Inspection on 30/08/06 for Agnes House

This inspection was carried out on 30th August 2006.

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 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Agnes House 28/11/07

Agnes House 08/01/07

Agnes House 26/10/05

Agnes House 17/05/05

Agnes House 22/02/05

Agnes House 05/04/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Agnes House 77 - 79 Newbury Lane Oldbury West Midlands B69 1HE Lead Inspector Mrs Jean Edwards Unannounced Inspection 30th August 2006 08:30 Agnes House DS0000004783.V309854.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 DS0000004783.V309854.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 DS0000004783.V309854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Agnes House Address 77 - 79 Newbury Lane Oldbury West Midlands B69 1HE 0121 552 5141 0121 552 5141 jasonlane@hotmail.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alphonsus Homes Karl Jason Lane Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. All service users accommodated at the home may also have a physical disability No service users who are wheelchair users are to be admitted to the home Date of last inspection 26/01/06 Brief Description of the Service: Agnes House is a small independent Care Home, which provides residential care for up to five younger adults with learning/physical disabilities. The two traditional detached bungalows, set in their own grounds are located on a main road in a mixed residential area. There is easy access to local amenities such as the leisure centre and public transport with links to towns such as Dudley, Oldbury and the Tesco shopping centre at Burntree. Externally the properties are generally well maintained, with limited car parking at the frontage and on the driveways of both bungalows. To the side and rear of the premises are gardens, with patios, lawned areas, trees and shrubs. The interiors of the bungalows strive to be domestic in style, promoting a homely environment whist providing a safe environment; they are maintained to high standards. The Home has a staff team of 30 people including the registered manager. Required information regarding the level of fees at this home has not been provided at the date of writing this report. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection has been conducted by an Inspector from the Commission for Social Care Inspection and has taken place over one weekday 8:20 a.m. and 6:30 p.m. The purpose of the inspection visits has been to assess progress towards meeting the Care Homes Regulations 2001 and National Minimum Standards for Younger Adults. The range of inspection methods used to make judgements and obtain evidence includes discussions with the registered manager, deputy manager, seniors and other staff on duty. There has been contact with professionals associated with the home and discussions and observations with five service users living at the home, three of whom do not have verbal communication skills. A number of records and documents have been examined, including responses to recent allegations of abusive behaviour. Other information was gathered prior to the inspection visit, from reports of visits undertaken by the organisations representative and pre inspection questionnaire submitted by the home. Five service user surveys were sent to the home by the CSCI and an analysis of the two survey forms returned is contained throughout this report. Comments have been very positive about the home and staff. What the service does well: Residents are encouraged to treat Agnes House as their own home and to be as independent as possible. Bedrooms are arranged and decorated according to each persons choice. Two residents who are able to communicate verbally say, “really love living at Agnes House and enjoy being independent. One residents states, I like the food, staff are ok another states I like my bedroom, I like the staff, I like being in control of my home, I like to make my own choices and I would like to get my own flat in 2 years time. Two residents are now taking control of their own medication with staff support and supervision. This home provides a secure and well adapted service for people with complex needs and behaviours, which offer considerable challenges for the service and staff. There are very comprehensive and detailed care plans and risk assessments in place for each person to guide staff to make sure good standards and safe care and support can be provided. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 6 People are generally able to attend daytime activities supported by the day care staff employed at Agnes House, one person continues to attend college courses and is proud of her skills. Activities continue to be geared to each person on an individual basis. All residents have been able go on one or more holidays this year, according to their wishes and abilities to cope. Meals are provided individually for each person according to their likes and dislikes. Usually two of the residents do their own shopping and cooking, supported by staff. Residents are supported to maintain healthy lifestyles and weight regimes. Two residents have successfully managed to lose unwanted weight gains through healthy eating plans and exercise, which has benefits for their heath and wellbeing. There has been good communication and rapport