saw and what we were told on the day of the visit to the home. What the care home does well People who live at Agape Annexe are asked how they like to live their life. People can tell the staff about the things that they use to do and want to keep doing. This could be going to work or the day centre. People are asked what help they need from the staff, when then come to live at the home. Every year people are asked what they think about the support that they get from the staff and what they thing about the home. This helps to improve the quality of service people experience. It also helps to make the service better for everyone living at the home. People make choices about their lives. They can go to the day centres, work and the sport centre. People can also meet with their family and friends and make new friends. They can socialise in the community where they live by going to the football club or the local pub. People have a good choice of meals. Some people like to help make drinks and meals with the staff. Sometimes people go out for meals or have a take-away, like fish and chips or a Chinese meal. People said they know who to speak with if they are unhappy or have something that upsets them. The staff are friendly and support people living at the home. People said they like the staff. People living at the home are involved in choosing the right staff to work at the home. The staff are trained to help people and care for them. Staff records show the training that they have done. What has got better from the last inspection There have been improvements made in the home. All the bedrooms, bathroom, kitchen, lounge/diner have been decorated. New locks have been fitted to the bedroom doors. Two new staff have been recruited to work at the home. The staff keep their training up to date. This will help to improve the lives of people who use the service. What the care home could do better The information telling people about the home and the complaints procedure should be made easier to read and understand. Pictures, symbols and easy read words used in care plans would help people understand what is written. This would help people to have a say about what they want to do and how staff should help. The forms showing the risks that affect people should be checked to make sure there are no new risks. This would help to make sure people are safe. The questions asked in the surveys given to people using the service could be made easier to answer. The use of pictures, symbols and easy read words may help. The answers from the surveys about the home should be checked with the information people get about the home. This would show if people get the service that they are told they will. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Rajshree Mistry CSCI CPC1 Capital Business Park Fulbourn Cambridge CB21 5XE Tel: 01223771350 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People considering using Agape Annexe are involved in the assessment process and have opportunities to visit the home to ensure this is the right place and their needs are met. Evidence: We read the information people receive about Agape Annexe, which includes the Statement of Purpose and the Service User Guide. The purpose of Agape Annexe is clearly set out known as the aims and objectives, so people can choose if this is the right place for them. The information tells people about what services are available to them, the type of facilities, social and leisure opportunities and the skills of the staff employed by the service. It sets out the process of how people are involved in choosing to move to the home. It also tells people how they can make a complaint if they are not happy. We discussed with the Registered Manager if the information about the service is available in formats that are suitable for both the people using the service and people that may consider using the service in the future. They told us that there are plans to develop this information in alternative formats using pictures, symbols and written in an easy read style. This is useful as not everyone living at the home was able to read although did recognise pictures and symbols. The information we gathered from the self-assessment completed by the Registered Manager, was comprehensive. It told us that people are encouraged to visit the home. It also told us people considering using the service and other health and social care staff are involved in the process to assess if the home is the right place for them. This shows the procedures are followed. Evidence: We spoke with all the people living at Agape Annexe. The newest person told us they had several opportunities to visit the home and asked questions to see if the lifestyle offered would suit their needs. They told us they were able to meet the staff and the people already using the service to help them decide if they want to live there. This supported the responses in the surveys completed by the people using the service. The comments received from the people we spoke with included; I came from the hospital but I had a chance to visit and meet everyone here They involved me in looking at this place and I chose to come here This is my home now Yes, it was my decision to come here … Im an adult The care files we read had copies of the assessment of needs completed by the Social Worker. We saw evidence of the assessments carried out by the Registered Manager, which detailed the individual care and support needs as well as their preferences and lifestyle. There was information about the individual social interests; health needs, going to the day centres and the family support. Information is gathered in relation to communication needs and level of support needed to help people with their individual fears, anxiety and security. Staff told us that they are introduced to people that are considering using Agape Annexe at the initial visits. They told us that once the person agrees to move in, they are given information about the person from the care and support needs to their lifestyle and challenges that affect their health and well-being. We saw the information that staff are provided with. The member