Inspection on 29/10/07 for Hilltop

This inspection was carried out on 29th October 2007.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hilltop 17/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Hilltop Hilltop 32 Trewartha Park Weston Super Mare North Somerset BS23 2RT Lead Inspector Nicola Hill Unannounced Inspection 29th October 2007 10:00 Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 1 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 Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 2 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 Adults 18-65. 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. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilltop Address Hilltop 32 Trewartha Park Weston Super Mare North Somerset BS23 2RT 01934 644875 01934 613517 enquiries@homes-caring-for-autism.co.uk www.homes-caring-for-autism.co.uk Homes Caring for Autism Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) TBA Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May provide a service for up to eight younger adults in the age range 16 - 18 years May provide a service for up to eight younger adults in the age range 18 - 40 years. 3. People at the age of 45 may be admitted with the express consent of CSCI. 17th October 2006 Date of last inspection Brief Description of the Service: The service is aimed at people whose behaviour can be challenging, and a high level of intensive one-to-one work is offered. The aim is to enable people to learn new ways of managing their own behaviour in order to live more independently or otherwise improve their quality of life. The home is in a quiet residential area, within easy reach of the town, the seafront, and other local amenities. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of the home was undertaken initially with the shift leader and then with the acting manager, Lee Derbidge and the deputy manager, Scott Bartlett. We offered to go through all of the standards with the acting manager as he had not been involved in an inspection before, but this was declined and the inspection continued as planned. We observed and briefly spoke with the people living at the home, and the staff who were on duty. We met briefly with one relative who was very complimentary about the care received by their son. We also looked at the records held at the home and used resident surveys to gather information about Hilltop. An AQAA had been completed and sent to the Commission, this was discussed with the Acting manager as part of the inspection process. The home has been assessed as having some good areas of practice, which have been highlighted in this report. The overall assessment is that Hilltop provides an adequate level of service to the people who live there. What the service does well: What has improved since the last inspection? The deputy manager was able to outline the improvement which had taken place since the appointment of the latest manager, and was confident that there had been a positive impact on the lives of people who use the service as Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 6 a wider range of activities were available, and flexibility in the staff team had improved. The acting manager and team are developing a quiet room and a sensory/Snoozlem area for people living in the home. 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. The summary of this inspection report can be made available in other formats on request. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. Prospective individuals are given the opportunity to spend time in the home. Individual members of staff are allocated to them to help them understand how the home is organised to give them special attention to help them to feel familiar and comfortable in their surroundings. EVIDENCE: The Statement of Purpose and Service User Guide need to be reviewed so that the information in them is current and up to date. The service user guide could also be produced in an accessible format i.e. DVD which may be more meaningful to the client group. The home has a good procedure for assessment and admission of new people. There was evidence that the potential resident, their family and other professionals worked together to facilitate a comprehensive preadmission assessment and to identify the agreed outcomes of the admission. The management at the home take into consideration the overall service provision and needs of the current resident community before proceeding with admissions. The process for admission to Hilltop is individualised and trial periods have agreed and planned review dates. The staff at the home are Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 9 trained and skilled to meet specialist needs, and the assessment processes ensures that potential needs can be met amongst the skill base within the team. The people living at Hilltop do not have an accessible contract; this was discussed with the acting manager and deputy manager. This contract could also include ‘House Rules’ and an accessible complaints procedure. The people currently living at Hilltop are all male; any diversity issues are identified and met through individual assessment and person centred care planning. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each individual has a care plan but practice of involving people who use the service in the development and review of the plan is variable. The care plan is not used as a working document and does not consistently reflect the care being delivered. EVIDENCE: We were able to read individual care plans and individual programmes of support. The evidence from the written documentation was that the plans are based on the activities of daily living. Whilst there was a significant amount of information relating to the support of the individual people at Hilltop it was difficult to cross reference information. The documentation did not clearly indicate where any restrictions on choice of freedom had been agreed with the person using the service or the use of physical interventions. The formats used contain limited information and little evidence of evaluation of the support to people. This meant that it was Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 11 unclear from the documentation that the home has any success with planning and working with people towards improving their quality of life. This was discussed in depth with the acting manager, as without clear documentation it was difficult to track people’ progress and evidence the good practice at the home. There was little evidence that people are involved in planning a chosen lifestyle and to work toward agreed outcomes. We acknowledge that developing meaningful communication systems with individuals is a lengthy process and is a work in progress. The key elements of the care plans could be produced as individual care plans and made accessible by use of the Change Picture Bank. Also, agreed techniques for interventions should be included. These should be linked to the individual