Inspection on 24/07/08 for Agnes House

This inspection was carried out on 24th July 2008.

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 15 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 19/11/07

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 08/11/2008.

CARE HOME ADULTS 18-65 Agnes House 11a Arthur Road Erdington Birmingham West Midlands B24 9EX Lead Inspector Brenda O`Neill Key Unannounced Inspection 24th July 2008 09:30 Agnes House DS0000067024.V368219.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.V368219.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.V368219.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 0121 241 6825 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 Manager post vacant Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia (MD) 14 2. The maximum number of service users who can be accommodated is: 14 19th November 2007 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 and a dining area. The dining area 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. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 5 The service user guide for the home stated the fees at the home ranged from £323.00 to £700.00 per week. Not included in the fees were hairdressing dry cleaning and extra curricular activities. 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.V368219.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes. Two inspectors carried out this key inspection over one day in July 2008. 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 manager, three 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. No complaints had been logged at the home since the last inspection. Some concerns were lodged with us just prior to the inspection in relation to a person who used to live at the home. At the time of writing this report these had been forwarded to the provider to investigate. No adult protection issues had been raised with us since the last inspection. However whilst we were at the home staff raised an issue with us about a staff member being verbally abusive to some of the people living in the home. This was discussed with the manager and one of the owners of the home. The manager then reported the allegation to Social Care and Health who made the decision not to follow this up but for the home to do their own investigation. This was still in the process at the time of writing this report. What the service does well: People wanting to move into the home could visit before admission to assess the facilities available to them. Overnight stays were available if people wanted these. Observations made indicated people were able to make choices and decisions in their everyday lives. The people living in the home were accessing local community facilities including the shops, pubs and doctors’ surgeries. Throughout the day of the inspection people living in the home were seen to come and go as they pleased. The people living in the home spoke to us about using the local adult education centres. The home was still organising monthly trips out both locally and further a field. These were discussed at meetings with the people living in the home to ask if they had enjoyed them. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 7 The people living in the home that we spoke to were satisfied with the food being served in the home. The minutes of the meetings held with them indicated that they were asked about the menus and if they liked the food in the home. The people living in the home had been made aware of how to raise any issues or concerns they may have. There had been little staff turnover at the home which was good for the continuity of care for the people living in the home. There were generally good relationships between the staff and the people living in the home. What has improved since the last inspection? What they could do better: There needed to be evidence on site that a pre admission assessment had been undertaken of any people admitted to the home. This would ensure there is evidence that the home have identified they can meet the needs of the people admitted to the home. Risk management plans needed to detail how all risks would be managed to a satisfactory conclusion and be cross referenced to any other relevant documentation. This would ensure any identified risks are minimised as far as possible. To ensure the confidentiality of the people living in the home the registered person needed to ensure that the records of the people living in the home were secure and complied with data protection regulations. To ensure the people living in the home received their medication as prescribed staff needed to ensure they only signed for medication when it was administered. The registered person needed to ensure staff were aware of their obligations under the Whistle Blowing policy for the home to report any issues without delay so that they can be acted on. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 8 The home only provided a basic standard of accommodation for the people living there. Considerable improvement was needed to ensure the home was of an acceptable standard and entirely safe for the people living there. Several requirements have been made in relation to the premises. To ensure new staff had all the necessary skills and knowledge to fulfil their roles the registered person needed to ensure that induction training was in line with the specifications laid down by Skills for Care. 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.V368219.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.V368219.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was information available for people wanting to move into the home to help them decide if the home could meet their needs. 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: The home had recently updated their statement of purpose and service user guide. The service user guide needed some minor amendments as it stated the home employed ancillary staff that they did not have. All the other required information that people who might want a service would need to know was included. The front cover of the statement of purpose for the home stated they were a ‘residential care home for people with mental disorder, learning disability and dementia.’ There are references made to these categories periodically throughout the document. The registration category for the home clearly states they cannot care for people with a learning disability or dementia and this cannot be included in their statement of purpose without prior consultation with the Commission. