Inspection on 02/07/08 for Agatha House

This inspection was carried out on 2nd July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Agatha House 21/09/07

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Agatha House Harold Court Knightswood Close Edgware Middlesex HA8 8FR Lead Inspector Brian Bowie Key Unannounced Inspection 16th July 2008 17.30 Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 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 Agatha House DS0000068781.V364567.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 Adults 18-65. 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. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Agatha House Address Harold Court Knightswood Close Edgware Middlesex HA8 8FR 020 8958 2187 TBA david.oginni@barnet.gov.uk 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) London Borough of Barnet David Oginni Care Home 6 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (1) of places Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2007 Brief Description of the Service: Agatha House is a purpose-built care home for six adults with mild to moderate learning disabilities. One of the residents is over retirement age. The home opened in 2007 and is run by the London Borough of Barnet. All the residents and most of the staff transferred from the former Oaktrees home. The new home is self-contained and all on the ground floor, with tenants of the Council’s learning disability outreach service living on the first floor. The building is light, airy and spacious and is designed for use by residents with physical disabilities. It is wheelchair accessible throughout including the garden. The bedrooms are large and have en-suite facilities. The home is in a cul-de-sac that is part of a housing estate in Edgware. Local shops, facilities and transport links are nearby. The fee for this service is £785/week. Agatha House makes available to residents and families information detailing the service provided at Agatha House, including inspection reports. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Younger Adults. The unannounced inspection took place over two days and lasted 11 hours. The inspection began at teatime so that the early evening routines in the home could be observed. The manager was interviewed and assisted with the inspection. Two of the residents showed us around the home. All six people resident in the home at the time of the inspection were seen and spoken to. Time was spent with residents in order to get their thoughts and experience of living at Agatha House. Some residents have difficulty communicating verbally. Throughout the inspection the way in which staff communicated with and supported residents was observed, as well as how residents got on with staff. We also interviewed staff to get their views and comments on the home. Relatives and care professionals involved with the home provided written feedback on what they thought about the home. We received six surveys completed by residents, 2 by professionals, 3 from relatives and 2 from members of staff. A wide range of records, including care plans, staff files and health & safety documents, were also looked at. The home’s Annual Quality Assurance Assessment also provided considerable detail about the running of Agatha House . The inspector would like to thank the residents and staff for their assistance with the inspection. What the service does well: ‘I always visit unannounced and at varying times, not deliberately, and I have never been disappointed with how the home is and has been run.’ This was the feedback from one of the relatives and reflected the positive feedback received from relatives about the care provided by Agatha House. The home is very good at helping each resident to lead the sort of lifestyle they want to. Care plans based on person-centred planning principles have been drawn up so that residents are put at the centre of what Agatha House is about. As a result the residents’ own wishes and needs are a very important part of how they are supported at the home. The people living at Agatha House are encouraged by the home to take as full part as possible in the life of the local community. Cultural and religious needs Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 6 are responded to. One resident has been supported to attend a church of their choice. Another resident who prefers not to attend a club linked to their religion has been helped to go to alternative social activities. Agatha House is very good at supporting staff and developing their skills further through appropriate courses, including NVQ training. As a result residents benefit from having staff who are skilled at identifying and responding to their needs and wishes. The home has a very experienced manager who sets high standards for the home. The manager keeps in close touch with both residents and relatives. As a result the home is providing an excellent standard of care within an attractive and comfortable living environment. The manager and staff are to be congratulated on making Agatha House such a nice home for the people living there. One relative who regularly visits the home had written: ‘The home is good at making our relative feel settled and content and feel he is in a caring environment, and is good at encouraging our relative to make their own decisions.’ The overall impression from the inspection was of a home that is providing an excellent standard of care within a very friendly, homely and supportive environment. This was confirmed by the amount of positive feedback, written and verbal, that was received from residents, relatives and professionals involved with the home. A relative of a resident commented: ‘I feel the staff at Agatha House are extremely caring and responsive towards their residents and the relatives. Given all the circumstances the care has been and is excellent.’ What has improved since the last inspection? The last key inspection took place in September 2007. All of the areas identified at this inspection for improvement had been dealt with. As a result the home has significantly improved the standard of service provided. This indicates that the home is committed to working with CSCI to raises standards at the home. There have been a number of improvements since the last inspection that has contributed to improving the quality of the service received by the residents. A new service user guide and statement of purpose have been produced which are in larger print and are pictorial. As a result they are more accessible for residents. Residents are more involved in decisions relating to their lives and in the running of the home. This is reflected in careplans now being in a very Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 7 visual format so that residents feel more involved in this process. The complaints leaflet and resident surveys are also now in a more pictorial format so that residents can more easily raise issues and give their comments about the home. Staff have attended courses and refresher training in the area of medication and this has helped to improve the effectiveness of the arrangements regarding medication in the home. 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. The summary of this inspection report can be made available in other formats on request. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Detailed information about the home is available so that residents and families know what they can expect from Agatha House. People moving into the home can be confident that their needs and wishes will be fully assessed and an appropriate plan for meeting these needs will be drawn up. As a result their needs are met. EVIDENCE: The statement of purpose and service user guide are both clearly written and contain detailed information about Agatha House. Both documents make use of pictures and are available in a large print so that it is easier for residents to make sense of them. As a result residents and families are fully informed about what they can expect from the care provided at Agatha House. ‘It’s a new adventure.’ This was the comment of one of the residents about living at Agatha House, who made it clear that they were enjoying their life in their new home. All 6 Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 10 residents had moved together into Agatha House from their old home of Oaktrees. The files for 3 of the residents were looked at and indicated that before they moved in a full assessment had been received from Social Services. A careplan had then been drawn up by the home showing how these needs were to be met. Each resident also had a detailed ‘Moving On’ plan indicating that careful thought, consideration, and consultation with the resident had taken place concerning their move to Agatha House. All six residents indicated either verbally or from observation that they liked living at Agatha House. A high standard has been achieved in this area that has contributed to residents being able to settle in quickly into their new home. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Careplans provided detailed information so that the needs of residents are met. The staff team at Agatha House is good at finding ways for residents to make as many decisions for themselves as possible. Residents are protected by risk assessments that are comprehensive and indicate clearly how risks to the safety of residents are reduced, whilst still promoting independence. EVIDENCE: ‘I like living at Agatha House.’ Five of the six residents verbally confirmed that they enjoyed living at the home. The remaining resident was able to show by their behaviour and interaction with staff that they are very settled at Agatha House. Throughout the inspection residents were observed in their daily routines and their contact Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 12 with staff. Residents were clearly relaxed with staff and looked to them where necessary for support and guidance. The records for 3 residents were looked at and indicated that for each one there was a current plan of care. Each careplan sets out the needs of the resident and how they are to be met by the home. As previously required careplans now contain photos and are written simply and clearly. As a result the careplans are now much more accessible and meaningful for the residents. One careplan had identified a resident’s wish to have more outings to London. The resident confirmed that they had recently been on such an outing. A professional who has very regular contact with Agatha House had written on their survey: ‘We are invited to regular care planning reviews. It has been noted that the people who live at Agatha House always indicate that they are very happy in their home.’ Careplans record the cultural and religious needs of residents. A question on the careplan asks: ‘How can we help you celebrate these beliefs e.g. food, worship, music, festivals, clothes.’ In one case the comment written was: ‘This residents enjoys the Christmas festival and food and the giving and receiving of presents.’ This was confirmed by the resident who showed us a photo of the Christmas party at Agatha House including the resident enjoying their presents. ‘Our relative is encouraged to make their own decisions on almost every aspect of their life.’ This was the comment of one of the relatives. The residents’ independence is being promoted by staff at Agatha House who offer them choice in choosing activities they enjoy and assisting them to develop in all aspects of their daily living skills. Throughout the inspection residents made choices about when they got up in the morning, when they had their meals, what they ate, and whether they went out or not. One resident wanted a new DVD player. He went out with a member of staff and chose to buy a silver rather than a black one. As a result residents feel they have more control over their lives and this is contributing to their life at Agatha House being such a positive experience for them. Residents’ files contain a risk management plan dated that has been signed by the manager, keyworker and the resident. The plan includes areas of risk and how they are to be managed in a way that ensures the resident’s safety, whilst promoting independence wherever possible. In one case a resident had had a number of falls when out of the home. The approach had been to refer the individual for occupational therapy and physiotherapy input to improve mobility Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 13 and ensure the person had the appropriate walking aid. As a result the individual is still able to go out, but with the necessary support in place. One resident had recently opened their own account so that they were more able to manage their own monies, rather than this being done through the home’s finance systems. As a result the resident had gained confidence in managing their own financial affairs. