Inspection on 08/04/05 for St Agnells House

This inspection was carried out on 8th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 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 28/11/05

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 08 April 2005 6:30 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 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 Stationary 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 Version 1.10 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 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 Limited Rachel Ogyaadu Care Home 8 Category(ies) of LD(E) Learning Disability over 65 8 registration, with number PD Physical Disability 8 of places LD Learning Disability 8 PD(E) Physical Disability over 65 8 St Agnells House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: There are no additional conditions of registration. Date of last inspection 30 November 2004 Brief Description of the Service: St Agnells House is a care home providing personal care and accommodation for eight adults with learning disabilities and profound physical disabilities. It is owned by CareTech Community Services, which is a voluntary organisation. The home is situated in a residential area on the outskirts of Hemel Hempstead, where there is a good range of community services and leisure activities. The home was opened in 1997 and consists of a two storey building with bedrooms on the ground floor and communal rooms on the first floor. It was converted from a grade II listed building. It is adjacent to another CareTech home. All the home’s bedrooms are single. None of the bedrooms have en-suite facilities. There is a passenger lift. There is a courtyard garden that is accessible for wheelchairs. St Agnells House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one day, starting at 6.30 in the morning in order to meet with the night staff before they finished their shift. The majority of time was spent observing and talking to residents and staff. All the residents have complex needs, including communication difficulties, but three were able to express their opinions in some way. Two night staff were on duty at the start of this inspection, and three-day staff started their shift with a handover at 7.00am. All the staff were spoken to and discussions were held with the home’s manager. Some time was also spent in the office looking at care plans, risk assessments, complaints, staff training, and staff files. The staff and residents were very welcoming, despite the early start. This was generally a positive inspection, and the majority of the standards were met. New requirements were made in relation to noticing residents’ needs and health and safety concerns. Requirements were repeated from the previous inspection report on assessments and staff records. Regulatory action may be considered if the requirement on staff records is not met. What the service does well: What has improved since the last inspection? The home has been through a period of instability, with several changes of manager and a period of time with no manager in post, also a reliance on agency staff due to difficulties with recruiting permanent staff, and an adult protection investigation, which resulted in no blame being attached to any member of staff. St Agnells House Version 1.10 Page 6 Staff morale appeared to be high during this inspection. The manager has been successfully registered by CSCI since the last inspection and the home now has a permanent staff team. No agency staff were employed at the time of the inspection. The members of staff spoken to were enthusiastic about their work and felt well supported. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Agnells House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection St Agnells House Version 1.10 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 standard(s) 1, 2 and 5 All the residents of St Agnells House have complex needs, including difficulties with communication and comprehension. The information available for them, in terms of the Service Users Guide and the statement of services, were reported as being under review. Although the documents are clearly written in plain English, they are not in a format that the residents of this home could understand. The residents’ care plans contain detailed information of all their needs, but no assessments are kept in the home. EVIDENCE: The Service Users’ Guide has been updated to include details of the current manager, but it still does not include all the required information that is listed under Regulation 5, including the terms and conditions of residence and the contact details of the CSCI. It should also contain all the recommended information listed in Standard 1, including a description of the accommodation, the number of places and the people for whom the service is provided, details of the staff, and the residents’ views. The Service Users’ Guide is a corporate Caretech document, not specific to St Agnells House. It is written in clear language and includes some clip-art illustrations. However, this could be further improved by producing the document in a format that can be contributed to and understood by the residents, possibly including photographs, video or audiotape. The information is important so that service users or their representatives can make an informed choice about living at St Agnells House. St Agnells House Version 1.10 Page 9 It was reported that assessments are archived by Caretech every year. The care plans contain detailed information on all the residents’ personal care and health care needs (see Standard 6), but it is a requirement that the assessment must also be kept in the home. It was reported that there has been no change to the statement of services (contract) since the last inspection, and it was not seen on this occasion. The statement of services that was seen during the last inspection provided a comprehensive description of the terms and conditions and services provided by the home, but it was recommended that it 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, in recognition that it is an agreement between the resident and the home. It was reported that a new format was being worked on, but it was not available on this occasion. The residents’ files that were inspected contained no assessments of their needs. St Agnells House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 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. The staff were observed to treat the residents with respect and to assist them to make choices about their lives, and to participate in residents meetings. However the care plans and daily recording do not reflect this involvement. EVIDENCE: The residents’ files have been moved into a cupboard in the office, which now provides appropriate secure storage. Detailed case tracking was carried out through the files of two residents. 