Agnes House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During this inspection we reviewed the provider's training records and found the staff team were not completing regular training to ensure their knowledge and skills were in line with best practice. We found some staff had not received training in certain subjects since commencing their employment and other staff had not attended refresher courses to update their knowledge. Subjects we reviewed included fire safety, first aid, and safeguarding. This is a breach of regulation 18 (Staffing). We did find staff were completing training in understanding people with a learning disability. People were supported by sufficient numbers of staff and the majority of staff had worked at the service for a considerable period of time. This meant staff knew people well and had a good understanding of people's care plans and risk assessments. We found accident and incident forms were completed when something happened but the outcome of any investigation was not always documented. We did not find evidence of anyone being harmed but more robust recording was required. The provider had safeguarding and whistle blowing policies in place but these had not been updated to ensure staff knew how to report concerns to external agencies such as, the local authority. We raised this with the provider who was responsive and updated their policies. We found the environment was tidy but maintenance work was needed to ensure areas were secure and address the general wear and tear to the building. We were told refurbishment plans were being put in place but the logistics of carrying out the work still needed to be agreed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s experiences were monitored but due to gaps in the record keeping, it was difficult to see what action had been taken when something went wrong to prevent similar incidents from reoccurring.

Staff and leaders were open and honest about the home and the support people received. Several staff told us the staff team need to update their training especially, in subjects related to health and safety. For example, fire safety and food hygiene. Leaders advised the courses were available, but staff were reluctant to complete the training. Staff were not always able to tell us about any learning from incidents that may have occurred. Leaders told us they learned when things went wrong, however there was no evidence to support this.

The provider had processes in place, but we found these were not always fully completed. Accidents and incidents were reported but the outcome of any investigation was not always clear. This meant we could not be sure any learning had been shared with the team to prevent future incidents from occurring.

People's safety was monitored, and guidance was put in place to reduce any known risks. This included, implementing professional guidance. People's relatives were made aware of any safety concerns and the management plans in place to support their relative. However, on reviewing processes and seeking feedback from partners, we found systems were not always effective in sharing information such as risks to people. This meant people's perception of risk management within the service and their actual experiences were different.

Staff and leaders told us they had sufficient information to meet people's needs safely and the correct care plans were either in place or, subject to current review. For example, one person’s diet plan was being reviewed at the time of inspection. Staff told us they had sufficient resources to support people to access activities they enjoyed. One staff member told us, “We support people to go out daily. Sometimes we go out several times as a day and access various settings. People are not restricted due to their risk assessments.” Leaders told us they worked closely with professionals and relatives to ensure relationships remained positive and risks were sensitivity managed to ensure the best outcomes for people.

We received feedback from multiple partners who told us the provider was not always effective at sharing feedback after actions had been identified. For example, following an assurance visit. Leaders told us actions had been completed. However, partners said they did not always know if the risks they had identified had been fully mitigated or, if there were areas which remained outstanding. Areas identified included, staff training and health and safety checks.

We reviewed the process in place for monitoring safety in the service and found that monitoring did take place. However, the systems were not always robust and it was difficult to fully establish what actions had or had not been resolved. We reviewed people's accident and incident forms and were advised these were fully reviewed. However, the documentation process was often incomplete meaning we could not be fully assured of the outcome. We also noted repairs were needed in the environment which had not been correctly escalated for attention, meaning risks would potentially be present for longer than necessary. For example, a lock was broken on the cleaning products cupboard which had not been reported to the registered manager to enable them to take action.

People relied on staff members and their relatives to raise concerns on their behalf. We did not identify any areas where people were being harmed and we did not receive any reports of harm occurring. However it was acknowledged by staff members and relatives that sometimes relationships can be strained especially, when the definition of harm is contested. People were supported by wider health and social care professionals and there was clear guidance in place which out lined the expectations for all and this was respected by all parties.

The majority of staff could explain how to recognise and report a safeguarding concern. Staff told us they thought the registered manager was responsive when concerns were raised, and they felt confident sharing information of concern with them. However not all new staff had received the training and a number of staff had not received refresher training in the subject for several years. The regulations state safeguarding training should be refreshed at regular intervals.

People were observed interacting well with the staff team and we did not observe any signs of people being subject to poor treatment. We observed people seeking emotional support from staff and laughing with others. People's choices were respected and people communicated with staff if they wanted assistance or to have their own space.

