Inspection on 29/07/05 for Gold Hill Residential Home

This inspection was carried out on 29th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Gold Hill Residential Home 27/02/09

Gold Hill Residential Home 24/09/08

Gold Hill Residential Home 30/04/07

Gold Hill Residential Home 15/12/06

Gold Hill Residential Home 21/04/06

Gold Hill Residential Home 29/11/05

Gold Hill Residential Home 14/03/05

Gold Hill Residential Home 18/08/04

Gold Hill Residential Home 26/03/04

Gold Hill Residential Home 15/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gold Hill 5 Avenue Road Malvern Worcestershire WR14 3AL Lead Inspector Nic Andrews Announced 29 July and 5 August 2005 - 9:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Gold Hilll Address 5 Avenue Road Malvern Worcestershire WR14 3AL 01684 574000 01684 891976 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manor Care Limited Mrs S Powell CRH 40 Dementia - over 65 Mental health Old age Physical disability - over 65 3 1 40 40 Category(ies) of DE(E) registration, with number MD of places OP PD(E) Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: At the time of the inspection the number of service users with a dementia illness exceeded the number of people within this category for which the home was registered. An application had been made to the CSCI by the previous Responsible Individual for a variation in the conditions of registration in order to address this issue. However, the matter was referred by the CSCI to the new Responsible Individual so that he could give consideration to this issue before a formal response by the CSCI was made. Date of last inspection 14 March 2005 Brief Description of the Service: Gold Hill is a large building occupying a corner position on a hill within close proximity to the centre of Malvern. There is a theatre nearby and Malvern has all of the amenities usually associated with a small town. There are car parking facilities at the front of the premises and a garden is located at the side of the building. The premises, which were formerly used as a hotel, have been adapted for their present use as a residential care home. The home is registered to provide a residential i.e. personal, care service for a maximum of 40 older people who may also have a physical disability. The home is also registered to provide care for three older people with a dementia illness. The service users are accommodated in 24 single bedrooms and 8 double bedrooms on four levels i.e. lower ground, ground, first and second floor. Sixteen of the single bedrooms and 7 of the double bedrooms have an en suite facility. Several of the bedrooms enjoy attractive views of the Malvern Hills and the surrounding countryside. The home has a small, two-person passenger lift. The home also has two lounges on the ground floor and a dining room on the lower ground floor. The dining room has an adjoining conservatory that is used as a smoking area by the service users that smoke. The homes stated aim is to offer the best of care whilst preserving the right of each resident to be regarded as an individual and to assist each resident to achieve maximum independence. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine inspection that took place over two days. Service users’ records and staff records were inspected and a tour of the premises was also made. Separate discussions were held with three service users and four members of staff. Time was spent with the registered manager and deputy manager assessing the extent to which the requirements and recommendations arising from previous inspections of the home had been implemented. A brief meeting was also held with the new Responsible Individual. The service users stated that they were looked after well by the staff and described them as ‘excellent’, ‘pleasant’ and ‘kind’. One service user said ‘They do what they can to help you’. Two service users spoke highly of the deputy manager in particular. They said that they felt able to raise any concerns about their care and expressed their confidence that their concerns would be listened to and dealt with appropriately. The service users commented positively about the choice, quality and quantity of the food provided. However, one service user said that she would like more fresh fruit and stewed fruit. They confirmed that they were able to get up and go to bed at the times that they wished. The majority of the responses to the questions that the staff were asked about the home and their work were positive. The staff felt that the registered manager and deputy manager were supportive and that there was a good relationship between the staff and the service users. They also said that the food was good. However, two of the staff felt that the home should provide more staff to enable more individual time to be spent with the service users. All four members of staff felt that more activities could be provided for the service users during the day and in the evening. One member of staff felt that the attitude of the staff was not always good. The improvements that the staff would like to see introduced included ‘new curtains, new uniforms, a bigger and more reliable lift and a proper staff room’. Following the inspection that was carried out on 14 March 2004, two further visits were made to the home on 16 May and 8 June 2005. The purpose of the visits was to assess the home’s response to the immediate requirements that had been issued during the previous inspections. This inspection was used as a further opportunity to assess the progress that had been made in regard to the outstanding issues. It was noted with concern that a number of requirements and recommendations had not been fully or satisfactorily implemented. Consequently, the number of requirements and recommendations continues to remain at an unacceptably high level. The home requires sustained investment of resources in order to ensure that all of Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 6 the National Minimum Standards are met. The registered persons must take appropriate action to implement all of the requirements and recommendations in order to avoid action being taken against them. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2 and 3 The contents of the statement of purpose, service users’ guide and statement of terms and conditions of residence all need to be improved. The admission procedure must include a full and proper assessment of the people moving into the home in order to ensure that all of their care needs will be met. EVIDENCE: A copy of the home’s statement of purpose was made available for inspection. The home’s response to the requirement that was made as a result of the previous inspection in regard to the statement of purpose was assessed. The requirement was that the statement of purpose must be amended to include all of the information required by Regulation 4 and Schedule 1 as indicated in the inspection report. It was noted that the requirement had not been fully implemented. The statement of purpose must be amended to include the organisational structure of the home and the details of the number and size of all the rooms i.e. the physical environment standards. In addition, the incorrect references to the Care Standards Commission and to the now former Responsible Individual, must be deleted and replaced with the correct information. The requirement still stands. A copy of the home’s service users’ guide was also made available for inspection. The home’s response to the requirement that was made as a result Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 9 of the previous inspection in regard to the service users’ guide was assessed. The requirement was that the service users’ guide must be amended in order to ensure that it includes all of the information referred to in Regulation 5 and Standard 1.2, as indicated in Standard 1 of the report, and copies given to all current, and any prospective service users. It was noted that the requirement had not been implemented. The service users’ guide must be amended to include details of the relevant qualifications and experience of the registered provider and the number and size of all the rooms i.e. the physical environment standards. In addition, the service users’ guide should include information about how to contact the local social services and health care authorities. The requirement still stands. The registered manager provided a two-page document entitled ‘Terms of Residence’. This document included a reference to the period of notice i.e. four weeks. However, the registered manager also made available for inspection a fifteen-page document attached to the ‘Service Users Information Pack’ i.e. service users’ guide, called ‘Agreement of Care’ that contained the statement of terms and conditions of residence i.e. contract. The contents of this document included details of all the issues referred to in Standard 2.2 except for the period of notice. The statement of terms and conditions of residence must include the period of notice. The registered manager confirmed that all the service users had been issued with a copy of the statement of terms and conditions of residence. However, a decision must be made as to which of the two documents the home intends to have as the statement of terms and conditions of residence. The home should dispense with any other similar documents in order to avoid confusion. The home should have one clear, accurate and comprehensive statement of terms and conditions of residence. The home’s response to the two requirements that were made as a result of the previous inspection regarding the assessment form and its use by the home was assessed. The first requirement was that the assessment form must be amended to include all of the revisions referred to in the inspection report in accordance with Regulation 14. A copy of the home’s assessment form was made available for inspection. It was noted with concern that the requirement had not been implemented. The assessment form must be amended to include all of the aspects of care referred to in Standard 3.3 i.e. personal care (e.g. use of the toilet), continence, weight, oral health and foot care. In addition, the assessment form should provide more space for additional comments. The requirement still stands. The second requirement was that a clear, comprehensive and detailed assessment that identifies all of the needs of the service users and the way in which the identified needs are met must be undertaken and recorded. The files of five service users were examined. Four of the service users were admitted to the home on 11 January, 5 May, 26 July and 27 July 2005 respectively. The fifth file was in respect of a service user who was regarded by the deputy manager as the most dependent person in the home. The first Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 10 file did not contain a risk assessment on falls or nutrition. The second file contained an assessment that stated that a risk assessment was required. However, a risk assessment had not been carried out. The third file indicated that the service user had ‘bad dandruff’. However, there was no risk assessment on skin care and no risk assessment in regard to nutrition or falls. In addition, the assessment sheets on mobility and communication had not been completed and there was no care plan. The fourth file indicated that the service user had a colostomy. However, there was no risk assessment in regard to this or in respect of skin care, nutrition or falls and no care plan. The fifth file of the most dependent service user indicated that she required the help of ‘two staff at all times’ and ‘all personal care’. However, there was no risk assessment on skin care. The requirement had not been implemented and still stands. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 10 and 11 The records about the service users held by the home and aspects of the service that affected their privacy and dignity needed to be improved. The home’s practices regarding the terminal care of service users were satisfactory. EVIDENCE: The home’s response to the four requirements that were made in regard to Standard 7 as a result of the previous inspection was assessed. The first requirement was that recordings made on a daily basis must contain adequate information about all aspects of the service users, including emotional care and social interaction. Although some progress had been made to implement this requirement, the details in the daily records that were examined contained limited information regarding the service users’ emotional care and social interaction. The requirement still stands. The second requirement that risk assessments must be put in place for skin care, nutrition and falls had not been implemented and still stands. The third requirement was that risk assessments must be put in place for service users who go out unaccompanied and be signed by them. The registered manager stated that this requirement was no longer applicable because none of the current service users went out of the home without an escort. If the circumstances of any of the current service users change or in the event of any new service users being able to go out of the home unaccompanied the requirement would apply. The fourth Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 12 requirement that accidents to service users must be recorded had been implemented. The home’s response to the requirement that was made as a result of the previous inspection regarding the provision of accredited training in the administration of medication was assessed. The registered manager stated that the information that she had provided the CSCI on 8 June 2005 in regard to accredited training had not changed. The information indicated that all the staff that were involved in the administration of medication had received training. However, four members of staff were about to complete a twelveweek updated course of accredited training in the administration of medication. Therefore, the requirement had not been fully implemented and still stands. The registered manager stated that the privacy and dignity of the service users was respected at all times. However, two members of staff were observed entering service users’ bedrooms without first knocking the bedroom doors. The home provided a