between staff and residents throughout this visit. During discussions staff demonstrate a dedicated and committed approach to their work. The established core group of staff clearly know residents’ likes and dislikes and how to meet their needs. They have answered questions in an open and honest manner. The organisation demonstrates a strong commitment to staff training, with its own accredited training centre. The home is clean, tidy and homely and generally provides a safe environment. There is an on-going program of redecoration and replacement, which maintains a pleasant environment. This inspection has been conducted with full co-operation of the Manager, staff and residents. The atmosphere through out the inspection has been cooperative and friendly. What has improved since the last inspection? The very detailed written risk assessments and ways to minimise risks in place for all types activities for each resident have been improved and expanded. Examples are community contact and community-based activities, such as using public transport, bowling, swimming and shopping. The home has copies of Sandwell MBC multi-agency procedure for the protection of vulnerable adults, which has been used on three occasions together with the homes procedures to make sure that vulnerable residents are properly protected. There are now improved levels of advocacy support the residents who do not have regular contact and support from their families. The organisation has repaired and resurfaced the front drive make access to 79 Newbury Road much safer. The garden at 79 Newbury Road has been considerably improved, and a shed has been purchased to provide a sensory and chill out room for one resident. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 7 The home is undergoing redecoration throughout the interiors of both bungalows. The residents at 77 Newbury Road say how pleased they are with the new more modern decor. They have chosen the colour scheme and one resident has provided very attractive and skilful paintings to be displayed in the lounge. The bathing facilities at 77 Newbury Road have been replaced and renovated. New robust dining furniture suitable for the group of people living at the home has been provided at 79 Newbury Road. Records of residents care, staff recruitment, service maintenance and health and safety have improved providing better safeguards for residents and staff. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 The overall outcome for this group of standards is judged to be adequate. There is good evidence that all service users needs are reviewed and reassessed, with multi-disciplinary health care professionals. No progress has been made to provide contracts/terms and conditions of occupancy for each person’s file this means that residents and their advocates do not have sufficient information regarding their rights and entitlements. This is a long-standing requirement, which must be actioned. EVIDENCE: There is evidence from discussions and examination of case files that residents needs are kept under review and are reassessed with other professionals involved in each persons care. For example residents have involvement from speech and language therapists, psychology teams, dieticians, community psychiatric nurses and social workers. The home is working to agreed strategies. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 10 The requirement issued at previous inspection visits to ensure that there is a copy of the costed contract / terms and conditions, appropriately signed and dated retained on each person’s case file, has still not been met. There are no details of levels of fees or what is to be provided as a contractual arrangement. No information relating to fees has been provided to the CSCI as required as part of the pre inspection questionnaire. This is a long-outstanding requirement, which must be actioned as priority. There is evidence from discussions and observations that there are now improved numbers of staff, though not all have the experience, training, and competence to meet the complex and diverse needs of the five residents accommodated. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The overall outcome for this group of standards is judged to be good. There is a clear and consistent care planning system in place providing staff with the information they need to satisfactorily meet each person’s needs. The approach of a person centred planning process means that residents have as much control as possible over their lifestyle and care. Risk assessments have been expanded since the last inspection visit to cover all aspects of personal and social, and health care; this improves protection for residents. EVIDENCE: The structure and presentation of the residents care plans is very good, with detailed individual needs, goals and aspirations. These include goals to improve social skills, communication skills and independent living skills. One resident is making progress towards her aim to eventually live independently, in a supported environment. This person is continuing to practice budgeting skills and travelling on public transport unaccompanied. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 12 During discussions with she has confirmed her active involvement in developing and implementing her care plan. She has been happy to share and discuss her care plan records as part of this visit. She is proud of her shopping and cooking skills, which are forming part of her weight control programme. Another resident has made noticeable progress developing basic verbal communication skills. Progress with use of PECS (Picture Exchange Communication System) has been reviewed it has been agreed to go back from stage 3 to stage 2, which appears to be more beneficial and places less stress on him, reducing behaviours as a result. Although the home has made some progress for residents to sign their care plan where it is meaningful for them to do so and it is stated that involvement of relatives or advocates for support of other residents is being sought, three care plans have no formal indication of involvement or agreement. Behaviour management guidelines, triggers, cues and physical intervention techniques are documented together with comprehensive risk assessments. These have been expanded for each persons individual activities, particularly those undertaken outside the home. There is evidence that the level and number of times physical intervention used for two residents have significantly decreased. Despite the continued relatively high staff turnover there is evidence that 80 of the current staff have received MAPA training (use of diffusion, low arousal and physical intervention techniques. In one residents daily records the term restrained on the floor has been used on more than one occasion. Discussions with the registered manager and staff concerned indicated that this is not a technique, which has been authorised or used and the written information is inaccurate and misleading. Staff must be precise and accurate when recording use of restraining techniques. Furthermore more detail is required relating to the length of time restraint is used. Discussions with staff and examination of records indicate that they feel better supported and feel listened to when raising issues or requesting assistance. In a recent meeting and written communication staff have made positive suggestions and are awaiting formal responses from senior management and the Proprietor. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 The overall outcome for this group of standards is judged to be good. Social activities and stimulation have improved with better staffing arrangements and as a result each person is now generally able to participate in appropriate social stimulation to follow their own hobbies and interests and developed their personal potential. EVIDENCE: There are structured activity programmes in place for each resident and these are generally flexible enough to allow spontaneous activities to be pursued. The manager and staff evaluate the enjoyment and value of daily activities, revising them accordingly. The staffing structure comprises residential care staff and dedicated day-care staff employed by the home to support each persons social activities within the community. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 14 The residents accommodated at Agnes House have conditions, which would not allow them to undertake paid, unpaid or voluntary employment opportunities. However there is ample evidence that residents are encouraged and supported to improve their independent living skills. Two of the residents have been risk assessed as being able to go out unaccompanied. One person is able to use public transport. The other person is making progress with trips into the community monitored by staff from a distance. Residents have engaged in a variety of activities throughout the day of the inspection visit according to each persons interests and abilities, with all residents spending some part of the day away from the home. One person has attended college to do art, one person has been shopping and three people have been out on separate day trips. The home has two allocated vehicles, which are used to transport residents as and when needed, which improves access to community facilities. People are also able to pursue a range of activities at Agnes House; these include the use of sports and outdoor activities such as swing ball and there is equipment, which is due to be installed in the soon to be erected shed, designated to be the quiet / sensory room. Each resident has at least one annual holiday arranged and funded by Agnes House, as part of the (undisclosed) contract fee. The holiday arrangements are individual according to preferences and needs, the number of days away varies taking account of each person’s tolerance level. One person spoke about his seven-day holiday to Aberystwyth in July this year. He spoke about doing his laundry, playing tennis, and shopping. The highlight of the holiday had been a trek to Devils Bridge. Each person receives support to access benefits and allowances, for example one person’s mother acts as his appointee, dealing with these matters, whilst other people receive support from social services departments. Three residents now have support from the Sandwell Advocacy Service and advocates have been instrumental in sourcing support for residents funded by Birmingham Social Services Department. All residents now have active involvement with their families. One person goes to visit his family at their home twice each week. Another person receives family visits at Agnes House twice each week, with the development of home visits to his mother’s home continuing to prove successful. Staff and the Community Psychiatric Nurse have supported this person to visit his family home to share the celebrations for the Muslim festival of Eide, which was very successful and thoroughly enjoyed by everyone. Although this resident is a non-practising Muslim and he and his family are happy for him to have Western food, his mother brings cultural food for him to eat twice a week. Staff are also aware of the final rituals to be observed to respect his familys cultural needs. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 15 The third person visits his mother on a weekly basis. Support is available at these visits, members of staff stay throughout the visits if requested. A fourth resident visits her parents. Family contact has been established for the fifth resident after many years without any family contact. The home has a range of weekly menus, which are varied, well balanced and nutritious. However menus do not currently shows at suppertime choices and are not provided in alternative formats suited to those residents without verbal or written communication skills. Meals and portion sizes eaten by each person are well-documented. The Home tries to ensure that each person has at least five portions of fruit or vegetables each day. Daily food diaries are in place and generally well completed. Wherever possible residents are involved in shopping and preparing food. Two residents at 77, Newbury Road shop and prepare their own meals supported by staff. Individual choices of food and meal times are easily accommodated. One resident at a number 77 Newbury Rd has decided to join Slimmers World slimming club, supported by a member of staff and by following an eating plan of green and red days, she is very pleased that she has reduced her weight by more than two stones. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 The overall outcome for this group of standards is judged to be good. The health needs of residents are well met with generally good evidence of multi disciplinary working taking place on a regular basis. The systems for the administration of medication have generally improved and there are more assurances to ensure residents’ medication needs are met. EVIDENCE: There is evidence from records, observations and discussions with two residents and staff as to how residents’ privacy and dignity are respected and how their independence is maintained and improved. Each resident has a key worker and link worker, generally working in teams, which enhances support for all aspects of care and development. Each person is encouraged to be as independent as possible. The two residents at 77 Newbury Road take overall responsibility for their own personal hygiene, generally only requiring verbal prompts. The other three residents are supported to undertake small personal tasks according to their capabilities and are given sensitive support to maintain good levels of personal hygiene and good grooming. There are detailed records in place on individual plans identifying the level of support residents require with personal care. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 17 Each person has detailed health care records, which demonstrate that the majority of health care checks are up to date. One resident at 77 Newbury Road attended a GP appointment, appropriately supported by staff during this visit. All residents receive annual health-care checks and one person who has received a well-person check for 40-year-olds has received additional help and support and with a healthy diet is managed to reduce his weight by approximately 2 stone. In addition with support from staff he is reducing his dependence on smoking, reducing cigars from 8-10 daily to 2-3 daily. Residents funded and supported from Dudley also receive import from the Intensive Support Team, part of the learning disabilities psychology service. One of the residents funded by Birmingham continues to receive support from the speech and language therapist, with very positive results. The residents use the services of health care professionals such as the NHS dentists, who make visits to the home, often making visit until the resident is comfortable with them and allows examination or treatment to take place. This is less disruptive for residents. To resume regular monthly monitoring residents weights From observation of care records there is now updated the information relating to SR regarding the change of GP, the current optician and the current audiologist and efforts are made to ensure regular appointments are scheduled. Although the home has comprehensive medication policies and procedures, these now need to be reviewed, expanded and updated. It is stated that all staff administering medication have received medication training provided by the organisation’s training section, however a previous requirement to provide documentary evidence of accreditation of the training remains outstanding. Formal written evidence must be presented to the CSCI for consideration or alternatively arrangements must be implemented for staff to receive properly accredited training. It is very positive that the two more able residents living at 77 Newbury Road are being coached and supported to take responsibility for their own medication with agreed staff supervision and written risk assessments. A small number of areas have been highlighted during this visit to be improved. Examples are that any handwritten entries on MAR sheets must be signed and witnessed, and internal and external medications stored together must be stored separately. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The overall outcome for this group of standards is judged to be adequate. The home has a comprehensive complaints system with some evidence that staff understand the need to listen and to act upon areas of concern. The complaints procedure has not yet been provided in alternative formats needed for residents without verbal communication skills. Policies, procedures, guidance and staff training have not been fully implemented in order to provide residents with safeguards from abuse. EVIDENCE: The home has a comprehensive complaints procedure, however there was no evidence of this visit of any pictorial or other alternative format for those residents without verbal or written communication skills. The pre inspection questionnaire discussions during this visit indicate that the home has not received any recent complaints, however the complaints log was not located during this visit. Discussions with staff on duty and with the two residents able to communicate verbally demonstrate that the mechanisms in place to ensure that complaints can be made and will be listened to, with action taken to resolve them. There have been three incidents in May, June and July 2006 involving the behaviour of residents towards members of staff and in one case a member of the public, a child resulting in injuries. The incidents have been appropriately reported to all relevant agencies, social services, CSCI and the police. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 19 Appropriate investigations have taken place and the police indicate that no further action will be taken. Investigations have taken account of care firms, risk assessments, staff training and staff supervision. The manager has taken steps to implement the recommendations where they have been made to improve the homes already vigilant practice. Although there is a continued relatively high turnover of staff and there is improved evidence to show that staff are receiving up to date approved/accredited physical and non-physical intervention MAPA training. The registered manager has contacted Sandwells Adult Protection Coordinator, with a view to accessing approved up-to-date training relating to the protection of vulnerable adults for all staff. There is evidence that some staff have attended the familiarisation training and the manager, deputy and seniors intend to attend the management training workshops. The homes policies and procedures relating to the protection of vulnerable adults are dated February 2003. All policies and procedures must be reviewed at least annually. Balances and records of temporary safekeeping monies held by the home on behalf of residents were examined and found to be generally accurate. There was a minor discrepancy on two balances. Although the home has copies of the organisations policies and procedures to protect residents finances there is insufficient security for money and valuables held in temporary safekeeping in the home. The organisation must provide an adequate, secure place and ensure that staff adopt appropriate security practices relating to key holding and signatures for financial transactions on behalf of residents. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 The overall outcome for this group of standards is judged to be good. The standard of the décor within this home is generally good with evidence of improvement through ongoing maintenance. The home generally presents as a safe, homely and comfortable environment for residents. EVIDENCE: Agnes House is comprised of two bungalows; 77 Newbury Road is a twobedded bungalow and 79 Newbury Road is a three-bedded bungalow. During the tour of both bungalows there is evidence that the physical environment is generally being maintained to satisfactory standards. Action has been taken to repair potholes and resurface the front driveway to 79 Newbury Road. It is noted that one of the residents had sustained an accident on the driveway prior to the required work being undertaken. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 21 The garden areas at 79 Newbury Road have been improved and work is still in progress for sensory areas. However the rear garden at 77 Newbury Road is in need of attention to remove weeds and repair small wooden boundaries. One of the residents states she would like a lawn instead of the tree bark, which she feels treads into the house and makes a mess. The internal decor is bright and cheerful; 77 Newbury Road has recently been redecorated in a light and airy colour scheme chosen by the residents. The interior of 79, Newbury Road is in the process of being redecorated. The purpose of some rooms in this bungalow has been changed to improve facilities for the residents. New dining furniture has also been provided in this bungalow. The home provides a range of adapted equipment, suitable for the needs of people who have learning disabilities and may exhibit challenging behaviour. The bathing facilities in both bungalows have been improved and the residents living at 77 Newbury Road are particularly