of staff told us and showed us the staff communication book, which is used to record information that needs to be shared about the health and well-being of the people using the service. This supports the handover meetings between the staff. We concluded that the information gathered from the assessment is made available to the staff so that they can provide the right support to people, which promote their well-being. The care files all contained signed contracts with the terms and conditions of the stay. The house rules were signed, which looks at the expectations of living in a shared household, showing respect and being responsible at home. We saw the agreement from the local authority that financially supports the people living at Agape Annexe. This demonstrates a formal agreement is in place to protect the people using the service. The observations made during the site visit to the home, showed people lived in a relaxed home environment. People were comfortable doing things around the home and when necessary staff provides support and guidance. It was evident that the people living at Agape Annexe were very much at home. Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 . People living at Agape Annexe make personal choices and decisions about their lifestyle and are supported by the staff. Evidence: We wanted to find out how peoples needs and choices are made known and supported by the staff. We read the care files for the people we case tracked. All had care plans in place, which tells the staff what help and support the person needs. The care plans outlined the goals the person had in relation to daily living and support to meet their needs. There was evidence that people were involved in setting their care plan and it gave clear guidance to staff providing the support. We saw short-term care plans where changes had been identified, so that staff could continue to support people. This should peoples support needs were being reviewed regularly that ensures their wellbeing. Some people said they are involved in developing their care plans. We saw an old pictorial weekly planner belonging to one person, in their bedroom. Although this was dated 2006, they said the day centre gave it to them. They told us what they did each day by looking at the pictures. This highlighted the need to consider developing care plans in formats that suit peoples needs. Staff said they operate a key working system, whereby people using the service have a named member of staff that they can go to. The key worker helps to develop the care plan. They told us that the contents in the care plan are explained to people and includes the support from the health care professionals. We saw one person had exercises that the Occupational Therapist had given. Staff said they do the exercises to Evidence: improve the persons physical health. We saw evidence of people attending health care appointments and having access to specialist equipment such as an alarm clock provided by the Sensory Impairment Team and an electric scooter. We saw assessments of risks had been completed with people to ensure their health; safety and choices were respected. We highlighted to the member of staff on duty that the risk assessments were last reviewed in 2006 and should be re-done to ensure peoples safety. Although we saw evidence of care plans being reviewed every six months or more frequently, risk assessments appeared not to be included as part of the review process. The Registered Manager gave us assurance that this would be done quickly for everyone, as all were overdue. We saw there are annual reviews carried out by the Registered Manager to assess and ensure people continue to be supported and have their needs met appropriately. The annual reviews include the individual person, their relatives and health care professionals that may be involved in their care arrangements. Questionnaires are given out and the responses are included in the reviews. This demonstrates reviews are holistic and personalised in the best interest of the individual. People using the service told us about the things that they do at home and the places they go to. These include Teamwork or to MIND, the day centre, the local pub, club and visiting their family. We observed people were very relaxed at home. One person answered to door when we arrived and asked us for some identification before letting us go into the house. People were very relaxed talking with us, making drinks and settling down for the evening. From what people were telling us and our observations, it was evident that people were making their own decisions. This supported the responses received in the surveys from people and the information gathered from the self-assessment tool completed by the Registered Manager. The comments received included: We do lots of things, we have house meetings to decide where we want to go on holiday. We also go for picnics on the park behind the house I like it here, I dont want to live anywhere else The people living at the home have their own money that is held in safekeeping. People told us that they preferred the arrangement. One person said, I get 2.50 per day to spend, which I prefer. We looked at the system for managing peoples money, which is recorded, reconciled and kept up to date. This demonstrated peoples money is protected by good systems. The staff demonstrated a good awareness of peoples needs and lifestyle. They gave us various examples of how they support people to make decisions, manage the different levels of risk that people may experience and offer advice to ensure people are safe when they are out in the community. One person said, staff will never tell us but advise us so we understand what is better and safer for us. This showed staff respected and valued the people using the service. Evidence: We saw the weekly planner used by the staff that shows the range of activities people participate in on a weekly basis and which is flexible. These ranged from doing the laundry to going to work at Teamwork or the MIND day centre, swimming, local pub for a meal or to the football club. Staff told us the weekly planner helps them to make sure