mobile handset to enable the service users to make and receive calls in private. The registered manager stated that approximately fifteen service users who did not have any family support were given items of clothing that previously belonged to deceased service users by the deceased service users’ relatives. The registered manager stated that the clothing was always relabelled. It was also stated that items of clothing sometimes went missing. However, it was pleasing to note that individual compartments had been installed in the laundry in order to minimise the possibility of the service users’ clothing being misplaced. The registered manager stated that the home’s Charter of Rights and induction training included a reference to the importance of staff using the term of address preferred by the service users. The double bedrooms 27, 25 and 31 did not require fixed screening at the present time. However, fixed screening should be provided in all of the other double bedrooms. The registered manager stated that the staff were supported in their care of service users who were terminally ill by the district nurse. The circumstances surrounding the care of the most recent service user to die in the home were outlined. The care practice that was followed as described by the registered manager reflected the principles and practice detailed in Standard 11. A copy of the home’s policy and procedure called, ‘Dealing with a Dying Resident’ was made available for inspection. Under the sub-heading ‘Pain Control’ the policy and procedure referred inappropriately to ‘The Nurse on Duty’. The reference should be deleted and replaced with a more suitable designation. In paragraph 4 ‘Notification of Death’ the policy and procedure also included two incorrect and out of date references regarding the reporting of a death. The policy and procedure must be amended accordingly. The recommendation that was made as a result of previous inspections that the service users’ wishes concerning terminal care and arrangements after death should be discussed, recorded in their individual care plans and carried out had not been implemented and still stands. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 13 Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14 and 15 The service users were able to receive visitors at any reasonable time and information was available in the home to show that their rights were supported. The home provided a good standard of nutritious food. EVIDENCE: The service users were able to maintain contact with their relatives/representatives and the local community and to receive visitors at any reasonable time. The service users’ guide stated, ‘Visitors are welcome at any time’. However, there was no evidence to show that relatives, friends and representatives of service users were given written information about the home’s policy on maintaining relatives and friend’s involvement with service users at the time of moving into the home. Therefore, the recommendation that was made in regard to this issue as a result of the previous inspection had not been implemented and still stands. Involvement in the home by local community groups was limited. However, a group of people from Priory Church visited once a month to hold a Communion service. A group of singers visited three times a year. The registered manager stated that children from the local school visited at Christmas and occasionally pupils from Malvern College also visited the home. The home’s statement of purpose and service users’ guide included references to the service users’ rights, autonomy, choice and independence. The registered manager stated that no person connected with the running of the Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 15 home acted as the appointee or agent on behalf of the service users. The service users were able to handle their own personal finances for as long as they wished to and had the capacity to do so. However, the relatives of the service users were sent an invoice at the end of each month for the expenses incurred by the service users in respect of hairdressing, chiropody, newspapers, toiletries, sweets and cigarettes etc. This procedure made it easier to maintain control of the service users expenditure but reduced the service users’ opportunity to handle their own finances. Information about the local advocacy service was displayed on the notice board near to the main entrance. The registered manager stated that written information about the advocacy service was kept in the home. The service users’ guide included a reference to the advocacy service. Both the statement of purpose and the service users’ guide included a statement confirming the service users’ right of access to their personal records held about them by the home. The registered manager stated that breakfast was served mainly in the service users’ bedrooms between 7:00 and 10:00 am. Lunch and the teatime meals were served in the dining room at 12:30 pm and at 5:30 pm respectively. Service users were able to eat all their meals in their bedrooms if they preferred. Drinks and snacks were served between meals. None of the current service users required liquefied meals or special diets for religious, cultural or health reasons apart from two service users who were insulin dependent. However, the registered manager stated that special diets could be catered for, if necessary. The home had a four-week menu. The registered manager confirmed that there were two choices for all main meals, a salad was always available and that the service users were consulted every day about their choice of food for the following day. Two service users had their food cut into small pieces in order to avoid the risk of choking. The registered manager stated that there were always two members of staff in the dining room at meal times to supervise the service users. It was stated that all of the current service users were able to feed themselves without staff assistance. One service user was provided with a plate guard. The record of the food provided was examined. The requirement that was made in regard to the record of the food provided as a result of the previous inspection had been implemented. The food was balanced and nutritious. It was stated that fresh food was brought in twice a week. The food stores were satisfactory. All of the service users who were spoken to during the inspection spoke positively about the quality, quantity and variety of the food provided. An inspection of the kitchen confirmed that the requirement that was made as a result of the previous inspection that food must be covered had been implemented. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 The home had a satisfactory complaints procedure but has failed within the last year to respond to all of the complaints that have been made about the service provided. Measures were in place to ensure that the service users’ legal rights were protected. EVIDENCE: The statement of purpose contained a reference to the home’s complaints procedure. Similarly, a copy of the complaints procedure was included in the ‘Agreement of Care’ as part of the service users’ guide. The contents of the complaints procedure were satisfactory. A record of the complaints that had been made directly to the home was maintained. Six complaints against the home within the previous year had been recorded. In addition, a further three anonymous complaints had been made directly to the CSCI against the home during the past year. The first complaint contained seven elements and was about poor care practice. The complaint was referred to the home for investigation on 11 February 2005. Despite being sent two further reminders, the home had not yet provided a response. The second complaint also contained seven elements and included poor care practice and an unacceptable staff attitude. One element of the complaint was upheld, four elements of the complaint were not upheld and two elements of the complaint were unresolved. The third complaint, that contained six elements, was also about poor care practice. The complaint was referred to the home for investigation. However, an unsatisfactory response was received. The complaint was, therefore, referred to the new Responsible Individual for a more thorough and detailed response. This complaint had not yet been resolved. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 17 The registered manager confirmed that some of the service users had access to their own solicitors and that the relatives of other service users had been given Power of Attorney. No advocates were involved in the care of any of the service users. The registered manager stated that none of the service users required the help of an advocate at the present time. However, the home held information about the local advocacy service. The registered manager stated that the advocacy service had been used in the past although, in practice, the relatives of most of the service users’ supported them and acted on their behalf. It was confirmed that all of the service users were registered to vote. Some of the service users used the postal vote at the last election and others were taken by their relatives to vote. The home’s response to the requirement and recommendation that were made in regard to Standard 18 as a result of the previous inspection was assessed. The requirement was that the home’s Adult Protection (Abuse) Policy must be amended to ensure that internal investigation of any allegations of abuse does not take place before the allegations have been referred to external agencies and advice taken. The requirement had been implemented. The recommendation was that an appropriate reference to consultation on finances in private should be included in the home’s policy on service users’ money and financial affairs. A copy of the home’s policy ‘Residents’ Financial Affairs’ was made available for inspection. The recommendation had not been implemented. It was also noted that the policy did not cover all of the other issues referred to in Standard 18.6. For example, the policy did not preclude staff involvement in assisting in the making of or benefiting from service users’ wills. On the contrary, the policy stated ‘there may be circumstances under which a staff member may engage themselves in the financial affairs of a client’. This statement is unacceptable and must be removed. The policy must be reviewed and revised. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 and 24 Limited progress has been made in improving the environment. A significant number of outstanding issues need to be addressed in order to ensure that the service users live in safe, comfortable and homely surroundings. EVIDENCE: The home was not accessible via the main entrance to people who require the use of a wheelchair. Access to the home by people in wheelchairs was possible through a side entrance. However, this arrangement is unsatisfactory. The external appearance of the home was not enhanced by the need to resurface the drive and car parking area and to repaint the outside of the building. The home’s response to the requirement and recommendation that were made in regard to Standard 19 as a result of the previous inspection was assessed. The requirement was that the window frames on the outside of the premises must be repainted. Although painting work had commenced the requirement had not been fully implemented and still stands. It was also noted that the frames on some of the windows needed to be replaced e.g. the window frames in bedrooms 2, 3, 4, 11, 12, 15, 16 and 23. The wording of the requirement has been amended to include the work that must be undertaken in order to Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 19 address this issue. Although it was evident that work was being carried out to upgrade the building, the recommendation that a programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented had not been implemented. The recommendation still stands. The service users had access to the garden via the dining room and conservatory on the lower ground floor. It was noted that new net curtains were needed in the en suite bathroom for bedroom 31 and that there were no curtains or blinds in the en suite toilet for bedroom 20 or in the communal bathrooms on the first and second floors. Curtains or blinds should be provided in all of the bathrooms and toilets in order to enhance the privacy of the service users and to help create a homely environment. The home provided two lounges on the ground floor and a dining room and conservatory on the lower ground floor. The conservatory was used as the service users’ smoking area. Access to the garden was obtained via the conservatory. The total amount of communal space, excluding the service users’ private accommodation, corridors and entrance hall, fell below the National Minimum Standard. However, as an existing service that was registered prior to 1 April 2002, the home did not have to comply with this Standard. Nevertheless, the registered provider should consider how the amount of communal space could be increased. It was noted that some of the furnishings i.e. chairs and sofas in the lounges, were low and no longer suitable for service users who are frail and have mobility problems. It was also noted that the carpet in the dining room had lifted and was presenting a possible safety hazard. The carpet must be re-laid. The home provided the following bathroom and toilet facilities, • Lower ground floor; 1 communal shower room with a toilet, 3 en suite baths each with a toilet and 2 en suite toilets. • Ground floor; 1 communal toilet, 6 en suite baths each with a toilet and 2 en suite toilets. • First floor; 1 communal bath with a toilet, 4 en suite baths with a toilet, 1 en suite shower with a toilet and 5 en suite toilets. • Second floor; 1 communal bath with a toilet, 1 communal toilet, 1 en suite bath with a toilet and 1 en suite shower with a toilet. The number of baths/showers and toilets for communal use was adequate for the number of service users for which the home was registered as a preexisting care home i.e. a home registered before the 1 April 2002, taking into account the present number of en suite facilities. However, the number of communal baths/showers and toilets and similar en suite facilities must not be allowed to fall