Agnes Court - Care Home with Nursing Physical Disabilities

We found the following examples of good practice.

The provider ensured consideration had been given to the impact of the pandemic on people’s and staff wellbeing. Risks assessments surrounding activities people attended took place; for example, to ensure social distancing during the rehabilitation activities or the meal service. Workplace risk assessments had been carried out with staff, these considered their individual health conditions and suitability of the personal protective equipment (PPE).

The registered manager told us there was a ‘we’re all in this together’ approach at the service. A staff member told us as a team they took the infection control good practices very seriously and added, “We all took on board the requirements and got on with it. Staff would challenge each other, it's all not just to protect the people but also ourselves.”

There was a sufficient stock of the PPE and the provider’s head office was responsible for ensuring the PPE supplied complied with the quality standards. Staff had training sessions around infection control and how to correctly use the PPE. Learning sessions were also facilitated by the nurse for people to reassure them about the reasons for using the PPE.

There was a system to ensure safe admissions, this included allowing a new admission or a person returning from hospital, only after a negative result of the test had been confirmed. The management team were aware of zoning and co-horting rules should these needed to be implemented.

Additional cleaning schedules had been introduced to reflect additional tasks such as cleaning of the frequently touched surfaces. Regular audits took place and led to making improvements, for example, an introduction of another laundry room.

There was a regular communication, this included a regular update for people and their relatives to share for example, any changes to the visiting policy. Information of sources of support to staff, including who to contact when worried and how to access wellbeing initiatives was also available.

The provider ensured regular testing for Covid-19 took place for both people and staff. The provider's head office team ensured the relevant policies were reviewed and updated to reflect the government's most recent good practice guidance.

On arrival to the service infection control procedures were explained to visitors and a declaration form given to be completed. It included the temperature of the person taken at the time. If needed, visitors were provided with the appropriate PPE, in line with the government guidelines. A garden visiting suite had been installed to safely facilitate relatives’ visits when the weather allowed. On the day of our visit we saw the delivery of a see-through screen ready to be installed in the activities room with an access from the outside to safely facilitate indoor visits.

Further information is in the detailed findings below.

Agnes Court is a service registered to provide accommodation and personal or nursing care to adults living with physical disabilities. The service can provide accommodation and care to up to 24 people and was fully occupied at the time of the inspection.

People’s experience of using this service:

People told us they were safe at the service. There was sufficient number of safely recruited staff to keep people safe. People had their medicines administered to them in a timely manner, safely and as prescribed. Risks to people’s well-being and individual conditions were recorded and updated as required. The management ensured any lessons learnt were reflected to improve the service and experience for people. Risks surrounding infection control were managed appropriately, the service was clean, airy and bright.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were aware of principles of the Mental Capacity Act. People were supported to access health professionals and any advice received was incorporated into people’s care planning process. People were encouraged to maintain good diet and nutrition. People benefitted from the environment that catered for their individual mobility needs. This included spacious bedrooms and wide corridors that allowed people to move freely and safely using their mobility aids.

People continued to receive caring and kind support. The senior team led by example and staff were committed to delivering compassionate care. People complimented about staff and told us they built positive working relationships with the staff. Staff respected people’s privacy, dignity and their individual needs including communication needs. People were supported to be as independent as possible and told us they were in control of how their care was provided.

People received support that met their assessed needs and in line with their care plans. People knew how to raise any concerns and told us any concerns were promptly addressed. No people received end of life support at the time of our inspection, people’s end of life wishes where appropriate had been recorded.

The service was managed by an experienced interim manager who planned to continue to support the newly appointed manager who was due to commence their employment next month. People and staff complimented the senior team and told us management were accessible and approachable. There was a clear staffing structure, staff were aware of their roles and responsibilities and had opportunities to develop in their roles. There were a number of effective quality assurance systems in place and an ongoing service improvement plan that supported continuous development. The service worked well with other partners, organisations and commissioners and the feedback we received from external professionals about Agnes Court was very positive.

Rating at last inspection:

Good (report published 30 July 2016).

Why we inspected:

This was our scheduled, planned inspection based on previous rating.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

More information is in Detailed Findings below.

