Inspection on 19/11/07 for Agnes House

This inspection was carried out on 19th November 2007.

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 found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Agnes House 28/04/09

Agnes House 24/07/08

Agnes House 24/05/07

Agnes House 09/06/06

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

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

CARE HOME ADULTS 18-65 Agnes House 11a Arthur Road Erdington Birmingham West Midlands B24 9EX Lead Inspector Brenda O’Neill Unannounced Inspection 19th November 2007 09:00 Agnes House DS0000067024.V350606.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 Agnes House DS0000067024.V350606.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. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Agnes House Address 11a Arthur Road Erdington Birmingham West Midlands B24 9EX 07718 628 757 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) Angel Care Homes Limited vacant post Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents must be aged under 65 years. The home can care for two named service users who are over 65 years of age, which is outside the category of registration 2 (MS (OP)). Date of last inspection Brief Description of the Service: Agnes House was previously two domestic properties, which have been modified and adapted. It is located in a residential area on the outskirts of Erdington and is convenient to local shops, colleges, transport and leisure facilities. Agnes House is owned and managed by Angel Care Homes Limited and the Responsible Person is Mrs Balver Bislar. The home is registered to accommodate up to 14 people with mental ill health. The people living in the home are all male and they all have single bedrooms. The home has three lounges. One of these is equipped with a tea bar where the people living in the home can help themselves to drinks and snacks. The home is suitable for people with near full mobility. There is a large garden to the rear of the home. There is a small amount of parking space on the drive of the home but visitors are also able to park on the road outside the home. The service user guide for the home stated the fees at the home ranged from £323.00 to £500.00 per week. This applied at the time of the inspection and the reader may wish to obtain more up to date information from the care service. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out by two inspectors over one day in November 2007. During the course of the inspection a tour of the home was undertaken, three files for the people living in the home were sampled as well as other care, health and safety and training documentation. The inspectors spoke with the acting manager two staff members and four of the people living in the home. Prior to the inspection one of the proprietors had completed an Annual Quality Assurance Assessment (AQAA) which gave some additional information about the home. Six questionnaires were sent out to the relatives of the people living in the home. Three of these were returned. The home had also had a random inspection in August 2007 to assess the progress being made on the requirements made following the inspection on 24/05/07. During this inspection a tour of the home was undertaken, care plans, risk assessments, daily records and staff files were sampled and an audit was undertaken on the medication in the home. The outcome of that inspection is commented on throughout this report. The home had not logged any complaints since the last key inspection. However it was clear when reading one of the files for the people living in the home that he had made a written complaint to the acting manager. There was no evidence that this had been responded to. Some concerns had been raised with the Commission just prior to the inspection. These were around the circumstances of one of the people living in the home being admitted to hospital when outside the home and the home had not reported the person missing. It was clear from the individual’s risk assessment that they would not have been reported missing at this early stage as they were out and about all the time. No adult protection issues had been raised about the home since the last key inspection. What the service does well: The people living in the home that were spoken with were satisfied with the staff team and friendly relationships were evident. Comments received from relatives included: ‘They take care of thirteen clients and each has different needs which staff cope with reasonably well.’ ‘I think they do a good job.’ ‘It seems to be looking after my son’s needs at the moment and he seems quite content.’ Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 6 During the course of the inspection it appeared that staff did listen to what the people living in the home were saying and there were regular meetings with them where they could raise any issues. However it was not always clear if there views were acted on. It appeared that people living in the home were encouraged to do things around the home, for example, keep the tea bar tidy and tidy their bedrooms. Clearly people saw their relatives and friends when they wanted to. Records indicated that the people living in the home often went out with relatives and went to visit them independently. The people living in the home were accessing local community facilities including the shops, pubs, doctors’ surgeries and the library. The home was organising trips out at least once a month to places such as Blackpool, Cardiff and Chester Zoo and these were well attended by the people living in the home. What has improved since the last inspection? The statement of purpose and service user guide had been updated and included all the information people would need to help them decide if they wanted to move into the home. The person that had