Inspection on 15/04/05 for Agape House

This inspection was carried out on 15th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 House 29/05/09

Agape House 28/10/08

Agape House 05/08/08

Agape House 12/02/08

Agape House 07/06/06

Agape House 15/05/06

Agape House 21/09/05

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 Lucy Ansell Unannounced 15 April 2005 10:00 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 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 H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Agape House Address 45 Maidstone Road chatham Kent ME4 6DG 01634-841002 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Nanthini Paramasivam Care Home 19 Category(ies) of Older People registration, with number of places Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 01 February 2005 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 19 older persons. There are a variety of aids and adaptations around the home, which enable more independence for the residents. The home has 16 bedrooms, 12 have ensuite toilets, 2 are single rooms no ensuite and 2 are shared rooms with an ensuite. Over the two floors are two communal toilets and two bathrooms with hoist chairs. 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. Agape is a Christian based home and has regular contact with local clergy Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection under the terms of the Care Standards Act 2000 carried out by two inspectors who were in the home from 09.50 to 15.00 on the 15th April 2005. A second meeting was arranged to meet the new owner and complete the inspection on the 19th April 2005 between 10.00 and 12.00. Documentation and records were read, including care plans. A tour of the premises was undertaken. The inspectors spent time talking with 12 service users and 4 relatives. The owner took over the home in October 2004 and is hoping to register as the manager. What the service does well: What has improved since the last inspection? What they could do better: Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 6 Limited progress has been made in addressing staffing shortages and as a result residents do not always receive a consistent standard of care. Staff morale is low with high levels of sickness and staff turn over. The residents of the home consider the level of activities that the home is currently offering too low. They repeatedly stated, “ There was not enough to do” and “ they needed more activities to stimulate their minds”. There will be requirements that the paperwork is kept securely and up to date. Also that the bathrooms are cleared of personal toiletries and laundry holders are not stored in them blocking access to the room. There will also be requirements around training and staff supervision. 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. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1-5 and 6 n/a Residents benefit from the home’s system of pre assessment which ensures that the home is able to meet their needs. The home’s Statement of Purpose and Service User guide do not contain the required information for residents and families to enable them make an informed decision about moving into the home. EVIDENCE: The home has an incomplete statement of purpose and service users guide. Advice was given to separate the documents for them to be more clear and concise with all relevant information included. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the homes contracts, which were very detailed. Residents are admitted following a full assessment by the homes owner and head of care, which also forms part of the overall, care plan. Service users and their families/representatives are invited to visit the home prior to moving in. Residents spoken to at the home confirmed that family members took the lead role in visiting the home and many had not visited prior to moving in. The head of care stated that the home is now committed to residents being involved prior to moving in. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 9 Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10,11 Whilst majority of care plans seen were of a satisfactory standard, there is a need for the home to ensure the new care plans encompass all the required information for the benefit of every resident. Residents benefit from being treated with respect and dignity and their independence is promoted. Service users wishes in the event of death are established in care plans and are respected. EVIDENCE: Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 11 Four residents care plans were looked at. These were detailed records, which contained good personal and health care recording. The risk assessments were clear and concise, however the information did not match with the care plans. The daily log recording that the staff are completing are very through and eliminate the need for a second staff handover book. Evidence was seen that reviews are taking place regularly. The home operates a key worker system where residents have an identified staff member. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. The care plans for the two recent admissions had no paperwork except the pre-assessment forms this is an unacceptable level of practice as the residents have been at the home for over a month. The staffs on duty were observed indirectly throughout the inspection, seen to interact in a positive and respectful manner with residents. Residents gave positive feedback during the inspection about the approach of the staff team, comments included “nothing is too much trouble for the girls” and “they are very kind and make you feel at home”. It was recommended at the last inspection that the Home continues to try and identify accredited medication administration training for staff and this has now been booked. The home has ordered new medication storage facilities to comply with current National Minimum Standards. Residents are consulted regarding their wishes concerning terminal care and arrangements after death. The home has collected this information in a sensitive and professional manner, and care and support is provided for relatives after bereavement. Visitors are made welcome at any time and a private visitors room is made available with refreshments as required. This was evidenced during the inspection and on speaking to relatives. They stated, “They were free to visit when ever they wished and were very happy with the home”. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12-15 The residents’ dietary needs of residents are well catered for with a balanced and varied selection of food available that meets resident’s tastes and choices. The residents are not offered a sufficient range of social activities which affects the quality of life for some of the residents. EVIDENCE: A number of residents spoken to in the home who commented on the food said how good it is and that they welcomed the daily choices offered. Residents were observed during meal- time and choice and variety was seen to be offered. One resident stated “ the food was excellent and they always have something on the menu which I like”. A Physiotherapist attends the home twice a week for gentle exercises classes, they also have an activity co-coordinator once a week for quizzes and games. Due to staff shortages, staff are unable to undertake social activities on the remaining days because their workload is already over stretched. The home does have entertainers coming in monthly. However, these need to be consistent and in line with residents wishes. Residents stated they are often bored and feel they are under stimulated. One resident stated, “ She would love to go out once a week to attend a church service”. