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Inspection on 08/01/07 for Agnes House

Also see our care home review for Agnes House for more information

This inspection was carried out on 8th January 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Agnes House 77 - 79 Newbury Lane Oldbury West Midlands B69 1HE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jonathan Potts     Date: 0 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Agnes House 77 - 79 Newbury Lane Oldbury West Midlands B69 1HE 01215525141 01215525141 jasonlane@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Alphonsus Homes care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: 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 Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 5 Brief description of the care home providing a safe environment that is suitable for the needs of the residents. The Home has a staff team of 40 people including the registered manager. Information regarding fees charged for living at the home is not included in the Statement of Purpose or Service User Guide. Interested parties are advised to contact the home direct if requiring this information. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was carried out over two days and involved one inspector. We drew evidence from a number of sources, primarily through tracking the care of three individuals living at the home (looking at a range of documentation related to their individual care) and discussing the care they received with them, or observing the care provided during our time at the home. We also spoke to a number of staff and the manager as well as reviewing a number of management records. We also received information about the home from the manager pre inspection, and have reviewed this with all the other information we have received about the home over the 12 months prior to our visit, this including such as notifications and discussion with other agencies. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Key areas for improvement identified include ensuring that the directions for as required medications are consistently clear; the risk of choking is assessed where this maybe an issue; that strategies in behaviour plans are consistent (i.e the card system) and when monies are deposited at the home for individuals by relatives they are evidenced through provision of a receipt. Less critical issues identified include the need to ensure the fee levels for living at the home are detailed in individual contracts, with Care Homes for Adults (18-65 years) Page 7 of 29 a potential range of fees present in the homes statement of purpose and/or guide; ensuring the homes complaints procedure carries CSCIs national helpline number; redecorating the larger bungalow (addressing issues detailed in the body of the report) and ensuring the responsible individuals monthly visits to the home are documented so as to evidence the completion of this statutory required task. We also noted that there is scope to review the homes record keeping so as to make this more concise and therefore more accessible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals that may use the service and their representatives have most of the information needed to assist them in deciding whether Agnes House can provide a service that will meet their needs. Evidence: We saw that the service has a statement of purpose and service users guide, the latter containing images to support the presented information, with photographs of such as the building, the manager and responsible individual and images related to the subject matter. There was no statement as to the fees the homes charges individuals for staying at the home, the statement of purpose stating that fees are arranged on an individual basis after a full assessment is carried out. When asked the manager was unclear as to the exact fees individuals or commissioners of the service paid (as not informed of this by the provider) although did say they were between 2 3000 pounds a week. Whilst it is not expected that the statement of purpose would detail an exact fee, it should contain a range from the minimum to the maximum that a placement would cost, this so that individuals that maybe admitted in the future have some idea of costs prior to assessment. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: We also saw that there was no date on the statement of purpose to identify when it was last reviewed and whilst information within this, and the service users guides was appropriate and informative it only carried reference to our website and not our national helpline number, which would be important for those people without internet access. We also saw that there are contracts available to service users (these in written not pictorial format) and these only containing a rough statement as to what the fees maybe. In respect of individual contracts this information should be exact. There have been no new admissions to the home for a number of years so it has not been possible to assess the services current practice in respect of pre-admission assessments. We did however discuss how an admission would be carried out with the homes manager and the way this was described was consistent with the expectations of the national minimum standards and the homes procedures. The manager stressed that the assessment process was critical especially in respect of new admissions and the speed of any admission process would be based on ensuring the home was able to meet the needs of the individual. We also saw that the home has on -going assessment processes in place to ensure that the needs of the current individuals living at the home are identified and that the home is still able to meet these. These assessments we saw are supported with involvement of other agencies such as social services. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals are encouraged to have involvement in their lives through discussion or close monitoring of their behaviours and reactions to situations. Where able the staff encourage full participation in planning the care and support they receive. Evidence: We saw that individuals that use the service have access to detailed care plans that carry a range of information as to their specific needs. The detail within these plans we saw is drawn from detailed assessment processes that involve relevant external bodies as and when appropriate. Time has been taken to draw up communication plans that outline preferred methods of discourse with residents whether verbal or non verbal. We saw that some individuals have some difficulties communicating their needs and the home approaches this through use of assessment of their preferred communication techniques. Where residents are able they told us that they have been fully involved in drawing up their individual plans with the support of their key worker. Discussion with a number of staff showed us that they had a good working knowledge of what the individuals plan said and how they should be put into practice. