Archived: Agate House - Care Home with Nursing Physical Disabilities

About the service

Agate House Care Home with Nursing Physical Disabilities is a residential care home providing personal and nursing care to 32 people, some who may be autistic or living with a learning disability or a physical disability, at the time of the inspection. The service can support up to 36 people.

Agate House Care Home with Nursing Physical Disabilities provides all accommodation, communal areas and therapy support on one ground floor level. The building is split into four separate wings, each of which has adapted facilities. People share communal areas such as kitchens, lounges and bathrooms and have their own bedrooms.

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

Right Support:

¿ Reasonable adjustments were not always made so that people could be fully involved in discussions about their support. Staff did not always communicate with people using their identified and preferred methods.

¿ People did not always benefit from an interactive or stimulating home environment and sometimes felt isolated or bored.

¿ Staff had started to support people to be independent if this was their choice. The management team were continuing to support staff to improve in this area.

¿ People were being supported to pursue their interests and achieve their aspirations and goals.

¿ People were supported to follow social interests and past times.

¿ The service gave people care and support in a clean environment which met their physical needs and people were able to personalise their bedrooms.

¿ The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

¿ Staff supported people safely with their medicines.

¿ People were mostly 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; the policies and systems in the service mostly supported this practice.

Right Care:

¿ People who had individual ways of communicating such as using symbols or body language could not always interact comfortably with staff as they did not have all the skills necessary to understand them.

¿ Staff did not always have the training or knowledge to support people effectively. The management team were still improving the way staff knowledge and competency was bring checked.

¿ People’s support plans did not always fully reflect their range of needs and promote their wellbeing and enjoyment of life.

¿ Staff supported people to assess any risks they might face in a safe way and supported people to take positive risks.

¿ Staff promoted people’s equality and diversity and knew them well as individuals for the most part.

¿ People received kind and compassionate care which fully promoted their privacy and dignity.

¿ Staff were prompting people to try new things which may enhance their wellbeing and enjoyment of life.

¿ Staff members mostly knew people well and communicated with them in a kind and compassionate manner.

Right Culture:

¿ Audits completed at the service by management had not always picked up on areas that could have been improved to help support a more positive culture.

¿ People and those important to them, felt they were not always involved in planning their support.

¿ Staff turnover was very high meaning people did not always receive consistent support from a staff team who knew them well.

¿ There were still some occasions where people were left without engagement from the staff team for extended periods of time.

¿ People received good quality care and support and were supported to lead inclusive and empowered lives for the most part.

¿ Staff were responsive to people’s needs and worked well together to achieve good outcomes for people. Feedback from people and relatives was that there had been improvements at the service.

¿ The new manager, staff and management team were passionate about continually improving the service and supporting people to achieve their goals and aspirations.

¿ Staff worked hard to achieve good quality care and good outcomes for people.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 19 July 2022) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of all the regulations in breach at the last inspection. However, the service was still in breach of one regulation.

This service has been in Special Measures since 15 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a continued breach in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Agate House- Care Home with Nursing Physical Disabilities is a residential care home providing personal and nursing care to 32 people. Most people using the service were living with a physical disability and some people were autistic or living with a learning disability. The service can support up to 36 people.

Agate House- Care Home with Nursing Physical Disabilities provides all accommodation, communal areas and therapy support on one level. The building is split into four separate wings, each of which has adapted facilities. People share communal areas such as kitchens, lounges and bathrooms and have their own bedrooms.

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

Right Support

¿ People were not supported to pursue their interests or achieve their aspirations and goals.

¿ People were not being supported to try new things or to follow social interests and past times.

¿ Reasonable adjustments were not always made so that people could be fully involved in discussions about their support, including support to travel where they needed to go. Staff did not communicate with people in their identified and preferred methods.

¿ Staff did not focus on people’s strengths or promote their independence, so people had a fulfilling and meaningful everyday life.

¿ People were not supported to make meaningful choices about their care and support.

¿ People did not benefit from an interactive or stimulating home environment and often felt isolated or bored.

¿ The service gave people care and support in a clean environment which met their physical needs and people were able to personalise their bedrooms.

¿ The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

¿ Staff supported people safely with their medicines.

Right Care

¿ Staff were not encouraging people to try new things which may have enhanced their wellbeing and enjoyment of life.

¿ People who had individual ways of communicating such as using symbols or body language could not always interact comfortably with staff as they did not have all the skills necessary to understand them.

¿ Staff did not have the training or knowledge to support people effectively. The registered manager was not checking staff competency to perform their job roles consistently.

¿ People’s support plans did not fully reflect their range of needs and promote their wellbeing and enjoyment of life.

¿ Staff did not support people to assess any risks they might face in a safe way and did not support people to take positive risks.

¿ Staff did not promote people’s equality and diversity and did not know them well as individuals.