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is good at enabling residents to get out and about so that they lead as ordinary a life as possible. Residents are getting a better quality of life because of the good links with the local community and the range of leisure activities available. Staff support residents to keep in close contact with friends and family, as well as respecting their rights and encouraging them to act responsibly. Residents enjoy their meals and benefit from being offered a healthy diet. EVIDENCE: ‘I like going out shopping, cinema, having my lunch out. I enjoy my puzzles, watching television and listening to music when at home.’ Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 15 This was the comment of one of the residents. During the inspection residents were involved in a range of activities. Some went to the nearby day opportunities centre. One resident goes to a day centre for people with physical disabilities. One resident went with a member of staff to buy a DVD player, another went with a member of staff to get shopping and a notice board for the home. After dinner on the first day of the inspection most of the residents helped to tidy up the garden at the front of the home which they clearly enjoyed. Cultural and religious needs in this area are responded to. One resident had been helped by staff to attend a social club for people from his religious background. ‘The residents have plenty of trips to shops, parks and enjoyable short breaks to good quality hotels.’ This was the comment of one of the relatives. During the inspection residents went out and about into the community to a variety of locations. One resident has their own car through the motability scheme and goes out with staff on outings or short breaks. Residents were very positive about the holiday centre in Norfolk that they regularly stay at. One resident goes by themselves to the local shop to get a paper and other items. Staffing arrangements have been changed so that residents now get out more regularly at weekends. The experience of the residents at Agatha House therefore is that they are part of their local community. ‘I have always been welcomed at Agatha House and informed of any events for family and friends of Agatha House.’ This was the comment of one of the relatives. Surveys from other relatives confirmed that families of residents have close and effective relationships with staff at the home. Residents in most cases are having regular contact with their families. Residents said that they enjoyed seeing their families. As a result residents have felt more settled at Agatha House. Careplans note the residents’ needs and wishes in relation to personal and sexual relationships so that support can be offered appropriately in this area. Observation throughout the inspection indicated that staff treat residents with respect and are patient when encouraging residents to do something. One relative had commented: ‘With regard to my relative, who can be difficult at times, the staff show extreme patience and go to great lengths to meet their requests.’ This approach was reflected in the manager’s statement about the residents: ‘It’s their life, their home- we work here.’ Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 16 As a result the residents have all settled quickly and have transformed their new house into their new home. Residents interviewed said that they enjoyed mealtimes and get a choice about what they eat. We joined the evening meal where the residents and staff all sat around the dining table and talked about what had happened that day, the inspection that was going on, and doing some gardening after dinner. The residents were very relaxed over dinner and enjoyed the food provided. Each of them had chosen what they wanted, and when someone changed their mind just before dinner this was accommodated. Healthy eating is encouraged with regular weight checks made. In one case a resident had lost a significant amount of weight with the introduction of a healthier and more balanced diet. One resident had been offered food appropriate to their ethnic and religious background but had chosen over time to eat more traditional meals. Staff files showed that staff have food hygiene certificates. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are good at meeting the physical and emotional health needs of residents. As a result residents feel more at home and relaxed at Agatha House. The residents are protected by effective arrangements regarding medication in the home. EVIDENCE: ‘Our relative is very healthy and happy.’ ‘My relative, who resides at Agatha House, is very happy there, which speaks volumes of the staff and their support for my relative.’ These comments from relatives indicate how positive they are about how people are getting on at Agatha House. Residents themselves said that they Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 18 liked their new home. A keyworker system is in place to ensure that residents get the support they need that is appropriate to their individual situation. One resident said: ‘It is nice here. I like my keyworker- he helps me. ‘ In this case the keyworker had helped the individual to choose items of furniture for their room. The resident took pride in showing us their new furniture. The careplans are detailed and set out clearly how staff should respond to the individual needs and wishes of residents, with guidelines about any areas of risk. As a result residents have felt supported in their new home and have become more independent than previously. For example residents now take a greater part in the daily running of the home including preparing and clearing the dining table, taking clothes to the laundry, keeping their room clean & tidy. Interviews with staff showed that staff had a good knowledge of residents’ needs, interests and preferences. ‘We are always made aware of any healthcare needs for people who live at Agatha House. We are advised of any mobility, dietary and emotional needs. Keyworkers work together to ensure careplans are followed.’ This was the comment of a professional who had very regular contact with the home. Health needs are responded to with evidence seen of referrals made to other relevant professionals. The local psychiatrist sees the residents to assess their wellbeing and decide if changes in medication are needed. One resident file had recorded: ‘The psychiatrist was pleased that this individual was doing so well that they no longer needed to see them.’ Interviews with staff showed that staff had a very good knowledge of the health needs of each resident. We sat in on the staff handover meeting. Key information about current health issues in relation to residents was shared and appropriate action agreed. Medication arrangements were gone through with a member of staff and were satisfactory. The records relating to the administration of medication to residents were seen and indicated that a detailed record is being kept. On the day of the inspection an item of medication that had been dispensed had not been signed as administered by the member of staff. This omission was picked up at the daily handover meeting that checks the medication administration sheets. In this way any errors are picked up quickly and put right. All staff have had guidance about the home’s procedures regarding medication and have had specific training in the administration of medication. When residents lived at Oaktrees a pharmacist used to visit the home regularly to check and advise on the medication arrangements in place. It is recommended that this Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 19 arrangement is reinstated to ensure that there is an external check on medication arrangements which will help to ensure they are as safe and effective as possible. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The residents can be confident in the complaints procedures in the home that make sure their concerns are responded to whilst at Agatha House. The residents benefit from safeguarding adults procedures that make sure that they are safe and secure whilst at Agatha House. EVIDENCE: ‘Although we have never had any concerns over our relative’s welfare we would have every confidence in Agatha House to listen to and take on any concerns.’ This was the view of one of the relatives, and was supported by feedback from other relatives. Residents said they talk to staff if they are unhappy about anything. One resident said: ‘I do tell staff at the residents’ meeting when I’m not happy with something, and staff help me to complete my complaint in the complaints book. I have made a complaint about not getting out so much at weekends.’ The complaint record showed that this issue had been recorded and then discussed by staff. As a result staffing arrangements had been changed in the home so that there was additional staffing at weekends. This had resulted in residents being able to get out more regularly at weekends. The home’s Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 21 complaints leaflet has pictures and is written simply and clearly so that residents know how to go about making a complaint. The complaints book lists all complaints made and the action taken. The concerns of residents as well as more serious complaints are recorded and followed up. As a result residents have been empowered to raise issues that are important to them. They also do this at the regular weekly residents’ meeting. The home is to be commended on the high standard achieved in this area. It is recommended that an outcome column is added to make it easier to monitor and check the outcome of all complaints made to ensure the process is working as effectively as possible. Staff have attended training courses on how to protect vulnerable adults from abuse and know what to do if they think a resident has been the victim of any form of abuse. A member of staff was able to explain what action they needed to take if a resident was to make an allegation concerning abuse of any type. Regular in-house sessions are held to remind staff of their responsibilities in this area. The home has a copy of the London Borough of Barnet’s adult protection procedure. There had not been any adult protection allegations since the home opened. As a result residents are protected by the arrangements in place in the home in relation to safeguarding adults. The home keeps a record of any accidents in the home. Where accidents occurs the record showed that these are followed up and the appropriate action taken to ensure the safety of residents. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents at Agatha House enjoy a very attractive and comfortable living environment that adds considerably to their quality of life, with a high standard of cleanliness and hygiene maintained in the home. EVIDENCE: ‘I watched the house being built and was given a choice of decoration for my bedroom- I chose the curtains.’ This statement reflects the fact that residents were able to see and be involved in the setting up of their new home. This has helped the residents to feel they have a stake in Agatha House and as a result they have settled in more quickly as a result. Two of the residents took pride in showing us around their new Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 23 home, including most bedrooms, as well as the garden at the rear of the property. This is a new home that opened in 2007. The building, furniture and fittings still appear new and attractive and of a high standard. The building has deliberately been made very accessible not only for the benefit of the one existing wheelchair user but also for other residents as they age and their mobility decreases. Each person has a very spacious bedroom with en suite facilities. The communal areas are also spacious with a large lounge/dining area. There is an attractive and wheelchair accessible garden. The garden is well maintained, with a patio area and garden furniture so that residents can sit outside if they wish. Residents said that they liked their bedrooms. All the bedrooms seen contained plenty of personal items, including photos, and had a comfortable and homely feel to them. Residents appear settled and at home in their living environment and this was reflected in the way they assisted during the inspection with meal preparation and clearing up and keeping the garden tidy. The appearance of the home reflects diversity with a multi-faith calendar on the wall and pictures reflecting different cultures. ‘There is a cleaner in the home who cleans the communal areas every morning and staff assist me to clean my room also with my participation.’ On arrival at the home on the first evening one of the residents was being helped by a member of staff to clean their room. On the second day of the inspection a cleaner worked at the home. The cleaner comes in each weekday morning. Throughout the inspection the home had a very clean and hygienic appearance. Feedback from relatives was positive about the cleanliness of the home. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by the committed, competent and experienced team of staff at the home. Residents are protected by the home’s rigorous recruitment procedures for new staff. Residents enjoy a good quality of life because staff have the training and support they need to provide a high standard of care. EVIDENCE: ‘I feel the staff at Agatha House are extremely caring and responsive towards their residents and the relatives.’ This was the view of one of the relatives. Throughout the inspection staff were seen to take time in listening to and responding to the needs and wishes of residents. Most staff have supported the residents for several years and have got to know them very well. As a result close relationships have built up with Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 25 residents feeling very relaxed and confident with staff, and staff feeling committed to meeting the needs of residents. Most members of staff have either achieved the NVQ Level 2 in care or are currently working towards this. Staff interviews showed that staff have built a good knowledge of each resident’s needs and wishes and how to support them in a way that develops their confidence and skills as far as possible. The manager said that the home was fully staffed. The home has a manager, deputy manager, senior support worker, and a number of support workers. The staff rotas enable the home to have 2 care staff on duty each shift, sometimes 3. No agency staff members are used as the home uses relief staff employed by the London Borough of Barnet if necessary. At night one staff member sleeps in the premises whilst another remains awake. A cleaner is employed on weekdays mornings. A part-time administrative assistant is employed to check and maintain a variety of financial systems operated by Agatha House. A relative had written: ‘There have been occasions when my relative did not want to accompany the other clients on outings but because of shortage of staff they had to either go with them or else the whole group could not go.’ This issue was discussed with the manager who said that staffing rotas had been changed so that 3 staff were now available on Saturdays. As a result more outings are taking place at weekends, with more scope for individual wishes to be taken into account. However feedback from staff indicated that there were still constraints in this area, given that some residents need 1 to 1 support when out. It is recommended therefore that a review of existing staffing arrangements takes place to identify if additional staffing is needed to provide the level of stimulation and activities needed by residents, especially at weekends. Staff files were looked at and contained the information needed to make sure that all new staff in the home have had the appropriate checks made, including obtaining written references and satisfactory CRB (Criminal Records Bureau) disclosures. As a result residents are protected by the procedures Agatha House has in place when recruiting staff. Staff turnover at the home has been exceptionally low, with most staff having worked at the home for a number of years. ‘The staff team demonstrate extensive knowledge of individuals’ support and health care.’ This was the comment of a professional that worked closely with Agatha House. Staff interviews confirmed they had a good knowledge of each resident’s needs and wishes, including religious and cultural factors. A Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 26 member of staff had supported a resident to attend a church of their choosing. The staff team has attended a range of relevant courses, including safeguarding adults, medication, first aid, food hygiene and health and safety. As a result staff are more effective in how they support residents, as confirmed by the feedback received from both relatives and professionals involved with the home. Staff interviews indicated that they have knowledge of personcentred planning, with many elements of this approach in place in the home and some training provided. Given the importance of this approach in working with people with learning disabilities it is recommended that all care staff have further training in person-centred planning so that the home responds even more to the needs and wishes of the residents. Feedback from staff indicated that they are aware of personal and sexual relationship issues in relation to residents and have had training in this area in the past. Staff said they would value more training in this area so that they were more confident in how they supported residents in this area. It is recommended therefore that staff have further training in supporting people with learning disabilities with personal and sexual relationships. Staff said they felt well supported at Agatha House. Records showed they attended a variety of training courses, had supervision meetings with a senior member of staff to improve their care practice, and had annual appraisals. In some cases recorded supervision meetings were only just meeting the required frequency of six meetings/annum. It is recommended that a staff supervision schedule is drawn up for the year to ensure all staff at all times get the required frequency of formal supervision meetings. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42,43 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well run home, where members of staff respond to and act on comments and suggestions from residents about how the home is run. The home has good procedures in place in relation to health and safety that help to ensure residents are protected at all times. EVIDENCE: ‘I always visit unannounced and at varying times, not deliberately, and I have never been disappointed with how the home is and has been run.’ Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 28 This was the comment of a relative of one of the residents and reflected the positive feedback received about the home from families and professionals. Care practice at Agatha House is of a high standard with priority given to meeting the needs of residents. The manager’s attitude was summed up in his comment: ‘It’s their life, their home- we work here.’ Both the manager and deputy have achieved the Registered Manager Award. Throughout the inspection residents and staff were comfortable in approaching and talking to the manager. One resident said about the manager: ‘He’s a nice man- he does well.’ The London Borough of Barnet service manager for Agatha House visits the home monthly and reports on how the home is running and areas to be improved. Written feedback from relatives about the home was positive. Service user meetings are held regularly so that residents can contribute their ideas on the running of the home. The manager had completed the AQAA (Annual Quality Assurance Assessmnent) that provides detailed information about the running of the services and areas needing improvement. The home had recently surveyed residents and families for their comments on Agatha House with positive feedback received. As a result Agatha House is run in a way that is always trying to improve further the service on offer and is responsive to the key parties involved, especially the residents. A range of records was looked at, including health and safety and fire safety. These records were detailed, up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted on. The home had current certificates covering gas, electricity, portable appliance testing, and the hoists used in the home. A fire evacuation procedure is in place and displayed around the home. A fire safety risk assessment is in place and kept under review. Fire drills take place at 6 monthly intervals. It is recommended that given the needs of the current group of residents that drills are held at least quarterly so that residents become very familiar with this situation. The manager agreed this was appropriate and indicated he would implement this in future. The administrative assistant for Agatha House was interviewed and she provided evidence that there are rigorous financial procedures in place in relation to Agatha House in order to ensure it is run in a proper manner and that the finances of residents are safeguarded. The London Borough of Barnet has a corporate business plan for learning disability services but does not have an annual development plan that is specific to Agatha House. This should incorporate the local authority’s business plan in order to show that the required funding is in place for the planned service developments, as well as Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 29 indicating on an annual basis the home’s objectives and priorities. The London Borough of Barnet must ensure that Agatha House has a satisfactory annual development plan in place. Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 4 2 4 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 x 30 4 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 4 LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 4 X 3 X X 3 2 Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 31 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 YA43 Regulation 25 (2) (c) Timescale for action The London Borough of Barnet 31/08/08 must ensure that Agatha House has a satisfactory annual development plan in place. Requirement 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 YA20 Good Practice Recommendations A pharmacist should regularly inspect medication arrangements at Agatha House to ensure that they are as safe and effective as possible. An outcome column should be added to the complaints book to make it easier to monitor and check the outcome of all complaints to ensure the process is working as effectively as possible. A review of existing staffing arrangements should take DS0000068781.V364567.R01.S.doc Version 5.2 Page 32 2 YA22 3 YA33 Agatha House place to identify if additional staffing is needed to provide the level of stimulation and activities needed by residents, especially at weekends. 4 YA35 All care staff should have further training in personcentred planning so that the home responds even more to the needs and wishes of the residents. Staff should have further training in supporting people with learning disabilities with personal and sexual relationships so that residents are fully supported in this area. An annual staff supervision schedule should be drawn up to ensure all staff at all times get the required frequency of formal supervision meetings. 5 YA35 6 YA36 Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Agatha House DS0000068781.V364567.R01.S.doc Version 5.2 Page 34 - 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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