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Archived: A G Palmer House

Overall: Requires improvement read more about inspection ratings

Morrell Crescent, Oxford, Oxfordshire, OX4 4SU (01865) 397940

Provided and run by:
Response Organisation

All Inspections

18 December 2015

During an inspection looking at part of the service

We inspected AG Palmer House on the 18 December 2015. At the last inspection in June 2015 we required the provider to take immediate action to make improvements to the service. This was in relation to the way risks were mitigated in relation to people’s needs. We also required the provider to make improvements to the way in which quality and safety was monitored within the service. The provider sent us an action plan with regard to how this action was going to be taken by 18 December 2015. We found that action had been taken to meet the requirements of the action took at our inspection in June 2015, but more time was needed to ensure the improvements were sustained and embedded within the service. We have not re-rated the service at this inspection due to needing more time to ensure improvement is sustained.

At this follow up inspection we found people’s needs were assessed and risks associated with their needs were mitigated through clear guidance and staff that understood and followed that guidance. Information in some files was still not always clearly set out and the detail in some areas was still lacking. However staff we spoke with could tell us about the risks in relation to these people’s needs. People we spoke with told us that the care they received had improved and there had been no issues in relation to staff not knowing their needs. Staff we spoke also felt more prepared to support people; however some staff did feel information could be more accessible at times.

Detailed action had been taken in relation to the monitoring of the quality and safety within the service. A dedicated quality team had been set up to support the manager and a new deputy manager had been recruited to support the day to day management of the service. There was a clear plan of improvement in place and a dedicated staff team and senior staff team focussed on achieving increased standards of care and support for people.

People feedback had been obtained in relation to the quality of the service and whilst the provider was still waiting on some feedback there was evidence that some of the feedback the service had received had already been acted upon.

23, 30 June and 3, 7 July 2015

During a routine inspection

We inspected AG Palmer House on 22 June 2015. The inspection consisted of four visits in total between the 22 June and 3 July 2015. AG Palmer House provides personal care to people living in their own homes in Oxfordshire. The service also provides personal care to people who are receiving a service from the provider’s supported housing projects. The majority of people who receive a service have mental health needs.

At our last inspection in September 2013 we required the service to make improvement with regard to the care and welfare of people who used the service. We found that there was no information about how risks were managed or what steps were being taken to reduce the risk to the people using the service. The provider sent us an action plan in December 2013 stating the action they would take to improve the service to the desired standard. At this inspection in June 2015, we found that these improvements had not been made.

There was a registered manager in post at the time of 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 2008 and associated regulations about how the service is run.

People had risk assessments in place that documented risks in relation to their needs. However, these risk assessments still did not always document strategies staff should take to mitigate these risks. On one occasion staff had been unable to provide care because they were un-prepared to manage risks.

We reviewed care files of people who lived in their own homes as well as people who were supported within a project setting. We observed there to be a noticeable difference in quality between the two. People living in their own homes had clearer more organised care plans in place. However the areas of improvement we found applied to all people using the service.

There were enough suitably qualified and skilled staff to ensure care was provided to people, however staff were not always deployed in a way that met people’s needs or supported their well-being.

Staff we spoke with had a good understanding of safeguarding, what constituted abuse and what action they would take if they suspected abuse. However the service was not always following the procedure set by the local safeguarding authority.

The service had an awareness of the Mental Capacity Act (MCA) 2005. The MCA is the legal frame for ensuring people right to make their own informed choices is respected. However we found the organisations systems were not supporting this understanding through their records. We have recommended that the service familiarise themselves with the MCA code of practice to improve this area.

The service had a system in place to support staff through formal supervision meetings and appraisals. However this system was not being used effectively and many staff were not receiving this support as a result. Staff told us they felt they were supported but would benefit from more formal meetings to discuss progress and plan their development.

People’s planned care was not always person centred. People’s records did not reflect their involvement or the involvement of other relevant people. Care was not clearly designed around the person’s wishes and preferences.

The service had systems in place to monitor the quality and safety of the service but they were not effective. Intended audits were not recoded to evidence improvement of the service. Spot checks that were designed to monitor the direct quality and safety of service delivery were also not being carried out consistently. There was also no local system to monitor accidents and incidents that occurred within the service to support the organisation in learning from these events.

Some staff were described as caring. Relatives provided lots of positive feedback with regard to more experienced or regular staff who were described as, “excellent” and “like angels”, but these views were not shared by everyone in relation to staff generally. We were told of some staff who were rushed or brusque in their approach which impacted on peoples well-being.

We were told of a recent review of the service that had identified some of the concerns we had found and action was being taken to try and improve the areas of concern however, this action had not been taken at the time of our inspection and not all of the issues we had identified had been identified in this review.

