Inspection on 23/05/07 for St Agnells House

This inspection was carried out on 23rd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 9 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 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

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 Marian Byrne Unannounced Inspection 23rd May 2007 10:00 St Agnells House DS0000019532.V335999.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.V335999.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.V335999.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 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.V335999.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2006 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. It was opened in 1997 and comprises two-stories 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 for single occupancy, although none have en-suite facilities. There is a passenger lift. A courtyard garden is available and is accessible for wheelchair users. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in the afternoon and evening, the inspector met seven of the eight service users. The Registered Manager was not present during the inspection. There were four staff on duty this included one agency staff member who regularly works at St Agnells. What the service does well: What has improved since the last inspection? What they could do better: A service user who will be 90 years of age next birthday and has a diagnosis of dementia was admitted to the home in October 2006. There was no assessment of needs available prior to the admission. Her needs still had not been assessed on the day of the inspection. Staff have not been trained to care for service users who have dementia, she had been admitted from a home for older people who could no longer meet her needs. Another service user who is semi-independent had also been admitted without a pre-admission assessment there was nothing to indicate that this was the best home for him. This means that their care plans may not reflect their needs or wishes. The Registered Manager is at present suspended on full pay and without prejudice from her St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 6 duties pending an investigation of a complaint against her. This is being fully investigated by her managers. 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.V335999.R01.S.doc Version 5.2 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.V335999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users who were admitted to the home were not assessed nor were they admitted within the registration category. EVIDENCE: The care plans of the two most recently admitted service users were inspected. One service users who has a diagnosis of dementia was admitted from a ‘Care Home with Nursing’ who could no longer meet her needs. There was no information available on their assessment. This admission is outside the registration category of the home and it does not have staff who are trained in delivering care to people who have dementia in a residential or nursing setting. The second care plan inspected also did not have an assessment of need. The service user is very independent and may benefit is a home where there are other more independent service users. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individual needs and choices have not been met. Service user’s ability to make decisions about their own lives is also curtailed. EVIDENCE: As the service users do not receive as assessment of need prior to admission, it is not possible to confirm that their needs are being met. Care plans for the service users who have lived in the home for a long time are very detailed, but confused. Staff, when asked if they had read them, stated that they had tried, were very interested in them but were unsure what was relevant and what was no longer up to date. One service user is unable to make her needs known, she has dementia and the home has none of her social history except for the most scant details. This service user gets very distressed when being assisted with personal care. The instructions in the care plan is for two cares to assist her one carer to hold her hands. The manner in which this is documented could be interpreted in a manner that would be viewed as restraint. There is no detail to indicate why she might be so upset. There was evidence that service users are supported to take risks. One service user suffers from epilepsy she is fully St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 10 mobile and wishes to use her mobility even though this means that she might fall when she has an attack. Staff walk with her to ensure her safety. Another service user lives as independent life as possible and was out on the day of the inspection. He has a love of animals and keeps a cat in his room. A cap flap has been fitted to his door. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lifestyle of the home is not planned around service users needs and therefore does not meet the needs of the service users. EVIDENCE: Staff are constrained on meeting lifestyle of the service users due to lack of information on some of the more recently admitted service users. On the day of the inspection five of the service users were present in the home. The acting manager recognised that some of the day care packages need to be improved. There is a designated driver attached to the home to ensure access to day centres and the local community events. The home uses ‘trips and treats’ who arrange trips out. Service uses are accompanied by staff on these outings. Staff prepare food and eat with the service users. The lifestyle of some of the service users in the home is good. This needs to be extended to ensure all of the service users have the opportunity for a lifestyle of their choosing. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 12 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): 18, 19 & 20. Quality in this outcome area is poor. This would have been adequate had staff been able to deliver personal care to all the service users in a manner that service user found acceptable. This judgement has been made using available evidence including a visit to this service. Medication was administered appropriately. Care was given to most of the service users well, but poor documentation prevented this to be delivered consistently to all service users. EVIDENCE: The lack of documentation on health care needs of service users means that it is difficult to know if their health care needs are being met. As already stated two service user were admitted without an assessment of needs. One of them is capable of letting staff know what their needs are. The other is unable to communicate their needs. Staff find it very difficult to administer personal care to her as she get very upset. There is no guidance to assist staff with this. Staff in the home do not have training in the delivery of care to service users who have dementia. Two service users have pressure areas that break down from time to time. There was no information available on why this breakdown of tissue happens or how to prevent it happening in future. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This would have been good had the staff been aware of the policies surrounding the Safeguarding of Adults in Hertfordshire. This judgement has been made using available evidence including a visit to this service. Complaints are investigated. Staff were not aware of the procedures for the Safeguarding of Adults in Hertfordshire. EVIDENCE: The home has received an anonymous complaint from a member of staff indicating that there were several areas of management in the home that were less that satisfactory. The Organisation has fully investigated these. The initial result is that the Registered Manager was suspended from duties on the 17th May 2007 pending further investigations. None of the complaints referred to the welfare of the service users. Staff when asked, were unaware of how to handle issues of abuse under the Safeguarding Adults Procedures. All staff spoken with stated that they would act if they saw or were aware of an incident of abuse but were unaware of how to proceed in line with Hertfordshire Social Services procedures. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 14 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): 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was clean and fresh and was suited to purpose. EVIDENCE: This home is very domestic in style. Rooms are decorated in a homely manner, all the rooms are different to reflect the different personalities of the service users. They contain good quality furniture and bed linen. One room has a cat flap to allow the resident to have his cat live with him. The acting manager has plans to convert a room used as a office to a quiet day room This room is perfectly suited for this purpose. It is light and airy and has an outlook over the countryside. On the day of the inspection the home was in good repair. Some work is being done and will finish soon, this includes finishing the tiling surround of n new hand basin in a service users room, finishing the tiling in the large bathroom and fitting new work surfaces in the kitchen. On the day of the inspection the home was bright and airy one room had an odour that could be St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 15 associated with incontinence. The acting manager was aware of this and the matter is being dealt with. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 16 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): 32, 34 & 35. Quality in this outcome area is adequate. This would have been good had the staff been trained in dementia care. This judgement has been made using available evidence including a visit to this service. Generally, the service users are supported by well-trained staff. However, no staff have been trained to support the service user who has dementia. Staff were recruited appropriately. EVIDENCE: The home has an established core of care staff. On the day of the inspection these staff were found to be kind, caring and anxious to expand their training to ensure the optimum care of the service users. This is a difficult time for them as their manager is suspended from duty. Those staff spoken with stated that the atmosphere in the home was much better and they are now better supported by the acting manager. Training records show that the staff have been attending training. In the last year they have had training in Epilepsy, Moving and Handling, NVQ2, First Aid, Adult Protection, The Administration of Medication. Staff were appropriately recruited three staff files were inspected and they all contained the required security clearance, proof of identity and two references. One member of staff had one day’s training in the care of St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 17 service users who have dementia. This is not sufficient training to appropriately care for a service user who has dementia. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not well managed by the Registered Manager. EVIDENCE: The Registered Manager has been suspended pending investigations into a complaint received by this Commission and passed to the service provider to investigate. Presently, the Registered Manger from a sister home directly connected to St Agnells is managing in a temporary capacity. She is aware of the failing of the home as set out in this report and is working to put procedures in place to ensure the home meets the needs of the service users. This includes maintaining the records of the service users’ personal allowance and monies. Prior to her auditing them and putting procedures in place the records were ‘confused and messy’. There is no evidence to indicate that there was any money missing, but the administration of the paperwork did not provide a clear record. St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 19 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 1 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 2 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 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 1 X 1 X X 3 X St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 20 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 Requirement Timescale for action 30/06/07 12(1)(a) & The care plan must evidence 13(1)(b) how specific individual needs are to be monitored, managed and met. This was a requirement at the previous inspection. Failure to meet this extended deadline could lead to the issuing of a statutory enforcement Notice. Recording of pressure area care is inadequate, and does not provide staff with the information that they need to provide good quality of care. This requirement was made at the two previous inspections. Failure to meet this extended deadline could lead to the issuing of a statutory enforcement Notice. The Registered Person must ensure that pre-admission assessments are carried out and that person are admitted to the home only where their needs can be met by trained staff and DS0000019532.V335999.R01.S.doc 2. YA19 12(1)(a) 30/06/07 3. YA2 YA12 14(1)(a), (b) & (d) 23/05/07 St Agnells House Version 5.2 Page 21 4. YA7 5. YA23 that service users are able to take part in age, peer and culturally appropriate activities. (15)(2)(d) The registered person must ensure that service users are involved in the decision making in relation to their own care. 13 (6), (7) The registered person must & (8) ensure that no service user is subjected to a staff intervention that could be regarded as restraint. Staff must be made aware of Hertfordshire’s Safeguarding Adults Policy. 18(1)(c)(i) The Registered Person must ensure that staff are trained to meet the needs of all service users. That service users must not be admitted to the home unless staff are trained to meet those needs. 9 (2)(i) The Registered Provider must ensure the home is managed in a manner that protects the service users and meets their needs. 12 The Registered Person must ensure that the health and emotional care needs of the service users who are unable to communicate their needs are identified and met. 31/05/07 23/05/07 6. YA35 30/06/07 7 YA37 23/05/07 8 YA19 23/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Agnells House DS0000019532.V335999.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area 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.V335999.R01.S.doc Version 5.2 Page 23 - 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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