Care Home: St Agnells House

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What the care home does well The residents have learning disability and their verbal communications are very limited. However, members of staff understand their body language and their individual communication style and assist them accordingly. The members of staff present treated the residents with respect and dignity. The residents present appeared well cared for. Two visitors commented “We are quite pleased with the service. My (resident) is taken out to the shops and the local pub for lunch each week and attends Jarman Park Day Centre three days a week. The members of staff are caring.” On the day of the site visit, residents were seen relaxing in the newly constructed sensory room. Members of staff interacted well with the residents, giving one-to-one attention. There was sufficient staff present to assist the residents with personal care, social activities and during mealtimes.St Agnells HouseDS0000019532.V378174.R01.S.docVersion 5.3 What has improved since the last inspection? Since July 2009, the service has been managed by the registered manager of the sister home which is next door to St Agnells. A new deputy manager was appointed since July 2009. The provider hopes to combine the two services into one under the registered manager. The application has been submitted to the registration section of the Commission. Under new management the written care plans have been revised using a more user-friendly and pictorial format known as “My Plan.” These care plans are person-centred which ensures that those who are looking after the residents have the required information to deliver the personal, social and healthcare needs of the people who live in the home. What the care home could do better: Under the new management, there has been an increase in the number of permanent staff. The management further confirmed that additional care workers will be recruited in the coming months. This will benefit residents who require continuity of care and constant supervision. Key inspection report CARE HOME ADULTS 18-65 St Agnells House Cupid Green Lane Hemel Hempstead Hertfordshire HP2 7HH Lead Inspector Yoke-Lan Jackson Key Unannounced Inspection 20th October 2009 12:30 St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service St Agnells House Address Cupid Green Lane Hemel Hempstead Hertfordshire HP2 7HH 01442 215805 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caretech-uk.com CareTech Community Services Ltd Manager post vacant 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.V378174.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2008 Brief Description of the Service: St Agnells House, owned by CareTech Community Services Limited, is a residential care home for eight younger adults with learning disabilities and profound physical disabilities. Another CareTech home is adjacent to St Agnells. The home is situated in a residential area on the outskirts of Hemel Hempstead, where there is a good range of community services and leisure activities. It was opened in 1997 and comprises two floors with bedrooms on the ground floor and communal rooms on the first floor. It was converted from a Grade II listed building. All the bedrooms are for single occupancy. The bathroom and toilet facilities are nearby. The home has a passenger lift. The courtyard and garden are fully accessible to wheelchair users. The fee varies with a minimum charge of £1337.30p per week. Information about the home and the service it offers is contained in the Statement of Purpose and Service User Guide. A copy of these and the most recent CQC inspection report are available in the home. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use the service experience good quality outcomes. The unannounced inspection was carried out on 20/10/2009. The acting home manager and the deputy manager were present. The home has 6 people in residence. The inspection included a tour of the premises. Time was spent observing how the staff interacted with the residents. Staff, residents and some relatives were spoken with and key documents were examined. The inspection ended with a thorough discussion with the acting management. Information received by us was reviewed. This included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete annually. The AQAA focuses on how the outcomes are being met for the people using the service and also provides us with statistical data. What the service does well: The residents have learning disability and their verbal communications are very limited. However, members of staff understand their body language and their individual communication style and assist them accordingly. The members of staff present treated the residents with respect and dignity. The residents present appeared well cared for. Two visitors commented “We are quite pleased with the service. My (resident) is taken out to the shops and the local pub for lunch each week and attends Jarman Park Day Centre three days a week. The members of staff are caring.” On the day of the site visit, residents were seen relaxing in the newly constructed sensory room. Members of staff interacted well with the residents, giving one-to-one attention. There was sufficient staff present to assist the residents with personal care, social activities and during mealtimes. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 6 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 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.V378174.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have the information they need to make an informed choice. A full assessment will be carried out before a prospective resident is admitted to ensure that all their care needs can be met. EVIDENCE: The home manager assured us that a thorough pre-admission assessment is carried out prior to an admission. This is to ensure that the home will only admit a prospective resident whose care needs can be met. Currently there are six residents living in the home. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will have written care plans so that staff will be able to identify their goals and care needs appropriately. This gives the people an opportunity to make everyday choices with staff respecting their preferences and requests and enabling them to achieve independent lifestyles. EVIDENCE: Residents are given the opportunity to participate in the daily routine in the home. They are supported in taking risks as part of an independent lifestyle. The members of staff present were observed to interact well with the residents. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 10 Each resident has a written care plan which is person-centred. This ensures that those who are looking after the residents have the required information to deliver the personal, social and healthcare needs of the people who live in the home. The manager said that all the care plans have been revised using a more user-friendly and pictorial format known as “My Plan.” The care plans are reviewed monthly. The daily written record for each resident has been kept up to date. Appropriate risk assessments were seen in the care plans examined. Each resident has a key worker who organises a weekly one-to-one talk-time meeting to ensure that the resident is consulted and that to the maximum extent possible their views are understood and acted upon. Most of the residents have limited verbal communication. However, members of staff understand their body language and their individual communication style. A full assessment of care needs is carried out annually. This involves all interested parties, including relatives, supporters, healthcare professionals, the social services and the management team. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 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): This is what people staying in this care home experience: Standards 12, 13, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are encouraged to lead an independent lifestyle and to be engaged in a variety of communal activities in accordance with their assessed needs and they can be assured that their preferences and rights will be respected. They will be encouraged to maintain contact with their friends and family and can be assured that a healthy diet is promoted. EVIDENCE: Residents lead an active lifestyle according to their wishes and preferences with support from the staff when required. They are encouraged to participate in activities of their choice, and to make use of local leisure facilities. There is a planned weekly programme of recreational and social activity for each resident. On weekdays most of the residents attend their respective day St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 12 centres. Transportation is provided. One of the care workers is also the driver for the minivan. On the day of the site visit, three of the residents were at their respective day centres. The management has regular liaison meetings with Day Service providers to monitor residents progress and resolve periodic difficulties that may arise. Some of the residents were present in the home during the site visit. Members of staff were observed spending time with individuals who prefer to relax in the newly constructed sensory room. Staff encourage and assist those residents who are able to do so with the daily living routine such as laundry, cleaning and tidying individual bedrooms. On days when residents do not attend their respective day centre, members of staff will assist them with alternative recreational activities such as shopping, local walks and meals out. Staff arrange holidays annually for the residents who are also encouraged to contact family members. On the day of the site visit, one of the residents was entertaining relatives in their new bedroom which has been recently redecorated. The home offers residents a nutritious and balanced diet. Residents have a menu to choose from and the menu is in picture format. Each member of staff takes turns to cook the meals and residents are given the opportunity to assist in preparing the meals. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are treated with respect and they will receive personal care and support in the way they prefer and require. They will have access to healthcare services when required and they will be protected by the homes medication policies and procedures, which ensure that medicines will be administered safely to them. EVIDENCE: Following a number of safeguarding meetings since the beginning of this year, the daily care of residents has improved. Members of staff present during the site visit were observed to be gentle and caring. One of them was seen stroking a resident’s hand to comfort and reassure the resident in the sensory room. The resident was constantly supervised in the sensory room by a member of staff. Similarly, the resident in the lounge was supervised by another member of staff. The staff members seemed to have a good St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 14 knowledge of the residents conditions and their likes and dislikes and gave support and care accordingly. The home has the support of healthcare professionals such as the family doctor, the dentist, the community nurse and the Hertfordshire Social Service Learning Disability Team. In recent months the Occupational Therapist has been involved in ensuring that individual residents have the use of the correct equipment such as slings for hoisting and supporting equipment for wheelchairs to ensure residents’ safety and comfort. Staff were given additional training on Moving and Handling. A trained member of staff administers medication. The home uses the monitored dosage system and all medicines that are in use are stored in a drug cupboard in the activity room. Stock medicines are stored in the storage room. The manager audits medication weekly to ensure that good practice is well maintained. The Medication Administration Record (MAR) charts seen were accurately recorded. However, the handwritten notes and instructions on the MAR charts do not always have the signature of the author and the date they were written. The new manager said that she would reinforce this practice immediately. There have been no medication errors in recent months. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that they will be listened to and that they will be protected from self-harm and abuse. EVIDENCE: Staff have had training on safeguarding issues and the homes whistle-blowing procedure. The home follows the joint safeguarding procedure issued by Hertfordshire County Council and a copy of the safeguarding manual is kept in the home. The home manager ensures that all members of staff are familiar with the procedures. The new management team has addressed all the issues raised through the Hertfordshire County Council joint safeguarding procedure. Issues raised included the misuse of slings and moving and handling issues, poor care practices in meeting individual personal care needs, infection control issues and the lack of respect for residents during personal care. With the support of the Learning Disability Team and the Occupational Therapist, members of staff have been retrained and local policies and procedures revised to ensure that each resident’s care needs are being appropriately met. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26, 29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the new management is working towards making the environment more homely, safe and comfortable to live in. EVIDENCE: The premises are well maintained. The carpet in the hall and stairs has been replaced and some of the bedrooms have been redecorated. Four new beds have been purchased which provide more comfort for the residents using them. All communal areas appeared clean and tidy. Residents are making full use of the sensory room which is well equipped with sensory items and lighting equipment. The manager said that two of the residents are waiting for their recliners following an assessment by the St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 17 Occupational Therapist. All the wheelchairs and hoists have been serviced and the servicing records have been updated. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34, 35 and 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the home has an effective staff team who will support them and can be confident that they are safeguarded by the homes robust recruitment policy and procedures. EVIDENCE: The home follows a thorough recruitment process in accordance with the providers defined recruitment policy and procedures. New staff are vetted appropriately. They have to pass the Criminal Record Bureau (CRB) check and the Protection of Vulnerable Adult (POVA) check before they are allowed to start work. Mandatory training for new care staff includes Moving and Handling, Fire Safety, First Aid and Food and Hygiene. Staff training needs have been identified and there are training dates scheduled for the coming months, and evidence of all training is kept in the staff training file. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 19 On the day of the site visit, there were two new members of staff shadowing senior staff members. The members of staff interviewed confirmed that they are currently undergoing the induction training programme. There is a six months induction programme. Recent training for staff included Medication, Epilepsy Awareness and Dementia. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 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 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, 41 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be assured that the new management will support their interests and that their health and safety will be promoted and protected. EVIDENCE: The home has been under new management since July 2009. The manager overseeing St Agnells is currently the registered manager of a sister home next door. She is assisted by a deputy manager appointed in July 2009. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 21 Under the new management, the service has improved to a good standard. All the care plans have been revised and kept up to date, all members of staff have had re-training on Moving and Handling, Infection Control and good practice issues such as respect and dignity for the resident during personal care. The manager confirmed that all staff have monthly supervision and that all supervision records have been updated. All records for the protection of the residents are kept secure and handled in accordance with the Data Protection Act 1998. The servicing records have been well maintained. The provider carries out an annual quality assurance and monitoring survey. This includes written questionnaire feedback from residents, relatives and others. The audit documents were readily available for inspection. There is a monthly proprietors report in compliance with regulations. The Annual Quality Assurance Assessment (AQAA) forms issued by the Commission were received on time for this inspection. The information provided was detailed and has been included in this report. St Agnells House DS0000019532.V378174.R01.S.doc Version 5.3 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 x 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x 3 3 x Version 5.3 Page 23 St Agnells House DS0000019532.V378174.R01.S.doc Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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.V378174.R01.S.doc Version 5.3 Page 24 Care Quality Commission East Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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