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 11 There had been one person admitted to the home since the last inspection. The file for this individual was sampled for evidence of a pre admission assessment. The file indicated social workers and mental health teams had been involved in the admission, as there were various letters and documents from them but no full assessment. The only documentation on file from the home was the initial referral form. The manager stated he had undertaken an assessment however the documentation for this could not found. The diary for the home indicated the individual had visited the home on several occasions prior to admission and two of the visits had included overnight stays. We were told staff had made some recordings about the outcomes of these visits but these could not be found. It is important that details of the pre admission assessment process are available so that it can be determined how the home made the decision that they were able to care for the individual. This person was spoken to and was very settled at the home and stated he liked it there. Agnes House DS0000067024.V368219.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, 9 and 10. 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 but 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 ensure any risks were minimised. The people living in the home were able to make choices and decisions in their everyday lives. EVIDENCE: At the time of this inspection three care files were sampled, two thoroughly and one briefly. As at the last inspection 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 about me’ and ‘my daily routine’. The booklets gave a lot of information about the individuals but the care plans did not show how they were going to be supported to the things they liked doing such as painting and drawing. This was identified at the last inspection. One person had stated he liked Caribbean food. There was no mention on the care plan of how he was to Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 13 get this food. One of the booklets was incomplete as the person had been in the home only a few months and some of this time he had been in hospital. The care plans were easy to follow and generally indicated how staff were to meet the identified needs of the people living in the home. Areas covered included such topics as communication, mobility, accessing the community, personal hygiene, medication, behaviours, food and drink and mental health. The care plans still did not include individual goals and aspirations and how staff were to help the people living in the home achieve these. Each of the sections on the care plans had corresponding risk assessments and these were generally well detailed. For example, one person who refused medication on occasions had a good management plan in place for this. Medical issues were clearly detailed, for example, one individual had asthma and it was clear staff must ensure he had his inhaler with him when he went out. Where there were restrictions on people due to health and safety reasons this was also detailed, for example, where people were unable to go out alone. The manager had further developed the risk assessments in place for individuals’ mental health and any resulting behaviour problems. These could have been further developed in some instances for example one person has some challenging behaviours in his booklet ‘about me’ it stated staff should ask him to go to his room to calm down. This was also in the risk management plan but it did not state what staff should do if he did not calm down. The individual did have a risk management plan that had been drawn up by the mental health team which gave much more detail. This should have been mentioned and the home’s risk management plan should have been cross referenced to this. Records indicted that staff did know what to do when incidents of challenging behaviour had become unmanageable. This person had been admitted to hospital after such an incident. It was also evident that staff knew they should call the police when necessary. Observations made indicated people were able to make choices and decisions in their everyday lives. People were seen to come and go from the home within the bounds of any risk assessments in place. There were restrictions in the home on where people were allowed to smoke but all were aware of this. When in the home they chose how they spent their time. People were seen sitting in different lounges chatting, watching television, in and out of the garden and spending time in their bedrooms. The people living in the home were able to choose where they ate their meals and what they ate. Some of the people living in the home were able to manage their own finances others were supported by the acting manager. One of the people living in the home had an advocate from his own background who visited him. Staff spoke to us about him refusing to see this person sometimes and this was not an issue. It was noted that some of the records for the people living in the home were kept in a cupboard in the area between the lounges, kitchen and communal areas of the home which was accessible to all the people living in the home Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 14 and visitors. The lock on the cupboard was broken therefore anyone in that area had access to the records. This breached the confidentiality of the people living in the home and data protection regulations. Agnes House DS0000067024.V368219.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. Staff were recognising the rights and responsibilities of the people living in the home on a day to day basis. It could not be evidenced that the people living in the home were leading fulfilled lives. 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. EVIDENCE: It was difficult to determine what the preferred leisure activities were for the people living in the home as these were not detailed on the care plans. Where the ‘about me’ books did detail some preferences it could not be evidenced that these were being followed through as the daily records were quite poor in relation to how people were spending their time. The home was in the process of drawing up activity plans for the people living in the home. Staff will need to ensure that when completed there is evidence that the activity plans are being followed. Daily records made only very brief references to how people were Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 16 spending their time for example, ‘played pool,’ ‘watched T.V.’ and ‘read newspapers.’ Records included statements such as ‘enjoyed his day yesterday’ but what the person had done was not detailed and ‘out with Allen’ (manager) but no detail of where the individual went or if he enjoyed it. The people living in the home were observed doing such things as going for the newspaper, making drinks for themselves and others, these were not detailed in daily records. The people living in the home were accessing local community facilities including the shops, pubs and doctors’ surgeries. Throughout the day of the inspection people living in the home were seen to come and go as they pleased. The people living in the home spoke to us about going to college. One person had finished one course and was going to start an IT course. Another spoke to us about wanting to go to college to do catering. We were also told that one of the people living in the home attended a day centre and another went out every day and used the local train service. The home were still organising monthly trips out both locally and further a field. These were discussed at meetings with the people living in the home to ask if they had enjoyed them. The rights and responsibilities of the people living in the home were being 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. Staff gave an example of how one of the people living in the home refused to see a visitor and did not want to speak to someone on the phone and staff had respected this. The people living in the home that were spoken with were satisfied with the food being served in the home. The minutes of the meetings held with them indicated that they were asked about the menus and if they liked the food in the home. No specific issues had been recorded in the minutes of the meetings. We were told there had been some issues with a staff member not following the menu and had been serving spicy food to all the people living in the home and some did not did not like. This issue had been addressed as a disciplinary issue. The menus in the home indicated choices were available at meal times. It was not possible to identify what choice people were actually having from the food records being kept as staff were ticking the records and not indicating the choices made. There was no evidence on the food records that people were receiving cultural diets. We were told that cultural diets were being catered for but staff were not recording this. Agnes House DS0000067024.V368219.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 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 needed to improve to ensure people received all their medicines as prescribed. EVIDENCE: Some of the people living in the home needed only prompting with personal care. Where assistance was needed this was detailed in the care plans but the daily records still did not evidence when staff were assisting or supporting people with their personal care to any degree. Observations made during the course of the inspection indicated that people did get the support they needed with their personal care and the appearance of one person in particular had improved. The manager was well aware that the appearance of one of the people living in the home was not generally acceptable but they had tried to get him to accept and wear new clothing but he had refused this several times. There were no health care action plans in place however the care plans for the people living in the home did detail any ongoing medical concerns, for Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 18 example, asthma and diabetes. Staff were recording when the people were seeing medical professionals including G.P.s, community psychiatric nurses (CPN), opticians and chiropodists and attending hospital appointments. This information was not always being recorded on the appropriate sheets and was put on daily records. This will make the information difficult to track in the future as the daily records build up quickly. For example, one of the people living in the home had had several visits from a CPN and these were on his daily records. It was also noted that the outcome of these visits were not always detailed. At times staff were recording such things as ‘seemed unwell asked if he wanted a doctor’ but no further detail of what that meant so staff following on would know what to look for. As at the last inspection 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. The vast amount of the medication in the home continued to be administered via a 28 day monitored dosage system. This was generally well managed and the requirement made following the last inspection in relation to ensuring all medication was acknowledged when received into the home had been met. Some of the boxed medication being used in the home was audited. One lot of tablets audited did not tally. Records indicated 60 tablets had been received and 49 had been administered which should have left 11. There were 13 left in the box which indicates staff had signed for medication not administered. There was some controlled medication being administered and this was appropriately recorded when received and administered. As at the last inspection it was recommended that when hand written entries were made on the MAR (medication administration record) charts two staff witnessed these as being correct. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 19 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 24. 