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: Observation of the staff interacting with individuals also showed us that they did follow the instructions as detailed in these plans as well. People we spoke to confirmed that the detail in the plans matched their needs, choices and aspirations and on going assessments and reviews of the plans with individuals ensure that they are current and up to date. Individuals told us they had copies of their plans where this was appropriate. We only found one discrepancy in a care plan in respect of the use of a card system to clearly indicate to an individual when their behaviour was becoming unacceptable.Staff we spoke to gave us conflicting information as to the use of this system despite reviews of the individuals plan making reference to its use. The individuals plan therefore needs to be clear as to how this approach is maintained, with staff clear about this so as to ensure practice is consistent. Plans are supported by comprehensive risk assessments that consider issues in respect of behaviour and any potential restrictions that may be in place due to safety considerations. The restrictions that we saw in place we judged to be justifiable and based on sound reasoning and in the best interests of the individual and others who live at the home. We heard from some individuals that they do not see an limitations in their day to day life and that they have the freedom to do what they want. We did however note that there was no risk assessment in place in regard to the risk of choking which is judged a potential risk for one of the individuals living at the home. Whilst the home and staff are to be commended for completing very detailed individual plans that are centered on the needs of the residents, this has in cases led to documents that are quite long. We discussed with the manager the possibility of considering how these could be summarized in ways that may allow them to be more accessible. An example is that the risk assessments we saw are at times quite repetitive, and where there are risks that are generic and applicable to all residents could be recorded as such, as opposed to repetition as part of the supporting documentation for every individual plan. Discussion with the manager showed he has a clear understanding around access to personal information related to individuals. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals that live at Agnes House are encouraged to make choices about their lifestyle, and supported to develop their life skills. Social, educational, cultural and recreational activities match individuals assessed and expressed expectations Evidence: The homes staffing group is structured so that daycare staff (staff employed to work during daytime hours) have more focus on activities for the resident (this as reflected in the discussions we had with staff). The individual plans we looked at are supported by activity plans that are reviewed on a regular basis, these reflecting the needs or preferences of the people that live at the home. People told us that they are consulted as to their preferred daily routines and where able can decide what they wish to do, or are supported to have involvement in activities either within the home or the wider community. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: We saw that whilst the home does have its own transport, residents are encouraged where able to access public transport to attend venues such as shops and colleges. Staff support to access these services is provided as needed. The staff encourage involvement in domestic routines such as individuals keeping their own rooms tidy, doing their own cooking and such like, the scope of this range from preparation of a full meal to only making drinks, this dependent on the individuals assessed ability. Some of the individuals we spoke to told us that they are able to manage their own monies, with support from staff as needed. They also have access to a lockable area in their room that they alone have access to. Individuals where able also have their own bedroom door and front door keys and where they do not have the capacity to hold keys do have a bedroom door that is lockable from inside when they want privacy, as we saw was the case. Staff do have keys to access in emergencies however. We saw that the any restrictions in respect of individuals contact with relatives are documented and the reasoning behind these understood by those person concerned as well as staff. Where there have been difficulties with issues due to differences of opinion between relatives and the home we saw that the manager looks to the involvement of such as social workers and health professionals to assist with resolutions. We saw evidence of an issue that had arisen that had implications due to mental capacity, this seen to be resolved to the satisfaction of all parties involved. The manager stated that the local social services department had been supportive to the home in addressing issues in the best interests of individual residents. The home was seen to have menus available although these are for guidance and individuals are able to make choices as to the foods they eat. Whilst the home does encourage healthy diets (such as low cholesterol and weight reducing) these are sometimes limited by residents choices. One individual did however tell us how well they had done with their weight reducing diet with staff support. Where able residents are involved in shopping (making their own shopping list) and the individuals living in no 77 do cook their own meals. Staff maintain food records for each individual and these show that there is a varied diet available. We saw that the home has a Gold Five for life award from Sandwell health partnership, this reflecting the homes provision of healthy food options. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that individuals receive is based on their individual needs and preferences, and staff support people in promotion of their health. Staff show respect for individuals and promote their dignity and privacy. Evidence: People told us that they receive care that is based on their individual requirements and is in keeping with their preferences and we heard that individuals are happy with the staff. Care plans set out peoples individual requirements and discussion with staff showed a working knowledge of what these plans said. We saw from observation that staff respect individuals privacy and dignity and this was further confirmed by what individuals told us. Where people have difficultly with communication, plans set out strategies to assist individuals to make choices, and we saw staff following these through into practice. We saw clear evidence that opportunities for independence are encouraged and supported by staff, this from observation and from what people told us. People are supported by key workers and where able to individuals told us who these staff were, and expressed satisfaction with the staff chosen to support them. We saw that preferences as to the gender of carers is explored by the home and that these preferences are followed in practice, as was confirmed verbally by individuals. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: We saw that individuals had access to helathcare and domiciliary services as needed and in accordance with their choices and assessed needs. Contact with health care services we saw is well recorded and includes access to specialist services such as psychiatry and psychology as is appropriate. One individual told us that they chose which chiropodist they wish to use. Feedback from consultations we saw was recorded and influenced plans for individual care. We saw evidence that the home is developing health action plans for individuals. The home was seen to have a medication policy that was acceptable and discussion with staff indicated an understanding of this, this assisted by training in medication management. We looked at records relating to the management of medication and found these to be up to date with the exception of the protocol for administration for as required (PRN) medication in one instance (in respect of the administration of salbutomol). We found the protocols for the administration of other as required medications clear and when asked staff understood them. Whilst there are still two signatures on medication administration records to evidence the giving of medication it is now clear (due to colour coding) as to which person is administering the medication and which person is witnessing this. We saw that there was documented evidence of regular reviews of individuals medication involving health professionals. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals who live at the home are encouraged to express their views and any concerns. Complaints are taken seriously and the homes procedures and practices protect individuals from abuse. Evidence: We saw that the home has a complaints procedure that is accessible to the residents, this through staff encouraging communication with individuals to ensure that they are able to express any concerns that they have. The home has received one complaint over the last 12 months which we saw from records (including correspondence from the complainant) to have been resolved to the satisfaction of all parties. We saw that there was information in respect of who to contact in event of concerns that included use of photos of the manager and responsible individual.The addition of CSCIs national helpline phone number would however be a useful addition. We saw that the home has policies and procedures for the safeguarding of adults available in the home, this including those of the local authorities the home contracts with. From notifications over the last 12 months the manager has kept us informed of potential safeguarding issues and has also informed other appropriate external agencies as well, this a noticeable improvement over our judgement at the point of the last key inspection. The homes practice over the last 12 months has shown us that they have an understanding as to when incidents should be reported. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: Discussion with staff showed that they have a good understanding of safeguarding issues and are also aware of the homes whistle blowing procedures. Staff have received training in how to respond to challenging behaviours and we saw little evidence of physical intervention, this fitting in with staff understanding of the need to use low arousal techniques in accordance with their training. We saw that any injuries to individuals as a result of such as self harming are well documented. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The design and layout of Agnes House is appropriate for the needs of the individuals that live there. The houses are safe and comfortable but in part could be better maintained. The environment does not present any barriers to individuals independence. Evidence: Agnes House consists of two linked bungalows that provide a homely environment for 2 individuals in no 77 and 3 in no 79. The environment is homely in presentation and whilst large enough to allow individuals privacy is small enough so as to be domestic in scale and non institutional. All of the individuals living at the home have their own bedrooms, these personalized (as we saw) and decorated in accordance with individual choices wherever possible. We saw that there was a contrast in the decor between the two houses, with the smaller house having been recently re decorated and as a result far better presented. The manager did tell us that No 79 was due to be redecorated however. We noted that there was some evidence of wear this consistent with the fact this is a higher dependency unit, with some wear to carpets on joints (these not tripping hazards at the time seen), wallpaper peeling in the lounge, the fire door to the dining room have a dropped hinge and some of the shelves over radiators whilst appearing clean been sticky to the touch. This was very much in contrast to the decor and presentation of the environment in number 77. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: All bedrooms have lockable doors and where residents are able they told us they have keys provided to these and the front door. We saw that individuals have access to free movement around their living environment. Whilst we did not notice any issues with odour at the time of the visit we were made aware of some issues in one area of the one house at times, this a matter staff are aware of and looking to manage. The management have some policies and procedures in respect of the management of infection although could develop a better auditing programme in respect of infection control, this as we noted issues such as cracked laundry bins that need to be replaced. There have not been outbreaks at the home of the last 12 months however. We saw that servicing records for the environment and any equipment in use are up to date and the homes Gold award from Environmental services confirms our view that food hygiene standards are good. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained, skilled and available in sufficient numbers to support individuals appropriately. The homes recruitment practices protect individuals living at the home. Evidence: Individuals who live at the home told us they like the staff that care for them and are comfortable with them. The dependency levels of some individuals demands high staffing levels and we saw that the home maintains these with a focus on staff availability at particular times of the day, for example; the day time staffing is focused on the provision of activities, and allocation of the staffing is based on trying to ensure a degree of consistency in which staff provide care to individuals. Staff we spoke to said that there had been some recent difficulties maintaining staffing due to influenza although existing staff had worked additional hours due to the identified need to ensure consistency as far as possible. It was also stated that time out was allowed and possible due to staffing levels, this seen as important due to the stressful nature of the work at times. The employer has is own NVQ assessment centre this allowing accreditation of training input and staff we spoke to were very positive about the training they received. From sight of the homes training plan and sampling of staff certificates we saw evidence Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: that supported what staff told us, with recently employed staff having access to an induction that gave them the skills and knowledge that they needed. This induction was also supported through working with more experienced staff for a protracted period. From what we were told staff are encouraged to commence vocational training as soon as possible, with the home having a good number of vocationally qualified staff. Based on tracking the homes recruitment practice through three recently employed staff we found the process to be thorough, this ensuring the safety of individuals living at the home. This process reflected the homes procedures. We sampled supervision records and found these to be detailed and discussion with individual staff indicated that they felt well supported by the management team. We noted that staff turnover has decreased in the last 12 month period in comparison to that for the previous 12 month period this indicative of increased stability amongst the staff team. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been on going development of management practices at the home over the last twelve months and whilst there is scope for continued improvement in some areas individuals that use the service have confidence in the management team. Evidence: The registered manager of the home has worked at Agnes House for a number of years and has worked with some of the individuals living at the home previous to this position. He is currently completing his registered managers award (ILM) and also has a NNEBs certificate in management. Staff we spoke to said that they receive good support from the manager and this ethos is carried through the staff team. At the time we visited the home the manager told us (as was confirmed by other staff) that they are currently training up more senior staff, this so as to extend the senior cover available across the two houses. Individuals who live at the home spoke positively about management and the manager in general, both as a manager and a key worker (the latter as covering this role whilst seniors are in the process of training/induction). The outcomes from this inspection evidence that the home has improved over the last twelve months, in particular in respect of monitoring potential safeguarding issues. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The provider monitors the homes performance through the responsible individuals visits to the home (these not however documented in the form of regulation 26 visits every month). The manager did tells us that although not always documented the responsible individual does visit the home frequently. We did see that there is an auditing programme that involves the managers from other homes the provider owns visiting and completing a checklist. This would inform the managers development of the home, although the current development plan was seen to be in need of review. In addition we also saw that the manager does carry out internal audits on such as care plans and records of corrective actions we saw are well recorded. Consultation with people living at the home is on an on going basis through such as care planning and people we spoke to felt involved in decision making process. Where individuals had communication difficulties the monitoring of behaviours was seen as a key indicator in respect of their views of the service and indirectly as to how their care was managed. We saw that outside professionals have been involved in the process of observing day to day interaction between staff and residents to improve outcomes for individuals. We noted that individuals are encouraged to manage their personal finances with support wherever possible, although we did note that monies deposited at the home by relatives are not receipted. A copy of a reciept should be given to the relative or person depositing the monies at the home for any individual. The home has a satisfactory health and safety policy and the last Environmental Health officers visit to the home in October 2008 gave rise to no requirements (this visit related to food safety). Overall records are of a good standard although earlier comments in respect of risk assessments should be noted, this so as to ensure records are as accessible, and as understandable as possible. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered manager must ensure that any risks presented by individuals choking are assessed and minimized. This is to ensure all staff are aware of the actions they must take to prevent and also respond to any potential incidents where residents may choke. 31/03/2009 2 20 13 The registered manager must ensure that all directions in respect of PRN medication are up to date and reflect current practice. This is to ensure that all staff and individuals receiving medication are clear as to what doses of PRN medication are permissible and when. 31/03/2009 Care Homes for Adults (18-65 years) Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The registered persons should ensure that the scale of charges for residency at the home is clearly detailed in the homes statement of purpose, this so that there is a clear illustration as to what the minimum and maximum charge would be. The registered persons should ensure that individual fee levels for the service recieved are clearly detailed in service users contracts. The registered manager should ensure that all strategies employed within behavior plans are understood by staff so that approaches are consistent. For example use of such as red/yellow card system. The registered manager should update the homes complaints procedure so that it carries the phone number for social services departments and the CSCI national helpline number. To ensure that there are consistent monthly regulation 26 reports available to the manager, these to be carried out by the Responsible individual or Representative of the provider. The registered manager must ensure that any monies received at the home on behalf of residents from relatives are acknowledged through the provision of a receipt to the person depositing the money. 2 5 3 6 4 22 5 39 6 43 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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