pleased with their new bathroom suite. However it is noted that the individual anti-slip bathmats, though clean are hung together and this especially inadvisable as one resident has an infected toe. Although at the previous inspection staff stated that there were plans to replace the heavily stained carpets in the communal areas at 79 Newbury Lane, this has not yet taken place. Action to replace the carpets must be taken as a priority. A sample of residence bedrooms have been viewed with their permission, they are attractively decorated, with personal possessions and equipment suited to each persons tastes and needs. The residents at 77 Newbury Road are in the process of having their bedroom redecorated, with flooring and storage according to their preferences. The kitchens in both bungalows are clean, tidy and well organised with only minor areas to be improved. The separate laundry is generally tidy and organised, though clothing is mixed together waiting to be laundered. Action must be taken to ensure staff follow the homes infection control and laundry procedures. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 The overall outcome for this group of standards is judged to be adequate. There continues to be a high staff turnover, this has the potential for residents not to receive consistent care. Recruitment and selection processes have improved and now provide better safeguards for the vulnerable people living at the home. The results of the strong commitment to training continue to be diluted due to the high staff turnover. EVIDENCE: From assessment of the pre-inspection information, staffing rotas and discussions with the manager and senior staff it is evident that there continues to be a relatively high staff turnover, though there is some very recent evidence this may be stabilising at last. According to records held by the home 14 staff have left the homes employ since January 2006. Currently there are five staff vacancies, two senior care and three weekend support staff posts. In addition it is stated that the numbers do not take account of staff that have commenced and left employment perhaps after one shift. It is stated that informal exit interviews are conducted to identify reasons and trends for high staff turnover. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 23 The home does not use agency staff. Staffing levels are being maintained by existing staff, with some people continuing to work excessively long hours. The registered person has not yet sought advice from the Local Authority Environmental Health Officer relating to the risks to staff well being and health and safety related to the excessive hours being worked, as strongly recommended at the previous inspection visit. The registered manager and seniors state that staff sickness levels have been very high. Some people have cited work related stress as a major reason, which includes staff shortages, long hours, insufficient pay and very challenging behaviours from residents. As a result of feelings running high among the staff group an anonymous staff questionnaire has been devised covering ten areas. These include: communication, training, behaviours, staff support, the environment and terms & conditions of employment. 17 out of 24 questionnaires were returned. The collated results and initial management responses have been shared with the CSCI inspector. A meeting has been held with the service manager and a further meeting is to be held. A group of staff spoken to, say morale is improving and staff feel less stressed and more supported. The organisation has robust recruitment procedures and from the assessment of a sample of staff files there is evidence that recruitment processes generally improved. There are still a small number of areas, which require improvement to demonstrate compliance with legislation and provide satisfactory safeguards for the vulnerable people living at Agnes House. A new post of deputy manager has been created at Agnes House; the registered manager acknowledges that the organisation has not followed its equal opportunities policy when recruiting to this post. There is evidence that disciplinary action has been taken with two members of staff who were dismissed for sleeping at night, however no Regulation 37 Notification has been received by the CSCI. The organisation continues to show a strong commitment to staff training and development. It is evident from discussions that staff value training and development opportunities. However the effect of the continual staff turnover is detrimental causing a heightened level of stress and pressure on the core group of highly committed staff and will continue to diminish the positive outcomes of training and supervision. It is indicated that some staff come to Agnes House receive the training and then leave for better paid prospects in similar organisations. The organisation should take heed of the impact of unfavourable terms and conditions of employment; on the continuity of care for residents, staff morale and recruitment and training costs to the service. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40,41, 42,43 The overall outcome for this group of standards is judged to be adequate. The manager is supported well by the senior staff in providing clear leadership throughout the home. The staff group demonstrate an improved awareness of their roles and responsibilities. Monitoring arrangements are improving and there are better safeguards for the health, safety and well being of persons using the service. EVIDENCE: The registered manager, Jason Lane, has been in the post since February 2005. He is registered as a candidate undertaking the Registered Managers Award (RMA) and A1 NVQ Assessors Award through the organisations accredited training centre. Staff and two residents consulted indicated that he is approachable and supportive. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 25 Though the home does not have an externally accredited quality assurance system the organisation has an internal system, which includes twice yearly audits conducted by managers from other homes within the organisation. The audit reports are made available to the home and proprietor. However no management audits were located during this inspection visit. The registered manager the home has not implemented any service user, relatives or stakeholders questionnaires for the current year. The home does not have an annual development plan, which must be developed and a copy forwarded to the CSCI office, Halesowen when completed. The home has copies of a comprehensive range of organisational policies, procedures and guidance, however the relevant ones have not yet been produced in alternative formats, such as symbols or pictures, suitable to residents capabilities, furthermore all policies, procedures and good practice guidance must be regularly reviewed, updated and signed by the registered manager. There has been a general improvement in the standard of record keeping across a number of areas, such as those already mentioned: medication, food diaries, weight records and staffing records. However there have also been failures to make notifications to the CSCI office, Halesowen in compliance with Regulation 37 about the dismissal of two night care staff. Accident records have been examining and there have been 16 recorded accidents involving residents and 95 recorded incidents /accidents involving members of staff. There are now regular analysis of incidents and accidents, with actions taken to review and if necessary revise risk assessments. However there are no separate violence to staff reports, as previously required. Random samples of fire safety, health and safety, maintenance and training records have been assessed. Up to date PAT test certificates and evidence of the five-yearly fixed wiring check must be forwarded to the CSCI office, Halesowen. Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 26 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 X 4 X 5 1 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 3 26 3 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 X 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 N/A 12 3 13 4 14 4 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 2 2 2 2 Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 27 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 YA5 Regulation 5(1)(b)(c) Requirement To ensure that there is a copy of the costed contract / terms and conditions, appropriately signed and dated retained on each person’s case file. (Timescale of 31/03/04 and 31/07/05 and 01/12/05 Not Met) To review the contract / terms and conditions taking account of the publication from the Office of Fair Trading relating to Contracts and terms & conditions in Care Homes To ensure individual fee levels and details of what is included is made available to residents / their representatives and for inspection purposes Timescale for action 01/11/06 2 YA5 5(1) 01/11/06 3 YA5 5(1) 01/11/06 4 YA16 16(2)(a) (m) To provide appropriate 01/11/06 access for residents to use technology such as personal computers, faxes etc. to assist with their methods of DS0000004783.V309854.R01.S.doc Version 5.2 Page 28 Agnes House 5 YA17 12(1) 17(1) communication and personal development (Timescale of 30/08/05 and 01/01/06 Not Met) 1) To include supper choices on menus 3) To provide menus in alternative formats suited to service users needs To provide documentary evidence of accreditation of medication training, to be submitted to the CSCI satellite office, Halesowen (Timescale of 31/03/04 and 30/06/05 and 01/12/05 Not Met) 1) To review and expand the homes medication policy and procedures to include all aspects of medication administration at Agnes House 2) To ensure that the specimen signature list is maintained to be up to date 3) To obtain the signatures of all staff involved in the administration of medication to demonstrate their awareness and compliance of the revised medication policy and procedures 4) To ensure that handwritten entries on MAR sheets are signed and witnessed and dated by two appropriately trained staff 5) To ensure that internal and external medications are stored separately 01/11/06 6 YA20 13(2) 01/11/06 7 YA20 13(2) 01/11/06 Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 29 8 YA22 22 1) To review and update the 01/10/06 homes complaints procedure and produce this in alternative formats suitable for service users 2) To implement a complaints log, which can be used to document the detail of complaints, investigations, outcomes and timescales To progress the planned replacement of the heavily stained carpets in the communal areas at 79 Newbury Lane (Timescale 01/12/06 Not