Agnes House

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.

At this inspection we found people's needs had been assessed and professional guidance had been embedded into people's care plans. However, we found not all care plans we accessible to the staff team. We needed to request the location of one care plan for a person who sometimes refused health care support, as it was not in their file. This was immediately rectified by the registered manager. We also questioned the accuracy of some of the recording around what people ate. This was to ensure the records reflected the guidance in place and provide reassurance the care plan was being met. The principles of the mental capacity act were being adhered to and although there was not always agreement between interested parties, clear plans were in place to reflect best interest decisions. The registered manager advised us they were waiting for deprivation of liberty (DoLs) assessments to be carried out by the local authority. We discussed how this was being monitored and the registered manager then implemented a tracking system to ensure they could evidence applications were being effectively monitored.

During this inspection we observed staff using gestures and sign language to support verbal communication with people. People indicated their choices and staff responded accordingly. People were supported to maintain their relationships with family members and were able to access the community on a daily basis. We reviewed the records of what people were doing when in the community and recommended further detail was required to support the range of activities staff told us people engaged in. People’s protected characteristics were respected by the staff team.

People's care plans reflected how people exercised control over their daily life and outlined people’s routines which were important to them and needed to be respected. Care plans included professional guidance and the provider worked with professionals to update and review when necessary. People had an active community presence and were supported by sufficient staff to ensure any issues could be safely managed and prevent unnecessary discrimination.

At the beginning of this inspection, there was some confusion regarding the number of people Agnes House could support and whether they offered respite care. We understood this was partly due to the provider having other registered services in the immediate area that worked closely together and there not always being a separation in how they were managed day to day. The provider immediately updated their statement of purpose, a required document which outlines their service provision and confirmed exactly what constituted Agnes House and the services offered. We found the provider shared rotas across more than one registered service which meant it was difficult to establish what staff were working where and whether they had the correct skills for the service they were allocated. The registered manager said they would review this moving forward. We found the provider had governance systems in place, but they were not always robust. For example, recording the outcome of investigations following an incident or ensuring staff training was reviewed as part of the audit process. We found the policies which guided staff on speaking up and reporting concerns were not always updated to ensure they reflected best practice. The provider acted immediately and added a version date to their policies and shared with us the updated whistle blowing and safeguarding policy which included information about the external agencies staff needed to be aware of. We received some mixed feedback from agencies who worked with the service. Some agencies told us they were still waiting for feedback on issues that had been raised. Staff and relatives were positive about the registered manager. Some staff told us the office could be unorganised at times but that the registered manager was supportive and responsive to concerns when raised. Staff told us they enjoyed working for the service and felt people were settled.