below the present level. Any bath, shower or toilet facilities that are removed because they are old, badly stained or damaged must be replaced with the same type of new facility. The home’s response to the requirement and recommendation that were made in regard to Standard 22 as a result of previous inspections was assessed. The requirement was that handrails must be provided in all of the Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 20 corridors including the main corridor on the first floor. It was noted that the corridor on the lower ground floor leading to bedrooms 32 and 33 and the wall on the second floor between bedrooms 3 and 4 had not been fitted with a handrail. Therefore, the requirement still stands. The recommendation that the advice of a qualified occupational therapist should be sought had not been implemented and still stands. It was also noted that there was no grab rail in the communal toilet on the second floor. The service users’ individual accommodation was inspected. It was noted that the service users’ bedrooms did not contain all of the items listed in Standard 24. In particular, there was no bedside lighting in bedrooms 11, 12, 15, 16, 20, 22, 28, 31 and 33. Comfortable seating for two people was not provided in bedrooms 4, 5, 8, 9, 11, 15, 17, 21, 24, 26, 32 and 33. Two accessible, double electric sockets were not installed in bedrooms 1, 2, 3, 4, 5, 6, 9, 10, 14, 16, 21, 26 and 33. There was no table in bedrooms 9 and 24. There was no bedside table in bedrooms 2, 3, 6, 9, 22 and 32 and only one bedside table in double bedrooms 10, 14, 19 and 31. There was no carpet in bedrooms 4, 25 and 28. There was no lockable storage in bedrooms 9 and 11. There was no fixed screening in bedrooms 7, 10, 14, 19, 23, 27 and 31. There was no window opening restrictors in bedrooms 7 and 22. All of the above items that were absent from the service users’ bedrooms must be provided unless the provision of any item poses an unacceptable risk to the safety of the service users. The home gives the appearance of being old and neglected and in need of improvement. For example, the appearance and décor of the service users’ bedrooms could be improved significantly by the provision of bright and more up to date colour-coordinated fabrics. The home’s response to the two requirements that were made in regard to Standard 24 as a result of the previous inspection was assessed. The requirements concerned the replacement of stained baths and wash hand basins. The requirement had not been fully implemented. For example, it was noted that the baths in the en suite facilities of bedrooms 18, 19, 24, 26, and in the communal bathroom on the first floor were badly stained. Similarly, it was noted that the wash hand basins in bedrooms 11 and 12 were also badly stained. All baths and wash hand basins that are stained must be replaced. The requirement still stands. Bedroom 29 on the lower ground floor was being redecorated. The staff hoped that the room, that was not entirely suitable as a bedroom, would be converted and used as a staff room in order to improve the current, rather sparse facilities available for the staff. The home’s response to the four requirements and one recommendation that were made in regard to Standard 25 as a result of the previous inspection was assessed. The first requirement regarding the provision of thermostatically controlled mixer valves to all hot water outlets had not been implemented. It was noted with concern that none of the wash hand basins used by the service users had been fitted with this safety device. The requirement still stands. The registered manager confirmed that the second requirement that the temperature of the rooms used by service users must be monitored and Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 21 maintained at a minimum of 21 degrees centigrade had been implemented. The inspection took place during a period of warm weather and, therefore, the temperature of the rooms was satisfactory. The temperature of the home must continue to be maintained at an acceptable level especially during the winter months. The third requirement was that free-standing heaters must be risk assessed and guarded where necessary. The registered manager stated that none of the free-standing heaters had been risk assessed. It was noted that there were unguarded portable heaters in bedrooms 5 and 20. Supplementary heating should not be necessary in a home where the central heating system is working effectively. Portable heaters also present a potential safety hazard to the service users. The heaters must be removed. The fourth requirement was that pipe work in areas used by service users must be guarded. It was noted that there was pipe work that was unguarded in bedrooms 2, 3, 4, 10, 11, 15 and 21 and in the shower room on the lower ground floor. The requirement had not been implemented and still stands. The recommendation was that the service users should be able to control the heating in their own bedrooms. It was noted that there were still some bedrooms where the temperature control device was encased within the radiator guard. The recommendation, therefore, had not been implemented and still stands. The home’s response to the four requirements that were made in regard to Standard 26 as a result of the previous inspection was assessed. The first requirement that the laundry floor finishes must be upgraded so that they are impermeable and readily cleanable had been implemented. The second requirement was that hand washing facilities must be prominently sited in the laundry. The requirement had not been implemented and still stands. It should be noted that the Environmental Health Officer had made a recent visit to the home and in his subsequent letter dated 9 August 2005 had confirmed that an extra hand washing facility needed to be installed by the exit door in the laundry. This was in addition to the existing wash hand facility near to the door leading to the rear garden. The third requirement was that soiled items of clothing or linen requiring washing must not be carried through the dining room to the laundry. The advice of the Environmental Health officer had been sought on this issue. It had been acknowledged that, due to the design and layout of the building, there was no other practical alternative to the current practice. Therefore, this requirement has been deleted. However, the registered manager must take appropriate action to ensure that all the staff are fully trained in the necessary procedures and that they adhere to the correct practices as outlined by the Environmental Health Officer in his letter. The fourth requirement was that food left on the kitchen surfaces must be covered at all times. During the inspection it was noted that the food that was being prepared in the kitchen was covered. The requirement was, therefore, regarded as having been implemented. It was noted that there was an unacceptable odour in bedrooms 2 and 19. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 and 29 The home has progressed well to achieve a satisfactory standard of staff training at NVQ level 2 and 3. However, the staff recruitment procedures need to be more robust in order to ensure the safety and protection of people living in the home. EVIDENCE: The registered manager confirmed that four members of staff had completed the NVQ level 3 training and eleven members of staff had completed the NVQ level 2 training. It was also confirmed that seven staff were undertaking NVQ level 2 training and that they hoped to complete the training by November 2005. The registered manager confirmed that neither agency staff nor trainees nor staff below the age of 18 years worked in the home. The registered manager confirmed that all the staff had been issued with a copy of the code of conduct and practice set by the General Social Care Council. The home’s response to the requirement regarding the contents of staff files that was made as a result of the previous inspection was assessed. The requirement was that staff files must contain all the information and documents listed in Schedule 2. The contents of the files in respect of five members of staff were examined. The job application form in one file did not include the person’s health declaration. A copy of the recently revised job application form was examined. The contents of the job application form were satisfactory and included a health declaration. The registered manager gave an assurance that, in the future, she would ensure that the correct job application forms were issued to all prospective new staff. One staff file did not include any proof of the person’s identity and another file did not contain a Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 23 disclosure check from the Criminal Records Bureau (CRB). The registered manager stated that a disclosure check had been applied for in respect of the particular member of staff and that a disclosure check from the CRB had been obtained in respect of all other members of staff. The requirement, however, had not been fully implemented and still stands. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 34, 35 and 36 A number of management practices need to be improved, e.g. financial procedures and staff supervision. Quality monitoring through regular monthly visits by the registered provider and the provision of an annual development plan would help to ensure that the standard of care and the quality of the service was improved. EVIDENCE: The registered manager had relevant experience and had undertaken periodic training to update her knowledge and skills. She had completed the NVQ level 4 and Registered Managers’ Award training in July 2004 and was also an NVQ Assessor. The registered manager had also undertaken first aid training at the appointed person level in May 2004. The recommendation that was made as a result of the previous inspection that copies of all the registered manager’s training certificates should be kept at the home and made available on request had been implemented. The registered manager’s job description was examined and the contents were satisfactory. The registered manager’s Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 25 personnel file did not contain any proof of identity and no references. The registered manager gave an assurance that references were obtained on her behalf when she was appointed. The registered manager’s disclosure form from the Criminal Records Bureau (CRB) contained an incorrect surname. The registered manager must make a new disclosure application for a CRB check. The home’s response to the three recommendations that were made in regard to Standard 32 as a result of the previous inspection was assessed. The first recommendation was that regular informal discussions with some of the more able service users should be introduced to enable the service users to have a greater influence over the way in which the service is delivered. A record of the discussions that are held and the decisions that are made should be maintained. The registered manager stated that group meetings were now held as well as individual discussions. The last group meeting was held on 22 May 2005. The home also had a ‘Residents’ Comments Book’ in which notes of the discussions with service users were recorded. The recommendation was, therefore, regarded as having been implemented. The second recommendation that an attempt should be made to reintroduce a key worker system for the benefit of the service users had not been implemented and still stands. The registered manager said that she tried to ensure that a full, staff meeting was held every two months. The most recent staff meeting was held on 27 June 2005. A staff meeting was also held on 4 August 2005 to discuss the home’s recent change of ownership. The staff meetings included items and suggestions that members of staff had placed on the agenda. It was intended that a further staff meeting would be held in approximately three months. It was confirmed that questionnaires had been issued to the service users but not all of the responses had been received. The home had an equal opportunities policy. The home employed four members of staff from Latvia. The home’s response to the requirement and recommendation that were made in regard to Standard 33 as a result of the previous inspection was assessed. The requirement that an annual development plan for the home must be introduced had not been implemented and still stands. The annual development plan should include proposed improvements in staff facilities. The recommendation that the results of service user surveys should be published had not been implemented. The registered manager stated that questionnaires had been issued to the service users in March 2005 but the results had not yet been analysed or published. The recommendation still stands. The home’s response to the recommendation that was made in regard to Standard 34 as a result of the previous inspection was assessed. The recommendation was that a business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually. The recommendation had not been implemented and still stands. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 26 The service users’ guide and statement of purpose contained information supporting the service users’ autonomy and independence. It was pleasing to note that no member of staff was acting as the appointee or agent on behalf of any of the service users. The registered manager stated that most of the service users’ relatives or prime supporters dealt with the service users’ financial affairs. The home handled the personal allowances in respect of two service users and maintained a record of their individual accounts. It was noted with concern that the records were not up to date. The home did not have any money belonging to either of the two service users on the premises. The home was paying money to the two service users out of petty cash. As the service users’ finances had been dealt with by the former Responsible Individual, who had recently resigned from his position, neither the registered manager nor the deputy manager were able to provide a full explanation of the system used for handling the service users’ money. Urgent action was needed to rectify the administrative and accounting procedure for handling the finances of the two service users. The home had secure facilities in which to keep the service users’ money and personal valuables. However, it was stated that the home did not hold any valuable items on behalf of any of the service users at the present time. It was confirmed that the staff were receiving individual supervision. However, the minutes of the meetings were not always recorded on forms that included all the issues that are listed in Standard 36. 