Inspection on 19/11/07 for St Agnells House

This inspection was carried out on 19th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 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 23/05/07

St Agnells House 12/05/06

St Agnells House 28/11/05

St Agnells House 08/04/05

St Agnells House 30/11/04

St Agnells House 14/05/04

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Paradise Lodge

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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 Yoke-Lan Jackson Unannounced Inspection 19th November 2007 10:00 St Agnells House DS0000019532.V355069.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 St Agnells House DS0000019532.V355069.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. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 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) www.caretech-uk.com CareTech Community Services Ltd vacant post 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.V355069.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th August 2007 Brief Description of the Service: St Agnells House, owned by CareTech Community Services Limited, is a residential care home for eight younger adults with learning disabilities and profound physical disabilities. Another CareTech home is adjacent to St Agnells. 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. It was opened in 1997 and comprises two floors with bedrooms on the ground floor and communal rooms on the first floor. It was converted from a Grade II listed building. All the bedrooms are for single occupancy. The bathroom and toilet facilities are nearby. The home has a passenger lift. The courtyard and garden are fully accessible to wheelchair users. Currently the home charges £1337.30p per week. Information about the home and the service it offers are contained in the Statement of Purpose and Service User Guide. A copy of these and the most recent CSCI inspection report are available on request in the home. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection was carried out on 19/11/2007. The home manager was present. The home at the time of the inspection has 8 residents. The inspection began with a tour of the premises. Time was spent observing staff interaction with residents. Both residents and staff were interviewed and documents were examined. The inspection included a visit by an expert by experience. The expert together with a representative from the Centre for Independent Living spent two hours with the residents in the lounge. An expert by experience is a person who, because of their shared experience of learning disability and ways of communicating, contributes to providing a better picture of what it is like to live in or use a service such as St Agnells. The arrangement for using an expert by experience was arranged by the Commission. The information and feedback received from an expert by experience are incorporated into the inspection report. Information received by the Commission since the last inspection was reviewed. This included the Annual Quality Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how well outcomes are being met for people using the service. What the service does well: All the residents appeared well. The two care workers present on the day of the inspection were working hard to accommodate each resident’s personal needs in spite of the shortage of staff on the morning of the inspection. Staff interviewed by the expert by experience said that some residents go to the day centre but some remain in the home, but the staff spoken to do not know why. For those residents who have difficulty reading, a member of staff will assist by reading to them. The expert by experience also mentioned that residents are given a set menu and for those residents who do not like the menu, there is an alternative dish. The expert by experience visited some of the bedrooms and said that they appeared clean and tidy. There were photos and television in the bedrooms. Some residents have radios. One resident has a projector and screen in their bedroom. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The staffing level was inadequate on the day of the inspection. The Manager said that this was not a regular occurrence. By lunchtime, an agency member of staff from the adjacent Caretech Home came to assist. The expert by experience observed that all the residents were sitting in front of the television with no other form of stimulation. He also observed that there were no staff present in the room with the residents at the time. The expert by experience felt that staff should have assisted a resident who was sitting at a table with nothing to do. He observed that there were no games in the lounge for the residents to choose from. He further observed that the interaction between staff and residents amounted to verbal instructions or asking a question. During feedback at the end of the visit, the expert by experience felt that the residents would benefit if the lounge was equipped with some sensory and stimulating objects since the residents spent most of their time in the lounge. He further suggested Makaton training for all the care workers as he observed that social interaction and verbal communication were minimal. Not all medication that was open in use contained an ‘opened date’. Some medication has a ‘use by once opened date’ which staff cannot monitor if they are not putting the date that is first opened on which may mean ineffective medication is being used. Using a date also helps audit medication in the home. Although generally the home was well maintained one bedroom was found to have an unpleasant odour. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Agnells House DS0000019532.V355069.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 St Agnells House DS0000019532.V355069.