¿ People were not receiving kind and compassionate care which fully promoted their privacy and dignity.

¿ The service did not have appropriately trained and skill staff to keep people safe.

¿ Some staff members knew people well and communicated with them in a kind and compassionate manner.

Right culture

¿ The management and staff team did not understand the key principles of guidance such as Right Support, Right Care, Right Culture. Audits completed at the service by management had not picked up on areas that could have been improved to help support a more positive culture.

¿ People and those important to them, were not always involved in planning their support. Staff did not evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate.

¿ Staff turnover was very high meaning people did not receive consistent support from a staff team who knew them well.

¿ People did not receive good quality care and support and were not supported to lead inclusive and empowered lives due to the negative culture at the service.

¿ Staff were not responsive to people’s needs and did not work well together to achieve good outcomes for people. People and relatives told us they were unhappy with the support they were receiving.

¿ There was a risk of a closed culture at the service and staff and the management team had failed to make or sustain improvements at the service.

¿ Some staff worked hard to achieve good quality care and good outcomes for people.

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 inadequate (report published 15 December 2021) and there were breaches of regulation. At this inspection we found the provider remained in breach of regulations. The overall rating for this service has remained inadequate based on the findings from this inspection. This service has been rated inadequate for two consecutive inspections.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for this service remains inadequate. We have found evidence that the provider needs to make improvements. Please see all the sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safe staffing levels, staff training, people being treated with dignity and respect, person centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Agate House is a ‘care home’ providing accommodation, personal and nursing care for up to 36 people with a physical disability. At the time of our inspection there were 33 people using the service.

Agate House Care Home provides all accommodation, communal areas and therapy support on ground floor level. The building is split into four separate wings, each of which has adapted facilities.

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

People were at risk of dehydration, poor outcomes and skin damage due to ineffective monitoring methods and oversight by the provider. Medication processes were not always safe, and staff practice surrounding medical devices placed people at risk of harm. We notified the local authority safeguarding team of our concern for one person during the inspection process.

Safe staffing levels were not robustly assessed or reviewed to ensure people’s needs were met in a timely manner. People, relatives and staff told us staffing levels were not adequate nor safe to meet the needs of people. Staff were not adequately supported nor supervised to ensure people’s needs were met. Staff competency assessments were not completed in all instances to ensure safe care, and to identify training needs.

Staff had not completed training to meet the needs of all people. Staff did not always know how to confidently respond to people’s changing needs and they lacked confidence in the provider’s procedures.

People were not always treated with respect and dignity. Choices for people were limited, and a person-centred approach to care was not always evidenced. People’s records were not stored in a secure and confidential manner in all instances. People, and their families, where appropriate, were not always involved in the ongoing care planning process.

People were not supported to raise concerns. The provider’s complaints procedure was not known and available to people and relatives. Staff told us their views were not always sought, listened to, and acted upon. Furthermore, staff told us they did not always feel valued.

People did not receive emotional and social support which met their needs. People were not always supported with their methods of communication and we observed missed opportunities for communication during the inspection.

The provider’s quality assurance and governance systems had not identified our findings and did not always drive continuous improvements. Safe person-centred practice was not evidenced on all occasions, nor embedded into service provision. We found oversight and processes relating to areas such as statutory notifications, complaints, safeguarding, medication management and incidents were not always effective.

People told us they felt safe and relatives told us regular staff were hard working and dedicated. People were supported with specialist diets and staff were aware of the recommended safe food and drink consistencies of people. The provider’s representatives took some immediate actions during the inspection and told us they were committed to making the required improvements. For example, they sent us information which identified action had been taken to complete staff competencies, and source additional training.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 18 November 2017). This service has deteriorated to Inadequate.

Why we inspected

We received concerns in relation to unsafe care, inadequate staffing levels, and poor leadership at the care home. We undertook a direct monitoring activity which did not provide us with assurances. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last inspections, by selecting the ‘all reports’ link for Agate House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing, dignity and respect, person-centred care and good governance at this inspection.

We issued a warning notice to the provider in response to a breach of regulation 17 (good governance) and we have imposed a timescale for the required improvements to be completed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

We found the following examples of good practice.

Cleaning schedules had been completed, which included cleaning of frequently touched areas. The provider had purchased a decontaminating unit to support enhanced cleaning of the visiting room.

A process was in place to support safe admissions to the home. All admissions were required to complete a COVID-19 test and a 14-day isolation period as a precautionary measure.

Personal protective equipment (PPE) was supplied by the provider and was required to be worn by staff and visitors. The home had an adequate supply of PPE and were knowledgeable of how to access additional stock.

An infection control and prevention (IPC) champion in the home cascaded updates of guidance and information relating to COVID-19. In addition, the IPC champion completed hand washing competency checks with staff to ensure safe practice was maintained.

