Inspection on 28/11/05 for St Agnells House

This inspection was carried out on 28th November 2005.

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 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 3 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 12/05/06

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

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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 Claire Farrier Unannounced Inspection 5:30 28 and 30 November 2005 th th St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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.V270544.R01.S.doc Version 5.0 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.V270544.R01.S.doc Version 5.0 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.V270544.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th April 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. It was opened in 1997. The home consists of a two storey building, and it was converted from a Grade II listed building. It is situated in a residential area on the outskirts of Hemel Hempstead, where there is a good range of community services and leisure facilities. It is adjacent to another CareTech home. All the home’s bedrooms are single, and none have en-suite facilities. There is a passenger lift between floors, and the home and courtyard garden are fully accessible for the residents. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over an evening and a following afternoon. Including preparation time, a total of five hours was allocated to this inspection, and the inspector spoke with and observed five residents, two visiting relatives and four members of staff. The interaction between residents and staff was observed. The records of residents’ care were checked. This was a positive inspection, and several areas of improvement were seen. All the residents spoken to were happy in the home. New requirements have been made concerning recording pressure area care and recording water temperatures, and a requirement concerning staffing records has been repeated. This was the second inspection of the year. Core standards that were not inspected on this occasion were assessed to have been met in the previous inspection report, to which reference can be made. What the service does well: What has improved since the last inspection? The manager has acted on the requirements made in the last inspection report. All residents have up to date assessments of their needs, and they are all members of Roar, which organises clubs, outings and activities for them. The proprietor’s response to the last inspection report stated that the service users guide and statement of purpose are being developed by CareTech, and that they will be adapted to St Agnells specifications when approved by CSCI. An acceptable draft service user guide has been produced, with the intention to use it as a basis for a CD or DVD. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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.V270544.R01.S.doc Version 5.0 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.V270544.R01.S.doc Version 5.0 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): 2 The home has sufficient information on residents’ needs and access to appropriate services to enable their needs to be met. EVIDENCE: Following the last inspection, the manager reported that there were no assessments on file either in the home or at headquarters for any of the residents, including residents that have been admitted to the home since 2002 when the Care Homes Regulations came into force. New assessments have been completed for each resident. A recent social services assessment was seen in the file of one resident, with information on her needs for personal care and health care, and for suitable activities. The other file inspected contained up to date information on the resident’s situation and needs. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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 and 9 The residents’ care plans contain detailed information on all their personal care and health care needs, and comprehensive risk assessments related to each individual, which enable the staff to provide a good quality of care. However the care plans and reviews show no evidence of the involvement of the residents in decisions about their care. EVIDENCE: Detailed case tracking was carried out through the files of two residents. No change has been made to the care plan format since the last inspection. The care plans are well written, with good details of all the residents’ personal care needs and of their likes and dislikes. The support requirements are written in the first person, for example “how I want staff to assist me”, and “how I don’t want staff to assist me” for each topic. This provides a basis for a person centred planning (PCP) approach, but there is no evidence that the whole concept of PCP has been addressed, which should focus on the person being totally at the centre of all planning, including how the process is carried out. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 10 The support requirements are not supported by aims or goals for monitoring how they are achieved. The daily recording in the residents’ daily service records does not provide relevant or useful information for monitoring the service requirements. The annual whole life reviews and the internal monthly reviews show no sense of the voice of the residents and no evidence of their involvement. There is a monthly co-ordinator report, a monthly review record and a monthly summary sheet for each resident. These are repetitive, with the same information on each. It is not clear what the difference is between these records, and why there is a need for three monthly review records. The staff spoken to also said that the recording is repetitious. Risk assessments were seen for individual residents, including for the use of bed rails, going out in the home’s minibus, the use of a lap belt on the wheelchair and checking during the night. CareTech provides a standard format for risk assessments, but each one has been completed individually with details of the risk and the measures to manage the risk that are specific to each resident. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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 and 17 The residents are encouraged to make choices for their activities, and to be involved according to their abilities in developing their skills for independence. This ensures good relationships with their families and with the local community, and that individual rights and responsibilities are recognised and supported. EVIDENCE: Five of the six residents attend Jarmans Day Centre two or three days a week. One resident is elderly and frail and now remains in the home. They all take part in community activities, including going to local shops. A cleaner/driver has been employed in the home, so that more outings are now possible. Three residents had been to Oxford on the previous day for Christmas shopping. Each resident has a social diary in their care plan, which records the activities that they take part in every day, and those seen include going for a drive, massage and manicure. Some residents also go to a hydrotherapy pool, following assessment from a physiotherapist. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 12 The residents are members of Roar, which organises outings and activities for them, including a Roar fun day and trips to the cinema. In the home they had made Christmas cards with assistance from the Roar activities co-ordinator. On the evening of the inspection they spent most of the time in the lounge with the television on. The staff spent time talking to them, and encouraging them to interact with each other. One of the residents spoke of a holiday that three residents had in the Isle of Wight, which was a highlight of his year. The residents’ families are encouraged to be involved in the home, and most residents have families who visit them regularly. The brother of one resident visited the home during the inspection. He said that his brother is very happy in the home, and very well cared for. The evening meal was observed during the inspection. Two residents ate their meal in the lounge, by their choice, one was in bed, and the others sat at the table in the dining room. The lounge and dining room are open plan, and the staff were available to talk to and assist all the residents during the meal. The menus have been drawn up with the involvement of a dietician, and they take the residents’ known preferences into account. One member of staff assisted a dependent resident to eat his meal, sitting beside him and talking to him while he ate. The other residents were able to eat with minimal assistance. Guidelines were seen in one care plan for mealtimes, including how the person’s plate and cutlery should be placed in front of him so that he was able to use them independently. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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 and 19 The staff provide good quality personal care and treat the residents with sensitivity and respect. The recording of the residents’ health care needs is generally good, but the recording of pressure area care is poor. EVIDENCE: The care plans that were inspected provide comprehensive details of the residents’ personal care and health care needs (see Standard 6). A good relationship was observed between the staff and the residents. They talk to the residents while they are assisting them. They were seen to encourage one person to eat independently, and to help him when he requested it. One resident has noticeably changed since the last inspection. She was walking independently, and she spoke enthusiastically of going to the day centre and taking part in activities, which she was unwilling to do previously. Detailed recording of each resident’s health care includes health notes for hospital visits and contact with GPs and other medical professionals, appropriate monitoring of epilepsy and regular weight checks. In one case the recording seemed to be more detailed than required, with a daily bowel chart for which there was no assessed need. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 14 One frail resident is cared for mostly in bed. The district nurse visits every day to monitor her pressure area care. The district nurses maintain their own records for pressure area care, but they do not provide clear information for the staff on the progress and what assistance is needed. The resident has no specific care plan for pressure area care. It was reported that she is turned regularly, but there is no specific information on the need for regular turning, and no record of how often she is turned while in bed. The reviews and monitoring do not provide sufficient information on the progress of healing, and what there is seems to indicate that the wound is deteriorating rather than improving. Although the district nurses carry out the daily treatment for pressure areas, the manager of the home is responsible for ensuring that good care is provided for all the residents, and the information and recording is inadequate for this purpose. The relationship between some district nurses and the staff of St Agnells House has caused some difficulties. The manager made a complaint about district nurses when hypodermic needles were left in a resident’s room, and a district nurse made a complaint about the attitude of some of the staff towards her. A strategy meeting was held at which it was agreed that there would be regular liaison meetings between the manager and the district nurses. This could also be the forum for ensuring that the staff have sufficient information on the needs of the residents who are becoming physically frail, including and specifically for pressure area care. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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): These standards were not inspected on this occasion. EVIDENCE: St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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 and 30 The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness and hygiene. EVIDENCE: The home consists of a two storey building with bedrooms on the ground floor and communal rooms on the first floor. It was converted from a timber framed Grade II listed building. There are exposed timbers throughout the home. All the rooms have individual character, with sloping ceilings and exposed beams and woodwork. The home appeared to be clean and well maintained. Repairs and refurbishments are carried out when they are required.A new assisted bath has still not been installed in the home. This has been awaited for over a year now. A requirement maybe made at the next inspection if this is not addressed in a timely manner. The staff spoken to confirmed that they follow the policies and procedures for maintenance of hygiene and control of infection. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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): 33 and 35 The home is staffed by experienced support workers who are appropriately trained to meet the needs of the residents. EVIDENCE: Staffing levels have been maintained at three on each shift during the day and two waking night staff. There are two vacant rooms in the home, and the staffing levels are sufficient for the six current residents. A driver/cleaner has recently been employed in addition to the care staff. A deputy manager was appointed following the last inspection, but she has since left. The manager was on sick leave at the time of the inspection, and feedback was given to a senior support worker who was taking responsibility for the home during her absence. One of the support workers spoken to had worked in the home for only four weeks. He said that he had had a thorough induction that included training in the home’s policies and procedures and shadowing the other support workers before he took his place on the rota. Evidence was seen during the previous inspection that CareTech provides a comprehensive training programme that covers all mandatory training and training for specific needs, such as autism and challenging behaviour. Following an investigation into an injury to a St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 18 resident earlier this year, every member of staff has had up to date training in moving and handling from CareTech’s moving and handling advisor. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is meeting its aims and objectives. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. One health and safety concern was raised during the inspection. EVIDENCE: It was not possible to fully assess the quality assurance procedures in the home, as the manager was not available to discuss this standard. The Area Care Director carries out monthly monitoring visits to the home that include talking to the residents and staff, and checking maintenance and safety in the home and record keeping. There is a monthly residents’ meeting, and the minutes of the last meeting, held in October 2005, were seen. The topics discussed include food, health concerns, family visits, outings and holidays, St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 20 and staff relationships. The views and wishes of the residents who took part were recorded for each topic. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. All the staff have training in moving and handling, fire safety, food hygiene and infection control as part of their induction. Water temperatures for all hot water outlets are recorded every day. There is some variation, for example in one bedroom the water in the washbasin measured 43°C apart from two days when temperatures of 47°C and 48°C were recorded. In another bedroom the temperature was satisfactory apart from one day when a temperature of 48°C was recorded. It was reported that any temperature over 43°C should be reported for maintenance, but there was no indication that this was happening. The water temperatures are measured at different times every day, which may explain the variation. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Agnells House Score 3 2 X X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 X DS0000019532.V270544.R01.S.doc Version 5.0 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 YA19 Regulation 12(1)(a) Requirement Recording of pressure area care is inadequate, and does not provide staff with the information that they need to provide a 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. Timescale for action 31/01/06 St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 23 2 YA34 17(2), 19(1)(b), All the required information on staff, as listed in Schedule 2 and Schedule 4(6) of the regulations, must be kept in the home, including evidence of identity, confirmation of the person’s health and evidence of satisfactory CRB checks. (Previous timescale of 31/01/05 not met) The proprietor’s response stated that application was made to Head Office for the required information. Staff files were not available for inspection on this occasion due to the absence of the manager. 31/12/05 3 YA42 13(4)(a) & (c) Regulatory action may be considered if this requirement is not met within the revised timescale. Water temperatures are 31/01/06 recorded every day, but there was some variations and temperatures recorded above a safe level. The registered person must ensure that hot water temperatures are maintained at close to 43°C, and that the temperatures are recorded accurately. St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 24 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 three previous inspection reports.) The proprietor’s 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. The care plan should demonstrate the involvement of the resident, or where this is impracticable, their representative. (This recommendation was also made in the three previous inspection reports.) The proprietor’s response following the previous inspection report stated that the care plan format is to be reviewed to reflect client involvement, but no evidence of this was seen on this occasion. It is also recommended that the daily recording and monthly reviews should clearly relate to the support requirements in the resident’s care plan, and avoid the need for repetition. The care plans seen contain detailed daily bowel charts, although there is no assessed need for this information to be recorded. There should be no need to record this information except for residents for whom this is an assessed need. (This recommendation was also made in the inspection report.) 2 YA6 3 YA19 St Agnells House DS0000019532.V270544.R01.S.doc Version 5.0 Page 25 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.V270544.R01.S.doc Version 5.0 Page 26 - 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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