There was a registered manager at the service. 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 told us they felt safe at the service. Staff were aware of how to safeguard people and protect them from harm and risk of abuse. Staff knew how to report any suspected abuse. There were sufficient numbers of staff in place to meet people’s needs. People were assisted promptly and with no unnecessary delay. Records relating to the recruitment evidenced that relevant checks had been completed before staff worked unsupervised at the service.

People were cared for by staff that were knowledgeable about their roles and responsibilities and had the relevant skills and experience. Staff received training required for their roles and they told us they were well supported by the management team.

There were systems in place to ensure safe administration of medicines. People received their medication as prescribed. People’s individual risks were assessed and recorded. Where people were identified as being at risk, detailed management plans were in place and action had been taken to manage these, allowing people to take any risks if they wished to.

Staff had access to development opportunities to improve their skills and knowledge. Staff received regular supervision and felt supported. Staff also received training specific to people’s individual needs such as what to do in an event of a person choking.

The registered manager followed the requirements of the Mental Capacity Act 2005 (MCA). This ensured the rights of people who may not be able to make important decisions themselves were protected. People benefitted from staff that were aware of the principles of the act. We observed people were asked for their consent before any care or support was carried out.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS enable restrictions to be used in a person’s support, where they are in the best interests of a person who lacks capacity to make the decision themselves. The registered manager made DoLS applications where required and we noted relevant people and professionals were involved in the best interest decision making process.

People were provided with a choice of food and drinks ensuring their nutritional needs were met. The people we spoke with commented they were happy with the quality of meals provided and confirmed they were able to choose what they wanted to eat. Staff were aware of people’s individual needs in relation to their nutrition and any individual needs were catered for by the chef.

People were supported to meet their health care needs. This included making referrals to various specialist services and professionals to source further advice if needed. People care records contained health plans to ensure people’s individual health care needs were assessed and met.

Throughout our inspection we saw staff supported people in caring and compassionate way. People were encouraged to be as independent as possible while taking into consideration any risks associated with their individual needs. People we spoke with told us they were happy with their care and they made positive comments about the way staff supported them. People told us staff respected their dignity and privacy. People had access to an in-house activities programme as well as a choice of outings and trips. People told us they enjoyed the activities and that they could choose what they wanted to do.

People told us they felt comfortable speaking to staff if they had any concerns. The provider had a complaints procedure which was available to people who used the service and relatives. We saw when complaints were received these had been recorded on the electronic system and responded to by the registered manager.

The registered manager sought people’s opinions through a yearly satisfaction survey and regular residents’ meetings as well as open door policy and quality of care spot checks.

People were assessed prior to admission to the service to ensure their needs could be met. People’s care records contained details of their personal preferences, likes, dislikes and the details of their health needs. People were supported to live their lives as they wanted and were supported to achieve their goals and aspirations. People’s individual needs and capabilities were assessed and considered by the staff. We noted various aids and assistive technology was used to meet these needs. Staff were knowledgeable about people’s changing needs and we saw many interactions which reflected staff understood he needs of people well.

The registered manager conducted a number of regular audits to monitor the quality of service. There was an open and transparent culture at the service. Staff we spoke with commented positively about the management and the team work. Accidents and incidents were recorded, investigated and appropriate action was taken when people had been involved in an accident or incident. The registered manager had a system to monitor the accidents to identify any trends or patterns.

People told us that they liked living at the home. One person said they were 'very happy' there. Family members told us 'It's a fantastic place.'

We found that people had access to a range of equipment and support to support their mobility and independence.

The home was clean and the staff had undergone training in infection control.

The service was staffed sufficiently by nurses and support workers. Volunteer involvement enabled people's access to a greater range of activities. A staff member told us 'I love doing this job.'

The provider took suitable steps to monitor the quality of the service. People and their families were a crucial part of this process.

People told us that they had their own bedroom and that they took part in how it was decorated and furnished. People liked to have their own things around them. They told us they liked the food and they were involved with picking the menus.

Staff told us that they felt supported to do the job. We were shown feedback forms from relatives and those involved with people in the home and these showed that people thought the home was a good place for their relatives to be. People told us that they felt safe and looked after. Staff had been trained to to identify possible signs of abuse and knew how to take action if required..