Inspection on 24/05/07 for Agnes House

This inspection was carried out on 24th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 26 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 19/11/07

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 24th May 2007 09:30 Agnes House DS0000067024.V342106.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.V342106.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.V342106.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.V342106.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)). 9th June 2006 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 residents 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 fees at the home range from £300.00 to £400.00 perweek. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this key inspection over one day in May 2007. During the course of the inspection a tour of the premises was undertaken, three staff files and two files for the people living in the home were sampled as well as other care and health and safety documentation. The inspectors spoke with the acting manager, two staff members, one of the proprietors and five of the people living in the home. Prior to the inspection a completed pre inspection questionnaire was returned to the Commission which gave some additional information about the home. Twelve ‘have your say’ forms were completed by the people living in the home and returned to the Commission. The majority of these had been completed with help from the staff. Few specific comments were made or issues raised. The home had had a random inspection in November 2006 to assess the progress being made on the requirements made at the previous key inspection. Areas assessed during that visit were admission assessment, care planning, residents’ risk assessments, health care, daily diaries, money management, the environment and health and safety in general. That visit is commented on in this report. Three complaints had been lodged with the Commission since the last key inspection. One was in relation to staffing levels, no CRBs being obtained for staff and food stocks. Some of the issues were dealt with over the phone. The others the proprietors were asked to respond to which they did and the response appeared satisfactory. The response did not indicate that any regulations were being breached. The second complaint was raised by a relative about the low food stocks in the home and people not receiving the required diets. This triggered an immediate random inspection in February 2007 when several other issues were raised in relation to the care received by one of the people living in the home and the environment. Numerous regulations had been breached at this point and some immediate requirements were left at the home. Also as a result of this inspection an adult protection referral was made to Social Care and Health on behalf of the individual concerned. A second random inspection followed shortly afterwards to ensure immediate requirements had been met which they had. These visits are also commented on in this report. Further issues were raised by the same relative but these were the same as previously, for example, low food stocks however when speaking to her she was satisfied with what the Commission had done in relation to the original complaint. She stated there was food in the home and work was being undertaken on the environment. What the service does well: Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 6 The people living in the home that were spoken with were satisfied with the staff team and friendly relationships were evident. 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. The people living in the home spoke of 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. Daily records evidenced that people living in the home had been visited at the home by their relatives and taken part in some in house activities including, badminton, darts and pool. What has improved since the last inspection? What they could do better: Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 7 Full pre admission assessments needed to be undertaken so that staff were aware of the needs of the people being admitted to the home. This would enable an informed decision to be made as to whether they could meet the needs of the individuals. All the people living in the home needed to have detailed care plans that they had been consulted about to ensure they received person centred care. Risk assessments needed to be undertaken for all the people living in the home and any necessary action taken to ensure the identified risks were minimised as much as possible. The registered person needed to ensure that the rights and responsibilities of the people living in the home were recognised on a daily basis. Daily recordings being made about the people in the home needed to be vastly improved and appropriate words used at all times. The registered person must ensure that where necessary guidance and support regarding personal hygiene is provided in a way that suits the people living in the home. Improvements were needed to medication management in the home to ensure it was safe for the people living there. There needed to be a system in place to evidence that the physical and mental health care needs of the people living in the home were being met. To ensure the people living in the home were safeguarded the registered person needed to ensure that anyone unable to manage or understand their finances got the appropriate support. Further improvements were needed to the environment to ensure it was kept to an acceptable standard for the people living in the home. The recruitment procedures for new staff needed to be improved to ensure the people living in the home were safe guarded. Staff needed to have appropriate induction and ongoing training to ensure they were equipped with the necessary skills and knowledge to care for the people living in the home. Further improvements were needed in the management of health and safety in the home to ensure the people living there were adequately safeguarded. Agnes House DS0000067024.V342106.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.V342106.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.V342106.