Inspection on 19/09/08 for St Agnells House

This inspection was carried out on 19th September 2008.

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

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

Other inspections for this house

St Agnells House 19/11/07

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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Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOME ADULTS 18-65 St Agnells House Cupid Green Lane Hemel Hempstead Hertfordshire HP2 7HH Lead Inspector Yoke-Lan Jackson Unannounced Inspection 19th September 2008 11:30 St Agnells House DS0000019532.V371897.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.V371897.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.V371897.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 www.caretech-uk.com 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 Services Ltd 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.V371897.R01.S.doc Version 5.2 Page 4 St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 5 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th November 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 in the home. St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use the service experience adequate quality outcomes. The unannounced inspection was carried out on 19/09/08. The home manager (appointed on 01/09/08) and the deputy manager were present. The home has 7 people in residence and 1 vacancy. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff and residents were spoken with and key documents were examined. There were no relatives present during this site visit. Information received by us included feedback from people who live in the home via written survey questionnaires. The Annual Quality and Assurance Assessment (AQAA), which focuses on how the outcomes are being met for people using the service, was not used on this occasion. What the service does well: The four residents present on the day of the site visit appeared neat and clean. The members of staff interviewed have knowledge of the residents’ care needs and preferences and personal care was delivered accordingly. The premises appeared well maintained, clean and tidy. As a resident commented, “We have a very good cleaner working in the home.” In a recent survey by the Commission the respondents (residents) gave the following comments: “I get a lot of attention and enjoy this very much.” “I enjoy most of the food and drink given to me regularly by staff.” “I do make decisions but I have help and support from staff.” “Whenever and wherever I want to go a member of staff comes with me.” “I will always air my views to staff whenever I disagree or am unhappy about something.” “Sometimes I have to fit in with other residents.” St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. St Agnells House DS0000019532.V371897.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.V371897.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): Standard 2. Quality in this outcome area is good. 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 newly appointed home manager has given her assurance that a thorough preadmission 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. One of the residents is waiting to be transferred to more suitable accommodation where their care needs can be better met. Another resident has moved to another county to be near their family. St Agnells House DS0000019532.V371897.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, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are given every opportunity to make everyday choices. However, those with changing care needs may not have their needs met as the written care plans, which detail the care required and how to meet any individual needs, have not been appropriately maintained. EVIDENCE: In general residents are encouraged to make their own choices and are assisted to achieve independent lifestyles. Their preferences and requests are respected. On the day of the site visit, a resident was observed having a late breakfast and drinks in the dining room while two residents were resting in the lounge. Since the last inspection, the care plans have not been well maintained. There were at least 3 care plan folders for each resident and some written documents were filed in the wrong folders. The new management team are in the process of revising all the care plan folders and hope to produce a more user friendly and improved person-centred format over the next few months. St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 11 The new manager said that she will review each resident’s care needs and carry out risk assessments where appropriate and update all written care plans. It was noted that some confidential information had been left on an open bookshelf in an unlocked room. Since the site visit, all residents’ personal files have been transferred to a secure and lockable cabinet. St Agnells House DS0000019532.V371897.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. People who live in the home are encouraged to maintain links with their families and they are encouraged to have a healthy diet. However, they would benefit from a more stimulating environment. EVIDENCE: A member of staff prepares the meals each day. Each resident has a choice of menu. A resident was encouraged to help himself during lunchtime with some assistance from a member of staff. A member of staff said that there are organised activities for the residents both indoors and outdoors and transportation is provided. On the day of the site visit, there were four residents in the home. It was noted that two residents was at the day care centre and another resident was in hospital. There was a bingo session in the afternoon. However, most of the time residents were merely sitting around in the lounge areas with the television on. It was not clear whether residents were given the choice of programmes to choose from St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 13 or whether the television was switched on routinely. The new manager said that work is in progress to provide a sensory room where residents can have access throughout the day. She has agreed to review the daily activities within the home. St Agnells House DS0000019532.V371897.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. People who use the service can be assured that they will be treated with respect and that they will receive personal care and support in the way they prefer and require. However, the home was not able to meet all the care and social needs for one of its residents and members of staff do not always follow the home’s medication policy and procedure. EVIDENCE: One of the residents is still waiting for a suitable placement in an environment which is more suited to meet all their care and social needs. The new manager said that alternative accommodation has been found and hopefully the resident will be transferred in a few weeks. Another resident has recently moved to a care home in another county to be nearer their family. One of the residents had a slight bruise on their right leg and this was properly documented including a body chart to indicate the site of the bruising and the date noted. Members of staff who know the resident well said that the resident has a tendency to knock against the furniture due to unstable gait. St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 15 Residents have access to healthcare professionals such as their own doctor and the district nurse. The service has the support of the Hertfordshire Learning Disability Team when required. A referral has been made to the local Wheel Chair Service for one of the residents who may need a replacement wheelchair. A trained member of staff administers medication. The home uses the Monitored Dosage System. The Medication Administration Record (MAR) Charts were examined and no gaps were found. However, the handwritten notes and instructions on the MAR charts do not always have the signature of the author and the date they were written. It was noted that not all medicine containers were appropriately labelled with the opening date written on the container. This was highlighted at the last inspection. There were medicines prescribed (as “when required”) for residents, who have not been taking them for some time as indicated on the MAR charts. There are no controlled drugs in use at the present time and the home does not have a Controlled Drug Cupboard installed. St Agnells House DS0000019532.V371897.