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents can be assured that a pre-admission assessment will be carried out before they are admitted to ensure that the home can meet all their care needs. EVIDENCE: There have been no new admissions since the last key inspection. However the management has given their assurance that a thorough pre-admission assessment will be carried out on all future admissions to ensure that only those clients whose care needs can be fully met are admitted into St Agnells. Currently there is a resident whose care needs are not being fully met and the resident is not happy to remain at St Agnells. The Manager has confirmed that the social worker will assess the situation on 5th December 2007 and that an alternative placement will be arranged for this resident as soon as possible. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given the opportunity to make everyday choices and they are encouraged to achieve independent lifestyles, and their preferences and requests are respected. Each resident has a written care plan which details the care required and how to meet any individual needs. EVIDENCE: Since the last inspection, all the eight residents have had their written care plans reviewed and changed to a person-centred format. Risk assessments were carried out and documented. Each care plan now reflects the specific and changing needs of the resident. In addition to the main care plan folder there is an easy-to-read folder in picture format. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 11 Residents are offered a one-to-one consultation monthly. This session is documented and the notes are kept in the resident’s care plan folder. Residents are given choices and staff respect their decisions and assist them accordingly. A resident was allowed to keep their cat and the bedroom was adjusted to accommodate the cat. Residents who are able to are encouraged to lead independent lifestyles. On the day of the inspection, a resident was making their own cup of coffee in the kitchen. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ rights are respected and they are encouraged to maintain links with their families. Residents have organised activities that are varied. However, they would benefit from a more stimulating environment and daily one-to-one interaction. The meals provided are wholesome and residents are encouraged to have a healthy diet. EVIDENCE: Residents are now actively involved in planning menus, activities and holidays. Each resident is given the opportunity to participate in the general décor of the home and the redecoration and furnishing of their bedrooms. Staff are being trained to focus on these changes and to assist residents in their chosen activities. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 13 Most residents attend the day care centre each day where they are encouraged to get involved in activities that are stimulating and educational. Sometimes residents are escorted to the local shops where they can buy whatever they want. Relatives are encouraged to visit the residents and are encouraged to get involved in the resident’s routine and social activities. However, on the day of the inspection there were no indoor activities provided. The expert by experience spent sometime in the lounge with six residents and observed that they were merely sitting in front of the television (with the sound turned down) and there were no staff present to assist them for some time. He observed a resident sitting in an armchair rubbing their head with nothing to stimulate them. The meals provided are nutritious and balanced. A dietician has been involved in assessing the nutritional needs of each resident. Staff take turns to cook the meals. They encourage the residents in healthy eating. There is a choice of menu. A resident was observed making their own drink with no supervision. The manager said that normally there is a member of staff present. However, the home was short of staff on the morning of the inspection. The two care workers on duty did attempt to ensure that the residents are safe by checking the lounge in between giving personal care to a resident in the bedroom. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are treated with respect and the majority receive personal care and support in the way they prefer and require. However, the home was not able to meet all the personal and social needs for one of its residents. Residents are safeguarded by the home’s medication policy and procedure but they are not always being followed. EVIDENCE: Since the last key inspection, the home has arranged for a doctor specialising in mental health to assess and advise staff in regard to the personal care of a resident. He attended on 10/08/2007 to observe the staff interaction with the resident and to assess the resident’s condition. The care workers were given training following the assessment. Two care workers are now assigned to assist this resident. Care workers are now given specific written guidelines to follow when they provide personal care to this resident. The staff are interacting positively with the resident and the need for staff intervention in the personal care of this resident has decreased as the resident’s condition has improved. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 15 The home has the support of health care professionals such as the General Practitioner and the Community Psychiatric Team. Health and behavioural concerns are referred to them for immediate assessment. The District Nurse is in attendance for a resident who has pressure sores and the recording has been maintained. A resident has been referred to the social worker for assessment as the resident felt that the home is not able to meet all their current needs and the resident wishes to be found an alternative placement. The Monitored Dosage System is used for drug administration. The Medication Administration Charts were examined and no gaps were found. However, not all medicines were appropriately labelled with the opening date written on the container. The Manager said that she would reinforce this practice immediately. There are no controlled drugs in use at the present time. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a robust Complaints Policy and Procedure in place so that residents are listened to and action is taken. Their legal rights are protected. EVIDENCE: The manager has arranged for all residents to attend Residents’ Meetings, which are held monthly. Minutes were taken at the last meeting and a copy was readily available for inspection. The management ensures that issues raised at each meeting are taken seriously and changes are made accordingly. Staff have training on issues concerning safeguarding of the vulnerable. The last training on Safeguarding Procedure was held on 04/09/2007. The home follows the multi-agency Safeguarding Procedure of Hertfordshire County Council. Since the last inspection there have been no safeguarding issues or complaints raised. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 25, 26, 27, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general, residents live in a homely and comfortable environment. They have access to all the communal facilities and the specialist equipment they require to maximise their independence. EVIDENCE: There is a rolling maintenance programme. In general, the home is kept clean and tidy, but on the day of the inspection, there were not enough care workers so the carpet was not vacuumed. Most of the bedrooms examined appeared clean with personal items on display, except for one bedroom where there was a smell of urine. None of the bedrooms have en-suite toilet facilities. The hoists, wheelchairs and the lift were in good working order. All doors are kept open with automatic hold-open door devices. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 18 The expert by experience felt that some sensory and stimulating objects in the lounge would be of benefit to the residents. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported and safeguarded by a robust recruitment policy and procedure. However, the staffing level on the day of the inspection was inadequate resulting in residents being left on their own intermittently which may expose them to risks to their safety. EVIDENCE: On the day of the inspection, due to a last minute cancellation by an agency worker, the home was short staffed. The two care workers managed to assist the residents with their personal care with the help of the Manager. However, residents who were in the lounge were then left on their own for short periods until lunchtime when a care worker was deployed from the adjacent care home to help out. Staff have defined roles and responsibilities. They are appropriately trained to ensure that they can meet the service users’ individual and joint needs. Proper staff records are kept and these are available for inspection. They have had specific training on Dementia Care and Safeguarding Procedure since the last inspection. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 20 The management encourages staff to undertake professional development in addition to mandatory training. Progress is being made with NVQ training for staff. The home is currently advertising for a deputy manager. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standards of administration and management of the home are improving, which is reassuring for the residents. However, residents’ safety is being compromised by shortage of staff. EVIDENCE: Currently the home has no registered manager. However, an ‘acting’ manager was appointed since the last inspection. She is on six months probation. The standards of administration and management have improved since the last inspection. This was in evidence at the random inspection on 28/08/07 and during this key inspection. However, the home is short staffed and it would benefit the service if the Manager was given more support by the provider to ensure that the staffing levels are adequate at all times. On the day of the inspection, the Manager did an extra duty as the number of staff was down to St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 22 two care workers. The Manager assured the inspector that normally there would be 3 care workers and a manager on duty. She did managed by lunchtime to get an additional care worker from the adjacent CareTech Home, which was not an ideal arrangement. There is a quality assurance and monitoring system is in place. All servicing records are updated. The Liability Insurance certificate and the CSCI Registration certificate are on display in the entrance hall. The yearly CSCI Annual Quality Assurance Self-Assessment (AQAA) form was completed and sent to CSCI on time for this inspection. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 23 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 3 3 2 4 X 5 x 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 3 26 3 27 3 28 X 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 3 3 3 X 2 x St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement To ensure the safety of residents, all containers of medicines that are opened for use must have the opening date clearly written on the container itself. The premises should be kept clean and the identified bedroom should be free from offensive odour. To ensure the safety of residents the staffing level must be adequate at all times. Timescale for action 30/12/07 2. YA24 YA30 23(2)(d) 16(2)(k) 30/12/07 3. YA33 YA42 18 (1)(a) 30/12/07 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 YA3 Good Practice Recommendations The management must ensure that all future admissions meet the requirements of the Care Standards Act and only admit people whose care needs can be fully met. It is recommended that the management review the daily DS0000019532.V355069.R01.S.doc Version 5.2 Page 25 2. YA14 St Agnells House 3. 4. YA29 YA33 activities in the home to ensure that residents have sufficient mental stimulation and recreational activities. It is recommended that the lounge be equipped with some sensory and stimulating objects of interests, since the residents spent most of their time in the lounge. It is recommended that more staff be deployed to assist with activities. St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Agnells House DS0000019532.V355069.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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