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): 2 and 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home were not complying with the numbers of people they were entitled to accommodate at the time of the inspection. The needs of the people wanting to live in the home were not being fully assessed prior to admission to ensure the home were able to meet them. EVIDENCE: The files for two of the people living in the home were sampled. One of the individuals had been living at the home for a month the other for four months. There was evidence that one of the individuals had been assessed prior to admission by a social worker and that both people had visited the home prior to being admitted. One of the individuals had been admitted quite quickly and the home had not had the opportunity to undertake a full assessment however neither had they obtained a copy of the Social workers assessment. The registered person needed to ensure that copies of the social workers assessments were obtained prior to people being admitted to the home so that they were aware of the individuals’ needs. The information on these assessments plus the information gained on pre admission visits would help staff make an informed decision as to whether the home could meet the needs of the individuals. The importance of pre admission assessments were also discussed with the acting manager at the time of the random inspection. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 11 At the time of the inspection the small office on the ground floor of the home had been converted into a bedroom as one of the people admitted to the home had some mobility difficulties. This change had been made without prior consultation with the Commission. As the room was below the recommended spatial standards arrangements needed to be made for the individual to have a larger bedroom at the earliest opportunity. Also at the time of the visit there were fifteen people living in the home and it was only registered to accommodate fourteen. One of the proprietors had contacted the inspector prior to the inspection about the issue of increasing their occupancy. This was fully discussed and he was advised he would have to apply to vary the home’s registration and wait until this had been agreed before additional people were admitted. An application for variation had been submitted to the Commission after the individual had been admitted to the home. At the time of the inspection the application to increase numbers had not been agreed and the home was operating outside its registration conditions. An immediate requirement was left at the home stating arrangements must be made to comply with the numbers on the registration certificate. Agnes House DS0000067024.V342106.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 poor. This judgement has been made using available evidence including a visit to this service. The systems in place for care planning and risk assessments were poor, lacked detail and failed to ensure that the needs of the people living in the home could be met and any risks minimised. EVIDENCE: At the time of the random inspection a lot of work had been undertaken to up date the care plans for the people living in the home and they had been involved in this process. The care plans were written from their perspective and detailed what they thought their needs were. Also included were details about likes, dislikes, their preferred daily routines and so on. The care plans were being reviewed with the individuals on a regular basis. Further development was needed to ensure all needs were included as it was evident in some cases that staff were offering a lot more support than the people living in the home perceived they needed. Ways of achieving this were discussed with the acting manager of the home. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 13 At the time of this inspection two files were sampled. Both files included booklets ‘about me’ but only one of these had been fully completed. These appeared to be more like an assessment rather a care plan. The booklets were typed as if the person living in the home had responded to the statements, for example, places I like to go: college, for a ride, daytrips, shops for sweets. The booklets were written from the individuals’ perspective and detailed what they thought their needs were. There were no specific goals or objectives detailed and little information about how staff were to offer any necessary support. There were no specific care plans about the individual’s lifestyle in relation to relationships, leisure, culture, meals, education, occupation and so on. The monthly review sheet stated care plan updated and reviewed with no detail of what had specifically been reviewed, if the individual concerned had been involved, if there had been any achievements and so on. For one of the individual’s living at the home there was no detail of any of his individual needs or the support staff needed to give him. This person had been in the home for a month which was ample time for an initial care plan to have been drawn up. It was evident from the daily records that this individual had some needs in relation to personal care and it did not appear from the recordings that these were always being met. At the time of the random inspection the files sampled evidenced that numerous risk assessments had been undertaken and the level of risk had been identified however in most instances there were no corresponding individualised management plans in place to minimise the risks. At the time of this inspection there had been no changes to the risk assessment process in the home. One of the files sampled had several risk assessments in place but these were not comprehensive and did not have any corresponding management plans. For example, from pre admission information this individual clearly had a history of violent episodes. The risk assessment in place indicated a low risk. All the risk assessments in place for this individual indicated a low risk in all areas. The forms being used indicated whether risks were low, medium or high then described what was to be done but these were generic statements. The second file sampled had no risk assessments in place. There was no evidence on either of the files sampled of risk assessments being in place that detailed the mental health needs of the people living in the home. It was of great concern that these were not in place as it had been a requirement at previous inspections. Staff needed to be aware of the early warning indicators of relapse and of what they must do should this happen. It was also of concern that a member of staff informed the inspectors that one of the people living in the home had burn holes in his mattress from smoking in bed but the manager seemed unaware of this. Staff needed to be made aware that any identified potential risks must be passed on to the acting manager so that they can be addressed. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 14 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. It was difficult to determine if any limitations were imposed on any individuals due to any risks as the risk assessments were not comprehensive and there was no evidence that the people living in the home were involved in the risk assessment process. 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.V342106.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 not recognising the rights and responsibilities of the people living in the home at all times. The meals being served at the home had improved and met the needs of the people living there. EVIDENCE: The people living in the home that were spoken with commented on how they were being encouraged to do more for themselves by the staff. They were being encouraged to take some responsibility for tasks within the home, for example, some cooking and tidying of their bedrooms. One person commented that the previous owners had done everything for him but now he was doing more for himself. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 16 Two of the people living in the home spoke to the inspectors about moving into supported living accommodation but had mixed views about this and did not really know what was going to happen. The people living in the home spoke of 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 college, another went to visit his mother, another visited his sister. A member of staff took some of the people living in the home out for a drive. Other people chose to spend much of their time in their bedrooms. Two people spoke to the inspectors about how they enjoyed spending time in the garden, which they were doing on the day of the inspection. One of them also enjoyed keeping the garden tidy. There had been some organised day trips for the people living in the home which people seemed to have enjoyed. Daily records evidenced that people living in the home had been visited at the home by their relatives and taken part in some in house activities including, badminton, darts and pool. 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. Although the staff were trying to encourage the people living in the home to do more both in and outside of the home there were occasions when the staffing levels would inhibit this as there were only two staff on duty. At these times if one member of staff took anyone out it would leave only one member of staff to supervise all those remaining in the home which was not appropriate. The rights and responsibilities of the people living in the home were not always clearly defined, for example, their rights to smoke but not put other people at risk. All the people living in the home had been given a key for the front door but not 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. However the daily records clearly showed a lack of respect for the people living in the home, for example, ‘naughty last night’, several recordings about someone being smelly and totally inappropriate terminology being used for incontinence. These types of comments were not acceptable and needed to be addressed by the acting manager. Staff needed to be made aware that the people living in the home had every right to read the notes being written about them. Inappropriate recording has been an ongoing issue in the home. Two random inspections were carried out at the home in February 2007 as concerns had been raised about very poor food stocks in the home by a Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 17 relative of one of the people living there. Issues were also raised that one of the people living in the home was not getting the appropriate diet i.e. soft food as he had no teeth and was diabetic. At the time of the visit on February 1st 2007 food stocks in the home were very low. Staff were not working to any set menus and had to prepare meals according to what food was available in the home. Immediate requirements were left at the home in respect of this. On February 6th 2007 the situation had improved and food stocks were much better. The inspector was also informed that an account had been set up at a local shop so that should staff run out of any food stuffs in the future they would be able to obtain them. Rotating menus have been drawn up at the home and the acting manager needed to ensure these were followed wherever possible and ensure the food in the home reflected what was needed for producing the meals on the menus. At the time of this inspection food stocks in the home were adequate and the menus remained in place. The food records indicated that the people living in the home were receiving a varied diet with some choices available. Staff spoken with stated there was ample food available in the home and that menus were adhered to as much as possible. Some of the people living in the home were being encouraged to occasionally make their own snacks. Many were able to make their own drinks in a small kitchen area adjoining one of the lounges. One of the people living in the home said the food was ‘O.K. there was hot dogs and he liked them’ another said he ‘was pleased with the food’. Agnes House DS0000067024.V342106.