been allocated a very small bedroom had been moved to a much more suitable room. There had been some improvements to the care planning and risk assessments in the home for the people living there. The people living in the home were more involved in this process. However further improvements were required. The rights and responsibilities of the people living in the home were being better recognised at the time of this inspection. The daily records had improved in terms of the terminology being used by staff and showed much more respect for the people living in the home. The recording of how people’s health care needs were being met had improved. And evidenced they received the health care they needed. A comment received from a relative stated: ‘He has a consultant and they are very good if he needs access to my son. My son is registered with a local G.P. and they are very good in arranging for my son to see him in respect of minor illnesses that arise which they do frequently.’ There had been little staff turnover which was good for the continuity of care of the people living in the home. Staff training had improved ensuring more of the staff could work safely with the people living in the home. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 7 There had been further improvements to the environment making it more acceptable to the people living in the home. The management of the home had improved ensuring safer outcomes for the people living there. What they could do better: Care plans need to be further developed to include all the needs, aspirations and goals of the people living in the home and how staff are to help people meet their needs. This will ensure people living in the home receive person centred care. To ensure the people living in the home are fully safeguarded risk management plans that are not having the desired effect must be reviewed at the earliest opportunity and alternative plans put in place. Risk assessments that identified the mental health needs of the people living in the home needed to be specific and not included in other risk assessments and include early warning indicators of relapse and inform staff of what they must do. To ensure the people living in the home receive their medication as prescribed there needed to be a complete audit trail for all medication. All complaints made by the people living in the home needed to be appropriately recorded, investigated and responded to. This will ensure the views of the people living in the home are listened to and acted on. To ensure the physical environment of the home is acceptable to the people living in the home an updated refurbishment plan must be forwarded to the Commission that includes the kitchen, bathrooms, toilets and any work outstanding in the bedrooms. There needed to be improvements made to the infection control procedures in the home to ensure people were not put at risk of cross infection. The shortfalls noted in the staff training needed to be addressed to ensure all the staff were equipped with the necessary skills and knowledge to care for the people living in the home. Some further improvements were needed in the management of health and safety to ensure the people living in the home were fully safeguarded. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 8 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. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 9 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 Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 10 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, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of the people wanting to live in the home were being fully assessed prior to admission to ensure the home was able to meet them. People wanting to move into the home could visit prior to admission to assess the facilities available to them. EVIDENCE: Information received in the AQAA stated that the home had an up to date service user guide and statement of purpose defining the service offered. The inspectors were told that both documents had been updated as required at the last key inspection to ensure they did not conflict with each other and ensuring people wanting to use the service had all the necessary information available to them. The service user guide was looked at briefly to ensure it included information details on the range of fees charged at the home. This information had been included. The file for one of the people living in the home was sampled and this showed that the person had visited the home prior to admission and staff had written a brief outcome of the visit. The file also included very comprehensive information from the admitting authority about the person which gave detailed information about the person’s history and mental health issues. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 11 The home had their own assessment documentation however this was quite brief and needed to be developed so that when necessary they could undertake their own comprehensive assessments. The file also included a copy of the placement agreement from the Local Authority and a terms and conditions of residence at the home (contract). The contract did not include the room number to be occupied or the fees. Numerous issues were raised at the last key inspection as the home were over numbers and the office had been utilised as a bedroom which was unsuitable. At the random inspection in August the home was within numbers and plans were in place to move the person from the converted office. At the time of this inspection the person who was occupying the small room that was the office had moved to a larger room. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 12 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 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The systems in place for care planning and risk assessments had improved further detail was required to ensure that staff knew how all the needs of the people living in the home were to be met and any risks minimised. EVIDENCE: At the time of the random inspection there had been some improvements in the care plans for the people living in the home. At this inspection there were two versions in use and both had some good points. However both needed more detail of how staff were to support the people living in the home and they needed to include individuals’ goals and aspirations and how staff were going to help them achieve these. At the time of this inspection three care files were sampled, two thoroughly and one briefly. All the files included care plans and booklets entitled ‘about me’. The booklets were written as if the statements had been asked of the people living in the home, for example, ‘special things I want you to know Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 13 about me’, ‘how I express myself’, ‘what makes me happy’ and ‘what I dislike.’ The booklets also included details of the individuals preferred routines and likes and dislikes in relation to diet. The booklets did give a lot of information about the individuals but the things they had identified as being what they liked to do, for example, painting and drawing were not mentioned in the care plans or how staff were to support the person to do this. One person had stated he liked Caribbean food. There was no mention on the care plan of how he was to get this food. One person stated he did not like anyone to touch his hair but wanted staff to wash it for him. The care plan did not reflect that staff would need to be cautious when supporting with this task. The care plans were easy to follow but did need to include all the needs that had been identified in the booklets and how staff were to offer support for these. Staff also needed to ensure that care plans included all the information staff needed to know to support the person with all their needs. One individual did not like to acknowledge he had a problem with incontinence but staff still needed to know how to support the person with this. Some of the care plans included some very good detail of the needs of the people living in the home and how staff were to meet them, for example, communication, diabetes and bedroom hygiene. The care plans still did not include individual goals and aspirations and how staff were to help them achieve these. The system in place for risk assessments had improved at the time of the random inspection and this improvement had been maintained. Risk assessments had been individualised and cross referenced to the care plan. Some of the risk assessments were very comprehensive, for example, one for offending behaviour detailed exactly how staff were to manage the behaviour to a satisfactory conclusion, another for diabetes was very clear of what staff should look for should the illness deteriorate. Others were more vague, for example, one person had three risks rolled into one and these needed to be separated and specific for each risk. Staff also needed to ensure that there were risk assessments that specifically detailed how staff would recognise when an individual’s mental health was deteriorating and what they should do about it. There was some information, such as ‘how I express myself’ and ‘managing my behaviour’ in the booklets but it was not clear if the comments under these headings were an indication of a relapse in the person’s mental health. The acting manager was able to give examples of how they knew when someone’s mental health was deteriorating and what he would do about it but this needed to be documented so that staff had all the information they required to care for the people living in the home. The inspectors had some concerns about the precautions in place for the people who were smoking in their bedrooms. One of the people living in the home had signed an agreement to say he would not smoke in his bedroom because of safety issues. Clearly he was still doing this and burning the carpet, linen and dropping cigarette ends on the floor. The acting manager and the proprietor were advised they were to address this with the individual urgently Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 14 as he was not only a risk to himself but also to other people in the home. If risk management plans are not working they must be reviewed at the earliest opportunity and alternative plans put in place to ensure the people living in the home are not put at risk unnecessarily. The inspector spoke to the acting manager about this a little after the inspection and a meeting had been held with the individual and a new management plan was in place. There had also been a meeting with the individual and the health care professionals involved with him. It was evident throughout the course of the inspection that the people living in the home made some decisions about their lives in relation to how they spent their time, what they ate and coming and going from the home as they pleased. Some limitations were imposed when people were deemed to be at risk, for example, smoking and alcohol consumption. Where there were restrictions put on individuals they had been fully informed of these and why. Some of the people living in the home were able to manage their own finances others were supported by the acting manager. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 15 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 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home were being encouraged to have a more independent lifestyle. Staff were recognising the rights and responsibilities of the people living in the home on a day to day basis. The people living in the home were satisfied with the meals being served. There was no evidence that the home was meeting the dietary needs of individuals in relation to culture or medical needs. EVIDENCE: It appeared that people living in the home were encouraged to do things around the home, for example, keep the tea bar tidy and tidy their bedrooms. The minutes of the meetings with the people living in the home indicated that people cooking for themselves and doing their own washing had been discussed but there was no evidence in the daily records that this had been followed up. There was evidence that one person did his own washing but this had been happening for a considerable amount of time. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 16 There were some leisure facilities available in the home, for example pool table, dartboard and books. It was difficult to determine what leisure activities the people living in the home took part in as the daily records were very brief. There were some comments about people playing pool and bingo, going into the garden, going out for a drive and making drinks for themselves and others. The people in the home did not have any activity plans in place therefore it was difficult to determine if their needs were being met. It was not clear from the records if the things people had indicated they liked doing, for example, drawing and painting were actually happening due to the lack of detail in the daily records. At the time of the random inspection four of the people living in the home were spoken with and they appeared quite happy. One spoke to the inspectors of having his hair cut and going out to the shops, another told the inspectors he had helped put the shopping away and another told us about the take away meal he had the night before. At the time it was discussed that this was the information that should be in daily records to evidence what type of lifestyle people were experiencing. This had not been addressed. The people living in the home were accessing local community facilities including the shops, pubs, doctors’ surgeries and the library. Throughout the day of the inspection people living in the home were seen to come and go as they pleased. One of the people living in the home was attending a college and another went to a day placement. The acting manager stated they were looking into college courses for some of the people living in the home who had expressed an interest in particular topics. The home was organising trips out at least once a month to places such as Blackpool, Cardiff and Chester Zoo and these were well attended by the people living in the home. Clearly people saw their relatives and friends when they wanted to. Records indicated that the people living in the home often went out with relatives and went to visit them independently. The rights and responsibilities of the people living in the home were being better recognised at the time of this inspection. For example restrictions were put on people if it affected the lives of others. All the people living in the home had been given a key for the front door and all of them were able to lock their bedroom doors if they wanted privacy. Staff spoke to the people living in the home in a respectful manner and the interactions seen were appropriate. The daily records had improved in terms of the terminology being used by staff and showed much more respect for the people living in the home. There were menus in the home which were varied and nutritious however the food records indicated that these were often changed. It appeared the changes were made by staff without consultation with the people living in the home. If menus are to be changed the people living in the home should be consulted Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 17 and their views taken into account. The records did evidence some choices were available however they were not specific enough and did not detail exactly what people had eaten. It could not be determined from the records that cultural or medical diets were being catered for. The people living in the home that were spoken with were satisfied with the meals being served. There have been issues at past inspections over the stocks lack of food stocks in the home. This had improved at the last inspection and the improvement had been maintained at this inspection. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 18 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 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans for the people living in the home detailed their needs in relation to personal care and how these were to be met by staff. People’s physical and mental health care needs were being met. The management of medicines had improved and ensured people received their medicines as prescribed. EVIDENCE: At the time of the last key inspection several concerns were raised about the lack of detail in the care plans in relation to the personal care needs of the people living in the home, no details of any specific cultural needs and the daily records suggesting that personal care was not being given appropriately. At the time of the random inspection in August 2007 there had been some improvements. Further improvements were required so that the care plans included details of how personal care needs were to be met by staff. At the time of this inspection there had been some further improvements. Personal care needs were included in the care plans with some detail of how these were to be met by staff. For example, one care plan detailed that the Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 19 individual was able to maintain his personal hygiene and only wanted staff to wash his hair. Another was clear about the issues in relation to the poor hygiene in one of the individual’s bedrooms and how they were to support the person with this. There was also evidence that staff were supporting