Inspection on 02/12/08 for Hilltop House

This inspection was carried out on 2nd December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hilltop House 08/12/06

Hilltop House 17/01/06

Hilltop House 13/07/05

Hilltop House 03/03/05

Hilltop House 15/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hilltop House 30 Hilltop Road Twyford Berkshire RG10 9BN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Chapman     Date: 0 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Hilltop House 30 Hilltop Road Twyford Berkshire RG10 9BN 01189340053 01189340659 janet@hilltophouse.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Janet Clarke Type of registration: Number of places registered: Mrs Janet Clarke care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Hilltop House is a care home for 8 people with mental health needs. It is registered for adults over 18 years of age and is able to accommodate both genders. It does not provide nursing care or provide care for people detained under the Mental Health Act 1983. The house is staffed throughout the 24-hour period, with the night staff sleeping in. The house is owned and managed by Mrs Janet Clarke. The house is within a quiet residential area of Twyford. It is close to local shops and a bus stop is directly outside the property. Twyford has a train station, which is about 15 minutes walk from the house. The fees in respect of this service are currently 689.33 to 848.40 pounds per week. 0 Over 65 2 Care Homes for Adults (18-65 years) Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection of this service was carried out on 8th December 2006. This inspection of the service was an unannounced Key Inspection. The inspector arrived at the service at 10.20 and was in the service for 5 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the owner or manager and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. Care Homes for Adults (18-65 years) Page 5 of 31 The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgments about the standard of the service. The inspector spoke with the owner who is also the Registered Manager, the Acting Manager and two staff on duty. Some of the service users spoke about aspects of their daily lives and six completed surveys sent to them prior to the inspection. A tour of the premises was carried out and records relating to care, staff and health and safety were sampled. After the site visit the inspector made contact with the Fire officer and Environmental Health Officer about some health and safety issues in the home. Both have agreed to carry out their own inspections to give their views on these. What the care home does well: What has improved since the last inspection? What they could do better: Care staff would benefit from having more information about about service users mental health history to help them meet their needs safely. Care Homes for Adults (18-65 years) Page 7 of 31 Individual bathing risk assessments need more detail to show that the risks of drowning and scalding have been fully assessed. Restrictions on service users access to kitchen facilities need review to make sure their freedom and choice is not unnecessarily withheld. For safety reasons medication needs to be stored in an area that is only accessible to authorised care staff. Managers would benefit from further Protection Of Vulnerable Adults training relevant to their role. Basic or introductory training in Mental Health should be mandatory training for all staff to make sure that they fully understand service users mental health needs. The role of the acting manager needs review to make sure the person in day to day control of the home is registered. Managers must undertake training in mental health issues that affect the service users. The home could seek the views of other stakeholders and include these and service users views in an annual service plan. Improvements need to be made in the storage of some records to ensure confidentiality and to keep communal space free for service users. Some health and safety risks need review to make sure they are properly managed and do not impinge on service users rights of access to the communal areas of the home. The development of a business plan that is reviewed annually would show how the registered person plans the finances for the running of the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes admissions process makes sure they can meet the needs of a prospective service user, including religious, cultural and disability needs. Service users receive information about the home and the service and have trial visits to the home to help them decide if they want to live there. Care staff would benefit from having more information about about service users mental health history to help them meet their needs safely. Evidence: Five out of six service users surveyed said they were asked if they wanted to move in to the home and that they were given enough information about the home to help them decide if they wanted to live there. There was good evidence to show that service users needs are fully assessed prior to them moving in to the home. This includes written information from previous placements or discharging hospitals. Reports from care managers, occupational Care Homes for Adults (18-65 years) Page 10 of 31 Evidence: therapists and nursing reports were seen on files sampled. Information includes any trigger points that may indicate a service user is becoming mentally unwell again. In discussion with the acting manager it was clear that care staff are made aware of trigger points that could indicate that a service user is becoming unwell again. However it was found that service users full mental health history is not shared with care staff. This matter needs to be reviewed as it means that care staff are not fully informed and could potentially put them and the service users at risk. The home has purchased a new system for documenting the care of service users and this includes an in house pre admission assessment. The file of a potential service user shows that the home is providing a gradual introduction to the home and that each pre admission visit is used to make further assessment of the service users needs. Three service users files sampled showed that they are given a copy of their contract outlining their terms and conditions of the placement. Care Homes for Adults (18-65 years) Page 11 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Up to date care plans meet service users assessed needs. Staff support service users to make day to day decisions about their care and daily routine. Risk assessments