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 had been made aware of how to raise any issues or concerns they may have. Staff needed to ensure they reported any issues that could be deemed as safeguarding promptly to ensure the people living in the home were fully safeguarded. EVIDENCE: No complaints had been logged at the home since the last inspection. A copy of the complaints procedure for the home was seen on the wall in all the bedrooms. Good relationships between the people living in the home and the staff were evident and individuals had no problems with approaching the manager. This would give people the confidence to raise any issues. There was evidence in meeting minutes that the complaints procedure had been discussed with all the people living in the home. It was suggested that any minor ‘grumbles’ and how they are addressed are documented as evidence that people are listened to. Some concerns were lodged with us just prior to the inspection in relation to a person who used to live at the home. At the time of writing this report these had been forwarded to the provider to investigate. No adult protection issues had been raised with us since the last inspection. However whilst we were at the home staff raised an issue with us about a staff member being verbally abusive to some of the people living in the home. This was discussed with the manager and one of the owners of the home. The Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 20 manager then reported the allegation to Social Care and Health who made the decision not to follow this up but for the home to do their own investigation. This was still in the process at the time of writing this report. The training matrix for the home indicated that all the staff working in the home had undertaken training in the protection of vulnerable adults. In light of the issue detailed above the registered person needed to ensure staff were aware of their obligations under the Whistle Blowing policy for the home to report any issues without delay so that they can be acted on. Some of the people living in the home managed their own financial affairs other needed assistance from the staff at the home. The records for this were sampled. All income and expenditure was detailed and receipts were available for any purchases made on behalf of people. All the balances checked were correct. It was recommended that records should detail what the expenditure was for as some of the receipts from local shops did not show this, when people owed the home money it should be shown as a minus balance and wherever possible the people living in the home should sign for their own money. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 21 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, 26, 27, 28 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home provided only a basic standard of accommodation for the people living there. Considerable improvement was needed to ensure the home was of an acceptable standard and entirely safe for the people living there. EVIDENCE: The home was in a very poor state of repair when the owners took it over in 2006 and although the home owners have been following a refurbishment plan what has been done has generally been at low cost and is not lasting any length of time. A tour of the home identified numerous areas that still need upgrading, particularly toilet and bathing facilities and the kitchen. Some health and safety issues were raised during the course of the inspection including, overloaded adaptor being used in the smoking area, whether the smoking area complied with the no smoking regulations, no handle on the oven door, split seal on the fridge door, the side of the toaster had melted and it could not identified if this was due to it being faulty or that it had been too Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 22 close to the open flame on the cooker. The toaster was taken out of use straight away. Dishwasher tablets were accessible to the people living in the home, these are a COSHH item, we were not informed of any risk assessment being undertaken for this. A system needed to be put in place to ensure that regular health and safety inspections of the home were undertaken, any issues noted and include the date when the issues have been resolved. Since the last inspection the owners had had CCTV installed for security reasons. One of the cameras was in the communal area between the kitchen and lounges and could impinge on the daily life of the people living in the home. This needed to be removed. Another needed to be slightly adjusted so that it only covered the front door of the home and not the stirs and entrance hall. Bedrooms in the home varied in size and some included basic en suite facilities. Some of the bedrooms were generally clean, tidy and decorated to an acceptable standard however the majority remained in need of some upgrading. There was adequate communal space in the home with three lounges and a dining area. The only area that had been kept to an acceptable standard was the dining area. This also had an adjoining kitchenette where the people living in the home could make their own drinks and snacks. To the rear of the home was a large garden. This was very overgrown with a lot of unused furniture stored there. There were also green houses that had not been used for a considerable amount of time. These had glass and Perspex panes in them and some of these were broken. There were adequate numbers of toilets and bathing facilities throughout the home but as stated earlier these were very basic facilities. One new toilet had been installed and one bathroom had had new flooring. The infection control processes in the home were generally poor. For example, the mops in the laundry were stored incorrectly and looked very dirty, the underside of the bath hoist was dirty, many of the carpets in the home were dirty, one bedroom had a very soiled chair, radiators were dirty and bathrooms and toilets were generally in a poor state. We were informed that staff were to have infection control training. The registered person needed to ensure this training took place and that the infection control procedures in the home were improved. It was strongly recommended that the home employed a cleaner for the communal areas in the home as staffing levels did not allow support staff enough time to clean the home effectively without this impinging on the life of the people living in the home. It was also recommended that the home ask the health protection nurses to undertake an infection control audit of the home so that they are aware of where they are failing. The contact number for the relevant department was given to the manager after the inspection. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 23 All the issues raised during the inspection were raised with one of the owners when giving feed back at the end of the inspection. We received an e-mail stating the repair of the oven door had been arranged and a new cooker was to be ordered, the kitchen was to be fully refurbished by the end of September, one bedroom would be fully refurbished to a quality standard by the end of October and the ground floor bathroom would be refurbished by the end of December. Progress on these time scales will be monitored. Agnes House DS0000067024.V368219.