people to set up personal hygiene plans for them to follow. It was still not clear if any of the individuals had personal care needs in relation to their culture. The terminology being used in the daily records had improved but the records still did not evidence when staff were assisting or supporting people with their personal care to any degree. At the time of the last key inspection concerns were raised about the lack of information on the files about any ongoing health concerns the people living in the home may have, how any health care concerns were being followed up and monitored and the lack of health care action plans. There had been a vast improvement in this at the time of this inspection. Care plans and risk assessments detailed such things as diabetes and what staff were to watch for to indicate any deterioration in this. Records clearly detailed visits to and from health care professionals including, G.Ps, psychiatrists, opticians, community psychiatric nurses and people having their medication levels checked. One of the comments received from a relative in relation to health care was: ‘He has a consultant and they are very good if he needs access to my son. My son is registered with a local G.P. and they are very good in arranging for my son to see him in respect of minor illnesses that arise which they do frequently.’ It was recommended that health care action plans are developed for the people living in the home so that all their health care needs and how these are to be met are detailed in one place making it easier for staff to find and record information. At the time of the last key inspection several issues were raised with the acting manager in relation to the management of the medication system. At the time of the random inspection in August 2007 this had improved vastly. At the time of this inspection the improvements had been sustained and there was only one requirement made. Staff needed to ensure that all medication was booked onto the Mar (medication administration sheets) when they were received into the home to ensure a complete audit trail. It was also recommended that when hand written entries were made on the MAR charts two staff witnessed these as being correct. The inspectors were informed that only staff that had received the appropriate training were administering medication. Agnes House DS0000067024.V350606.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): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in the home were listened to but it could not be determined if their views were acted on. The systems in place in the home and the training staff received ensured the people living in the home were safeguarded. EVIDENCE: The home had not logged any complaints since the last key inspection. However it was clear when reading one of the files for the people living in the home that he had made a written complaint to the acting manager. There was no evidence that this had been responded to. The acting manager stated this had been addressed. The complaint was in relation to staff going into the individual’s room and he did not think they should do this. Due to health and safety reasons staff did have to enter this person’s room however the complaint should have been formally logged and responded to and records kept of any actions taken. Some concerns had been raised with Commission just prior to the inspection. These were around the circumstances of one of the people living in the home being admitted to hospital when outside the home and the home had not reported the person missing. It was clear from the individual’ risk assessment that they would not have been reported missing at this early stage as they were out and about all the time. However there had been an incident two days before the hospital admission and at this point the risk assessment should have been reviewed to ascertain if the risks of the person going out had changed. Any changes to the assessment would not have avoided the person Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 21 being admitted to hospital due to the nature of the diagnosis but it may have prevented the person being on their own. During the course of the inspection it appeared that staff did listen to what the people living in the home were saying and there were regular meetings with them where they could raise any issues. However it was not always clear if there views were acted on. Comments received from relatives indicated they did know how and who to complain to. Comments were: ‘I would know who to make a complaint to’ ‘There are one or two issues which I feel I can take up with the management at this time its nothing too important.’ No adult protection issues had been raised about the home since the last key inspection. It was known by the inspector that there were policies and procedures available in the home in relation to adult protection. There had been further training for the staff this year in adult protection issues. The training matrix indicated that only two staff still required this training. At the last two inspections requirements have been in relation to the systems in place for managing the money of the people in the home. At the time of the last inspection in some instances the documentation needed to be more precise and the registered person did need to ensure that the people living in the home who were unable to manage or understand their finances got the appropriate support. These issues had been addressed at the time of this inspection. The records sampled at the time of this inspection detailed all income and expenditure, receipts were available and there were two staff signatures on the records wherever possible. It was recommended that when money towards fees was taken from the accounts the period to which the payment applied be included as this would provide a clear audit trail. Agnes House DS0000067024.V350606.