The provider had policies and procedures in place to advise staff on how to manage safeguarding concerns. However, we found the policies needed updating to ensure staff knew how to report concerns outside of the organisation. The majority of staff had at some point received safeguarding training, but many had not refreshed their training for some time and required the policies to give them up to date guidance. We also identified new staff who had not received safeguarding training as part of their induction. Staff told us they would speak to the management if they were concerned but not all knew who to approach outside of the organisation. The provider updated their policies as soon as we brought our concern to their attention. We also discussed with the provider the need to ensure leaders documented the outcome of any investigation in to concerns raised. We found staff completed incident forms when people were found to have bruised themselves, but we could not always find the outcome of any investigation completed.

People's relatives were aware of the risk assessment people had in place. One relative told us they did not always agree with the risk reduction measures but, they were aware they had been put in place with the agreement of involved professionals.

Staff and leaders told us they felt risks in the service were mitigated. Leaders acknowledged there were some staff who needed to complete refresher training but told us staff did know what they were doing. Staff told us they were knowledgeable of people's health needs and their diagnoses. Staff told us, they were aware of what they needed to do to keep people safe, even if that meant sometimes this led to disagreements with relatives. Some staff told us repairs to the property could take some time to get resolved but that work was completed at some point.

There was an understanding of risk in the service and people had several risk assessment in place. The risk assessment we reviewed demonstrated people were supported to go in to the community and were not being limited by past history. We saw evidence of risk assessments being updated on a regular basis. However, we could not always be sure risk assessments were updated after incidents. This was because the incident investigation outcome was not recorded.

People were able to freely access certain areas of the home but due to known risks there were areas of the home where access was restricted. For example, people could access their bedroom but were unable to access the kitchen without staff supervision.

The environment was generally clean and tidy, but we observed a number of areas requiring attention. We observed extractor fans in the kitchen needing a deep clean and worn sealant in the bathroom. As well as the overall decoration of the home needing refreshing. This was something mentioned by several staff members. We discussed the plans for the environment with the registered manager who advised they did want to redecorate but were in the process of working out the logistics with the people living at the home. In one of the properties, we found the cleaning cupboard was unsecure and this had not been reported following the environmental checks. This had the potential to expose people to harm. However, this was addressed before the end of our site visit. People were not observed utilising any technology as part of their day-to-day routine.

People's relatives told us there was enough staff to meet people's needs and ensure people could access the community. One relative told us, they wished they could have more contact using technology. They explained home visits did happen but in between they would like more video calls which they did have during the pandemic.

Staff and leaders told us there was enough staff to meet people needs. We were told any shortfalls could be managed by the team, avoiding the need for agency staff who did not know people well. Staff told us there was a low turn over of staff, with many staff being in post for many years. We did receive some mixed comments about the training. Some staff told us they had thought the training would have been better while others mentioned the training was available but some staff were reluctant to complete refresher training.

People were observed being supported by enough staff. Staff were able to respond to people needs at home and support them to access the community whenever people wanted. There was staff available in the office to ensure care staff could focus on people's care and administrative tasks were managed separately. Due to people spending time in their rooms it was felt staff had time available to them should they need to complete additional activities such as training.

The service ensured there was sufficient numbers of staff on shift. However, we could not find the assurances needed to confirm all staff had the correct knowledge and skills. The provider was not routinely supporting new staff with the care certificate. The care certificate is a nationally recognised induction programme to support staff who are new to working in social care. The provider was aware of the care certificate and had enrolled some staff on the induction programme, so it was unclear why this was not rolled out to all new recruits. The provider had also engaged online training providers who provided courses that staff could access at any time but many staff had not made the most of this opportunity. We found many staff still needed to complete refresher training on a range of subjects. For example, fire safety and safeguarding training. One staff member told us, "Staff know they need to update their training but for some reasons some staff don't do it when asked." We did ask the provider to make improvements in this area as it is a requirement that staff complete refresher training on a regular basis to ensure they remain competent and are aware of any changes to practice. Due to the staff rota covering more than one service it was unclear how shifts were planned in advance in terms of staff skill set, activities to be undertaken and shift leading responsibilities. However, we did see staff working well together and putting in certain systems to support the smooth running of shifts for each other. For example, preparing activities in advance if a staff member was unable to participate due to their own personal circumstances.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.