people are supported to continue with their daily activities including the morning routines and the use of the bathroom. This supported what people told us about their daily routines in the home, which promotes their independence and well-being. The information we gathered from the self-assessment tool completed by the Registered Manager demonstrated how the home and the staff promotes individual needs and choices. The evidence seen on the day, showed there is good care planning and support so that people are able to continue doing the things that they enjoy, safely. It also told us people benefit from the support provided by the family, health care professionals and the day centre staff. The records we read during the site visit supported the details we gathered in the selfassessment tool, which demonstrates the practises in the home benefit the people using Agape Annexe. The self-assessment tool also identified areas for improvements that included to continue to review care plans promptly, every six months, send out questionnaires in preparation for reviews and improve the regularity of key worker sessions. This shows the service recognises how it needs to continue to improve to ensure the people experience a better quality of life whilst living at Agape Annexe. Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 . People living at Agape Annexe are supported to enjoy and experience a lifestyle of their choice and opportunities that promote their well-being Evidence: We wanted to find out how people are supported to continue with their choice of lifestyle and have new experiences that promote their well-being. The information we gathered from the self-assessment tool completed by the Registered Manager stated people are supported to continue or re-establish old activities such as day placements and social activities; maintain relationships with family and friends; introduced to new social educational and health activities such as swimming, going to the gym and holidays. On our arrival to the home, we met one person who was at home alone for a short while and waiting for other people to return from various daytime activities. All three people living at Agape Annexe attend various day placements such as MIND or Teamwork. People described to us their lifestyle at home; what they enjoy doing alone or with the staff and the other people using the service. Two people told us they keep in contact with their family by visiting them or by telephone. The comments received from people using the service included: We can go for picnics, theres the Rothwell pub that we go and we meet the residents from the other home Evidence: Go home to see my parents Sometimes,.. and I will go to my room and play with the dolls or watch a video I see my sister and we sometimes go shopping We went to Blackpool last year, I would like to go to Blackpool again Play my Wii Game, I like playing golf on Wii I speak with my father, I think hes supposed to call me this evening I did some volunteer work. I go to Teamwork and MIND I want to become a social worker I love it here, theres no pressure and it is home for me This was good evidence indicating people felt this was their home and made their own choices. This also supported the information gathered from the self-assessment tool completed by the Registered Manager. People had already told us about their contact with family and friends. People told us that they have house meetings, where everyone has an opportunity to speak, especially about any problems, menus and holidays. This was reflected in the care plans we read, which detailed the things and people that were important to the people using the service. People showed us their individual bedrooms, which were reflective of their interests and things that were important to them. This showed people had a homely life that suited them. One person showed us the picture weekly planner. They described what each picture meant to them and what days they do specific activities. This showed it was a useful tool for that person and helped them to know what they were doing that day. Whilst the weekly planner was informative, it was dated 2006 and produced by the day centre. Consideration should be made to developing a similar weekly planner for the person that is more up to date, as it showed the benefits to them. Staff said they do speak with people about relationships and sexuality, when questions are asked. Staff said people were comfortable about talking about their feelings on an individual basis and were aware that some people had developed closer friendships with people that use the day centres. Staff said they recognised the need to make sure people had an understanding of friendship and relationship, making sure they were aware of peoples safety, conduct and consent. Staff showed awareness of peoples vulnerability and demonstrated how they, through discussion, help people to be more aware of their own safety. Agape Annexe is a small home for up to three people. The house blends in with the other residential properties in the area. People said they feel part of the local Evidence: community and some feel confident to go to the local shops on their own. People said they are responsible for keeping their bedroom tidy. Some people help around the house, some do their own laundry and help each other, like making the beds. People told us they have house meetings, with the staff and the Registered Manager, where they can bring issues up for discussion and be involved in any changes or future plans. This showed people are involved in the running of the household and part of a family. We saw one person helping the staff prepare the evening meal. The person helping in the kitchen and the member of staff, both wore hats and aprons. People were able to make snacks and drinks for themselves, and all were involved in choosing the menu for the month, which was displayed in the kitchen. People sat at the dining table to enjoy their evening meal, which was homemade and followed with a fresh fruit and ice-cream desert. The care records read, showed the preferred choices of meals. The menu showed the meals were varied and healthy. The comments we received about the meals included: We would like to have a Chinese takeaway meal so we will tell ... or... Theres no problem about the food that we have It was evident from observing people, that Agape Annexe was very much their home, they appeared happy and comfortable with their lifestyle. This supported the information gathered from the self-assessment tool and the surveys received, indicating benefits to peoples health and well-being. Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Agape Annexe have their personal and health care needs met by trained staff that promote health, independence and well-being. Evidence: We wanted to find out how people are supported to manage their personal and health care needs. The people we spoke with said they managed their own personal care and were supported to attend appointments to see the General Practitioner (GP) or attend other health appointments. One person showed us the electric shaver, which the staff use. This was consistent with the records we read in the care files indicating the staff promote peoples health and personal hygiene. People living at the home do not require support with their mobility. One person told us they had an operation and were provided with walking aids for recovery. They said although they do not use the walking aids but it is there should they require it in the future. They told us they use a scooter, which further demonstrates how peoples independence is promoted. People told us their dignity and privacy is respected by each other and the staff. The care plans read were reflective of peoples daily routines. Staff demonstrated how individual routines differed, dependent on the day and the activities they were doing. This showed peoples independence and lifestyle needs were flexible and met by the staff that know and understand the people using the service. The information gathered from the self-assessment tool completed by the Registered Manager, stated assistance is provided to support people to meet hygiene and routines, including support from other health care staff such as the Psychiatrist, Psychologist, Sensory Impairment Team and the GP. From the evidence gathered Evidence: during the site visit, from discussion with the people using the service and viewing the records, it showed the service provides what it says it will provide. This demonstrates peoples health and well-being is promoted, although the health care professionals returned no surveys. The staff we spoke with showed good awareness of peoples health needs. The member of staff on duty said a designated member of staff is responsible for overseeing health care checks, appointments and ordering the medication. People using the service were seen talking to that member of staff about their health appointments. This showed the benefits of having some continuity in staff supporting people with their health care needs and appointments promotes their health and wellbeing. The care files have records of the health care visits, which supported our findings on the day. We saw information downloaded from a health web site about a specific health issue. Staff said although the health issue was explained by the GP; we got the information to help the staff understand. We saw a person had a special clock, provided by the Sensory Impairment Team to help promote their health and independence. This showed staff are informed about illnesses and how it can affects people, helping staff to be pro-active. It also showed that people are provided with specialist equipment that promotes their independence and well-being. The comments received from people confirmed they are supported to make choices about their health and well-being and included: I go to the optician at... they always check my eyes and clean my glasses One day Id decided I walk not going to use anything and would walk, never looked back, but I leave it here just in case. The member of staff on duty described the system of managing and administering medication. The staff training records showed staff were trained to give medication. The member of staff on duty told us that a training course has been identified to learn about the different types of medication and how it benefits people. This showed the service continues to develop the staff knowledge. We looked at the care files, which have a medical profile detailing the medication they take and the purpose of the medication. One person takes medication and described how the medication helps them. They told us they now also listen to relaxation music, which helps them when they feel they are becoming upset or agitated. The medication is prepared into blistered packs by the Pharmacy. The management of medication and the practice to give out medication and recording was good. The person who takes medication said the staff always gives them their medication on time. This shows peoples health and medication needs are met. Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. 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 . People living at Agape Annexe have their rights protected, confident concerns are addressed and are protected from harm and abuse by trained staff. Evidence: We wanted to find out if people using the service know their rights and how to make a complaint. We saw the complaints procedure, which is displayed in the home and is included in the information people receive about the home before their move in. The complaints procedure sets out the process of how the concerns or complaints will be investigated. We discussed with the member of staff and the Registered Manager that some consideration should be made to providing the complaints procedure in an alternative format to suit the needs of the people using the service. The surveys we received from the people using the service indicated they know who to speak with and how to make a complaint. The people we spoke with told us they felt comfortable to speak with the staff or the manager about any concerns that they might have. They told us, house meetings take place, where everyone has an opportunity to bring general shared living issues for discussion and to resolve. The minutes