development plans, and focus on positive behaviour with the reinforcement of agreed boundaries. Some of the information on files came from previous placements. For example, we discussed with the shift leader the appropriateness of using a bedtime routine for one of the people living there, which had been put in place when the person was much younger. The shift leader acknowledged that it was not currently used and that to have this in a file was misleading about the type of support the person received and how the person was being perceived i.e. as a child not an adult. Information and care documentation should be reviewed and updated so that the current situation and practice are recorded. It is acknowledged that the people may not always be able to make an informed choice in their best interest, and the home use the support of other professional people involved with the person i.e. consultant psychiatrist, to promote safe decisions. Risk management is central to the function of the home and supporting people take responsible risks for their personal development, whilst implementing agreed actions to minimise risk is recorded, but must be linked to the care planning processes. Hilltop were able to demonstrate they promote people taking decisions by supporting them with information to make an informed choice. In the downstairs hallway is a daily activity board for the people. This uses pictures to indicate the daily plan for each person. Where there are options for activities then more than one picture is used and people can then make an informed choice. We discussed how this good practice should be used throughout the home to promote decision making by the people living at Hilltop who have no verbal communication. We discussed that the home do not record their practice well and although staff and management were able to recount verbally the positive developments for the people who live at Hilltop, there was a lack of documented evidence available to be able to cross-reference and so verify the verbal evidence. We discussed that the documentation must have clear and purposeful outcomes for the people who use the service, linked to how and when these outcomes Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 12 are to be achieved. By reviewing this process the home can then demonstrate how successful, or not, different strategies and ways of working with people have been. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability; however their involvement in the planning of their lifestyle and quality of life is not documented. Where appropriate education and occupation opportunities are encouraged, supported and promoted. EVIDENCE: In the time immediately after moving to the home, people have a period of adjustment and getting used to a new place with different people and routines. We were able to note that during this time the staff at the home observe the actions and reactions of individuals to different situations and use this information to plan appropriate day time activities. People have a full timetable with varied daytime and evening activities as well as being able to practice their household skills during their ‘Home Day’ with their keyworker. We discussed the way the people who live at Hilltop can access all areas of the home and use them to develop their skills. For example, Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 14 the kitchen remains locked as it has been assessed as presenting a hazard to the people. However, this means that those people capable of making themselves a drink are denied this opportunity and remain reliant on the staff team. The acting manager and deputy manager accepted that this was an issue but the deputy manager was able to tell us that since the appointment of the acting manager things had started to change around the house, and areas such as the activity room now remained unlocked and accessible to the people who live there. We also discussed the impact of the shift times for the staff on the range of evening activities people can attend. Currently the staff shift changes at 8pm, and staff have been flexible by remaining at work if people wish to attend and evening activity. We discussed the variety of activities which people are supported to enjoy; people use various community facilities and also visited the other Hilltop homes for social events. At the time of the visit one person had gone to work, whilst others went swimming or went to planned activities. Friends and relations are allowed to visit or phone, if necessary the home can provide transport to facilitate contact, people can also go home to families for weekends. This was confirmed to us by a relative who was visiting the home, and by the care records. We also saw evidence of the staff team working closely with people who use the service to address issues around sexuality. The menu planning at the home incorporates a balanced diet and meal preferences of the people who use the service. The dining room is pleasant and well furnished. The people who live at Hilltop have produced some art work, which has been hung on the walls of the dining room. All of the people have a preferred place to sit; the staff take meals with the residents. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is responsive to the varied and individual needs and preferences of the people who use services. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. EVIDENCE: The personal care support at the home is gender specific and the management are working to ensure that the staff gender mix always reflects the personal preferences of the people. Some of the people are self caring and require prompts rather than direct care, however, there is staff support available to them. Since the last inspection there has been no change in the way the home accesses primary health care services on behalf of people. The home continues to benefit from the support of the local mental health and learning disabilities teams as well as the consultant psychiatrists who are accessed for expert advice and regular reviews of medication. We discussed the implementation of health action plans, this had been was discussed at the last inspection. Currently the people do not have Health Action Plans and generally health care is reactive. We discussed how the Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 16 health action plans could work in promoting independence and communication between the individual and the health care provider, as well as planning health care interventions such as regular health screening. This is important in promoting good health and well being because the majority of people living at Hilltop are non verbal and may be unaware of a problem. We advised that the local contact for Health Action Planning is Su Ring based at Partnership House. We discussed with the acting manager how continence was managed at the home. For those people needing support the continence advisor had visited and provided suitable aids. We discussed how the staff team at the home could support people toward being continent and how diet and routine may help this process. There is a unit dosage medication system in use at the home; the records and stock levels of medication were checked and found to be correct. In respect of the medication we discussed with Scott Bartlett that medication for one person that was not used on a regular basis and additional to the unit dosage system needed to be recorded on a medication administration record sheet so that it could be audited.We advised that all medication should be recorded so that the home can easily audit their stock. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that meets the National Minimum Standards and Regulations. Complaints from individuals are not always fully recorded, the records are incomplete with timescales, outcomes and actions not being properly logged. All staff understand what restraint is and alternatives to its use in any form are always looked for. EVIDENCE: At the time of the visit the acting manager was unable to show us an accessible complaints form for people to use at the home, however we have been informed that this documentation is available. Hilltop has dealt with three complaints/concerns from neighbours since the last inspection. When reviewing the recorded complaints we discussed the necessity of following through the procedures so that the home can demonstrate that the complainant was satisfied with the outcome of the complaint. It was recommended that all elements of complaints are kept in one place i.e. complaints file, this then allows for easier auditing of the system. The home should record concerns as they are raised and use the organisational documents provided. The home also records any untoward incidents that occur in the home. This process should ensure that remedial action could be taken at an early stage to prevent incidents recurring as well as sharing information. We noted that one person had several incidents, which followed a pattern. We discussed with a member of staff (shift leader) what action had been taken to reduce or Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 18 eliminate the incidents. They informed us that a review meeting with lthe Community Assessment and Service Development Team had been arranged for the end of November. Because of the frequency of incidents we stated that this was too long and that action should be taken to secure an earlier meeting to prevent incidents reoccurring and potentially causing injury. The shift leader will discuss this with the manager. Safeguarding adults training has been provided for all the staff at the home. The recruitment process ensures the protection of the vulnerable adults at the home. We reviewed the documentation relating to Safeguarding Adults and noted that the local protocols and procedures were available to staff at the home. We discussed the information contained in the organisational guidance which was incorrect. The acting manager and the deputy manager were able to confirm verbally the action to be taken should an incident of abuse occur at the home. The organisation must change their guidance to reflect the correct practice. Physical intervention may be needed in certain circumstances and this should be identified on the care plans of people who use the service. The staff team confirmed verbally, and this was verified by reading staff training records, that positive response training has been provided and staff are aware of the deescalation techniques. We have not received regulation 37 notifications for all of the incidents that have occurred at the home, however the information included on those we have received has been good with clear action taken. The Commission must be notified via regulation 37 notices of incidents when physical interventions have been used. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. EVIDENCE: Hilltop was refurbished to a good standard last year prior to being registered. It is a large house with varied facilities for people who live there and provides a comfortable home. The areas visited by the inspector were clean and tidy. The people have large rooms, which they are encouraged to personalise and use as their own personal space. The staff team are currently working to convert a front room into a quiet area and sensory room. This will be an asset to the people who use the service . We recommended that the small door from this room to the garden should be protected with safety glass, as it is a leaded glass door. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 20 The rear garden is inaccessible to people who use the service and this limits the amount of outside space available. The organisation is in the process of obtaining quotes for the landscaping of this area. We saw that the lounge ceiling has water damage and were informed that this is in the process of being repaired. The hallways and corridors are all painted magnolia and have no decoration on them. This combined with the practice of locking rooms, creates a less homely feeling for the people who live there. This was discussed with the deputy manager who stated that the décor was intentional to allow people to make choices about wall decoration, however, the home has been in operation for a year and this had not been progressed. This is an area for development with the people using the service. The people living at Hilltop are supported to make choices about what they have in their rooms and the décor. We observed that people had various items and that one person chose to decorate their door with their name. Each room has two metal cabinets fixed to the wall; these are for medication and valuables. We stated that this was not very homely and the cabinets could have been more sympathetically placed within a fixed wardrobe. People who live at Hilltop either have an en suite bathroom or share a bathroom with one other person. The laundry facilities were adequate and available for people to do their own washing. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are consistently enough staff available to meet the needs of the people using the service; staff members undertake external qualifications beyond the basic requirements. EVIDENCE: The staff rota indicated that there were sufficient staff on duty to support the six people currently living at the home. The staff who spoke briefly with us talked about their role as keyworkers to people who live at the home. It was apparent that they found this role very satisfying. We also discuss how the success of their work with individuals is recorded and could be demonstrated. Whilst the staff could verbalise what had been achieved there was a lack of documented evidence. Both the acting manager and deputy manager stated that they preferred to be more ‘hands on’ than get involved with paperwork, but understood that what they did each day with the people who use the service had to have some purpose and be evaluated. This was further discussed and we acknowledged that there was a wealth of information about people and their achievements, but the care plans and other documentation at the home did not link together to provide a clear evidence of how staff work with the people living at Hilltop. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 22 Over recent months, staff supervision has not taken place on a regular basis. The acting manager at the home has started to arrange for staff to have one to one supervision sessions and work with them to recognise any training needs. The home has a recruitment procedure for all new staff, which ensures that the interests of people are safeguarded. There has been a significant turnover of staff since the last visit; we were able to have access to and read the personal staff files for new staff. The records for the remaining staff had been examined at the last inspection. There were no documents missing from the files and the home was able to demonstrate a clear pathway of staff recruitment, induction and training. There is a structure in the home that allows for team meetings, and day to day support through shift handover sessions. When there are incidents at the home the staff are given one to one debriefing sessions. The deputy manager stated that the felt the strengths of the home were that the team worked closely together and were supportive of each other. The quality and quantity of training that was provided was recognised as being integral to providing a quality service for the people who live at Hilltop. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. More work is needed in this area. EVIDENCE: Since being registered last year Hilltop has several changes in management, currently the acting manager is Lee Derbidge and the deputy manager is Scott Bartlett, both of whom have only been in post a short time. We discussed the day to day management of the home with the acting manager who stated he recognised that the home had not been managed in a consistent way and this had impacted on the outcomes for people who use the service (as detailed elsewhere in the report) and staff morale. We discussed in depth the areas Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 24 where the home needed attention so that the service provided to the people who live there was person centred and promoted and developed their independence skills. We observed the routine of the home and told the acting manager and deputy manager that we had not seen anything during the site visit which raised concerns about the well being and practical care of the people who live there, and there were obviously areas of good practice at the home. We observed that the relationships between the support staff and people who use the service were good. The people who live there were welcoming and did not show any indication of ill being, they were settled in activities and confident when observed moving around the house. The routine for the home is flexible around the needs of people, however shift times can be changed so that people can access evening activities. However, there are areas of practice in the home, which are not up to the standard expected such as fully recording actions and methods of working with people, and the failure to fully report all incidents required under regulation 37, and action must be taken to improve these areas of provision. We discussed how the service was monitored so that they could demonstrate that it was run in the best interests of the people who live there. Currently there is little documented evidence of this and the acting manager could not provide any quality assurance information. The questionnaires sent by the Commission had not been understood by the people living at Hilltop and alternative systems will be used at future inspections. We talked about how the home managed the personal monies for the people who live there, as this was an issue from the last inspection. This situation has deteriorated as now no one has their own cash at the home and any monies required for purchases or activities, is provided from petty cash. There is no record of each person’s expenditure and the home cannot demonstrate that people are accessing their personal allowances. The acting manager agreed that this was an unusual situation and one that he was not familiar with. We informed him that it was unacceptable and action must be taken to provide evidence that people receive the money they are entitled to and that auditable accounts of expenditure are kept. This was a requirement from the last inspection that the home must meet. The acting manager and deputy manager carry out the risk assessments of the premises and monitor the implementation of health and safety procedures in the home. People using the service are included in the promotion of health and safety. Regulation 26 visits are undertaken by a senior manager and were available to us. Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 Standard No Score 1 2 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X 2 3 X Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 26 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 YA6 Regulation 12(2)(3) 15(1)(2) Requirement Timescale for action 29/01/08 2. YA8 2. YA37 3. YA41 The care plans for people using the service should be person centred and must include evidence of their agreement to the plan and involvement in reviewing the plan for success. 16(2)(m)(n) The registered manager should 24(3) ensure that people using the service are supported to participate in how their home is run. 8 The registered provider shall appoint a permanent registered manager to provide the management and leadership to the home. 17(Sch.4) A clear and accurate record must be kept of all money or other valuables held for safekeeping on service users behalf. 29/01/08 29/01/08 29/11/07 Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA22 YA1 YA22 YA23 Good Practice Recommendations The organisation should produce a complaint procedure that is accessible to people who use the service. The information for prospective people should be produced in an accessible format. Complaints received at the home are fully recorded including the outcome for complainants. The organisational abuse guidance must be reviewed to ensure it complies with the local No Secrets procedures and is consistent. The risk assessments of people using the service must be cross referenced to the individual care plan to demonstrate that the home supports and does not prevent risk taking as part of an independent lifestyle. The home should further develop communication systems with people who use the service so that they can make informed choices. A quality assurance system is introduced which monitors practice at the home and demonstrates that the home is run in the best interests of the people who live there. 5 YA9 6 7 YA7 YA39 Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Hilltop DS0000067863.V348085.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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