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, 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 there but did not ensure good housekeeping around the home. Staff were receiving the appropriate training to ensure they could care for the people living in the home. Recruitment procedures were robust and ensured the people living in the home were safeguarded. EVIDENCE: Although staffing levels for the needs of the people living in the home were appropriate there were insufficient staff to ensure good housekeeping around the home. As stated in the previous section of the report it was strongly recommended that a cleaner was employed at the home. There had been little staff turnover at the home which was good for the continuity of the people living in the home. There were generally good relationships between the staff and the people living in the home. One issue was raised with us as detailed earlier in this report however this was being dealt with appropriately. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 25 There had been one new staff member employed since the last inspection. The recruitment records for this person were checked and all the required documents were available and checks had been undertaken prior to employment. These included, completed application form, POVA first check, CRB check and two written references. There was evidence that new staff were undertaking induction training and this had been improved since the last inspection. The induction training covered many more topics however the manager needed to ensure that it cross referenced to the Skills for Care specification. The training matrix for the home indicated there had been a considerable amount of training undertaken by staff since the last inspection including first aid, manual handling, food hygiene, adult protection and fire safety. Other training planned included infection control and mental health awareness. There was one person on the training matrix who had not undertaken the required training however this was due to non attendance at training when arranged and was being dealt with by the manager and the owners of the home. The AQAA returned to us prior to the inspection indicated all support staff had NVQ level 2 however the training matrix indicated six of the ten had achieve NVQ level 2 and three were undertaking this. The required 50 of staff being qualified to NVQ level 2 or the equivalent had been achieved. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 26 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: Since the last inspection the manager of the home had been registered for a domiciliary care agency owned by the same people as the home. This was now a dormant service and he was not spending anytime at this service. Agnes house had not had a registered manager since being taken over by the current owners in 2006. This issue needed to be addressed. There had been some further improvements in such things as staff training and risk assessments for the people living in the home. Further improvements Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 27 were required to ensure the environment was kept safe and up to an acceptable standard and entirely safe for the people living in the home. However this could not be achieved by the management of the home alone as it had financial implications and would need considerable input from the owners of the home. The manager demonstrated a good knowledge of the needs of the people living in the home and his relationships with them were clearly very good. He was able to tell us how he knew when anyone’s mental health was in decline and the processes to be followed at that time. 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, food and their responsibilities within the home i.e. good personal hygiene and health and safety issues such as fire procedures. It was recommended that the minutes for the meetings detailed exactly what people said and how topics or issues that needed to be followed up had been addressed. This would ensure the people living in the home were listened to and their views acted on. There were also regular 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 AQAA states regulation 26 visits were carried out but these were ad hoc. Records on site indicated only one visit for 2008 and this had been in June. These visits should be undertaken every month and records kept to show that someone is overseeing the management of the home. As at the last inspection it was strongly recommended that the reports of these visits are forwarded to the Commission so that progress in the home can be monitored. The information on the AQAA in relation to the servicing of equipment indicated that all servicing was up to date but by the time of this inspection the servicing of the gas equipment in the home would be due. This was checked but there was no evidence on site that this had been carried out. Evidence must be forwarded to us that the gas equipment in the home has been serviced. The in house checks on the fire system were all up to date. Fire drills tended to be undertaken every week as the people living in the home responded when the fire alarm was tested. It was recommended that fire drills for the staff and the people living in the home were undertaken at different times other than when the alarm was tested. Issues raised at this inspection in relation to health and safety included, poor infection control and the lack of general health and safety checks of the home. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 28 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 2 2 2 3 X 4 3 5 X 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 1 25 2 26 2 27 1 28 2 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 1 X X 2 X Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 cross referenced to any other relevant documentation. Risk management plans must detail how risks will be managed to a satisfactory conclusion. This will ensure the people living in the home are safeguarded. The registered person must ensure that the records of the people living in the home are secure and comply with data protection regulations. This will ensure the confidentiality of the people living in the home. Staff must only sign MAR charts when medication has been administered. This will ensure the people living in the home are receiving their medication as prescribed. The registered person must ensure staff are aware of their obligations under the