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, 25, 27, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some improvements had been made to the environment however further upgrading was required to ensure the environment was kept to an acceptable standard and safe for the people living in the home EVIDENCE: The proprietors of the home had submitted a refurbishment plan for the plan as the environment was of concern. At the time of the last key inspection the plan was being followed and the dates met. At the time of the random inspection there had been some further improvements but the dates on the refurbishment plan had not been met. For example, the plan detailed that between April and July the front downstairs hallway would be refurbished this had not been done. At the time of this inspection further work had been undertaken in the home however the refurbishment plan was not up to date and the proprietors needed to submit an updated plan that detailed when all the required work was due to Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 23 be undertaken. This was discussed with one of the proprietors at the time of the inspection. He stated the plan had fallen behind due to unforeseen repairs being needed, for example, water leaks. At the time of the random inspection the smoking room had been relocated to the back of the home and new furniture had made the room very comfortable for the people living there. There had also been new dining room chairs and tables purchased. At this inspection several issues were raised about the infection control procedures in the home these included, the sealant around the kitchen sink had not been replaced and needed to be addressed, there were foods being stored in the main fridge that had not been dated on opening, the fridge in the small kitchenette was very dirty and the seal was splitting badly and there were personal toiletries around the communal facilities including hard soap and sponges. Some of the sponges were very dirty. In the ground floor bathroom there was also an electric razor and hairbrush. These issues had been addressed at the time of this inspection. It was noted that the microwave in the kitchen had not been replaced and was rusting. The acting manager removed this and a new one was purchased the same day. The other improvements noted at this inspection were: - All the corridors downstairs had been painted and those upstairs were being done. - One of the bedrooms had been totally refurbished and others repainted. - The person that had been sleeping in the small room that was the office had moved into a larger room and the office had been moved back into the smaller room. - All the bedroom doors had been fitted with locks that were easily accessed by staff in the case of emergency. However it was noted that one of the bedrooms still had a working Yale lock which meant that staff would not be able to gain access should the person drop the catch on this. There were also some rooms where old locks had been removed and holes had been left in the doors making them unsafe as fire doors. Issues noted at this inspection were: - All the toilets and bathrooms were in need of refurbishment, skirting boards were coming away from the walls, flooring was worn, tiles were old and the grouting stained and so on. - The carpet in some of the bedrooms was very old and could not be cleaned. One bedroom had two very dirty mats and these needed to be replaced with washable mats. The stair carpet was dirty. - Some bedrooms were still in need of redecoration. - A fan heater was being used by one of the people living in the home and the vents on the top of this were very dirty and blocked making it unsafe. This needed to be removed. - All the chopping boards in the kitchen were worn and needed to be replaced. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 24 - Fresh food was not being dated when frozen. Fridge and freezer temperatures were not being monitored for all appliances. The cutlery drawer in the kitchen was quite dirty. Kitchen work surfaces were quite worn in parts. Mops in the laundry looked quite dirty and worn. Colour coded mops should be used throughout the home and these should be washed regularly. The updated refurbishment plan needed to include dates for when the kitchen, bathrooms and toilets were to be refurbished and when outstanding work in the bedrooms was to be completed. The communal lounges were furnished and decorated to an acceptable standard and the people living in the home appeared comfortable. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 25 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, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels at the home were appropriate for the needs of the people living in the home. Staff recruitment and training had improved. Some gaps remained in staff training which could potentially put the people living in the home at risk. EVIDENCE: At the time of the last key inspection numerous issues were raised in relation to staffing including, staffing levels, poor recruitment and lack of staff training. At the time of the random inspection in August 2007 there had been some improvements. The same staff files were sampled as had been sampled at the last inspection in May. The files included almost all the necessary information and evidence of CRB checks being undertaken. Two references were still outstanding and needed to be followed up. Clearly the majority of this information had been obtained after the employees had started work at the home and the acting manager and the proprietor were advised they must not let this happen again. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 26 There was some evidence of induction training for new staff however this was just a checklist and it was all signed off on one day. The training matrix for the staff group had not been updated and clearly there were several gaps in training that must be addressed. At the time of this inspection the rotas indicated that the manager was now working five days a week giving extra cover to the home. The issues raised over on calls had been resolved and these were being shared by two staff. There were still only two staff on over the weekend however the inspectors were advised that if necessary extra staff would be brought into the home. Staff turnover had been very low since the last key inspection which was good for the continuity of care of the people living in the home. Relationships between the staff and the people living in the home were good. Comments received from relatives included: ‘They take care of thirteen clients and each has different needs which staff cope with reasonable well.’ ‘I think they do a good job.’ ‘It seems to be looking after my son’s needs at the moment and he seems quite content.’ The inspectors were told no new staff had been recruited therefore it was not possible to check that recruitment procedures were being followed. The two outstanding references noted at the random inspection had been obtained. An updated training matrix was available at this inspection. This indicated there had been a vast improvement in the training staff had undertaken. Training undertaken recently included, health and safety, food hygiene, manual handling, adult protection and first aid. The acting manager and another staff member had also undertaken some training directly related to mental health needs. It was strongly recommended that all staff undertake this training. The training matrix showed that three staff had quite a few gaps in their training and this needed to be addressed. Also staff had not had fire training for just over twelve months and this needed to be addressed. Five of the ten support workers at the home had NVQ level 2 or above giving the home the required fifty percent. Another four staff were undertaking their NVQ level 2. As no new staff had been recruited it was not possible to assess the induction training being undertaken therefore the requirement for this has been left in this report. Agnes House DS0000067024.V350606.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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home had improved and it was running smoothly. Further improvements were required to ensure the people living in the home were entirely safe. EVIDENCE: Clearly the management of the home had improved ensuring safer outcomes for the people living there. Care plans, risk assessments and staff training had all been improved since the last key inspection. The acting manager had increased his hours and was working five days instead of four and this was also benefiting the home. He had got to know the people who were living in the home well and they were very comfortable in his presence. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 28 The Commission had not received an application for the registration of the acting manager. He had applied for the manager’s post of a domiciliary care agency that was being set up by the proprietors of the home. If he is successful with this the proprietors must notify the Commission of the management arrangements for the home. The Commission must be assured the home will not go into decline should the acting manager leave. The home still did not have a formal quality monitoring system in place. There were regular meetings with the people living in the home and the minutes for these were seen. Topics discussed included leisure activities, their responsibilities within the home i.e. keeping the tea bar clean, encouraging independence in relation to people cooking and doing their own laundry. There were also staff meetings. The home needed to have a quality assurance system in place based on seeking the views of the people living in the home with a view to continuous improvement. The proprietor spoken with stated that regulation 26 visits were being undertaken and the AQAA stated there were regular regulation 26 visits. However the only records on site for these were one for February and one for October. It is strongly recommended that the reports of these visits are forwarded to the Commission so that progress in the home can be monitored. At the time of the last key inspection the home had not been notifying the Commission as required of any incidents in the home. This had improved greatly and all accidents and incidents were being notified. The information asked for on the AQAA in relation to the maintenance of equipment had not been completed. The records on site were checked. These showed that all the in house fire checks on the fire system were up to date, regular fire drills were undertaken, gas appliances had been serviced and the bath hoist serviced. The last fire inspection detailed that two emergency lights were required and this needed to be addressed. Also although the bath hoist had been serviced the only evidence of this was a payment slip. The home needed a certificate stating it was left in good working order. Other issues raised during this inspection in relation to health and safety included, infection control, staff needing fire training and the Yale lock on one of the bedrooms. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 29 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 3 2 2 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 2 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 2 X Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 30 Yes. 