3. The registered manager acknowledged that the supervision meetings were ‘not up to date’ and that responsibility for supervision needed ‘to be delegated’. The records of the supervision meetings that were examined indicated that supervision meetings were not being held at the required frequency i.e. six times a year. For example, the file in respect of two members of staff contained only one recorded supervision meeting dated on 6 May 2005. Another member of staff had attended two supervision meetings in six months. The requirement that was made as a result of the previous inspection in regard to staff supervision had not been implemented and still stands. The home’s response to the requirement that was made as a result of the previous inspection regarding Standard 37 was assessed. The requirement concerned the provision of reports made in accordance with Regulation 26. The requirement had not been implemented and still stands. The home’s response to the five requirements and one recommendation that were made in regard to Standard 38 as a result of the previous inspection was assessed. The first requirement was that arrangements must be made to ensure that all the staff receive suitable training in first aid, moving and handling, fire safety, infection control, food hygiene and health and safety. The registered manager stated that ten members of staff undertook moving and handling training on 27 June 2005 and that eight members of staff undertook first aid training on 8 April 2005 and fire safety training on 28 February 2005. Eight members of staff undertook module-based infection Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 27 control training on 22 April 2005. It was stated that another group of staff would undertake infection control training in September 2005. Training in food hygiene was undertaken on 19 July 2005. However, the four members of staff from Latvia did not undertake the training. No evidence was provided to show that staff had undertaken any training in health and safety. Therefore, the requirement had not been fully implemented and still stands. The second requirement was that footplates must be attached and used where wheelchairs are being used to assist service users to move. The registered manager gave an assurance that the requirement was being implemented. However, it was noted that one service user that used a wheelchair was being moved without footplates attached to her wheelchair. The registered manager stated that the members of staff were acting in accordance with the service user’s decision and that the service user’s wishes on this matter had been recorded in her care plan. A risk assessment must be carried out, recorded and kept under review in respect of the service user who uses a wheelchair without footplates attached. The third requirement was that a valid copy of the home’s electrical safety certificate provided by a qualified electrician must be obtained and made available for inspection. The requirement had not yet been implemented and still stands. The fourth requirement was that the water system must be checked and inspected by a competent person to reduce the risk of Legionella bacteria. The evidence of this check must be available for inspection. The registered manager made available a bacteriological analysis certificate of results in respect of water samples that had been tested on 23 June 2005. The certificate stated ‘No species of Legionella bacteria were isolated from the samples analysed’. The requirement was, therefore, regarded as having been implemented. The fifth requirement that a risk assessment for the transporting of soiled laundry around the home must be produced had been implemented. The recommendation that accidents in the home should be monitored and audited on a monthly basis had been implemented. During the inspection it was noted that there were no opening restrictors on the windows in bedrooms 7 and 22. It was also noted that the carpet near to the door opening to bedroom 19 had become loose. This presented a safety hazard. The carpet must be re-laid. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 1 2 3 x x 1 x x STAFFING Standard No Score 27 x 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 1 3 x 2 2 x x 2 2 x x Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement The statement of pupose must be amended to include all of the information required by Regulation 4 and Schedule1 as outlined in this report. (Previous timescale of 30 April 2005 not met). The service users guide must be amended to include all of the information referred to in Regulation 5 and Standard 1.2 as outlined in this report, and copies given to all current and prospective service users. (Previous timescale of 30 April 2005 not met). The home must provide one clear, accurate and comprehensive statement of terms and conditions of residence that includes the period of notice and all of the other information detailed in Standard 2.2. The homes assessment form must be amended to include all of the issues referred to in Standard 3.3 as outlined in this report and individuals who are self-funding and without a care management assessment must E52 S18654 Gold Hill V232630 290705.doc Timescale for action 30 September 2005 2. 1 5 30 September 2005 3. 2 5 30 September 2005 4. 3 14 30 September 2005 Gold Hill Version 1.40 Page 30 5. 3 14 6. 7 15 7. 7 15 8. 9 13,18 9. 11 37 10. 19 23 be assessed using one comprehensive and appropriately worded form in accordance with Regulation 14. (Previous timescale of 30 April 2005 not met). A clear, comprehensive and detailed assessment that identifies all of the needs of the service users must be undertaken and recorded. (Previous timescale of From the next admission not met). Recordings made on a daily basis must contain adequate information about all aspects of the service users, including emotional care and social interaction. (Previous timescale of From the date of the inspection not met). Risk assessments must be put in place for skin care, nutrition and falls. (Previous timescale of From the date of the inspection not met). All of the care staff must be provided with accredited training that includes basic knowledge of how medicines are used and how to recognise and deal with problems in use and the principles behind all aspects of the homes policy on medicines handling and records (Previous timescale of 31 May 2005 not met). The homes policy and procedure on Dealing with a Dying Resident must be amended in accordance with Regulation 37 as outlined in the guidance given in this reort. The rotten window frames must be replaced and others must be repainted, where necessary. (Previous timescale of 30 June 2005 not met). 