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 poor. This judgement has been made using available evidence including a visit to this service. The people living in the home were not receiving the personal support they needed in a way that suited them. It could not be evidenced that people’s physical and mental health care needs were being met. Improvements were needed in the management of the medication in the home to ensure all the people living in the home were safe guarded. EVIDENCE: At the time of the random inspection in February the inspectors were alerted that one of the people living in the home was living in a very unsanitary room due to his personal care needs (as a result of his mental health) not being met. The room was found to be extremely dirty and very unhygienic and not fit for the resident to live. How to avoid this happening was clearly detailed in the person’s file but staff had not been following the management plan in place. It was also noted that the door handle was broken and the person was unable to lock their door. Immediate requirements were left at the home in relation to this. At the visit made on February 6th 2007 the requirements made about the room had been met apart from the lock on the door and this was to be pursued for all the people living in the home. No further progress had been Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 19 made on this at the time of this inspection. At the time of this inspection the manager stated that staff were addressing the individual’s personal care needs on a daily basis but that it was problematic at times. It was difficult to determine if the personal care needs of the two people being case tracked at this inspection were being met as they were not specifically detailed in any care plans. For one of the individuals there was some information that he had determined as his personal care needs but nothing about how staff were to meet these needs. It could not be determined if this person had specific needs in relation to his culture, for example, hair and skin care. For the other person there was no information for staff about his personal care needs. It could be determined from the daily records that he was receiving some support with his personal care but this was clearly not meeting his needs as he was often described as ‘smelly’ by staff. As stated previously this terminology is not acceptable and also questions if his personal care needs are being met. There were also statements on the daily records stating ‘clothes soaking wet nobody took him to the toilet’ indicating again that the individual’s personal care needs had not been met. Also of concern was a statement that indicated the person had been unwell which had caused some incontinence he then apologised for this the next day. The way this was written was totally unacceptable and brings into question what the attitude of the staff was at the time of the incident. There were no health care action plans in place on the files sampled. There were some health care records for one of the people being case tracked which indicated he had seen the optician. There were no records to indicate if the individuals had any ongoing health care problems. Of great concern was the lack of information about the individuals’ needs in relation to their mental health and how staff would recognise if they were having a relapse. Some of the statements in the daily records indicated there were some issues, for example, there were several entries stating ‘walking about the home laughing’ and another stating ‘fine spending the day in bed’ but no explanation as to why the person felt the need to stay in bed all day. None of the issues detailed above appeared to have been addressed by the acting manager in the home. Medication was being administered via a 28 day monitored dosage system. Several issues were raised with the acting manager in relation to the management of the system. The amounts of medication received at the home was not being entered on the MAR (medication administration record) therefore it was difficult to audit the system. Some were able to be checked against the dispensing label and were found to be correct. Balances of medication held at the end of one cycle were not being brought forward to the next MAR chart. There was some guidance for staff to follow for the Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 20 administration of some of the PRN (as and when necessary) medication but not for all. Some controlled medication was being administered. This was kept locked in the medication trolley and should have been kept in a separate controlled drug cabinet, again there was no entry on the MAR chart stating how much had been received and when and although there was a controlled drug register on site this was not being used. There was medication on one person’s MAR chart that had not been dispensed by the pharmacist this had apparently been discontinued however there was no mention on the person’s health care records of any change of medication. Information detailed on the pre inspection stated that the vast majority of staff administer medication. The action plan received from the home after the random inspection stated that all staff administering medicines had all had appropriate training. This was not reflected on the training matrix given to the inspectors. According to this only four staff had undertaken medication training. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 21 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 lack of staff training could potentially leave the people living in the home at risk from abuse. EVIDENCE: Three complaints had been lodged with the Commission since the last key inspection. One was in relation to staffing levels, no CRBs being obtained for staff and food stocks. Some of the issues were dealt with over the phone. The others the proprietors were asked to respond to which they did and the response appeared satisfactory. The response did not indicate that any regulations were being breached. The second complaint was raised by relative about the low food stocks in the home and people not receiving the required diets. This triggered an immediate random inspection when several other issues were raised in relation to the care received by one of the people living in the home and the environment. Numerous regulations had been breached at this point and some immediate requirements were left at the home. Also as a result of this inspection an adult protection referral was made to Social Care and Health on behalf of the individual concerned. A second random inspection followed shortly afterwards to ensure immediate requirements had been met which they had. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 22 Further issues were raised by the same relative but these were the same as previously, for example, low food stocks however when speaking to her she was satisfied with what the Commission had done in relation to the original complaint. She stated there was food in the home and work was being undertaken on the environment. 