Inspection on 12/05/06 for St Agnells House

This inspection was carried out on 12th May 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Agnells House 19/09/08

St Agnells House 19/11/07

St Agnells House 23/05/07

St Agnells House 28/11/05

St Agnells House 08/04/05

St Agnells House 30/11/04

St Agnells House 14/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 St Agnells House Cupid Green Lane Hemel Hempstead Hertfordshire HP2 7HH Lead Inspector Angela Dalton Unannounced Inspection 12th May 2006 10:35 St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 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 St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 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. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Agnells House Address Cupid Green Lane Hemel Hempstead Hertfordshire HP2 7HH 01442 215805 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) Caretech Community Service Limited Rachel Ogyaadu Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (8), Physical disability (8), of places Physical disability over 65 years of age (8) St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th November 2005 Brief Description of the Service: St Agnells House is a care home providing personal care and accommodation for eight adults with learning disabilities and profound physical disabilities. It is owned by CareTech Community Services, which is a voluntary organisation. The home is situated in a residential area on the outskirts of Hemel Hempstead, where there is a good range of community services and leisure activities. The home was opened in 1997 and consists of a two-storey building with bedrooms on the ground floor and communal rooms on the first floor. It was converted from a grade II listed building. It is adjacent to another CareTech home. All the homes bedrooms are single. None of the bedrooms have en-suite facilities. There is a passenger lift. There is a courtyard garden that is accessible for wheelchairs. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector conducted this unannounced visit on 12th May 2006 and focused on key National Minimum Standards. The manager was present for the latter part of the inspection but prior to this a senior support worker had been leading the shift. Two service users were at home and the Inspector spent time with them to gain insight into St Agnells. It was a positive inspection and staff have a good relationship with service users and know them well. One requirement has been brought forward from previous inspections and some new requirements have been made. These are linked to fittings within the home, documentation and health and safety. On the day of inspection the home was very hot in some areas. What the service does well: What has improved since the last inspection? Water temperatures have now stabilised and records reflected this. Staff files were available for inspection and all the required documentation was in place to evidence a robust recruitment procedure for the protection of service users. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 6 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. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 7 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 St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 8 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): 1,2,3,4 & 5 Service users’ needs are assessed prior to moving in to the home. The contract is not in a user friendly format. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: A prospective service user has been spending time at the home and a comprehensive assessment was in place to form the foundation for the care plan. The home currently has three vacancies and should referrals be made the appropriate documentation is available. Service users have access to a paper copy of a service users guide and this is kept in each bedroom. A previously made recommendation to ensure that the service users’ contract is in a format that can be easily understood remains outstanding. The proprietors response to the previous report indicated a steering group was to be formed to action this recommendation. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 9 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): 6,7,8 & 9 Care plans do not contain adequate information relating to individual health requirements but are descriptive in other areas. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans contained a comprehensive amount of information but it was difficult to identify how individual needs are met. Little or no guidance was available to evidence how epilepsy, hepatitis B and pressure care are managed. Other areas that need additional attention are management of osteoporosis, weight and nutrition. A previous requirement has been made in relation to pressure care. District nurse notes are kept in a service users’ bedroom but are not referred to in the care plan. Risk assessments are in place to ensure that risks can still be taken but are monitored and managed. All service users have a named keyworker and spend one to one time to review their needs. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 10 Care Tech has not yet implemented any guidance regarding Person Centred Planning but some staff have attended training and feedback this information to the team. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 11 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 A variety of social opportunities are provided. Mealtimes are focused upon service users but interaction could be improved to make this a more social occasion. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: A designated driver is employed to ensure service users can access day care or alternative provisions. When the driver is not available the manager ensures another driver is on duty. Service users utilise the local facilities and regularly go to the pub and bowling alley etc. One service user attends church weekly and all service users are given the opportunity to participate in organised activities by Roar which is linked to Mencap. Service users are currently planning their holidays which they fund as it is not part of their contract conditions. The inspector joined service users for lunch and this was well presented and tasty. Staff eat with service users and this provides a social opportunity as well as enabling staff to monitor service users’ wellbeing. A recommendation has been made for staff to interact more with service users at mealtimes e.g. to inform them about what the meal being served is and to converse during the meal. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 12 The manager is exploring an alternative to the ‘bibs’ that service users currently wear to ensure dignity is observed. Appropriate aids are available at mealtimes to maximise service users’ independence. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 13 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 medication system does not safeguard service users. Individual health needs are not evidenced as being met. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans explain the individual way in which service users’ personal care requirements are met. As discussed earlier in the report further attention is needed in documenting how health needs are monitored, managed or met. Service users’ individual diagnoses were recorded but no management plan was attached. In the case of a service user with epilepsy there was information describing how their medication was administered but no description of their seizures or how they were managed. A diagnosis of Hepatitis B was also recorded but there was no information how this was managed. One service user receives treatment from the district nurse for pressure care but this is not well reflected in the care plan. There is no explanation about the size of the pressure wound, monitoring of the condition or treatment. Staff may benefit from training in this area. Medication storage and records were checked. One service user had disposed of their medication down the sink but it had been signed for by a staff member as being administered. Some staff were aware of this risk but it is not recorded in the care plan. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 14 This would ensure that staff who administer medication remain with the service user to monitor the outcome and record accordingly. Medication is stored in the office, which was very hot. A record of storage temperatures must be kept to ensure medication is kept safely as the effectiveness of medication can be reduced if incorrectly stored. The manager will liaise with the pharmacist to check the condition of current stock. Labels were being used on the Medication Administration Record (MAR) sheets and this practice must cease. The home keeps a large amount of stock under the stairs. This is stored in six plastic boxes stacked on top of each other and poses a health and safety risk. The temperature is not recorded to ensure safe storage. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 15 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 Service users are encouraged to share their views. An adult protection policy is in place. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have the opportunity to formally raise their concerns in residents’ meetings or one to one meetings with keyworkers. Staff are trying to obtain the services of an advocate and befriender for one service user without family. Staff had a good understanding of adult protection and how to protect service users from abuse. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 16 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): 24,27 & 30 Insufficient bathrooms facilities are in place to meet service users needs. The home is clean and odour free. Quality in this outcome area is poor; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean and tidy. It is evident that it is the service users’ home and is personalised by photographs and drawings. Each bedroom reflects the personality of service users. Some bedrooms had gaps in the ‘patio’ doors leading outside which must reduce the temperature in the winter. Lagging is exposed in a bedroom. The manager will refer this to the maintenance team. The home has a shower room and two assisted bathrooms. The shower room has been decommissioned due to drainage problems and one assisted bath is not working. The assisted bath that is in use is leaking and as a result the floor is marked and cracked. This must be addressed and appropriate facilities must be available to meet service users needs. The home currently has three vacancies will decrease to two over the coming weeks. Staff reported that the reduced bathroom provision delays delivery of personal care and impacts upon service users’ choice of when to bathe. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 17 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): 32,34,35 & 36 Adequate staffing levels are in place. Staff receive mandatory training but would benefit from specialist training to support service users individual needs. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The level of staffing is sufficient to meet the current number of service users. A vacancy for a deputy manager exists and interviews are taking place shortly to fill this post. A rolling training programme is in place to ensure that staff receive mandatory training. It is recommended that Pressure Care training is made available so to further support in meeting individual service users needs. Recruitment records were checked and all required documentation is in place for the protection of service users. Staff receive monthly supervision and the manager has increased the number of staff they supervise in the absence of a deputy manager. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 18 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): 37,38,39 & 43 Service users’ views are accounted for by the company. The health and safety of service users and staff is not assured. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff had a good understanding of their roles and responsibilities. The home has a calm and friendly atmosphere, which promotes a calm living and working environment. The manager is advised to record their shifts on the rota as their shift pattern is not known by the staff team. CareTech conducts regular quality audits and one is planned for this month to ensure quality assurance. As discussed earlier health and safety requires some attention: cleaning fluids were not locked away and left in bathrooms; doors were wedged open and this poses a fire risk; a thermostat was broken with wires displayed and a handle on a freezer was broken with holes in the seal. The temperature in the home was very hot and although some areas had fans there was no way of reducing the level of heat. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 19 The kitchen door opens inwards and poses a risk if the fridge/freezer door is open. There is no way of seeing if the fridge door is open. The manager will investigate any options and report their findings to CSCI. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 1 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 2 X 3 2 3 X X 1 X St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 12(1)(a) & 13(1)(b) Requirement The care plan must evidence how specific individual needs are to be monitored, managed and met. Particular attention must be paid to osteoporosis, Hepatitis B, weight, nutrition, epilepsy and pressure care. Recording of pressure area care is inadequate, and does not provide staff with the information that they need to provide good quality of care. The registered person must liaise with the district nurses to ensure that appropriate care plans and recording are in place for all the residents’ health care needs, and in particular for the management of pressure area care. THIS REQUIREMENT WAS MADE AT THE PREVIOUS INSPECTION. Medication must be stored at the correct temperature and records kept. Labels must not be used on MAR (Medication Administration Sheets). DS0000019532.V294105.R01.S.doc Timescale for action 30/06/06 2 YA19 12(1)(a) 30/06/06 3 YA20 13(2) 31/05/06 St Agnells House Version 5.1 Page 22 4 YA24 23(2)(b) 5 YA27 23(2)(j) 6 YA42 13(3) Medication must be administered safely and accurate records kept. A realistic amount of stock must be kept. The gaps in service users patio 30/06/06 bedroom doors must be addressed. The garden must be kept in good condition to ensure easy access to service users. The lagging on display in a bedroom must be attended to. Bathrooms must be fit for use. 30/06/06 Only one assisted bath is available and is leaking causing the floor to crack. The health and safety of 31/05/06 service users and staff must be assured. The issues identified in the body of the report must be addressed eg: door wedges/cleaning fluids/temperature of the home/fridge door. St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA5 Good Practice Recommendations The statement of services should be drawn up in a format that the residents can understand. It should be signed by the resident or their representative and by the registered manager of the home. (This recommendation was also made in the four previous inspection reports.) The proprietors response following a previous inspection report stated that this had been referred to Head Office, and a steering group was to be created to action this recommendation. No evidence of this was seen on this occasion. Staff interaction at mealtimes should be improved. An alternative to bibs should be implemented, as they are not age appropriate. Staff should attend pressure care training. The manager’s whereabouts should be reflected on the rota. 2 3 4 YA17 YA35 YA38 St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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. Extracts may not be used or reproduced without the express permission of CSCI St Agnells House DS0000019532.V294105.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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