Agnes House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At this inspection we found people's needs had been assessed and professional guidance had been embedded into people's care plans. However, we found not all care plans we accessible to the staff team. We needed to request the location of one care plan for a person who sometimes refused health care support, as it was not in their file. This was immediately rectified by the registered manager. We also questioned the accuracy of some of the recording around what people ate. This was to ensure the records reflected the guidance in place and provide reassurance the care plan was being met. The principles of the mental capacity act were being adhered to and although there was not always agreement between interested parties, clear plans were in place to reflect best interest decisions. The registered manager advised us they were waiting for deprivation of liberty (DoLs) assessments to be carried out by the local authority. We discussed how this was being monitored and the registered manager then implemented a tracking system to ensure they could evidence applications were being effectively monitored.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People had lived at the service for a considerable period of time. It was reported people had become more settled in their day to day lives since they initially moved in. People's relatives were aware of the guidance which had been put in place to support people with their care needs and had contributed towards the discussions over the years.

People were supported by staff who had been trained to work with adults with learning disabilities. Staff told us they knew people well and understood their needs. Staff told us, "[People's names] have lived here years. People are settled and staff understand what people need and how to communicate with them. We all use some level of sign language which helps." Staff also told us they worked well with health professionals and updated people's care plans when necessary. One staff member showed us the file where they stored care plans that were being updated and explained they would also be getting professional training to support new guidance being implemented.

The care plans in place were person centred and contained sufficient detail to ensure staff had a holistic view of people's needs. The care plans were set up many years ago but were updated on a regular basis and contained a detailed record of people's personal history. The care plans gave an honest account of any difficulties people had experienced and the strategies required to support people. The registered manager told us they led on a lot of the engagement with families and professionals and worked with the team to implement and new guidance following any assessment of need. Staff kept daily records to evidence the care that people had received and allow for a review of the effectiveness of the plans in place.

People were supported by staff who understood their routines and what was important to them. People were supported by staff who understood learning disability care and were focused on ensuring people were not disadvantaged due to their disability and/or historic behaviours. People's relatives contributed to people's care plans to ensure people had access to items which they knew were important to them such as, cultural food and long standing habits.

Staff and leaders told us people's needs were managed in line with best practice. Staff told us they had attended newly developed courses in learning disability care and they ensured people had care plans in place which reflected best practice. Staff told us they ensured people had up to date health action plans, oral hygiene plans and attended annual health checks. Leaders advised they worked with professionals to update people's care plans as needs changed or best practice was revised.

The provider had a process in place to review and update people's care plans and share best practice. Updated plans were kept in a central file for staff to read. Once all staff had read the plans, they were placed in people's care files. We observed staff using adapted sign language with people and they appeared to respond well. However we were unclear how new staff gained these skills. Staff told us they would book Makaton training but as people had developed their own set of signs, the staff would have to adapt. We did not see any evidence of assisted technology being used.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

People had care plans in place surrounding their health needs and people were supported to see the GP when needed. However, for one person we were unable to locate all of their health-related care plans, as some were not in their file. This meant the staff on shift did not have easy access to the information, especially in an emergency. The registered manager remedied this situation once we had highlighted it. We also found that some of the daily records suggested people had eaten foods they should not have access to. This was felt to be more of a recording issue, as staff were very knowledgeable of people's dietary needs. However, the recording issues had not been identified prior to our visit. It was therefore unclear how the provider was reassured staff were following the guidance in place and making sure people's health conditions were appropriately managed.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People were supported to make their own decisions throughout the day. When more complex decisions needed to be made, the principles of the MCA were followed and decisions made in people's best interests were clearly documented. Although there were times when a differing of opinion was reported; people's relatives were aware of decisions which had been made in the best interests of their relative.

The registered manager told us they were complaint with the requirements of the MCA. However, we were unable to review Deprivation of Liberty (DoLs) applications which meant we were unable to confirm whether the restrictions people experienced had been agreed via the DoLs processes. We were advised the applications were awaiting further assessment by the funding authority and copies were not available. We discussed the need to be able to review the whole process and as a result of our discussions, the registered manager introduced a DoLs tracking system to ensure they and others could monitor when applications were submitted, assessed and expired. This will be reviewed on our next inspection visit.