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. 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. St Agnells House Version 1.10 Page 11 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. Caretech provides a standard format for risk assessments, for example 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. All the residents of St Agnells House have high needs, and the same standard risk assessments are appropriate for all of them, but each one has been completed individually with appropriate details and information for each resident. All the residents of St Agnells House are highly dependent, with limited communication, but the staff showed that they understood their needs and encouraged them to make some decisions about their lives. The staff were observed to have a good relationship with the residents, and to support them in taking decisions, for example giving each resident a choice of what they wanted for breakfast, rather than make an assumption for those with limited communication. The residents participate in the weekly menu plans, and the menus displayed in the kitchen show some of their individual choices. The minutes of the last two residents’ meetings showed that they are enabled to make their views and wishes known, with discussions on outings, holidays, and not going to bed too early. St Agnells House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15 and 16 Personal development opportunities are encouraged for all service users ensuring good relationships with their families and with the local community, and that individual rights and responsibilities are recognised and supported. Most of the residents attend a day centre, and some activities are arranged by the home, but these do not necessarily reflect the individual residents’ wishes and interests. EVIDENCE: All the residents of St Agnells House are highly dependent, with limited communication, but evidence was seen in their care plans that they are encouraged to do as much as possible for themselves, with requirements to develop their social, emotional and independent living skills. One example was for a resident to take their clothes to the laundry. The staff were observed to work closely with the residents on a one to one basis to ensure that they were able to communicate their needs and wishes (see Standards 6 and 18). 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. St Agnells House Version 1.10 Page 13 One resident spoke of the meetings he attends for old patients of Cell Barnes Hospital, organised by a local church, which he said that he enjoys very much. Residents take part in social activities individually and as a group, including going for a drive, having lunch out, shopping, going for a walk and visiting their families. The activities are recorded in a social diary in each resident’s file. Each file also contains a Life and Leisure Plan, which is completed for six months in advance with activities planned for each month. The planned activities, including pub lunch, karaoke nights, cinema, video nights, New Year celebration, bear little relationship to the activities recorded in the social diaries. No social activities have been observed taking place in the home during this or previous inspections, other than residents being seated in a semi-circle in the lounge with either the television or music playing, or going for a drive in the home’s vehicle. These may be appropriate activities for some residents at some times, but there has been no evidence seen that planned activities from the individual Life and Leisure Plans have taken place. Evidence was seen from the minutes of the residents meetings that their wishes for activities, outings and holidays are discussed. The residents’ families are encouraged to be involved in the home, and most residents have families who visit them regularly. One resident has regular visits to his brother’s home, and one said that his mother and sister visit him at St Agnells House. This inspection started at 6.30am, and the morning routines were observed. All the residents of St Agnells House are highly dependent, and on most days the night staff assist one resident to get up before the day staff came on shift so all the residents due to go to Jarmans Day Centre can be ready in time. It is recorded in the handover book, and the resident who was up early on the day of the inspection had been awake and was happy to get up. He was observed to enjoy the individual attention from the staff early in the morning. 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. St Agnells House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The staff provide good quality personal care and generally treat the residents with sensitivity and respect, although they did not notice that one resident was sitting in a draught and feeling cold. There is good recording of all the residents’ health care needs. The procedures for administering and recording medication are followed appropriately. 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. However two windows in the lounge and one in corridor outside the dining room were open during the inspection, and a resident sitting in the lounge seemed to be cold. The staff on duty did not notice this until it was brought to their attention, when the windows were closed and a jacket was brought for the resident. 