Inspection on 12/02/08 for Agape House

This inspection was carried out on 12th February 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Agape House 29/05/09

Agape House 28/10/08

Agape House 05/08/08

Agape House 07/06/06

Agape House 15/05/06

Agape House 21/09/05

Agape House 15/04/05

Agape House 01/02/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Agape House 45 Maidstone Road Chatham Kent ME4 6DG Lead Inspector Sue McGrath Unannounced Inspection 12th February 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Agape House Address 45 Maidstone Road Chatham Kent ME4 6DG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01634 841002 Nanthini Paramasivam Thiyagarajah Paramasivam Nanthini Paramasivam Care Home 20 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (16) of places Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2007 Brief Description of the Service: Agape House is a detached Victorian home providing accommodation on two floors, there is a passenger lift to the first floor. Agape provides care for 20 older persons. It has four beds for service users with a diagnosis of dementia. There are a variety of aids and adaptations around the home, which enable more independence for the residents. The home has 16 bedrooms. The home is situated in a residential area less than a mile from Chatham railway station and town centre. The home is located on a main bus route and within walking distance of shops and a Post Office. The home has attractive front and rear gardens with seating. The fees charged by the service range from £385 to £450 per week. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on 12th February 2008 and was conducted by Sue McGrath and Anne Butts, Regulation Inspectors for the Commission for Social Care Inspection. The key inspections for care home services are part of the methodology for The Commission For Social Care Inspection. The home provides information through a questionnaire process (AQAA) and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken with, records were viewed and a tour of the environment was undertaken. Judgements have been made based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CSCI to be able to make an informed decision about outcome areas. Further information can be found on the CSCI website with regards to information on KLORA’s and AQAA’s. Not all of the requirements made at the last inspection had been complied with. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: During the inspection staff were seen to be courteous and polite to residents and all residents spoken with confirmed that staff treat them with respect and they felt well cared for. Staff were keen to deliver good care but it was clear they were not always fully supported by the registered manager/owner. Staff were seen to support one resident to enjoy a glass of beer with his lunch. Other residents confirmed the food was of a good quality and they had a choice and sufficient quantities. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The management of the home is poor and this needs to be addressed urgently. The manager must spend sufficient time in the home to ensure she can carry out her responsibilities effectively and efficiently. There is a general blame culture in the home, which is not helpful when managing a home. There are several health and safety concerns including poor care planning, inadequate fire procedures and some work is required on the electrical system to make it safe. The home has changed the way it assesses prospective service users and no longer carries out an in depth assessment. This must be addressed urgently as the home is unable to evidence that it can meet the diverse and complex needs of some of the residents. Dementia care is poor with service users’ complex needs not being fully addressed. The registered person may wish to reconsider whether she wants to continue to offer this type of specialist care. Care planning and risk assessments are also poor with inadequate guidance given to care staff. Care plans are reviewed but changes of condition are not always recorded and updated. There was evidence that G.P.s are not always called quickly enough and instruction not closely recorded or monitored. The administration of medication needs to improve and the current audit system carried out by the registered person is not sufficiently robust. The induction programme used is poor and the delivery is rushed and does not support new staff to gain sufficient knowledge to deliver adequate care. The registered person must also ensure that recruitment procedures are robust and that the home recruits according to their own procedures and the requirements of the Care Standards Act 2001. The Commission will be taking enforcement action on this service in order to gain compliance of regulations. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live at this service are put at risk because of serious lapses in the assessment process and this means they cannot be assured their care needs will be met. EVIDENCE: The admission process was reviewed for the last three service users to be admitted to the home. There was little evidence that sufficient assessments had taken place for any of them, and some confusion amongst the management team as to why. The reason to admit appears to be based on the need to fill beds and not on whether the home can meet any specialist needs. The result is that people with specialist needs who live in the service may receive poor quality care. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 10 Both the registered manager/owner and deputy manager confirmed that one service user had been admitted into the home, without having visited or being assessed prior to moving into the home. Their information had been supplied from the family who had said that the home was suitable. This is not acceptable and they have failed in their duty of care to appropriately assess the needs of this service user and evidence that they can meet them. This service user had a diagnosis of dementia and diabetes and there was conflicting evidence to say where the assessment had taken place. One member of the team said an assessment had taken place in hospital but the registered manager/owner said it had not. Some evidence was seen that a very basic assessment had taken place, somewhere, but it did not reflect the complex needs of the prospective service user, for example how to manage the diabetes or support with daily living skills. The home is currently registered for four dementia beds and records showed that at the time of this admission, the home already had four service users with dementia in residence. Discussion with the manager/owner evidenced that she was unsure of the identity of the other four residents. At the previous key inspection the process of admission was assessed as being good. The manager/owner could not explain why the process had changed. Information from care managers could not be found and the manager confirmed this had not been requested. This lapse in the admission procedure meant that the home could not fully meet the needs of the service users because they had not been identified. One of the new service users stated that he did visit the home prior to admission with his daughter, others could not remember. None seemed aware that a trial period was offered. Agape House does not offer intermediate care. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live in the home do not benefit from care plans that identify their current and changing needs and cannot be confident that their health care needs will be fully met. This has the potential to put them at risk. People who live in the home are not protected by the home’s procedures for dealing with medication. EVIDENCE: It was observed that the standard of care plans has significantly deteriorated since the last inspection. Risk assessments and healthcare monitoring have also significantly deteriorated. Service users’ wishes regarding how they are supported with personal care are not recorded, and there was no evidence to show that they had taken an active role in devising their plans. There was little consideration given to individual likes, dislikes or preferences. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 12 Care plans were poor and all of those reviewed demonstrated major shortfalls. Specifically, care plans were very brief – both in terms of identifying care needs and the type of support required on how to assist an individual. For example, one of the recently admitted service users has dementia and diabetes. The care plan was very basic with only three areas of support covered. Risk assessments did not identify any specific diet to follow and staff said family had advised he could eat what he wanted. This resulted in an unbalanced diet and wide fluctuation in blood sugar levels on a daily basis. The home was advised to hold a multidisciplinary meeting to ensure his diabetic needs are adequately met. Staff are currently training with the District Nurse to administer the insulin and will only do so when competent. The above example is indicative of the information being incorporated into the care plans and this lack of information and understanding of people’s needs contributes to some poor care practices observed during our visit. At one stage a service user who had been calling out had cream applied to his back whilst still in the lounge. This did not indicate that respect and dignity are at the heart of the care practises. There is a generic approach to care planning that is not person centred and does not respect individuality and diversity. Therefore this has contributed to people receiving a sub-standard level of care and support in their daily lives and this approach does not meet with either accepted good practice guidelines or National Minimum Standards. Where care plans and assessments have been reviewed, in some cases, this was a paper exercise with only dates being written in and there was no evidence to show that these had actually reflected people’s changing needs. An unsigned note on a bath recording sheet identified a service user was no longer self-caring but the care plan had not been updated to reflect this. Incomplete records did not support how the home meets individual healthcare needs. There was no evidence of appropriate nutritional screening and there were intermittent weight records. There was no actual monitoring of food and fluid intake and incorrect record keeping is not safeguarding people living in this home. There are limited details for support given from healthcare professionals. Where it has been identified by a Doctor that a person needed to be monitored, there was no record of this happening. There was no evidence to support or manage people’s health care needs with regards to skin integrity or any challenging behaviours. Evidence of erratic monitoring of blood sugar levels also puts any diabetic service user at risk. For example, one service user needed to have her blood sugar levels checked twice a day, a review of the last three weeks showed that on ten occasions this had only occurred once a day. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 13 Following a formal complaint from a previous resident’s family it was identified that GP assistance had not been called as early as would have been expected. This had very serious consequences. It would appear that no senior member of staff was reading the daily care notes, staff were raising concerns but they were not being dealt with efficiently or effectively. This has now been partially addressed by the home and senior staff now sign the daily notes to confirm they are aware of issued raised. Most risk assessments inspected were inadequate and none contained any further detail on the full description of the risk or how to support effectively. Very little information from any of the risk assessments was actually fed into the plans. The manager/owner must take ownership of the care plans to ensure they give staff sufficient guidance. Medication is inadequately managed with poor outcomes for people. Several errors were found in the management of the administration medication. For example one resident had been without one tablet for 17 days and 2 more tablets ran out 3 days previously. Two further tablets had run out on the morning of the inspection. There were also two loose tablets in the service user’s individual box and these could not be explained. The deputy manager stated that they had contacted the pharmacist on the morning of our visit and a new prescription was being collected. It is recognised that this was a new service user and they needed to be registered with a new GP, but the home had not acted efficiently or in a timely manner in ensuring sufficient medical supplies. It is not acceptable for service users to run out of prescribed medication. It is advised that when a new resident is admitted and may require a new G.P. the home ensures sufficient medication is bought in with them. This must form a part of the admission process. Another resident had an excessive stock of one tablet that could not be accounted for. No one could explain why this had happened and the records identified that the medication had been administered. One idea was that excess stock from previous months had been carried over, but there was no evidence of this. There was no consistency when new medication was delivered to the home in that not all individual medication was counted in on the MAR (medication administration record) sheets. Hand written MAR sheets were not counter signed by another competent member of staff. The registered manager/owner had been completing a monthly audit as recommended in the last report, but this had not identified any errors. This calls the quality of the audit into question. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 14 Several of the service users were very complimentary of the staff and said they felt well cared for and safe. Staff were seen to knock before entering bedrooms and addressed service users by their preferred names. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Little consideration is given to supporting people’s individuality or social preferences and staff choose the activities provided. The food in the home is of a satisfactory quality and well presented. EVIDENCE: Service users confirm the daily routines remain fairly flexible and they feel free to ‘come and go as I like’. Several commented they were bored and others said they missed the weekly exercise classes as they now only happened once a fortnight. Some said they missed going out and would like some outings. At the last inspection the registered person said she was arranging some trips out but the residents said these had not happened. The home does not have a dedicated activities co-ordinator and staff try to amuse the residents to the best of their abilities. It was noted that the same quiz questions were used in the morning as in the afternoon by different staff. Nothing was recorded regarding activities on that day. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 16 Aspirations of service users are not recorded and there is no information regarding previous hobbies or lifestyles. The home is not responding to the diverse needs of people and there was little evidence to show that their religious, cultural and social interests are being taken into account in their daily lives. Service users confirmed that their relatives could visit whenever they liked and that they were always made very welcomed. One visitor was seen coming in through the kitchen and the manager might wish to address this as this could pose a cross contamination risk. The meals were viewed and looked fairly appetising and a choice was offered. The menu looked varied and evidence was seen of fresh fruit and some fresh vegetable being used. The store cupboard was well stocked and this time the freezer was in a better condition. None of the frozen food had any freezer burn. Cakes are now made daily and staff confirmed they had more supplies. The cook stated that all the diabetics had yogurt for dessert but this was not always the case, as was seen during this lunchtime. She was also unaware that one of the service users was allergic to eggs and the manager is strongly advised to ensure that any food allergies or specific dietary needs are relayed to the cook to act upon. Most residents said the food was good and that they had sufficient quantities. Drinks were available during the day as well as meal times. There was no record of the food taken and again it is recommended that this be addressed to ensure that residents are receiving a balanced diet. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are protected by robust policies and procedures for complaints and Safeguarding Adults, but some practises in the home put some residents at risk. EVIDENCE: The registered person and the Commission have received a major complaint and this is currently being dealt with. The outcome at this stage is unknown. The home does have a formal complaints procedure and the above complainant was advised to use it by the home. The manager stated that the home tries to ensure the residents are safeguarded from any abuse, neglect or harm by having a policy for the home as well as the Local Authority Guidelines. In the case of the above complaint these guidelines were not followed. The Commission was not informed of the complaint and Social Services were also not informed. Evidence was seen in a recent daily notes of a care plan that one service user was sometimes scared of the person she shared a room with. The deputy manager spoke with some of the people concerned, including families, but no formal action was taken. The deputy manager stated that they were monitoring the situation but there were no records to support this. Care Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 18 Managers were not informed of the incident. A regulation 37 report was not completed as is required. The home has a duty to report such incidents under regulation 37 of the Care Standards Act 2001. Not all of the staff had received formal training in Safe Guarding Adults as required from the last inspection but the manager confirmed she had arranged courses for March 08. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that meets the needs of the people who live there. Maintenance and refurbishment work tends to be reactive rather that proactive. Some remedial electrical work is needed. EVIDENCE: Following a recent random visit to the home there were several areas that required urgent attention. It is of concern that it was necessary to have to point these issues out and make requirements for the work to be completed. The majority of the work has now been completed however. The conservatory had been re painted, as the original redecoration was poor. New carpets had been fitted to the lounge, conservatory and stairs. Some bedrooms also had new carpets. The wall lights in the lounge area had been refitted, as bare wires were hanging out of the wall at the last inspection, with no concern for safety. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 20 At the random inspection many of the light bulbs had blown but this has now been remedied. This had meant that the lighting in the lounge was poor, making it difficult for the residents to read should they wish to do so. The registered manager stated that new dining room chairs were on order. The current ones were showing signs of wear and tear. Many of the bedrooms were viewed and most were clean and tidy. One room (4) required a new carpet and the curtains were hanging off the rail. The manager said this would be dealt with immediately. One of the vacant rooms also needed new carpets and a new bed. The manager stated this would be made available before a new service user was admitted. The sealant around the bath in one of the bathrooms was broken and mouldy; again the manager stated this would be repaired immediately. At the random inspection room three had an aerial wire hanging out of the wall with exposed bare wires. This had now been cut back to the wall and plastered around. A proper repair had not been made and