Archived: Agape House Limited Also known as Agape House

Our inspection team was made up of two inspectors and we spent time in the home over the course of four days. We spoke with some of the people who used the service, the registered provider, the registered manager, care and ancillary staff. We also observed staff supporting people with their daily activities.

We considered our inspection findings to answer questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found. This summary is based on our observations during the inspection, discussions with people using the service, staff supporting people, the provider and the manager:

Is the service safe?

The service was not safe. Practices in the service did not protect people using the service and staff from the risk of harm.

The home's safeguarding policy did not include reporting procedures to ensure that staff knew what to do if they suspected that abuse was occurring. We witnessed an incident while we were in the home which we reported to the Local Authority Safeguarding team.

Systems were not in place to make sure that the registered provider, registered manager and staff learned from accidents and incidents, concerns, whistleblowing and investigations. Therefore risks to people were not recognised and acted upon.

Staff and management were not putting into practice the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure that people were not subject to any form of restraint except as a last resort. The provider had not ensured that appropriate consultation had taken place with relevant health and social care professionals to make sure that people were only subject to restraint when it was in their best interest. Restrictive practices were not regularly reviewed and there were no risk assessments in place when these had been employed.

The environment was not well maintained and risks were not identified or managed to ensure the risk of potential harm to people who lived in the home was reduced.

Staffing levels were not assessed and monitored to ensure there were enough suitably qualified and experienced staff to meet people's identified needs and keep them safe at all times

Is the service effective?

The service was not effective. Our observations showed that people did not always receive the care outlined in their plan in the way it was agreed to be delivered. It was clear from what we saw and from speaking with staff that they did not always understand people's care needs.

Staff did not have effective support, induction and training to make sure they understood how to provide appropriate care for people who lived in the home.

Management did not have up to date plans to promote good practice and develop the knowledge and skills of their staff. Staff were not provided with appropriate training in the specialist needs of people who used the service such as nutrition or hearing and visual impairment training.

People were not provided with suitable food throughout the day and night. Meals were not flexible to meet people's individual needs or choices. People's identified needs in relation to nutrition were not monitored or managed effectively.

People's needs were not met because their independence was not promoted through the use of appropriate furnishings, signage, decoration and other environmental adaptations.

Is the service caring?

People and their relatives were encouraged to make their views known about their care and support.

There was evidence that staff who worked in the home cared about the people who lived there. Generally over the four days we were inspecting in the home we saw that staff treated people with kindness. However there were times when staff did not actively seek, listen to or act on people's views and decisions.

People's privacy and dignity was not always respected or promoted in the way that staff communicated with each other and with people who used the service.

Inadequate induction training meant that new staff did not know the people they were caring for and supporting, including their preferences and personal histories because they were not given time to read people's care plans.

Is the service responsive?

People were encouraged and supported to express what was important to them through regular resident's meetings with the manager. They were supported to be involved as much as they were able to, in the assessment of their needs.

People had access to activities. However these were not planned such a way as to ensure they were meaningful to them through the use of information about their individual interests, backgrounds and social histories.

Staff were not clear about their roles and responsibilities and who took accountability for people's individual care needs.

Shortfalls and risks in the environment were not addressed when a risk had been identified.

Where equipment was broken, it was not replaced or repaired in a timely manner.

Is the service well-led?

The service is not well-led. The provider and manager lacked an understanding of the risks that affected people in the home.

Management were not aware of the day to day culture in the service, particularly during the night shift when staff were routinely waking one person up early.

Resources and support had not been made available to the manager to develop or drive improvement.

There was no effective system in place to report accidents or incidents. For example we had not been notified about a recent accident that occurred in the home in accordance with current regulations.

The provider did not have a robust quality assurance system in place which could be used to drive continuous and sustainable improvement. We found that auditing processes did not identify areas of concern. This meant that these may not be picked up and dealt with in a timely manner.

We found that staff, particularly new staff did not know or understand what was expected of them because there was not an effective induction process in place.

We found that people seemed happy with their care and observed staff treating people gently and with kindness.

Risk assessments had not always been carried out when appropriate which meant that people's safety and welfare had not been considered. One bedroom was being used as a handyman's workroom and store on the day of our visit. This room was unlockable and contained power tools and wood stacked up against the window. The person who usually slept in this bedroom had dementia and was known to 'Wander' at night.

We found that a new hoist was in use but that the previous one had failed a safety test in November 2013.The provider told us that the unsafe hoist had continued to be used to transfer people until February 2014.

We read staff recruitment files and found that criminal records checks had been undertaken. However, we saw that there were no references on file for one staff member and that there were gaps in staff's employment histories without written explanations of them.

Staff rota information differed from that in the staff signing-in book. We found that there had been less staff on duty on a number of occasions than had been recorded on the rotas.

People we spoke with told us'The staff are very good' and 'I don't think they could do anything better for me'.However, we saw that risk assessments had not always been carried out when appropriate. Scoring tools used to identify people's level of risk had been incorrectly added up by staff in some cases, giving inaccurate results.

We found that there were not effective systems in place to prevent the spread of infection. Standards of hygiene were observed to be inadequate and some equipment could not be properly sanitised.

Medicines had not been stored safely within the service and the administration and recording of people's medicine was not always completed appropriately.

We observed that the premises was poorly lit and in need of maintenance and redecoration to keep it safe and pleasant for the people living there.

Staff had received some training but we found that none had been given in identifying pressure areas and using risk-measuring tools correctly and effectively.

The most recent survey conducted by the service received comments such as' Very happy with the care'.However, staff views of the service were not always considered.