help service users take responsible risks and be as independent as possible. Individual bathing risk assessments need more detail to show that the risks of drowning and scalding have been fully assessed. Evidence: The home has recently purchased a new system for documenting service users care. The files of three service users were sampled and show that they have a care plan that is routinely reviewed every six months with the service user, family and reviewing officer. Care plan guidelines show how service users prefer to be supported and give staff guidance on how to support service users to maintain their independence. Daily logs show that care plans are carried out. Residents confirmed that they are involved in care planning and attend their reviews. Care Homes for Adults (18-65 years) Page 12 of 31 Evidence: Residents are encouraged to make their own decisions and staff support them to look at any negative outcomes of decisions. Risk assessments sampled show how service users can maintain their independence safely and that they are reviewed regularly. Bathing risk assessment did not fully document that the risks of drowning and scalding have been fully assessed. Care Homes for Adults (18-65 years) Page 13 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users choose their lifestyle in line with their needs and wishes. Staff support them to take part in activities and resources in the local community. Staff support them to keep in touch with families and friends. Service users are involved in the choice of meals and staff support them to eat healthily. Restrictions on service users access to kitchen facilities need review to make sure their freedom of movement and choice is not unnecessarily withheld. Evidence: One service user surveyed said that they can always make decisions about what to do every day, two said sometimes, two said usually. Six said they can do what they like in the day, evening and weekend. Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: Staff support service users to attend the local church, mental health drop in centre and Unit Two an occupational unit. One service user spoke about how he enjoyed attending the drop in centre and Unit Two. The acting manager said there are plans to further develop activities with another residential home in the area. Service users are supported to excercise their voting rights by post if they wish. There is a company vehicle for outings and staff support service users to use the local hairdressers, chiropodist and shopping trips. There are a variety of table top games in the home and a computer that service users can use. One staff has ten hours per week designated for 1-1 or group activities with service users. This has enabled more cinema and theatre trips and staff helped service users tell about films seen recently. There are plans to attend local pantomimes and for a Christmas party. Christmas raffle prizes were on display in the home and the acting manager said that the home fund raises to gain extra funds for service users leisure activities. Staff described how they support service users to keep in contact with family and friends. They said that the local shops and community are friendly towards the service users and there are no problems with neighbours. Service users take turns to choose the main meals and cultural food needs and wishes can be met. Service users help themselves to cereals and toast at breakfast and hot drinks throughout the day. Staff prepare a main lunchtime and a teatime meal. Menus were sampled and show that a variety of appetizing meals are provided. The use of a gate to prevent access to the kitchen area during the day and a large gate to prevent access to the kitchen and dining area need to be reviewed in line with service users right to access to their home and health and safety. Risk assessments should be in place to support the need for any restrictions on service users freedom of movement and choice. Care Homes for Adults (18-65 years) Page 15 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users receive personal care and support in the way they prefer. Staff support them to stay healthy and they have access to a variety of health professionals. Staff are trained to make sure that service users receive their medication safely. Medication should be kept secure in an area accessible only to authorised care staff. Evidence: Records show that staff support service users to be as independent as possible and that service users receive personal care and support in the way they prefer. Service users confirmed that they have flexibility and choice in daily routines and can choose when they get up and go to bed. Service users have regular meetings with their key worker and their likes and dislikes are recorded on their files. Service users confirmed that they attend appointments with their GP and other medical professionals. Health care records are kept and there are annual health checks and reviews of medication. The acting manager said that the home is well supported by care managers and health professionals. She said that they respond quickly if staff Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: have concerns about a service users mental health. Staff have received training from a health professional about a specific medication taken by one service user. The home has a medication policy and procedure. Staff receive medication training in house and via distance learning. Medication has historically been kept in a metal filing cabinet that is currently sited in the hallway. Guidance states that medication should be kept secure in an area accessible only to authorised care staff. It is recommended that this be reviewed to ensure better security and confidentiality and to keep communal space free for service users. Should the home in the future need to store Controlled Drugs, all Controlled Drugs, including Temazepam, should be kept in a cupboard which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. Care Homes for Adults (18-65 years) Page 17 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know who to talk to if they have a complaint and that there is a procedure for dealing with these. Staff are trained to know how to identify and report potential abuse. Managers would benefit from further POVA (Protection of Vulnerable Adults) training relevant to their role. Evidence: The Commission has not received any information about complaints made about the service. Service users surveyed confirmed they know who to talk to if they have a concern. Each service user has a copy of the complaints procedure in their Service