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. The home needed to have a complaints log that detailed any complaints lodged at the home including the investigation undertaken and any outcomes. It was recommended that any minor issues raised by the people living in the home were also recorded as evidence that people were being listened to and their concerns acted on. The adult protection procedures were not viewed at this inspection. There is an outstanding requirement that the home’s policy must comply with the multi agency guidelines. The action plan for the home stated that compliance to the policy is being assessed. The training matrix for the home details only two staff having had any training in adult protection issues and there was no indication on the pre inspection questionnaire that this training was planned. One member of staff was spoken to about adult protection and they did not seem to understand their responsibility in relation to adult protection. Staff must undertake training to ensure they know how to respond appropriately to any events or suspicions of abuse. At the last key and the random inspection in November 2006 requirements were made in relation to the systems in pace for managing the money of the people in the home. At the time of this inspection it was pleasing to note that the individual books had been taken out of use and the money management sheets were being used. Some of the people living in the home were able to manage their own money others needed support to do this. The amount of support needed varied. The records for three of the people living in the home were sampled. Generally the records were appropriate. Incoming and outgoing money was detailed and signed for and receipts were available for expenditure. In some instances the documentation needed to be more precise, for example, for one person it stated that he had received some money but the money had actually been used to purchase cigarettes. These had been bought in bulk but a copy of the receipt highlighting his expenditure needed to be on his file. 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. For example, one of the individuals was having some money taken from his account under a direct debit and no one knew what this for. This needed to be explored and if necessary social care and health involved to ensure the person was being safeguarded. Another individual was not receiving Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 23 any personal allowance. The acting manager was under the impression this money was going into the home’s business account but the proprietor stated that it was not. The whereabouts of this person’s money needed to be determined to ensure he had access to money when he needed it. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 24 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, 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: At the time of the last key inspection numerous requirements were made in relation to the environment and a refurbishment plan was submitted to the Commission. At the time of the random inspection in November 2006 some progress had been made, for example, some redecoration, a new washing machine with a sluice cycle had been installed and one of the boilers had been replaced. However the building was in need of upgrading and refurbishment in the majority of areas to make it an acceptable environment for the people living there. This was discussed with the proprietors at the last key inspection and they were asked to submit a timed refurbishment programme to the Commission. This was not done. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 25 At the time of the random inspections in February 2007 the home was toured and several issues were raised. In general the environment was found to be very poor. Issues raised included: • The unhygienic state of one of the bedrooms being occupied by one of the people in the home. • Fire doors were wedged open and a fire exit blocked. • COSHH substances were accessible to the people living in the home. • Security of the home was very poor. • The small kitchenette area that is part of the residents smoking area was in a very bad state of repair and very dirty. • Several areas of the home were in need of redecoration and refurbishment, for example, several items of furniture needed to be replaced, one of the bedrooms had no curtains or blinds up at the windows another had very dirty blinds and some of the carpets in the home were very dirty. Some immediate requirements were left at the home, which had been complied with at the time of the second random inspection in February. The proprietors were also asked for a comprehensive action plan to be drawn up that detailed what needed to be done in each room, in order of priority, completion dates to be included. A copy was to be forwarded to the CSCI. The refurbishment plan had been received and progress on this was checked at this inspection. Further improvements had been made to the environment and the refurbishment plan was up to date. The rear lounge to the home and the small kitchen area adjoining it had been completely refurbished making it much more comfortable, clean and hygienic for the people living in the home. Smoking was no longer allowed in this area and had been relocated to another room. The middle lounge had also been refurbished including new décor, flooring and some new furnishings. The upstairs landing had been decorated and the issues over the damp mould resolved. The security of the home had been improved and all the people living in the home were able to have keys to the house if they wished. The front of the home was being repainted and the outside was generally tidier. Five bedrooms had been improved some completely refurbished others had had some items of furniture replaced or new flooring. All the other areas in the home that need to be improved are detailed in the refurbishment and progress on these will be monitored at future inspections to ensure the home is kept to an acceptable standard throughout for the people living in the home. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 26 As mentioned earlier the small office on the ground floor had been converted into a bedroom. A person with mobility difficulties had recently been admitted to this bedroom. Arrangements needed to be made to move this person to a bigger room at the earliest opportunity. The office had been relocated to what was the COSHH cupboard. The COSHH cupboard had been relocated to a cupboard under the stairs. This contained flammable substances and the fire officers needed to be contacted to ensure this was a safe location. Some other issues were noted during the tour of the home which needed to be addressed. • COSHH substances had been left accessible to the people in the home in the laundry. (Large container of bleach and another substance. • There were scrubbing brushes and scourers in the laundry which are not conducive to good infection control. • The sealant around the work surfaces and sink in the kitchen needed to be replaced as it was peeling and very dirty. • Bins, mops and buckets obstructed the fire exit on the first floor of the home. • One of the people living in the home had a Yale lock on his room if he dropped the catch on this staff would not be able to get in if there was an emergency. • There was an electric heater in one of the bathrooms that had a collection of dust along the bars. The heater was still operational and could pose a fire risk. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 27 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 poor. This judgement has been made using available evidence including a visit to this service. The staffing levels at the home were not always adequate enough to ensure the needs of the people living in the home were met. Poor staff recruitment and training left the people living in the home at risk. EVIDENCE: Several new staff had been appointed to the home since the present proprietors took over the home. Information on the pre inspection questionnaire detailed there were only five staff who had been employed at the home for over a year and one of these was the acting manager. The people living in the home that were spoken with were satisfied with the staff team and friendly relationships were evident. Staff at the home had a multi task role that included cleaning, cooking and laundry in addition to their prime role of supporting the people in the home. Copies of the rotas for the home had been sent to the Commission prior to the inspection. These indicated that from Monday to Thursday there were three staff on duty during the day but this included the acting manager’s hours. On the other three days there were only two staff on duty. With only two staff on Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 28 duty it would not be possible for staff to take any of the people living in the home out for any activities as this would leave only one person to oversee the rest of the home. Also the rota indicated that one staff member was a support worker and administration support but it was not clear how many hours were allocated for administration this would cut down the hours for support workers even further. An issue was also raised about one person being on call seven nights a week this is not acceptable no one can be expected to be available seven nights a weeks. On two of the occasions the person was on call they had already worked a 12 hour shift in the home. This was happening on an ongoing basis over the weekends. The person in question was not a senior staff member and during discussion it became apparent they were available to help night staff in an emergency and that the manager was also on call if needed but this was not evident from the rota. The recruitment files for three staff were sampled. None of the files included all the necessary information and it could not be evidenced that the appropriate checks had been undertaken prior to employment. Only one file included an application form, there was no evidence of any references being obtained for any of the employees and the two CRBs that were seen were obtained after the staff had commenced their employment. One of the staff members had a visa which would have entitled them to work a specific amount of hours. The person was working in excess of these hours. The registered person needed to explore this issue. The pre inspection questionnaire detailed that over fifty percent of staff had achieved NVQ level 2 but this did not cross reference to the training matrix which only detailed three support workers with this qualification. There was no evidence that any of the new staff had undertaken any induction training. It was of great concern that a member of staff with incomplete recruitment documentation, no detailed induction training, no previous experience of working with people with mental health needs and no evidence of any training in safe working practices was a lone worker on nights. The training matrix indicated that many of the staff in the home had not received any training in safe working practices, for example, food hygiene, adult protection, fire procedures and health and safety. It also appeared that none of the staff had undertaken any training specifically related to supporting people with mental health needs. The action plan received by the Commission from the home stated that training needs were being reviewed, it was not established if this had been done. The pre inspection questionnaire detailed that training had taken place over the 12 months in relation to fire safety and medication. The training matrix detailed only six staff had up to date fire training and four with medication training. The gaps in staff training needed to be addressed as a matter of urgency to ensure they could support the people living in the home appropriately and safely. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 29 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 poor. This judgement has been made using available evidence including a visit to this service. The arrangements for managing the home were poor overall and lacked competence to ensure good running which was having an effect on the well being of the people living in the home. The home needed to have a system in place for reviewing the quality of the service offered based on seeking the views of the people living there. EVIDENCE: The acting manager had been in post since March 2006 and no application for registration with the Commission had been received up to the time of this inspection. Overall management of the home was poor. Numerous improvements were needed in the home to ensure the people living there were safe guarded and Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 30 received person centred care including the systems in place for care planning and risk assessments, meeting personal care needs and appropriate recording. Many of these issues had been raised at previous inspections and no progress had been made. It was of great concern that the acting manager was not addressing issues as they arose, for example, the very poor recordings being made by staff and medication errors. Quality Assurance was discussed with the proprietor of the home. He stated they did have a system that was for the care organisation but this needed to be individualised for the home. The action plan received for the home following the random inspections in February stated the quality system would be in place by 31/03/07. The inspectors were told that meetings were held with the people living in the home every month however the minutes for these were not readily available. Staff meetings were also held monthly but again the minutes for these were not readily available. 