The provider had policies in place to support maintaining a safe environment during the COVID-19 pandemic. These documents were regularly reviewed and updated to remain current and were made available to people, staff and visitors.

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

People and their relatives told us that people were safe living in the service. Risks to people were appropriately assessed and managed. There were robust recruitment procedures in place to help ensure staff were of good character and suitable to work at this type of service.There were sufficient numbers of skilled and competent staff available to support people when they needed it.

Staff received appropriate induction, training and support to help them carry out their roles effectively. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People were supported to have choices and control of their lives and staff supported them to retain as much independence as possible. People received appropriate support to eat and drink sufficient amounts to keep them healthy and people were supported to access a range of health care professionals to meet their individual needs when required.

People who used the service were treated in a kind and caring way by staff who respected their privacy and maintained their dignity. People, relatives and professionals were given the opportunity to feed back on the service and their input was valued and used to improve the service.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access meaningful activities appropriate to peoples individual abilities and interests. People told us they knew how to complain and were confident they would be listened to if they needed to make a complaint.

The service was being well managed by two deputy managers as the registered manager was off on long term sick leave. The deputy managers had worked hard to create an open, transparent and inclusive atmosphere within the service. There were systems and processes in place to monitor the overall quality of the service and where shortfalls were identified they were promptly acted upon to improve the service.

Agate House is a residential home in Ampthill providing nursing care and support to up to 36 people with physical disabilities. At the time of our inspection there were 35 people using the service.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

People were safeguarded from avoidable risk of harm and staff understood the process to follow to report concerns regarding people’s safety. There were risk assessments in place which detailed how people could be supported safely. Staff received training in moving and handling which allowed them to move people safely using the correct equipment. People’s care plans were person-centred and included information regarding their backgrounds, preferences and how they could be supported effectively. These were subject to regular review with involvement from people and their relatives where possible.

People’s healthcare needs were identified and met by the service and a dedicated team of nurses with a variety of specialisms. External healthcare support was sought if required from community-based professionals. People had enough to eat and drink and the food and drink on offer took into account their individual needs and choices. There was a creative and vibrant programme of activities on offer so people could pursue their interests in and out of the home. People were treated with dignity and respect and had opportunities to have their opinions and views heard. People gave their consent to receiving care and treatment at the service.

Staff were not always supported through a regular programme of supervision and appraisal. The service did not supervise staff on a regular basis and some staff had been without a formal supervision for an extended period of time. The service had not acted upon their feedback to resolve this issue efficiently.

Staff received a variety of training to enable them to carry out their duties effectively. They completed a thorough induction programme when they first joined the service. The recruitment processes used to employ new staff were safe and ensured that staff employed had the skills, character and experience to meet people’s needs. There were enough staff to keep people safe and protocols in place in case of shortages or staffing issues. The manager held team meetings and sent out staff surveys to provide staff with an opportunity to provide their feedback and contribute to the development of the service. Staff understood the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLS) and these were applied correctly in practice.

There was a robust quality monitoring system in place for identifying improvements that needed to be made across the service. The service had formed strong links with the local community and had a team of volunteers and fundraisers who were an integral part of the home’s culture and ethos. The environment was clean and well maintained with robust systems in place for monitoring health and safety and controlling the potential spread of infection. Equipment was regularly checked and there were contingency plans in place in case of emergency.

During the inspection we found that the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we’ve asked the provider to take at the end of the report.

One person told us, "It's great here. The care is really good and the staff are always very kind. I have had an issue before but that was dealt with to my satisfaction." Another person told us, "I am given choices and can do what I want to. I can go out when I want to or stay in and join in with the activities. It's nice living here." A relative told us, "The care is good here. Staff are helpful."

We observed that care plans were person centred and took account of preferences and likes and dislikes, with risk factors being appropriately assessed.

Staff generally felt well supported at work and said they found the home manager to be approachable. They received written and practical supervision and were supported with appropriate training and development to assist them in their roles.

We observed a robust complaints policy prominently displayed. Both staff and people who used the service told us they would feel able to raise any concerns or issues that they had.

Some of the people were unable to express their views directly because of complex communication problems so we observed engagement between them and staff. It was evident that staff interacted positively with people and respected individual needs and abilities. We saw that people were encouraged to remain independent and were offered choices as to how they spent their free time.

It was evident from our discussions and observations that Agate House was considered as home. We noted that staff were considerate of this when helping people. One example being that staff knocked before entering individual rooms and checked if it was ok to enter. This showed that people's dignity and respect was valued.

We noted that the weekly activity schedule had been discussed with people prior to being commenced. People told us that they were given choices as to whether they attended activities on a regular basis and if they wished to remain in their room, this was not a problem for care staff. One person said, "It's our home, its our choice."