of the January 2009 house meeting were read and showed the topics discussed, which included, washing put away, new crockery, meeting with the care manager, menus, activities, staff and bus passes. From our observations and comments received, it indicated people were comfortable to talk to the staff about any minor issue that they may have. The comments received from the people using the service included: Id talk to ..., Michael or Julia We have the house meetings and we can talk about the problem to sort it out Staff told us they recognise if someone is unhappy, having supported people for a number of years. Staff said I will personally, follow-up a concern if they tell me there not happy with something. This demonstrated the passion of the member of staff, to Evidence: ensure peoples concerns are addressed to their satisfaction, which promotes peoples well-being. The information we gathered from the self-assessment tool completed by the Registered Manager before the site visit stated people and their family are encouraged to participate in the annual review meetings. This is done through completing questionnaires and being involved in the review meetings. This showed people and their family can also raise issues of concerns at these meetings. The information gathered from self-assessment tool completed by the Registered Manager stated the home received no complaints. The Commission for Social Care Inspection received no complaints or expressions of concerns about Agape Annexe. People told us they felt very safe at home and knew that staff were available to help and protect them. People told us they often have discussions with staff about their safety and said, they will advise about our safety. This indicated that staff helped people to consider their own safety when they are out in the community or in public places. Staff we spoke with demonstrated a good understanding of safeguarding issues. This means promoting the well-being of people using the service from harm, risk and abuse. The member of staff recognised peoples vulnerability and described how they help them to understand how they can make sure they are safe. The examples given by the member of staff related to making sure people do not place themselves at risk by talking to strangers. Staff were confident that people always told staff what happened to them, especially if the experience made them uncomfortable or unsafe. We observed staff responding to peoples questions, given them time to express themselves. This showed that staff had a good relationship and trust with the people using the service for their benefit and safety. The staff said they were confident to report concerns or poor conduct of practice using the homes whistle-blowing procedure. The staff training records viewed showed staff had received training in safeguarding procedures. Copies of the homes policies and procedures are available at the home for staff and the people using the service. People using the service were aware of the policies and procedures and took out the folder for us to read during the site visit. This showed there is an open culture to ensure staff have the skills and access to procedures and information to promote peoples health, safety and well-being. The people living at the home have their own money that is held in safekeeping. People told us they prefer the arrangement. We looked at the system for managing peoples money, which is recorded, reconciled and kept up to date. This demonstrated peoples money is protected by a good system. One person said, I prefer to have a set amount of money everyday otherwise I would spend it all. Evidence: The staff recruitment records viewed for two staff all contained evidence that recruitment checks were carried out, such as criminal records bureau (CRB) checks and references. Staff told us as part of the recruitment and selection process, people using the service are involved in the staff recruitment process, to make sure the right staff are employed. 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 . People live in a home that is clean, tidy, well-maintained, comfortable and personalised. Evidence: Agape Annexe is situated in a residential area and blends in with other private residential properties. There is good access to the local community, shops, social and leisure facilities. People can use the public transport or the transport provided by the service. For those who attend day centres, transportation is arranged. One person also uses their own scooter, which further demonstrates how peoples independence is promoted. On the day of the site visit one person was already at home and the other two people arrived some time later. People were very relaxed at home, choosing to sit in the lounge, help in the kitchen or spend some time in their bedroom. There are 3 single bedrooms, all on the first floor. People can choose to have a key to their bedroom, if they wish. This shows people are encouraged to be as independent and responsible as far as practicable. Since the last inspection of the service and the information gathered from the selfassessment tool completed by the Registered Manager, there have been some improvements made to the home environment. These included decorating the bathroom, peoples bedrooms, kitchen, lounge/diner and the hallway and new locks fitted to the bedroom doors. People we spoke with told us they were asked about decorating the home, which shows decisions are made with the involvement of the people using the service. The home is clean, has a feel of a family home, with pictures on the walls and ornaments. The decor in the home is complimented with matching furnishing and furniture to create a homely atmosphere. People were relaxed and were seen to be Evidence: enjoying the programme on the television. The responses and comments received in the surveys supported the evidence gathered on the day, saying, the home is fresh and clean. Other comments received from people included: These are my dolls I like to have things organised and in order like my books and tapes This is the big bathroom and theres plenty of space We were invited to see all the bedrooms and the bathroom