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. St Agnells House Version 1.10 Page 15 In one case the recording seemed to be more detailed than required, with a daily bowel chart for which there was no assessed need. The morning medication round was observed. None of the residents are able to administer their own medication. The Boots blister pack system is used and PRN (when required) and liquid medications that cannot be dispensed in blister packs are kept on a separate shelf for each resident in the medication cupboard. Two members of staff administer the medication, and good procedures and recording were observed. St Agnells House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The home has a simplified complaints policy for the residents, and appropriate policies and procedures concerning adult protection, which follow the guidelines given in the Hertfordshire County Council adult protection procedures. EVIDENCE: The complaints policy provided for residents in the Service Users’ Guide has been reviewed. It is clearly written in plain English, and includes details of Caretech senior management and CSCI. The record of complaints shows that no complaints have been made since 2001. Caretech has a vulnerable adults procedure, which was seen during the last inspection. The Hertfordshire County Council Adults at Risk Procedure is in the home, and was followed for a recent concern that was then investigated by Social Services, with the result that no person was found to be at fault. Caretech’s policy on managing behaviours, which challenge was seen during the last inspection, and included methods of restraint. A local policy has now been added for St Agnells House, which states that physical restraint is not practised in the home, and that there are individual behaviour management programmes for the residents who need them. St Agnells House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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, and despite the early hour of this inspection, there were no offensive odours. Staff spoken to confirmed that they follow the policies and procedures for maintenance of hygiene and control of infection. There are some health and safety issues for which immediate requirements were made, concerning storage of cleaning materials, use of window restrictors, and storage of out of date food (see Standard 42). St Agnells House Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,35 and 36 The home is staffed by experienced support workers who are appropriately trained to meet the needs of the service users, and supported by regular supervision. Each worker has a job description and their particular roles and responsibilities within the home are clearly defined. The staff team are enthusiastic and appear to take pride in the service. The staffing records required by the Regulations are not maintained in the home. It is therefore not possible to verify that service users are protected by robust recruitment procedures. EVIDENCE: Two night staff were on duty at the start of this inspection, and three day staff started their shift with a handover at 7.00am. All the staff were spoken to, as well as the manager. Staffing levels have been reduced to three on each shift, with two waking night staff, while there are two vacant rooms in the home. The level will be increased to four on each shift when the home is full. The manager arrived early at 8.30am to assist with getting the residents up. Several new members of staff have been recruited. The home is now staffed completely with permanent staff, with no use of agency workers. The staff were clear about their roles and responsibilities, and felt positive about their work in the home and their relationship with the residents. St Agnells House Version 1.10 Page 19 Specific responsibilities have been allocated to pairs of staff, covering medication, maintenance, health and safety, menus and activities. The files of four members of staff who have started work since the last inspection were inspected. The manager reported that she sees all the information for each member of staff, including their application form and references, but the documents are then sent to Caretech headquarters and photocopies should be returned to the home. The file for one person held no information as the copies had not yet been returned to the home, and the other files contained two references but no evidence of identity and confirmation of health. The originals of the CRB (Criminal Record Bureau) disclosures are stored at Caretech headquarters, and only the CRB number and date of the disclosure is returned to the home. The information returned to the home should include the result of the disclosure, whether it was clear or not. From the records maintained in the home it is not possible to verify that service users are protected by the organisations recruitment procedure. Caretech provides a comprehensive training programme that covers all mandatory training and training for specific needs, such as autism and challenging behaviour. All the staff spoken to, including the night staff, confirmed that there is plenty of training available, and they are able to choose any training from the Caretech manual that they are interested in. The staff confirmed that they have regular supervision with the manager, and the supervision schedule on the office wall provided evidence that all the staff have had regular and recent supervision. St Agnells House Version 1.10 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 and 42 The home is well run by a competent manager who leads a dedicated and enthusiastic staff group. There are three health and safety issues for which immediate requirements were made, concerning storage of cleaning materials, use of window restrictors, and storage of out of date food. EVIDENCE: The staff spoken to felt that