Inspection on 15/05/06 for Agape House

This inspection was carried out on 15th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 12/02/08

Agape House 07/06/06

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 Agape House 45 Maidstone Road Chatham Kent ME4 6DG Lead Inspector Lucy Ansell Key Unannounced Inspection 15th May 2006 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.V292479.R01.S.doc Version 5.1 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.V292479.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Agape House Address Agape House 45 Maidstone Road Chatham Kent ME4 6DG 01634 841002 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) Nanthini Paramasivam Thiyagarajah Paramasivam Nanthini Paramasivam Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 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. 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. The fees charged by the service range from £385 to £415 per week. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced Key inspection by one inspector Lucy Ansell. This took into account a thorough look at how well the service is performing, detailed information provided by the services owner/ manager, and any information or concerns the CSCI has received since the last inspection. Time was spent case tracking and reviewing records kept within the home. The Inspector also asked the views of the people who use this service, and looked at the environment with a tour of the premises, these all combined will inform how well the service is meeting the standards set by the government and decide how the service is rated. What the service does well: What has improved since the last inspection? The home has updated its statement of purpose and service users guide, The manager needs to evidence that residents all have the updated information. The plans of care have been significantly improved and contain much more information than was previously held. The home is able to evidence that it is recording more information and is aware of the care needs of each resident. The importance of promoting privacy and dignity is now covered in the induction, with evidence seen of staff providing this in their day-to-day interactions. The routines of the home are starting to evidence more flexibility to suit the residents’ preferences and capacities. The home has now started to offer more activities and outings for the residents. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 6 What they could do better: 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 DS0000061836.V292479.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Agape House DS0000061836.V292479.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3,4 6N/A The overall quality of service is adequate. The residents and their families have sufficient information to make an informed choice about where they could live and the terms and conditions of this stay. EVIDENCE: The home has produced an updated statement of purpose that contains the aims, objectives and philosophy of care of the home along with services and facilities and terms and conditions. The home has also updated its service users’ guide and this is now to be given to all residents with evidence of this recorded on their files. The home has updated its contracts and statement of terms and conditions and all new residents have this. However this also needs to be given to all existing residents and evidence of this recorded. Evidence was gathered that the manager is completing all new assessments and does this alongside their care manager or family representative. Evidence was seen of the needs assessment forms. These have been reviewed and updated and are now a comprehensive tool. The manager, once she has Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 9 completed a needs assessment, also completes a social history to ensure a holistic approach, and to assure the home can meet service users’ care needs. However whilst the home is able to meet the care needs of older people, when the home changes registration the staff need to evidence they have sufficient knowledge or experience to provide a specialist service for dementia. The manager needs to demonstrate that services are based on current good practice and reflect relevant and specialist guidance. The home will need to find an appropriately qualified person to assess the specialist needs of the client group and the homes capacity to meet this. Evidence was not found that collectively staff have the required skills and experience to deliver specialist services, however a training program to address this is being sought. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 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 the following standard(s): 7,8,10,11 The overall quality of service is adequate. Residents benefit from an adequate standard of care planning and are treated with respect and dignity. All residents benefit from being consulted, regarding their wishes concerning terminal care and arrangements after death. EVIDENCE: Residents care plans were looked at; these have all been rewritten and now contain sufficient detail of personal and health care recording. The care plans had been improved but still need to contain a better range of information. When they are next reviewed they need to look at use of language and providing precise details of how the care is to be provided. The owner also spoke about how the paperwork may be changing which would allow for more and precise information to be held. The risk assessments need to be clear and concise with what the risk is, how to reduce the probability of this risk and whom is it a risk for. They also need to be reviewed regularly. A good practice recommendation was made to ensure Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 11 all moving and handling assessments are also made into risk assessments, and prevention of falls are risk assessed. Evidence was seen that reviews of the care plans are taking place but not as regularly as required. The monthly reviews are scheduled with the key workers taking