Met) This must now be actioned as a priority 1) To provide maintenance for the rear garden at 77 Newbury Road and improve the garden areas to be weed free and in a safe condition for residents use 1) To replace the broken vegetable rack at 79 Newbury Road 2) To replace the broken drawer front in the freezer at 79 Newbury Road and ensure fridges and freezers are regularly defrosted To ensure that any member of staff choosing to work excessive hours has a written risk assessment undertaken and the management of the Home must consult with Environmental Health Services to ascertain their view of the health and safety risks to staff. DS0000004783.V309854.R01.S.doc 9 YA24 23(2)(d) 01/12/06 10 YA24 23(2) 01/12/06 11 YA24 23(2) 01/10/06 12 YA33 18(1)(a) 01/10/06 Agnes House Version 5.2 Page 30 (Timescale of 26/10/05 Not Met) 13 YA33 18(1)(a) To devise and implement a staff sickness absence policy and procedure The registered persons must demonstrate that the Equal Opportunities policy has been followed when appointing or promoting staff 1) To ensure that there is a full employment history on all applications forms, with a documented explanation for any gaps in employment 2) To ensure that there is an accurate, up to date job description on individual personnel files To complete and update individual staff training profiles and plans and provide evidence all staff attend 5 days (pro rata) paid training each year 1) To progress the annual development plan, forwarding a completed copy to the CSCI office, Halesowen 2) To progress the use of service user questionnaires, with collated results forwarded to the CSCI office, Halesowen 3) To progress the use of relatives questionnaires, with collated results forwarded to the CSCI office, Halesowen 01/11/06 14 YA34 19(1) 01/10/06 15 YA34 19(1) 01/10/06 16 YA35 18(1)(c) 01/11/06 17 YA39 24 01/11/06 Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 31 18 YA39 24 19 YA40 17(1) 20 YA41 37(2) 4) To progress the use of stakeholder questionnaires, with collated results forwarded to the CSCI office, Halesowen To ensure that written reports of Regulation 26 visits by the organisations nominated representative are copied consistently to the home and the CSCI on a monthly basis To ensure all policies, procedures and good practice guidance is reviewed and updated regularly (annually) and is signed and dated by the registered manager The registered person must ensure that notifications are forwarded to the CSCI of any event affecting the well being of residents such as: - Suspension of staff members - Misconduct / disciplinary action - Staffing shortages (Timescale of 26/10/06 Not Met) 01/10/06 01/11/06 01/10/06 21 YA41 13(6) 17(2) 1) To ensure that there are two signatures for every financial transaction conducted on behalf of residents, one of which may be the resident, where there is capacity 2) To conduct regular documented audits of residents temporary safekeeping accounts 3) To provide a safe for monies and other valuables 01/11/06 Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 32 held on behalf of service users on the premises 4) To implement a secure system for key-holding to safeguard service users valuables held in safekeeping 22 YA42 523(4) To include smoking arrangements (SH): - In the resident’s individual contract (Timescale of 31/03/04 and 30/06/05 and 01/12/05 Not Met) To provide ALL staff with updated mandatory training, including: basic first aid, food hygiene and infection control (Timescale of 31/07/05 and 01/01/06 Not Fully Met) 1) To ensure accident records are fully and accurately completed (Timescale of 01/12/05 Not Fully Met) 2) To implement and monitor records of violence towards staff 25 YA42 13(4) 1) To ensure the anti-slip bathmats are washed, dried and stored separately, especially whilst one resident has a fungal foot infection 2) To ensure all laundry is segregated in accordance with the homes laundry and infection control procedures Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 33 01/11/06 23 YA42 18(1)(c) 01/11/06 24 YA42 17(2) Schedule 4(12) 01/10/06 01/09/06 26 YA42 13(4) To forward to the CSCI office, Halesowen copies of the following: Portable Electrical Appliance (PAT) tests Five yearly fixed wiring check To develop a business and financial plan, forwarding copies to the CSCI Area Office for consideration (Timescale of 31/03/04 and 30/06/05 and 01/12/05 Not Met) To send a copy of the last years audited accounts for Agnes House to the CSCI satellite office, Halesowen (Timescale of 31/03/04 and 30/06/05 and 01/12/05 Not Met) 01/11/06 27 YA43 25 01/12/06 28 YA43 25 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA9 Good Practice Recommendations That service user plans are signed the service user where it is meaningful for them to do so, or alternatively by their representative That staff are mindful of the use of terminology in records when describing restraining techniques such as restrained on floor when this is not accurate and more detailed records should be made regarding length of time restraint is used That staff signatures are obtained to demonstrate that they have read and are familiar with the homes and the multi-agency procedures for protecting vulnerable adults 3 YA23 Agnes House DS0000004783.V309854.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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