We inspected AG Palmer House on 22 June 2015. The inspection consisted of four visits in total between the 22 June and 3 July 2015. AG Palmer House provides personal care to people living in their own homes in Oxfordshire. The service also provides personal care to people who are receiving a service from the provider’s supported housing projects. The majority of people who receive a service have mental health needs.

At our last inspection in September 2013 we required the service to make improvement with regard to the care and welfare of people who used the service. We found that there was no information about how risks were managed or what steps were being taken to reduce the risk to the people using the service. The provider sent us an action plan in December 2013 stating the action they would take to improve the service to the desired standard. At this inspection in June 2015, we found that these improvements had not been made.

There was a registered manager in post at the time of 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 2008 and associated regulations about how the service is run.

People had risk assessments in place that documented risks in relation to their needs. However, these risk assessments still did not always document strategies staff should take to mitigate these risks. On one occasion staff had been unable to provide care because they were un-prepared to manage risks.

We reviewed care files of people who lived in their own homes as well as people who were supported within a project setting. We observed there to be a noticeable difference in quality between the two. People living in their own homes had clearer more organised care plans in place. However the areas of improvement we found applied to all people using the service.

There were enough suitably qualified and skilled staff to ensure care was provided to people, however staff were not always deployed in a way that met people’s needs or supported their well-being.

Staff we spoke with had a good understanding of safeguarding, what constituted abuse and what action they would take if they suspected abuse. However the service was not always following the procedure set by the local safeguarding authority.

The service had an awareness of the Mental Capacity Act (MCA) 2005. The MCA is the legal frame for ensuring people right to make their own informed choices is respected. However we found the organisations systems were not supporting this understanding through their records. We have recommended that the service familiarise themselves with the MCA code of practice to improve this area.

The service had a system in place to support staff through formal supervision meetings and appraisals. However this system was not being used effectively and many staff were not receiving this support as a result. Staff told us they felt they were supported but would benefit from more formal meetings to discuss progress and plan their development.

People’s planned care was not always person centred. People’s records did not reflect their involvement or the involvement of other relevant people. Care was not clearly designed around the person’s wishes and preferences.

The service had systems in place to monitor the quality and safety of the service but they were not effective. Intended audits were not recoded to evidence improvement of the service. Spot checks that were designed to monitor the direct quality and safety of service delivery were also not being carried out consistently. There was also no local system to monitor accidents and incidents that occurred within the service to support the organisation in learning from these events.

Some staff were described as caring. Relatives provided lots of positive feedback with regard to more experienced or regular staff who were described as, “excellent” and “like angels”, but these views were not shared by everyone in relation to staff generally. We were told of some staff who were rushed or brusque in their approach which impacted on peoples well-being.

We were told of a recent review of the service that had identified some of the concerns we had found and action was being taken to try and improve the areas of concern however, this action had not been taken at the time of our inspection and not all of the issues we had identified had been identified in this review.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.

6 November 2013

During a routine inspection

People who used the service and relatives we spoke with were complimentary about the service. One person told us that the care workers were 'polite, friendly and really cared'. A relative of a person who used the agency said 'I can't fault them''.

People were assured that their care would be delivered. People told us that care visits were never missed and care workers were seldom late.

AG Palmer House provided care and support to people with complex mental health needs. We found that people had an assessment of their needs and risks to their health and welfare. We spoke with five staff members and found they were caring, respectful and committed. We saw that care plans did not always accurately reflect people's needs or include important information. Care workers did not always have accurate and sufficient information to know how to support people appropriately to ensure their safety and welfare.

The agency had arrangements in place to protect people from the risk of abuse. Care workers understood the local safeguarding arrangements and knew how to respond to any concerns relating to abuse. We saw that investigations had been undertaken in line with the local safeguarding procedures.

We found that care workers had received appropriate induction, training and supervision to ensure that they had the skills to undertake their care tasks competently.

The agency had systems in place to monitor the quality of care provided. A customer survey undertaken in August 2013 showed that most people were satisfied with the care they received. Systems were in place to monitor risks and the agency ensured that they learned from investigations. People we spoke with told us they knew how to complain and we found that the agency took account of complaints to improve the service.

9 January 2013

During a routine inspection

We spoke with four people who had experience of the agency. This included a relative and people using the service. We also spoke with the Director of Care and a representative from Human Resources. We looked at the results of a satisfaction survey completed by people using the service.

The survey showed that 78% of people felt that had control over the services they received and 99% reported that they were treated with politeness, respect and courtesy by their care workers. People said 'the carers are very helpful' and 'the carers are polite and lovely.' A relative had written 'No concerns, well looked after.'

Staff we spoke with had a good understanding of people's needs and how to respond if they noticed any changes. Care records were comprehensive and included the views and wishes of people using the service. Staff were supported and appropriately trained to carry out their roles and one person said there was a 'very supportive staff team.'