morale has improved, due in part to the clear expectations of the manager, and in part to the increased number of permanent staff. Several staff had some creative ideas for improving the involvement of the residents, and they felt encouraged and supported by the manager and the company. The home maintains appropriate records for protection of the residents and the efficient running of the business, with the exception of staff files as those inspected did not contain all the information that is required to be kept in the home. St Agnells House Version 1.10 Page 21 The cupboard by the front door was open, although a notice on the door stated “Keep locked at all times”. The contents, on a low shelf close to the door, included cleaning items marked with COSHH (Control of Substances Hazardous to Health) symbols. The COSHH cupboard in the laundry was unlocked, and accessible contents included other potentially hazardous cleaning items. During the inspection, the items from the cupboard by the front door were moved to the COSHH cupboard in the laundry, and that cupboard was locked. Out of date food items were seen in the refrigerator in the kitchen. They were disposed of during the inspection. A window in the first floor lounge was open from 6.30am, when the inspection started, until 9.30am. A window restrictor was fitted to the window, but was not in use while the window was open. The residents of St Agnells House are all highly dependent, and only one is mobile without a wheelchair and the assistance of care staff. The risks detailed above may therefore be less than in other establishments. There is a risk, however minimal, and all substances hazardous to health must be stored securely at all times, and window restrictors must be in place for all first floor windows. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: St Agnells House Version 1.10 Page 22 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 2 2 x x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 2 3 3 2 3 3 x Standard No 31 32 33 34 35 36 Score 3 x 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x 2 2 x St Agnells House Version 1.10 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14(1)(b), 17(1)(a), Schedule 3(1)(a) Requirement A copy of the assessment for each resident must be kept in the home. (Previous timescale of 31/03/05 not met) The proprietor’s response stated that an application had been made to Head Office to trace the initial assessment records, but none of the residents’ files seen on this occasion contained assessments. No evidence was seen that the activities planned for individual residents are taking place. The registered person must ensure that residents are enabled to take part in a varied and appropriate programme of activities. The staff on duty did not notice that a resident was sitting in a draught and showing signs of being cold. The registered person must ensure that there is effective provision for all aspects of each resident’s care. Timescale for action 30 September 2005 2. YA11 16(2)(m) &(n) 30 September 2005 3. YA18 12(1) 30 September 2005 St Agnells House Version 1.10 Page 24 4. YA34 YA41 17(2), 19(1)(b), Schedule 2, Schedule 4(6) All the required information on staff 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, but none of the staff files seen on this occasion contained satisfactory information. 30 September 2005 5. YA42 13(4)(a)& (c) 6. YA42 13(4)(a)& (c) 7. YA42 13(4)(c) Regulatory action may be considered if this requirement is not met within the revised timescale. A window in the first floor lounge From was fully opened, without use of 08 April 2005 and the window restrictor. henceforth Window restrictors must be fitted to all first floor windows, and connected when the windows are open. Cleaning items marked with From COSHH symbols were stored in 08 April unlocked cupboards. 2005 and henceforth All substances hazardous to health must be stored securely at all times. This was addressed during the inspection. Out of date food items were seen From in the refrigerator in the kitchen. 08 April 2005 and Food that is out of date must not henceforth be stored in the home. St Agnells House Version 1.10 Page 25 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 YA1 Good Practice Recommendations The Service Users’ Guide should include the information listed in Standard 1, including a description of the accommodation, the number of places and the people for whom the service is provided, details of the staff, and the residents’ views. (This recommendation was also made in the two previous inspection reports.) The proprietor’s response following the 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 Service Users;’ Guide should be produced in a format that is suitable for the residents of St Agnells House to understand. (This recommendation was also made in the two previous inspection reports.) The proprietor’s response following the 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 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 two previous inspection reports.) The proprietor’s response following the 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. 2. YA1 3. YA5 St Agnells House Version 1.10 Page 26 4. YA6 The care plan should demonstrate the involvement of the resident, or where this is impracticable, their representative. (This recommendation was also made in the two previous inspection reports.) The proprietor’s response following the previous inspection report stated that this was ongoing with each care plan review, but no evidence of this was seen on this occasion. It is also recommended that the daily recording and monthly reviews should relate to the support requirements in the resident’s care plan. 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. 5. YA19 St Agnells House Version 1.10 Page 27 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts 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 Version 1.10 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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