Whistle DS0000067024.V368219.R01.S.doc Timescale for action 14/09/08 2. YA10 17(1)(b) 14/09/08 3. YA20 13(2) 31/08/08 4. YA23 13(6) 01/09/08 Agnes House Version 5.2 Page 30 Blowing policy for the home to report any issues without delay so that they can be acted on. This will ensure the people living in the home are safeguarded. The registered person must 14/09/08 ensure that a system is put in place to ensure regular health and safety inspections are undertaken of the premises, any issues noted and include the date when these have been addressed. This will ensure the people living in the home are safeguarded. All COSHH items must be stored securely. The registered person must ensure that the home is complying with the no smoking regulations. Any double or triple electric adaptors must be replaced with appropriate trailing sockets. This will ensure the people living in the home are safeguarded. The registered person must ensure that any CCTV cameras do not impinge on the lives of the people living in the home. This will ensure the people living in the home do not have their privacy compromised. The registered person must ensure that all areas of the home are reasonably decorated. This will ensure the home is kept to an acceptable standard Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 31 5. YA24 13(4)(c) 6. YA24 13(4)(c) 31/08/09 7. YA24 12(4)(a) 14/09/08 8. YA24 23(2)(d) 01/01/09 for the people living there. 9. YA27 23(2)(j) The registered provider must ensure the ground floor bathroom is fully refurbished within the time scale give. This will ensure the facilities available for the people living in the home are adequate. The registered person must ensure the garden is made safe for the people living in the home. This will ensure the people living in the home are not exposed to unnecessary risks. The registered person must ensure there are robust infection control procedures in place throughout the home. 31/12/08 10. YA28 13(4)(a) 14/09/08 11. YA30 13(3) 14/09/08 12. YA30 This will ensure good infection control throughout the home. 18(1)(c))(i) The registered person must ensure the staff in the home undertake infection control training. This will ensure good infection control processes in the home. The registered provider must ensure the kitchen is refurbished within the time scale given. 01/10/08 13. YA30 13(3) 30/09/08 14. YA35 18(1)(c) This will ensure adequate standards are maintained for the people living in the home. The registered person must 01/10/08 ensure induction training in the home is in line with the specifications laid down by Skills for Care. This will ensure new staff have the necessary knowledge and skills to care for the people Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 32 living in the home. 15. YA42 13(4)(c) The registered person must ensure that evidence that the gas equipment in the home has been serviced is forwarded to the Commission. This will ensure the people living in the home and staff are not exposed to unnecessary risk. 14/09/08 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 YA1 Good Practice Recommendations The statement of purpose for the home should be amended to ensure it includes only the registration category for the home until there has been some consultation with the Commission about any changes. The service user guide should be amended to ensure it reflects the current information in the home, for example, staffing. This will ensure that the information for people wanting a service for the home is correct. There should be evidence on site that a pre admission assessment has been undertaken of any people admitted to the home. This will ensure there is evidence that the home have identified they can meet the needs of the people admitted to the home. 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. Not assessed for progress at this inspection. 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 DS0000067024.V368219.R01.S.doc Version 5.2 Page 33 2. YA2 3. YA5 4. 5. YA6 YA12 Agnes House 6. 7. 8. YA12 YA17 YA18 9. YA19 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 cultural needs of the people living in the home are being met. Daily records should evidence where the people living in the home are receiving assistance with their personal care. This will show that the people living in the home have their personal care needs on an ongoing basis. 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 all health care visits for the people living in the home are documented on the appropriate sheet and include the outcome of the visit. This will ensure easy tracking of information. It is recommended that when hand written entries are made on the MAR charts two staff witness these as being correct. It is recommended that any minor issues and how they have been addressed are recorded to show that the people living in the home are listened to. It was recommended that records for financial expenditure on behalf of the people living in the home states exactly what the money has been spent on. The people living in the home should sign for their own money wherever possible. When the people living in the home owe money to the home this should be shown as a minus balance. This will ensure the records in the home show that the people living there are fully safeguarded. It is recommended that the home ask the health protection nurses to undertake an infection control audit of the home so that they are aware of where they are failing. It is strongly recommended that the home employ an additional member of staff to help with the cleaning of the home to ensure it is kept to an acceptable standard. The registered provider should ensure that the manager of the home is registered with the Commission. This will assure the people living in the home know there is a competent person running the home. The home must implement a system of self-monitoring assessment to determine its performance against its goals DS0000067024.V368219.R01.S.doc Version 5.2 Page 34 10. 11. 12. YA20 YA22 YA23 13. 14. 15. YA30 YA33 YA37 16. YA39 Agnes House 17. 18. YA39 YA42 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. It is recommended that fire drills are undertaken at times other than when the fire alarms are tested. Agnes House DS0000067024.V368219.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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.V368219.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. 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