Agnes House

Agnes house is a residential care home providing personal care to two people aged 18 and over at the time of the inspection. The service is registered to support up to five people who may have a learning disability. The service has two buildings which accommodate up to five people, however at the time of the inspection there was nobody residing in one of the buildings.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. However, we have found improvements are needed.

People’s experience of using this service and what we found

The building required maintenance to meet the needs of people living in the service. Training staff received was not always up to date, which meant staffs skills and knowledge was not updated in a timely basis. We found people had enough to eat and drink.

We have made a recommendation about mental capacity assessments. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice.

We have made a recommendation around involvement in care planning. People were supported by staff who knew them well and promoted their independence.

Governance systems required strengthening. Audits were completed but did not always identify issues that needed addressing and when problems had been identified, these were not always addressed in a timely way. The culture within the service did not always provide positive outcomes for people. However, the provider did work in partnership with other professionals.

People were protected from the risk of potential abuse. Staff were aware of the different types of abuse and knew how to report their concerns if necessary. People received their medicines safely and were protected from the risk of cross infection as staff wore personal protective equipment. Staff were safely recruited, and people received support in line with their commissioned hours.

People received personalise care that was responsive to their needs and accessed the community regularly. The provider was working in line with the Accessible Information Standards and although nobody was receiving end of life support the provider had systems in place to address this situation should it arise.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and remain as independent as possible.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There was a manager in post and he was present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last inspection in August 2015 we found that the provider was meeting the regulations we checked of the Health and Social Care Act 2008. However some improvements were needed which we found were in the process of being made at this inspection.

A person told us they felt safe and we observed people were supported safely by the staff members. Staff were aware of their responsibilities to report any concerns about people’s safety or risk of harm, and they confirmed they had received training in relation to safeguarding people from abuse. People were supported by sufficient staff in accordance with the requirements of the funding authority. People received their medicines safely. We identified some areas where improvements could be made to the medicine procedures in place.

We saw that improvements were being made to provide refresher training to staff. However this was on-going and we found that training for several staff had expired based on the provider’s renewal timescales. This included training in relation to managing people’s behaviour. This meant staff were supporting people without having received refresher training in a timely manner to ensure their skills and knowledge were updated.

Staff sought people’s consent before providing support. Where people were unable to consent to their care because they did not have the mental capacity to do this, decisions were made in their best interests. Staff knew which people had their liberty restricted to keep them safe, but they were unsure about any conditions attached to the authorisations in place.

People were treated with kindness, and respect and staff promoted people’s independence and right to privacy. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health or well-being. People were supported to eat and drink in accordance with their preferences and dietary requirements.

There was a complaints policy in place and staff were aware of the signs to look out for which may indicate people where unhappy. Records showed how complaints had been responded to and the actions taken. We also saw that people had family or representatives to advocate for them.

People, staff and professionals told us the service was managed well and in people’s best interests. Systems were in place to gain feedback from these people to enable the service to make any required improvements. Audits were undertaken regularly to monitor the quality of the service provided.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used all the information to answer the five questions that we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We observed that people were treated with dignity and respect by the care staff. We saw that people were given choices about their care. All relatives that we spoke with told us that they were very happy with the care at the home. One relative told us, 'I know my relative is totally safe in the home and always well care for.'

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receive care and were able to make informed decisions. The registered manager told us and records showed that all staff had received DoLS and Mental Capacity Act 2005 training. This ensured that staff understood their responsibilities and the provider had taken the appropriate action to ensure that the rights of people were protected.

The registered manager told us and we saw records which showed that applications had been made to the local authority for them to consider. The local authority determined that no one who lived here was deprived of their liberties.

The provider had policies and procedures in place to protect people from harm. Some people had complex support needs, with some difficult to manage behaviour. All staff spoken with understood what safeguarding people meant. Staff all had up to date training on how to protect vulnerable adults and how to support a person when they displayed behaviours that may harm themselves or others. This meant that the safety of people who lived there and of others was promoted and protected.

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

We saw that systems were in place to make sure that learning takes place from accidents, incidents, complaints and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

Both relatives that we spoke with confirmed that they could visit throughout the day. We saw that facilities were available so people could meet in private if they wanted to.

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people could influence the care they received. One person we spoke with said, 'I choose what I want to eat each day and where I want to go. The people that help me here are kind to me."

We saw that relatives were involved with people's care. A relative told us, 'They always ensure that my relative's health care needs are well met, they involve other health professionals and inform me of what is happening.'

All staff spoken with were able to give us good detail about the support they provided to people. People's health and care needs were assessed and care plans told staff what people's care needs were so they could support people consistently. Referrals had been made to external professionals so people got the support they needed to maintain their health and wellbeing and we saw that staff followed their advice.

We saw that people's cultural, dietary and linguistic needs were met by staff with the appropriate skills. For example, we saw that people were supported by care staff that were matched to their needs and understood their language or cultural requirements.

Records sampled showed that people were encouraged to eat a healthy and nutritious diet. We saw that they had a choice of what to eat and enjoyed the food provided. Their weight was recorded regularly. This is important as a significant loss or gain of weight could be an indicator of an underlying health need. This meant that people were supported to eat and drink sufficient amounts to meet their needs and ensure their health and wellbeing.

Is the service caring?

We saw that staff treated people with dignity and respect. We saw that were patient and caring they took their time and did not rush people. Staff were seen to be attentive and interacted well with the people they supported. We saw that people responded positively to staff.

People, their relatives and other professionals involved with the service had completed an annual satisfaction survey. We saw that relatives had made positive comments in the surveys we looked at.

People's preferences, interest and aspirations and diverse needs had been recorded in their care records.

Is the service responsive?

We saw that people were supported to take part in a range of activities at home and in the local community. We saw that staff responded to spontaneous requests from people to do activities, or to spend their time in a way that they preferred. People had also been supported to go on holiday.

We saw that when needed staff had requested the involvement of other health professionals in people's care and their advice was followed.

Is the service well lead?

The home had a manager who was registered with us, CQC. They were experienced and knowledgeable about the needs of the people that lived in the home.

We found that robust systems were in place to regularly assess the quality of the service that people received. Records showed that regular spot checks on staff skills and work practices were by carried out by the manager. We sampled the findings and saw that they were detailed and feedback was provided to staff following these checks. Supervision and training records showed that supervision and staff training was regular and up to date. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.

Staff that we spoke with were clear about their role and responsibilities. They had a good understanding of the ethos of the home and the systems in place to monitor quality assurance. This ensured that people received good quality of care.

Some people were unable to tell us what it was like to live here. We saw care staff spending time with them and giving them individual attention. People were treated with respect and dignity and were happy and at ease with the staff.

We saw that people had personalised care plans which were regularly reviewed and updated. These included advice form health care professionals involved in their care and treatment. This meant that staff had all the information they needed to support people appropriately and safely in the way they preferred.

One person we spoke with told us that the staff had helped them to become more independent. They said, 'I make my own drinks and meals when I want. I go to college to learn how to cook.'

We saw that people took part in a variety of activities such as swimming, going out to the local disco or to the shops. This meant that people were supported to lead interesting lives.

Systems were in place to ensure that people were safeguarded from harm.

Staff were trained to give them the skills and knowledge to know how to meet people's needs and ensure their wellbeing.

People's views were sought and were listened to. There were systems in place to monitor how the home was run to ensure people received a quality service.