the manager agreed she would not accept this in her own home. This needs to be repaired properly and an appropriate cover fitted. The laundry room was cleaner at this inspection and the pump for the washing machine was now covered. A new sink top had been fitted but unfortunately to the old base unit which was in a poor condition. At the last random inspection old chemicals were found, these had now been removed and the manager assured the inspector that all chemicals were now safely stored and the appropriate Data Sheets were available. Evidence was seen that the home had hoists appropriate to the needs of the service users and that they were now properly maintained and serviced. The home was again advised to obtain a copy of Kent and Medway’s Infection Control Guidelines and the manager ordered a copy before the end of the inspection. It was a concern that the home did not have a copy of this document. Discussion took place around the sitting of a new sluice and the manager was advised to talk to the Infection Control Department. An electrical report on the home identified some work that needed to be completed to ensure safety. This work has not been completed despite the report being completed some months ago and noted to be urgent. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a recruitment procedure in place but does not always follow it and this has the potential to put service users at risk. Staff receive mandatory training but the home’s induction programme does not meet the required standard and therefore puts service users at risk. EVIDENCE: The rotas were viewed and on the day of the inspection sufficient numbers of staff were on duty. At the random inspection in December 07 it was identified that there were no identified senior staff on duty after approx 3pm and over the week-ends. All staff who were previously senior had been downgraded to care staff by the registered person. The current rota did not indicate who was the senior on duty and the manager rectified this on the day. However there were still no senior staff identified for the week-ends. The registered person had not appointed anyone at that stage. The manager /owner stated that she was intending to offer the post to a member of staff that week. A new job description for the senior post had been prepared. A requirement to ensure that sufficient senior staff were on duty at all times had been made at the random inspection and the completion date was 25/01/08 so this area of work should have been completed. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 22 At the random inspection in December 07 a requirement was made to ensure that there are staff with a recognised first aid certificate on duty at all times to ensure the safety of the service users. The completion date had not been complied with. The registered person was instructed again to either provide sufficiently trained staff or to complete a risk assessment to ensure the first aid provided by the home is tailored to the first aid needs of the people who use the service. The registered person confirmed the home’s induction programme was conducted over the space of one hour and this is insufficient time to fully cover all of the required aspects. At the last random inspection and the previous two inspections, a requirement was made for the registered provider to ensure there was a staff training and development programme which meets the national training organisations (NTO) workforce training targets and this includes a suitable induction programme. At the last key inspection in June 07 information was left with the manager/owner regarding induction programmes but this had not been used. A complaint was made to the Commission in November last year that the home was employing under aged staff. A random inspection was carried out and it was confirmed that two staff members were working under the age of eighteen. The Commission does not want to discourage younger people working in care homes, but they must not be undertaking personal care unsupervised. In one of these cases one staff was employed as a carer and was identified on the rota and one as a general assistant. Neither had undergone Protection of Vulnerable Adults (Pova) or Criminal Records Bureau (CRB) checks and neither had appropriate references. A warning letter was issued to the home and the manager decided not to continue to offer employment to both concerned. At this inspection the newest three employees staff files were inspected. One of the posts was a temporary domestic post. POVA had been applied for but no evidence could be found that a CRB had been applied for, however the manager did confirm that an application had been made. It is advised that when an application is made a photocopy or copy of the application number is retained so that the home can evidence that an application has been made. There was also some confusion over the reference for this person. The names were different on the application forms and the relationship between the referee and the applicant was different. The inspector does recognise that as the applicant had only been in the country since December 07 references would be difficult to obtain, but the manager/owner must be more vigilant and actually cross check all references offered. The second file viewed held one written reference and one verbal reference; the verbal was to be confirmed in writing. This new employee was due to start Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 23 for her induction on 15th February but her induction paperwork had already been signed off on 7th February. The contents included sixteen topics. The deputy manager and the applicant had signed all sections. It would not be possible to cover all sixteen areas in one hour and this calls the validity of the induction programme into question. There was no supporting evidence that a thorough induction had taken place. At the last inspection the manager was advised to consult the ‘Skills for Care’ website to improve the contents of the induction programme. This had clearly not happened. The third file had all the paperwork required and evidence was seen that the CRB check had been applied for. The induction paperwork was the same for this member of staff. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being managed efficiently and there is no leadership, guidance and direction to staff to ensure service users receive consistent quality care. This results in practices that do not promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: A lot of the issues raised at this and the previous random inspections were discussed with the manager who agreed she had not been spending sufficient time in the home to manage it effectively. She had reduced her hours to two/three mornings a week and this was clearly insufficient. Too many areas Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 25 had suffered as a result. At the first random inspection the manager/owner admitted she had ‘taken her foot off the gas after the last inspection’. She now is spending more time in the home but needs to be more proactive and fully meet her legal responsibilities. The care assessment process and care planning had gone from good to poor and areas of communication between staff and management had broken down due to a lack of management control. There was a strong blame culture in the home with nobody wishing to take responsibility. The care staff had been left to manage the best they could, but they were without strong leadership. There was evidence that staff had reported problems with service users but the management team had not taken action promptly. The manager confirmed that she does not hold monies on behalf of the residents and normally pays for the extras such as hairdressing, chiropody and newspapers etc and then invoices the families directly. At the random inspection it was noted that the periodic wiring inspection was overdue, this has now been completed, however the report indicated that two areas needed urgent remedial action and that overall the inspection was unsatisfactory. This was pointed out to the manager who seemed unaware that this was the case. The manager must read and react to this report as a matter of urgency to ensure service users live in a safe environment. This is putting the safety of service users and staff at risk. A requirement was made in November 07 that the registered person must ensure the premises used as a care home is of sound construction and kept in a good state of repair. Enforcement action will now be taken as this has not been complied with. Other Health and Safety checks were being carried out. At the last key inspection June 2007 a requirement was made to review the fire evacuation procedures to ensure it complied with good practise guidelines. The fire risk assessment was viewed at this inspection and was found not to be complete. The owner must take expert advice to ensure it complies fully with current legislation. The written fire drill was also a problem, as several different versions existed and all were different. The procedure posted next to all the fire doors was very dated and was different to the one the manager thought was in place. Another concern was that each member of staff spoken with had a different version. Some would evacuate to the front of the building and some to the back. The most recent fire procedure said not to evacuate but to place service users behind two fire doors and wait for the Fire Brigade to arrive. The manager must ensure a current fire procedure is in place and all staff must be trained in its correct use. Advice must be sought from the local Fire Officer. This has the potential to put service users at great risk. This issue was discussed at the last inspection and was included in the report. A requirement was made both in the inspection in June 07 and the random inspection in December 07 for the Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 26 registered person to review the fire evacuation procedure to ensure it complies with good practise guidelines. This had not been complied with and enforcement action will now follow. Because of the lack of action and the high level of concern a Statutory Notice will be issued. The manager confirmed the fire signage had been approved by ‘First Business Support’ but was unable to find the report. ‘First Business Support’ had also been involved in producing an up to date health and safety manual for staff but the manager was still waiting for the updated copy. It was noted at a previous inspection that the document being used contained the previous owners details and was out of date. This had not been identified by the manager/owner. Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X X X 3 2 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X X 3 X X 2 Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 18(1) Requirement The registered person ensures that there is a staff training and development programme which meets the National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. This is carried forward from the last three inspections and remains unmet. 2. OP38 23(4)(iii)S chedule four The register person should review the fire evacuations procedure to ensure it complies with good practice guidelines. This is carried forward from the last two inspections and remains unmet 3. OP7 15 The registered person shall 12/02/08 ensure that all service user have current risk assessments in place to ensure they are safe and take into account any change of DS0000061836.V357903.R01.S.doc Version 5.2 Page 29 Timescale for action 12/02/08 12/02/08 Agape House circumstances. In that all service users have manual handling risk assessments and guidance to staff in place. This has been carried forward from the last report and remains unmet. 4 OP19 23(1)(a)( b) The registered person shall 12/02/08 having regard to the number and needs of the service users ensure that the premises to be used as the care home are of a sound construction and kept in a good state of repair externally and internally. This has been carried forward from the last two reports and remains unmet. 5. OP30 12(1)(a)( b) The registered person must ensure that at all times there are staff with a recognised first aid certificate on duty to ensure the safety of the service users. This has been carried forward from the last report and remains unmet. 6. OP27 18(1) The registered person must ensure that there are sufficient senior staff on duty at all times to ensure the safety of the service users. This has been carried forward from the last report and remains unmet. 7. OP18 12 The registered person shall ensure that all staff receive training in Safe Guarding Adults. This has been carried forward Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 30 12/02/08 12/02/08 12/02/08 8. OP29 19 9. OP7 15 from the last two reports and remains unmet. The registered person must have a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. The registered person must ensure each resident has a service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. The registered person must not admit any service user without a thorough and detailed assessment to ensure assessed needs can be met. 31/03/08 31/03/08 10. OP3 14 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Agape House DS0000061836.V357903.R01.S.doc Version 5.2 Page 32 - 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. 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