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 regulation 26 visits were being conducted and also that two of the directors are at the home at least once a week each. This was also reiterated in the action plan for the home which also stated that their visits include weekends and evenings and that they had started to carry out checks on various aspects of the home. The proprietor was asked to forward the regulation 26 visit reports to the Commission so that progress on the management of the home can be monitored. The Commission had received very few regulation 37 notifications of any accidents or incidents in the home. The inspector had been told by one of the proprietors that one of the people living there had been given notice to leave the home. No regulation 37s had been forwarded to the Commission in relation to any incidents leading to this to indicate that this person was in breach of their contract. Also during the inspection one of the people living there informed the inspectors he had recently had a stay in hospital no Regulation 37 notification had been received in respect of this. The Commission must be notified of any accidents or incidents in the home that affect the well being of the people living there to ensure these are being managed in the best interests of the people concerned. The documentation for the servicing of the equipment in the home was not sampled at this inspection. However the pre inspection questionnaire completed by the acting manager detailed that this was all up to date with the exception of the electrical wiring which was not detailed but this has been seen at previous inspections. There were concerns in relation to health and safety of the people living in the home and these are detailed in the report including, access to COSHH Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 31 substances, lack of staff training in safe working practices, obstructed fire exit and so on. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 32 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 X 2 2 3 1 4 X 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 2 25 2 26 X 27 X 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 1 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 2 X X 1 X Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 33 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 YA1 Regulation 4(1)15(1) Requirement The statement of purpose and service users guide must be amended to ensure information in the documents does not conflict. This will ensure all the people living in the home have the correct information about the facilities at the home. (Previous time scale of 01/12/06 not assessed for compliance at this visit.) The registered person must ensure that a full pre admission assessment is carried out on all prospective users of the service and records of this are kept. This will ensure the needs of all the people living in the home are known prior to admission. (Previous time scale of 14/12/06 not met.) The registered person must comply with the numbers of registration Timescale for action 14/07/07 2. YA2 14(1)(a) 14/07/07 3. YA4 CSA 2000 Section 24. 29/05/07 Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 34 4. YA6 15(1) 5. YA9 13(4) being 14 persons with a mental disorder and not provide a care service to persons above this number. Arrangements must be made to comply with the home’s registration. An immediate requirement for this was left at the home. All the people living in the 14/07/07 home must have an up to date, detailed care plan that they have been party to. This will ensure that they receive person centred care. (Previous time scales of 14/12/06 and 01/03/07 not met.) Risk assessments must be 14/07/07 fully developed and implemented to identify the mental health needs of the people living in the home and must include early warning indicators of relapse and inform staff of what they must do. (Previous time scales of 30/06/06, 14/12/06 and 01/03/07 not met.) Risk assessments must be undertaken for all the people living in the home and action taken to minimise any identified risks or hazards. All risk assessments and the associated management plans must be reviewed on a regular basis with the individuals living in the home. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 35 6. YA16 12(4)(a) This will ensure the people living in the home are safeguarded. (Previous timescales of 31/07/05, 30/06/06 and 01/03/07 not met.) The registered person must ensure that: All the people living in the home are able to lock their bedroom doors if they wish. (Previous time scale of 31/12/06) Any recordings made about the people living in the home are appropriate. This will ensure the rights of the people living in the home to privacy and dignity are further enhanced. The registered person must ensure that where necessary guidance and support regarding personal hygiene is provided in a way that suits the people living in the home. This will ensure their personal care needs are met. (Previous time scale of 23/02/07 not met.) All the people living in the home must have health care action plans in place. Any recordings that may suggest there is an issue in relation to any individual’s mental health must be explored. This will ensure both the physical and mental health 14/07/07 7. YA18 12(4)(a)(b) 14/07/07 8. YA19 13(1)(b) 14/07/07 Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 36 9. YA20 13(2) care needs of the people living in the home are met. Residents who self01/07/07 administer medicines must have a risk assessment completed and regular compliance / safety checks carried out. This will ensure people are taking their medicines as prescribed. (Previous