30 September 2005 With immediate effect 30 September 2005 30 September 2005 30 September 2005 31 October 2005 Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 31 11. 20 16 12. 13. 20 22 16 13,16 All the chairs and sofas in the communal areas that are too low or worn and no longer suitable for use by service users that are frail or that have mobility problems must be replaced with more appropriate seating. The carpet in the dining room must be re-laid. Handrails must be provided in all of the corridors as outlined in this report and grab rails in all of the communal toilets. (Previous timescale of 31 May 2005 not met). All of the items of furniture specified in Standard 24, as outlined in this report, must be provided in rooms occupied by service users. If the provision of any item poses an unacceptable risk to the service user or they decline the provision, details of the discussions and decision about this should be recorded in the assessment of the service users needs. All stained baths and wash hand basins must be replaced with new baths and wash hand basins as indicated in this report. (Previous timescale of 30 June 2005 not met). Thermostatically controlled mixer valves must be fitted to all hot water outlets used by service users, including the wash hand basins in their bedrooms, in order to prevent the risk of scalding. (Previous timescale of 30 April 2005 not met). Portable heaters must be removed from all areas of the home used by service users, including the service users bedrooms. 31 October 2005 With immediate effect 30 September 2005 14. 24 16 30 September 2005 15. 24 16,23 31 October 2005 16. 25 16,23 31 October 2005 17. 25 13 With immediate effect Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 32 18. 25 13 19. 26 13,16 20. 26 13, 21. 22. 26 29 16 17,19 23. 31 19 24. 33 24 25. 35 17 26. 36 18 Pipework in areas used by service users must be guarded. (Previous timescale of 31 May 2005 not met). Hand washing facilities must be prominently sited in the laundry. (Previous timescale of 30 June 2005 not met). Evidence must be provided to show that all the staff have been trained in, and that they adhere to the correct procedures and practices for dealing with the disposal of soiled linen. The home must be kept free from offensive odours, in particular bedrooms 2 and 19. Staff files must contain all the information and documents listed in Schedule 2. (Previous timescale of 30 April 2005 not met). A disclosure check from the Criminal Records Bureau must be obtained by the registered manager. An annual development plan for the home, based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users, must be introduced in accordance with the requirements of Regulation 24 and Standard 33. (Previous timescale of 30 June 2005 not met). The practice and procedure for handling and recording the service users money must be revised in order to ensure that it is clear, detailed and accurate. Care staff must receive formal supervision at least six times a year that includes all aspects of practice, philosophy of care in the home and career development needs. (Previous timescale of 30 June 2005 not 31 October 2005 30 September 2005 30 September 2005 With immediate effect 30 September 2005 With immediate effect 30 September 2005 30 September 2005 31 October 2005 Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 33 met). 27. 37 26 A visit to the home by the registered provider must take place at least once a month and a written report on the conduct of the home supplied to the CSCI and the registered manager in accordance with the requirements of Regulation 26. (Previous timescale of 30 June 2005 not met). Arrangements must be made to ensure that all the staff receive suitable training in infection control, food hygiene and health and safety in accordance with Regulations 13 and 18 and Standard 38.2. (Previous timescale of 31 May 2005 not met). A risk assessment must be carried out, recorded and kept under review in respect of the service user who uses a wheelchair without footplates attached. A valid electrical safety certificate for the home provided by a qualified electrician must be obtained and made available for inspection. (Previous timescale of 31 May 2005 not met). Opening restrictors must be fitted to the windows in bedrooms 7 and 22. The carpet near to the door opening to bedroom 19 must be re-laid. 30 September 2005 28. 38 13,18 30 September 2005 29. 38 13 With immediate effect 30. 38 13 31 August 2005 31. 32. 38 38 13 13 30 September 2005 With immediate effect RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Gold Hill Refer to Good Practice Recommendations E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 34 1. 2. Standard 1 10 3. 10 4. 5. 11 13 6. 18 7. 8. 9. 10. 19 19 19 22 11. 12. 13. 14. 25 32 32 33 Information about how to contact local social services and health care authorities should be included in the service users guide. All the staff should be reminded of the importance of respecting the service users privacy and dignity by always knocking the bedroom doors before entering the service users bedrooms. Fixed screening should be provided in all of the double bedrooms except where the service users e.g a married couple, have chosen not to have them. In these cases, the decision of both service users should be recorded in their individual care plans. The service users wishes concerning terminal care and arrangements after death, should be discussed, recorded in their individual care plans and carried out. Relatives, friends and representatives of service users should be given written information about the homes policy on maintaining relatives and friends involvement with service users at the time of an admission to the home. The homes policy and procedure regarding service users money and financial affairs should be amended in order to include a reference to all of the issues referred to in Standard 18.6 and the guidance contained in this report. Consideration should be given to improving the means of access to the home for people who use wheelchairs. A programme of routine maintenance and renewal of the fabric and decoration of the premises should be produced and implemented. Curtains or blinds should be provided in all bathroom and toilet facilities in order to enhance the privacy of the service users and to create a more homely environment. The advice of a qualified occupational therapist should be sought in order to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of the service users. The service users should be able to control the heating in their own bedrooms. An attempt should be made to reintroduce a key worker system for the benefit of the service users. The home should introduce management planning and practice that will encourage innovation, creativity and development. The results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties, E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 35 Gold Hill 15. 34 including the CSCI. A business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually. Gold Hill E52 S18654 Gold Hill V232630 290705.doc Version 1.40 Page 36 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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