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 YA9 Regulation 13(4) Requirement Risk management plans must be reviewed when they are not having the desired effect and alternative plans put in place. Risk assessments that identify the mental health needs of the people living in the home must be specific and not included in other risk assessments and include early warning indicators of relapse and inform staff of what they must do. This will ensure the people living in the home are safeguarded. There must be a complete audit trail for all medication held in the home. This will ensure the people living in the home are receiving their medication as prescribed. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 31 Timescale for action 01/01/08 2. YA20 13(2) 01/01/08 3. YA22 22(3) The registered person must ensure that all complaints made by the people living in the home are appropriately recorded, investigated and responded to. This will ensure the views of the people living in the home are listened to and acted on. The registered person must ensure that an updated refurbishment plan is forwarded to the Commission that includes the kitchen, bathrooms, toilets and any work outstanding in the bedrooms. This will ensure the standard of the environment is acceptable for the people living in the home. The fan heater in use in one of the bedrooms must be removed. This will ensure the people living in the home are safeguarded. All areas of the home must be kept clean. The chopping boards in the kitchen must be replaced. Fresh food must be dated when frozen. The temperatures of all the fridges and freezers must be monitored. Old mops must be replaced 01/01/08 4. YA24 23(2)(a)(b) 01/01/08 5. YA24 13(4)(c) 01/01/08 6. YA30 13(3) 01/01/08 Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 32 with colour coded equipment that is washed regularly. This will enhance the infection control procedures in the home. The registered person must ensure that all new staff undertake induction training in line with the specifications laid down by Skills for Care. This will ensure new staff have the knowledge and skills to care for the people living in the home. (Previous time scale of 14/07/07 not met. Time scale of 14/09/07 not assessed as no new staff.) The registered person must ensure that: The shortfalls highlighted on the training matrix for three staff are addressed. That all staff have updated fire training. (Previous time scale of 01/10/07 not met.) This will ensure the staff can care for the people living in the home safely. Locked bedroom doors must be accessible to staff in the case of an emergency. This will ensure the people living in the home are accessible in an emergency. (Previous time scales of 14/07/07 and 01/09/07 Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 33 7 YA35 18(1)(c) 01/01/08 8 YA35 18(1)(c)(i) 23(40(d) 31/01/08 9 YA42 13(4)(c) 01/01/08 not met.) 10. YA42 13(4)(c) The issues highlighted on the fire inspection in relation to the emergency lights must be addressed. This will ensure the people living in the home are fully safeguarded. 01/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA2 Good Practice Recommendations The statement of terms and conditions of residence at the home/contract should include details of the room number to be occupied and the fees to be paid. This will ensure the people living in the home have the information they need. The home should develop their own pre admission assessment documentation to ensure it covers all the required areas and that they would gather all the necessary information. Care plans should include all the needs of the people living in the home including their goals and aspirations and detail how these needs are to be met by staff. The people living in the home should wherever possible have structured weekly activity programmes in place that they have been involved in so that staff know what they would like to do and offer the required support to help them achieve their goals. Daily records should be further developed to show how the people living in the home are spending their time. Food records must show how the medical cultural needs of the people living in the home are being met. All the people living in the home should have health care action plans in place. This will ensure both the physical and mental health care needs of the people living in the home are met. It is recommended that when hand written entries are made on the MAR charts two staff witness these as being correct. DS0000067024.V350606.R01.S.doc Version 5.2 Page 34 2. YA5 3. 4. YA6 YA12 5. 6. 7. YA12 YA17 YA19 8. YA20 Agnes House 9. YA23 10. 11. YA35 YA37 12. YA39 13. 14. YA39 YA42 It was recommended that when money towards fees was taken from personal accounts the period to which the payment applied be included as this would provide a clear audit trail. The registered person should explore the possibility of staff undertaking training in relation to caring for people with mental health needs. If the manager is successful in becoming the registered manager for another service the proprietors must notify the Commission of the management arrangements for the home. The Commission must be assured the home will not go into decline should the acting manager leave. The home must implement a system of self-monitoring assessment to determine its performance against its goals and objectives. This will ensure plans are in place to continuously improve the service for the people living in the home. The registered person should forward the Regulation 26 visit reports to the Commission so that progress on the management of the home can be monitored. The home should have evidence on site that when the bath hoist was serviced it was left in good working order. Evidence of this was sent to the Commission prior to this report being sent out. Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Agnes House DS0000067024.V350606.R01.S.doc Version 5.2 Page 36 - 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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