on the first floor, which is accessible by the staircase. The bedrooms were individually decorated and personalised to reflect their interests, such as family photographs, computer, dolls and cuddly soft animals like teddy bear and gorillas, music, television and a collection of videos and books. We saw people were involved in household jobs, such as emptying the bins, taking the wheelie bins out on collection days. Some people did their own laundry and helped with the meals. The household jobs people do were reflected in the weekly planner, which helps everyone know what needs to be done. One person said, I do my own laundry and I will help ... to make his bed, he struggles. People told us that they have the house meetings, where they can discuss any issues that may arise from living in a shared house. The minutes of the last house meeting included topics such as new crockery and putting away the laundry. The evidence gathered from discussion and records viewed showed people are supported to take responsibilities and be active in the home. The staff training records showed staff had completed training in infection control, health and safety and food hygiene. The home does not have any moving and handling equipment, as no one requires any physical help or support. One person does have a walking frame but this is not used anymore, as they are independent. The care files had assessments of risk completed, relating to health and safety, which needed to be reviewed and updated. This was brought to the attention of the Registered Manager and assurance was given that these would be done as a priority. Also refer to section on Individual Needs and Choices. We saw records that showed the cleaning programme and a system for reporting faults and repairs needed. There was evidence of servicing and testing of electrical equipment in the home, which shows the home, is in good state of repair and maintenance. 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 . People living at Agape Annexe are supported by staff that have undergone a good recruitment process and training to support and promote peoples well-being. Evidence: We wanted to find out whether people using the service are supported by trained staff that understands the needs of people. We saw people using the service to enjoy a positive relationship with the staff and the Registered Manager. People were seen returning home from various daytime activities, to be greeted by the member of staff. One person made a point of asking everyone if they wanted drink and made drinks as people started to relax for the evening. The member of staff then started to prepare the evening meals, and one person chose to help in the kitchen. This showed that the staffing levels support the people using the service and their daily routines, which promote peoples well-being. The information gathered from the self-assessment tool completed by the Registered Manager stated staff recruitment and selection procedures are good and people are involved in staff selection process to ensure the right staff are employed. The Registered Manager explained to us that the applicant would have an opportunity to meet the people using the service in a social setting and are observed as to how they respond and interact. People using the service have an opportunity to share their views about the applicant, which contributes to selecting the right applicant to work at the home. Since the last inspection of the service, the home had recruited a further two staff. We looked at the two staff files, both contained evidence two satisfactory references and criminal records bureau (CRB) checks, to make sure the person is suitable to work with vulnerable people. This demonstrated staff recruitment process is robust and people using the service influence the recruitment process to ensure the right person is appointed. Evidence: We observed there was a good relationship between the member of staff and the people using the service. There was laughter and the use of pet names, to tease each other but without offence. People told us about the staff that work at the home, which showed there was continuity and consistency of staff that support people. We received very positive comments from people using the service about the staff. These included: We know all the staff and ... the manager also works here ... should switch-off I can discuss anything with... We looked at the staff induction and training records. Agape Annexe has registered with Skills for Care and had provided new staff with the recommended induction programme. We saw staff received training in learning disability and mental health, to positively support and help to understand the needs and challenges of the people using the service. Other evidence of the training completed by the staff included, infection control, health and safety, safeguarding adults, medication administration and first aid. Staff on duty told us she has asked to attend updates in mental health and effect of medication as part of her development. This shows the staff development policy is actively used to promote staff knowledge, skills and maintain the current best practice to support the people using the service. The Registered Manager and a number of staff have attended the Deprivation of Liberty training held at the local authority. This further demonstrated the home promotes staff development in line with changes in the law that influences and promotes peoples rights. The information gathered from the self-assessment tool completed by the Registered Manager stated all the staff have attained the National Vocational Qualification level 2 or above in care. It also told us that a number of staff are completing NVQ 3 and 4, which includes the Registered Managers Award. We saw there was a relaxed and an open culture, where morale appeared to be good. Staff said they benefit from working closely as a small home and have good communication between staff and the management team. Staff said they share information about the well-being of the people using the service through the handover meetings and the communication book, so that staff are kept informed and up to date. Staff confirmed they receive regular supervision and support as and when required, including in emergencies. We saw the minutes of the staff meetings, which showed that staff are kept informed of peoples well-being, development and changes within the home. Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 . People living at Agape Annexe benefit from a well-managed home, contribute their views through quality assurance and review systems that promotes health, safety and well-being. Evidence: We wanted to know how the management of Agape Annexe ensures the people using the service benefit from a well managed home. The Registered Manager, the Registered Provider and the Deputy Manager have been managing the home for many years. All have experience of working with people with a learning disability and mental health. All have recently attended training in Deprivation of Liberty course and recognise that there may be changes that promotes the rights, choice and support offered to people to make informed decisions. This Registered Manager confirmed that they have already registered with Skills for Care. At present the staff skill-mix is being reviewed to identifying training needs to ensure the staff have the right skills to support the people living at the home that improves the quality of life people experience. Staff told us they have good communication and clear roles and responsibilities, having supported people for a number of years. They told us the Registered Providers also work at the home and are contactable in case of an emergency. The management systems, policies and procedures are accessible to staff and good care planning supports the people using the service, which promotes their well-being. People using the service recognised the management team. People said they felt confident to speak with the staff and members of the management team, which shows they are open and approachable. Comments include: Evidence: Were quite happy here, we all get on with each other I can talk to staff anytime I need and about anything and they will always advise me The information gathered from the self-assessment tool completed by the Registered Manager stated the home carries out annual care reviews with each person using the service. This involves sending out questionnaires to the people living at home, their relatives and health care staff who are involved in their well-being. These include the day centre staff, Psychiatrist, Psychologist, Social Workers and General Practitioners. The care reviews read showed these were holistic. It also provided information about the service, which assesses the home and how staff support people. The Registered Manager told us that issues relating to the home or the staff are addressed as part of the quality review and through staff supervision. We did send out surveys to health care professionals for the comments about the service provided to the people living at Agape Annexe. However, these were returned incomplete, as the case was not open to the team. Therefore, the annual care reviews conducted by the home, demonstrate that in the interest of the people using the service, their needs are kept under review to ensure the home continues to meet their needs. This further supports the ethos of the home, as stated in the self-assessment tool completed by the Registered Manager, which states the moto of the home is caring with the family and is evident in the practice within the service. We suggested to the Registered Manager that some consideration should be made to making the questionnaires suitable to the needs of the people using the service. This means using simple or easy read words, pictures and symbols to communicate the information. We also suggested that they should consider measuring the results from the quality assurance against the statement of purpose to see if people actually experience the service as intended. This will help to identify areas for improvements as the service develops. The information gathered from the self-assessment tool completed by the Registered Manager details the regular checks, servicing and maintenance of the home. We saw records of the fire checks and tests carried out including the recording of food and fridge temperatures. There is a system in place for reporting faults that needs repairing. This shows that the home is maintained in a safe and good working order to ensure peoples health and safety. Are there any outstanding requirements from the last inspection? Yes  No  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 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 Description 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 Description 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 1 1 It is good practise to develop documentation and information about the home alternatives formats such as easy read supported wit pictures and symbols to suit the needs of people living at the home or considering using the home to help them understand the processes easily. It is recommended that care plans are made available in alternative formats to suit the needs of people who would be able to contribute and influence the support they receive that results in outcomes that improve the quality of life people experience. It is recommended that all the assessment of risks are updated and the measures to ensure health, safety and well-being is reflected in the care planning. The complaints procedure could be more accessible and developed in alternative formats that would suit individual needs, using pictures, symbols and easy read words. The home should consider developing quality assurance questionnaires in alternative format to suit individual needs, where they can understand with the use of short 2 6 3 9 4 22 5 39 words, pictures or symbols, to express their opinion about the service they receive and experience. The homes quality assurance results should be measured against the statement of purpose to show if the expectations of the service are met, help identify areas for improvement and ensure the aims and objectives evolves as the service develops. Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!