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The residents benefit from having access to the home’s clear complaints procedure. Residents and relatives are aware of how to complain and feel that their views are listened to and acted upon. EVIDENCE: The home has a clear step-by-step procedure that meets the requirement of the regulations. The complaints procedure was displayed within the home and evidence was seen of it included in the statement of purpose and service user guide. The home has received one complaints since the last inspection, this was seen recorded in the complaints book. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19-26 Residents live in a safe, well-maintained, clean and homely environment. However, whilst the bathroom areas are clean staff need to ensure that they eliminate risk of cross infection. EVIDENCE: Most residents occupy spacious single bedrooms, two of the rooms are shared, one by a married couple and one by two friends. The majority of rooms have ensuite toilet facilities and where these are not included a suitable bathroom is located nearby. The home has sufficient toilet and bathroom facilities for the number of service users. The home has three communal lounges, one of which is a quiet room, another for viewing the television and a conservatory. The home has a large dining area, which benefits from being light and airy as attached to the conservatory. Several relatives spoken to commented “On the welcoming feeling of the home”. Bedrooms seen had all been personalised by the service users. The rooms were all clean and well decorated. Bedrooms have sufficient space to accommodate the required furniture. The home has very high standards of cleanliness and no odours were detected anywhere in the house. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 15 In the communal bathrooms it was noted that resident’s toiletries were left out and the home stores its laundry holder’s in the bathroom restricting access, requirements have been made. The home has a separate laundry room, which met infection control requirements. The kitchen was viewed and this was well maintained. Following from the last inspection the home is now recording water temperatures. The home has no sluice room and needs to develop how this can be changed. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Poor staff morale and high staff turnover and sickness affects the consistency of care to the people using this service. The number of staff employed is not sufficient to provide the level of care required for the residents. The staff team need to develop their knowledge and skills so as to provide a more competent and skilled workforce better able to provide a high standard of care to all residents. EVIDENCE: Staff rotas were seen and evidenced that staffing was inadequate to provide appropriate shift cover. The home needs to have three members of staff on, covering hands on care and one staff designated to the office. Whilst the head of care was engaged with the inspection process, this left only two members of staff who found it difficult to meet the required needs of residents. The majority of residents spoken to highlighted that there did not appear to be enough members of staff on duty. One commented, “They are always rushing around and when you buzz no one comes for ages”. Another resident stated, “the staff are always busy and you don’t want to bother them”. Evidence seen suggested staff training was not meeting the required standard. One member of staff spoken to required basic training on First Aid and Adult Protection. The owner is working towards all staff being up to date on training needs and a training plan was seen to evidence this. The head of care confirmed three members of staff had completed NVQ 2 and one was on the course. One member of staff had completed NVQ 3. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home is run in the best interest of the residents and home’s policies, procedures and management largely safeguard the residents’ rights and best interests. The manager needs to continue to introduce supervision and further training to enhance staff skills so as to further safeguard all residents. EVIDENCE: The manager has undertaken lots of training since taking over the home. She is now a trainer in Moving and Handling, Food Hygiene and Health and Safety. Her past experience as a registered nurse enables her to meet the needs of the residents and with formal management training that is being undertaken during her NVQ4 and R.M.A. she is expected to finalise her role of fit person in September of this year. During a tour of the home records were found to not be kept in a secure and safe place. There was no evidence that formal staff supervision took place this was confirmed in discussion with staff and also by the manager who intends to start supervision as soon as possible. The manager also confirmed that the induction process for new staff needs to be Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 18 using the TOPPS paperwork and she will undertake this training. Quality assurance needs to be more robust as the home not aware of the residents comments and complaints. Resident and relative meetings are taking place and minutes were seen. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 2 x 2 3 x 2 2 x Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? 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 OP 1 Regulation 5 Requirement The Statement of Purpose and Service User Guide needs it to be clear which one it is and contain all the required information. More emphasis is put on inviting residents to visit the home before they make a decision to stay. Care plans to be completed and signed for all new residents within 28 days of admission. Social activities to meet the needs of individual residents. The social activities for all residents is kept under review to ensure choice and stimulation. All communal areas to be kept clear and suitable provision is made for storage for the purposes of the care home. Three members of staff are covering hands on care whilst one is designated to the office per shift to meet the needs of residents satisfactorily. Supervison of staff to be provided regularly. Staff training needs to be addressed with urgency. Ensure all records are kept securely in the care home. Timescale for action 31/05/05 2. OP 5 14 (1) 31/05.05 3. 4. OP 7 OP 12 15 16 31/05/05 31/05/05 5. OP 20 23 31/05/05 6. OP 27 18 31/05/05 7. 8. 9. OP 27 OP 27 OP 37 18 18 17 31/05/05 31/05/05 31/05/05 Page 21 Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP 26 Good Practice Recommendations It is recommended that the communal bathrooms are kept free of all personal toiletries. Agape House H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection The Oast Hermitage court Hermitage Lane Maidstone, Kent, ME16 9NT National Enquiry Line: 0845 015 0120 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 H56-H06 S61836 Agape House V221908 150405 Stage 4.doc Version 1.30 Page 23 - 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. 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