on more responsibility, however the manager needs to push for this to occur in a timely fashion. The manager needs to have in place a system to monitor all care plans after the staff have completed their reviews. The home operates a key worker system where residents have an identified staff member. Evidence was seen of involvement of the resident and their family by agreeing and signing care plans. The staff are still not recording enough detail in the daily report. It was also noted that when events and care delivery occurs throughout the day a detailed and comprehensive record needs to be kept with good use of times. The pages need to be numbered and name and signature clearly readable. There should be no gaps left, so leaving room to alter notes previously made, staff need to draw a line to the end of the page. The health needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. The home promotes and maintains residents health through supporting and facilitating medical appointments as required. The home is able to manage residents and promotion of continence is sought. The home has good links with other professionals and the home can offer a choice of G.Ps from the many surgeries situated locally. The importance of promoting privacy and dignity is now covered in the induction, with evidence seen of staff providing this in their day-to-day interactions. The staff on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents. All residents and family or friends 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 show great care and kindness”. In the residents shared rooms it was noted that privacy curtains were in place that ensured privacy and dignity for the occupier. The manager also evidenced that consent forms for all residents sharing were on their files. Residents are consulted regarding their wishes concerning terminal care and arrangements after death and this is recorded on their care plans, allowing them a dignified death according to their own wishes. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 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 the following standard(s): 14,15 The overall quality of service is good. Residents now benefit from having more choice and control. Dietary needs of residents are well catered for with a balanced and varied selection of food. EVIDENCE: The routines of the home are starting to evidence more flexibility to suit the residents’ preferences and capacities. They can get up and wander around the home, and can choose one of four places to sit. The residents are now being encouraged to exercise choice in relation to meals and mealtimes, and with some leisure and social activities like the time to get up or to retire for the evening. Evidence was seen that staff are now starting to record choices made and are keeping records of activities for each person. A number of residents spoken to in the home, commented on the food and said how good it is and that they welcomed all the choices offered. Evidence was seen of a four weekly rota on the wall, and a daily menu was displayed however not where service users could see it. Residents were observed during meal- time and choice and variety was offered. One resident stated “ the food was excellent and they always have something on the menu which I like”. The Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 13 cook regularly makes home made cake and tea and cake or snacks are offered mid-morning and mid-afternoon. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 16,18 The overall quality of service is adequate. Residents have access to a clear complaints procedure, which is acted upon by the home when necessary. Whilst residents benefit from all staff knowing how to report appropriately any possible abuse, training for staff needs to be a priority to protect residents further. EVIDENCE: The complaints procedure had recently been rewritten, but still needs to include time scales. The home could improve on information of whom to complain to. Evidence was seen of it displayed within the home and within the service users guide. Good practice would be for all residents and family and staff to have been given revised copies one of which was signed and put on file. The home has received no complaints since the last inspection. The manager is advised to ensure family can record concerns, complaints and compliments and to have a book for relatives to do this along with complaint forms and policy in an area they would see. The home now ensures the residents are safeguarded from any abuse, neglect or harm by having a policy for the home as well as the Local Authority Guidelines. The manager gives guidance for all staff at induction, however all staff must attend courses in the Local Authorities protocols on Adult Protection, the manager is trying to arrange this training for as soon as possible. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 15 Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 16 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 the following standard(s): 19,26 The overall quality of service is adequate. Whilst residents now benefit from living in a safe, well maintained, clean and homely environment in which there are high standards of décor, furnishings and fittings, they also need secure access to the grounds of the home. EVIDENCE: The home’s location and layout is suitable for its stated purpose; recent visits have been made to the home by the fire service and environmental health to ensure they meet all their requirements. The home needs to evidence a monthly routine of checks and maintenance and renewal programme. The home has been completely repainted outside since the last inspection. Bedrooms seen had all been personalised by the service users. Bedrooms have sufficient space to accommodate the required furniture. There are several areas that need repainting and carpets replacing that were noted by the home’s owner and is due to be completed this year. The home has good standards of cleanliness and the cleaning staff know which rooms to deep clean daily and only very low odours were detected Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 17 The home has a separate laundry room, which met infection control requirements. The kitchen was viewed and this was well maintained. The home has no sluice room and this is still outstanding from previous inspections. The home has been looking for a suitable place to site it. Hand washing facilities are prominently sited and the provision of protective clothing was clearly seen. The new office is also an area that lacks storage space and shelves are needed to house all policies and procedures. A recommendation was made to ensure the garden at the back is made secure and is in use for residents as the warm weather is nearly here. The garden also needs to be tidy, safe and accessible to residents to allow access to sunlight. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The overall quality of service is adequate. Residents’ needs are met by sufficient staff however the staff team need to develop their knowledge and skills so as to provide a competent and skilled workforce to ensure residents are provided with safe care. EVIDENCE: The home has a full complement of staff. This is managed for each shift with the manager or a senior on duty then 3 care staff working on the floor for the morning shift and 2 care staff working on the floor for the afternoon shift with 2 waking night staff. The home has produced a training matrix so they can see at a glance what training is required, however this needs to be up to date and in line with the staff training certificates. The home is committed to training however there are significant gaps still. The home needs to send all staff on Adult protection training, and all staff need to complete the five basic training core skills and also dementia care. The home does invest in good induction training and also has produced a induction booklet, evidence was seen on staff files of this. Discussion was made about the home training a responsible person to become a trainer for the home in the new induction process Skills to Care. The home has seven carers who have NVQ 2, and three staff who have started their NVQ 2, and three staff who have NVQ3. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 19 The home has excellent staff files, which contain all the required info, however these need tidying so information is clearly accessed. The staff folders would also benefit from having a checklist /Index. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36,38 The overall quality of service is good. The residents benefit from the manager continuing to enhance staff skills. The interests of the residents are guarded by the home’s policies, procedures and management. The residents can be confident that staff are in receipt of regular supervision. EVIDENCE: The owner evidenced she is competent and experienced by passing her fit person interview at the Commission for Social Care Inspection. She has been undertaking training to update her knowledge and skills since she took over as manager. She is familiar with conditions and diseases associated with old age due to her nursing background. The homes head of care is also competent to act up as acting manager should the manager be absent from the home. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 21 Supervision is occurring on a regular basis, and does appear to be a in-depth process which reflects practice, the home’s philosophy and identifies any training or further support needs. The home’s head of care has recently finished a course on supervision. The manager, as far as is reasonably practicable, ensures residents and staff are protected by good health and safety practices. However it was noted that many policies and procedures did not have reviewed and updated dates on them so it was not evident this had occurred. Training on some of the core subjects is out of date or not booked yet. The risk assessments and monthly visits are not completed, with significant findings of the risk assessments recorded. The home must ensure that all notifiable incidents and injuries are recorded and reported to the relevant bodies. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 22 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 3 3 3 2 X 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 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 2 Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 23 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 OP37 Regulation 24(1) Requirement Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. Timescale for action 30/08/06 2. OP30 18(1) The registered person ensures 30/08/06 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. The home does not have a sluice machine and a requirement is made for the home to purchase one. The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or DS0000061836.V292479.R01.S.doc 3. OP26 23(2)(k) 30/08/06 4. OP18 13(6) 30/08/06 Agape House Version 5.1 Page 24 self harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. 5 OP7 12(2) 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. This is reviewed every month, and includes risk assessment particularly prevention of falls. 30/08/06 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. 2. 3 4 5 6 7 Refer to Standard OP28 OP29 OP1 OP16 OP2 OP38 OP15 Good Practice Recommendations The training matrix needs to be up to date and tally with staff certificates. The staff files needs to be more organised and a front sheet detailing what is contained in them. The updated statement of purpose and service users guide needs to have a review date added to them The complaints procedure needs to have timescales added to it. The home needs to ensure all residents have updated contract and terms and conditions. All policies and procedures need updating and the date this was completed. To ensure residents can clearly see what’s on the menu and activities for the day. Agape House DS0000061836.V292479.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone 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. 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