time scale given not assessed for compliance at this visit.) The home must ensure consistency in administration of PRN and as ‘directed medications’ and must develop written protocols informing when and in what circumstances these medications should be given. This will ensure that people living in the home receive their medication when needed. (Previous time scales of 14/12/06 and 01/03/07 not met.) There must be a complete audit trail for all medication held in the home. Controlled medication must be stored appropriately. The controlled drug register must be used for recording the receipt and administration of controlled medication. This will ensure the medication system is safe 01/07/07 10. YA20 13(2) 11. YA20 13(2) 01/07/07 Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 37 12. YA20 13(2) 13. YA23 13(6) 14. YA23 13(6) 15. YA24 23(2)(a)(b) 16. YA25 23(2)(f) 17. YA30 13(3) for the people living in the home. All staff that administer medication must undertake accredited training. This will ensure staff are competent to administer medication safely. The registered person must ensure that all staff have undertaken training in adult protection issues. This will ensure that staff are aware of how to recognise and report any suspicion or incidents of abuse appropriately. The registered person must ensure that the people living in the home who are unable to manage or understand their finances get the appropriate support. This will ensure they are safeguarded from abuse. The registered person must ensure that progress on the refurbishment plan is made within the stated timescales. This will ensure the standard of the environment is acceptable for the people living in the home. Rooms within the home must not be converted into bedrooms unless they meet the spatial standards detailed in the National Minimum Standards. Scrubbing brushes and scourers must be removed from use in the laundry. The sealant around the 01/09/07 01/09/07 01/07/07 01/01/08 01/09/07 01/07/07 Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 38 sink in the kitchen must be renewed. This will enhance the infection control procedures in the home. The registered person must ensure all the required checks are carried out on new employees for the home prior to them commencing their employment. This will ensure the people living in the home are safe guarded. The registered person must ensure that staff lone working at night in the home are appropriately trained. This will ensure that the people living in the home receive the support they need and are not put at risk. 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. 18. YA34 19(1)(b)(i)2(1)(6) 01/07/07 19. YA35 18(1)(c) 01/07/07 20. YA35 18(1)(c) 14/07/07 21. YA35 18(1)(c)(i) 22. YA39 24(1) There must be evidence 01/10/07 on site that all staff have undertaken all regulatory training. As a minimum this must include: Fire procedures Basic food hygiene Health and safety Infection control. The home must implement 01/09/07 a system of selfmonitoring assessment to DS0000067024.V342106.R01.S.doc Version 5.2 Page 39 Agnes House 23. YA42 37 24. YA42 13(3) 25. YA42 23(4)(a) determine its performance against its goals and objectives. (Previous timescales of 30/04/06, 30/09/06, 31/01/07 and 01/03/07 not met.) This will ensure plans are in place to continuously improve the service for the people living in the home. Any accidents or incidents 01/07/07 in the home that affect the well being of the people living there must be notified to the Commission. This will ensure any issues are being managed in the best interests of the people living in the home. The registered person 01/07/07 must ensure that COSHH substances are stored securely. This will ensure the people living in the home are safeguarded. The registered person 01/07/07 must ensure: That fire exits are not obstructed. That the heater in the bathroom identified during the inspection is made safe. This will ensure the people living in the home are not put at risk. Locks on 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 DS0000067024.V342106.R01.S.doc 26. YA42 13(4)(c) 14/07/07 Agnes House Version 5.2 Page 40 an emergency. 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 YA12 Good Practice Recommendations 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. The home must fully develop a medicine policy that reflects all current practice. The home should have a complaints log that details any complaints lodged at the home including the investigation undertaken and any outcomes. It is recommended that any minor issues raised by the people living in the home are recorded as evidence that people are being listened to and their concerns acted on. The Adult Protection policy for the home should comply with guidance given in the Multi Agency Guidelines, and DOH document No Secrets. Documentation on money management sheets should be as precise as possible and copies of receipts for bulk purchases kept on individuals’ files. To ensure staff are to support the people living in the home appropriately fifty percent of staff should have NVQ level 2 or the equivalent. The rotas should be true reflection of the roles and hours undertaken by staff so that it can be assured sufficient staff are on duty to support the people living in the home. Staffing levels should be reviewed to ensure the needs of the people living in the home can be met at all times. The training matrix for the home should be updated so that it is a true reflection of exactly what training staff have undertaken. The registered person should explore the possibility of staff undertaking training in relation to caring for people with mental health needs. Arrangements should be made to improve the management of the home. This will ensure someone is DS0000067024.V342106.R01.S.doc Version 5.2 Page 41 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. YA20 YA22 YA22 YA23 YA23 YA32 YA33 YA33 YA35 YA35 YA37 Agnes House 13. YA39 overseeing the day to day running of the home in a competent manner and that it is run in the best interests of the people living there. 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. Agnes House DS0000067024.V342106.R01.S.doc Version 5.2 Page 42 Commission for Social Care Inspection West Midlands Regional Office 1st Floor Ladywood House 45-56 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.V342106.R01.S.doc Version 5.2 Page 43 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!