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. The home has a robust Complaints Policy and Procedure and people can be assured that their complaints will be listened to, action will be taken, and their legal rights will be protected. EVIDENCE: Residents’ Meeting is held monthly. 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 home follows the multi-agency Safeguarding Procedure of Hertfordshire County Council. Since the last inspection the Commission received a complaint that was referred to the Hertfordshire Learning Disability Team as a safeguarding issue which was investigated. No further action was required and the case was closed. St Agnells House DS0000019532.V371897.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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the management is working towards making the environment more homely, safe and comfortable to live in. EVIDENCE: There is a rolling maintenance programme. The home has a domestic worker who was present on the day of the site visit. All communal areas appeared clean and tidy and the domestic worker was observed cleaning the bedrooms. All doors are kept open with automatic hold-open door devices. Work is in progress to re-arrange the office, the medication storage room and the recreation room. The management ensures that the residents’ routine is not unduly affected during this time. St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 18 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, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that there is now an effective management team in place to support them and they can be confident that they are safeguarded by the home’s robust recruitment policy and procedures. EVIDENCE: Since the last inspection, a new home manager and a deputy manager have been appointed. The home manager commenced work on 01/09/08 and the deputy manager has been in post since July 2008. On the day of the site visit, there was a new support worker shadowing a member of staff. The recruitment policy and procedure for new recruits have been followed and appropriate checks via the Criminal Investigation Bureau (CRB) and the Protection of Vulnerable Adult (POVA) have been done. Members of staff are encouraged to undertake professional development in addition to mandatory training. Progress is being made with NVQ training for staff. On the day of the site visit a member of staff was being assessed by an NVQ assessor from a training organisation. It was noted that not all the staff follow the home’s policies and procedures on the safe handling of confidential information and medication. St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 19 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, 39, 41, and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the new management will support their interests and that their health and safety will be promoted and protected. EVIDENCE: The service has been operating without a registered manager since July 2007 and for a few months there was no home manager in post. A new home manager was appointed on 01/09/08. She has yet to be registered with the Commission. The new management team have recognised a number of shortfalls in the service that needed to be addressed immediately. These shortfalls include issues that involve the handling and storage of confidential information under the Data Protection Act 2008, the review of care plans folders to a userSt Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 20 friendly format, improving on the person-centred planning for each resident and the need to review the daily activities within the home and to create a more stimulating environment for people with learning disabilities. The new management need to ensure that all members of staff follow the home’s policies and procedures on record keeping and on the safe handling of medication. The provider carries out its annual quality assurance and the quality monitoring system is based on seeking the views of the residents, families and advocates and the healthcare professionals. There is an annual report that is readily available for inspection. The area manager carries out a monthly visit and produces a report in accordance with the Care Home Regulations 2001. St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 21 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 x 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 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 2 LIFESTYLES Standard No Score 11 x 12 2 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 x 3 x 2 2 x St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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) Misuse of Drugs (Safe Custody) (Amendment) Regulations 20 2007. 2. YA20 13 (2) Requirement In order to comply with the Misuse of Drugs (Safe Custody) Regulations 1973, Amendment 2007, the service must have a Controlled Drug Cupboard installed. 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. (Carried forward from the previous inspection. Failure to comply with this requirement may result in enforcement action.) Timescale for action 30/12/08 30/11/08 St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 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 YA10 YA35 YA41 Good Practice Recommendations It is recommended that all staff have training on the Data Protection Act 1998 and the home’s policies and procedures on the safe handling of confidential information and medication. To ensure the safety of residents it is recommended that all staff have refresher courses on the safe storage, handling and administration of medicines. It is recommended that all handwritten notes and instructions on the Medication Administration Record Charts be dated and signed by the author. It is recommended that the management review the daily activities in the home to ensure that residents have sufficient mental stimulation and recreational activities. (Carried forward from the previous inspection) It is recommended that the lounge be equipped with some sensory and stimulating objects of interests, since the residents spend most of their time in the lounge. (Carried forward from the previous inspection) 2. YA20 YA42 3. YA20 4. YA14 5. YA29 St Agnells House DS0000019532.V371897.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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. 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