Users Guide and staff verbally outline the procedure to make sure they fully understand this. Records show that the home has not received any formal complaints in the last 12 months. The Commission has not received any information about safeguarding refferrals made about service users in this home and the Annual Quality Assurance Assessment (AQAA) confirmed that the home has not needed to make any safeguarding refferrals in the last 12 months. Records show all staff are CRB (Crimminal Records Bureau) and POVA (Protection Of Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Vulnerable Adults) list checked before starting work and that all staff have attended a POVA course. The acting manager and registered manager have not yet attended a POVA level 2 course to make sure they are fully informed if they should need to make a safeguarding referral. Care Homes for Adults (18-65 years) Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a homely, well maintained and decorated home that meets their needs. Staff are trained to keep the home clean and hygienic. Evidence: A tour of the premises showed that the home is kept clean and is warm and homely. There is a system for the reporting and dealing with maintenance issues and the acting manager said that they have access to a reliable handyman. It was seen that there is an ongoing programme of redecoration. Some service users bedrooms were seen and these were clean and homely. The decor and carpeting in some rooms appeared dated and did not seem to reflect the personalities of the individual service users. The acting manager said there are plans to refurbish bedrooms and replace bedding and curtains. In the last 12 months a new office space has been developed, the downstairs shower room has been revamped to make the shower bigger and improve access. New washing machines, Hoover and a free view TV have been purchased. Records show that monthly health and safety and fire equipment checks have been carried out. Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: The acting manager said that there are plans to revamp back garden to make it more accessible to service users. Currently there is no lawn and space is limited due to large decorative fish ponds. Four service users surveyed said that the home is always fresh and clean, two said sometimes and one said when its tidied up. Staff are trained in food hygiene and infection control. Some health and safety issues were noted during the tour of the premises and will be referred to under standard 42. Care Homes for Adults (18-65 years) Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by an enthusiastic and trained staff team in sufficient numbers to meet their needs. Basic or introductory training in Mental Health should be mandatory training for all staff working with service users with mental health issues to make sure that staff fully understand service users mental health needs. A robust recruitment procedure makes sure suitable staff are employed to protect service users welfare. Evidence: The arrangements for staff were verified and show that there are appropriate recruitment, induction, training and supervision systems in place. In speaking to staff and from sampling records it was found that staff have a recorded in house induction, shadow staff for an agreed period and complete a Skills For Care induction. Staff confirmed their recruitment process and recruitment files sampled showed that Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: the appropriate checks and references were carried out before they started work. There is a training plan in place. From discussion with staff and sampling records it was seen that they receive and are regularly updated in mandatory training such as Fire Safety, Food Hygiene, Health and Safety, Infection Control, Manual Handling and Medication. Staff have also had some training relating to the particular needs or behaviour of individual service users, for example Diabetes, Self Defence and complex medication. Some staff have taken up the opportunity to visit a local mental health resource and said that they found it helpful to see how service users experience in-patient treatment. Although the home receives good information about service users mental health needs from care managers and health care staff they have not been given any basic or introductory training in Mental Health. This should be mandatory training for all staff working with service users with mental health issues to make sure they fully understand the service users mental health needs. Staff deployment was verified and shows that this meet service users current needs. There are two staff plus the manager on daytime shifts and extra staff are deployed when needed. At night there is one sleeping in staff and an on call rota for advice and support if needed. There is a programme of National Vocational Qualification training in place and the home has achieved the target of 50 of staff or over having NVQ 2 or above. It was seen that there is a programme of regular staff supervision in place and records sampled confirmed the frequency of this. Staff spoken with were positive about working in the home and said the team works well together. Three service users surveys show that staff always treat them well, two said usually and one said sometimes. Two said carers always listen and act on what they say, one said usually and three said sometimes. Care Homes for Adults (18-65 years) Page 23 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed by a qualified registered manager and acting manager and service users are well cared for. The role of the acting manager needs review to make sure the person in day to day control of the home is registered. Managers must undertake training in mental health issues that affect the service users. Service users know that their views are taken into account in developing the service, but this area could be further developed by seeking the views of other stakeholders and the development of an annual service plan. Up to date policies and procedures support the way that staff work and the care given to service users. Records are generally well kept and are up to date. Improvements need to be made in the storage of some records to ensure confidentiality and to keep communal space free for service users. Care Homes for Adults (18-65 years) Page 24 of 31 Judgement: Health and safety systems are up to date and staff are trained in health and safety. Some health and safety risks need review to make sure they are properly managed and do not impinge on service users rights of access to the communal areas of the home. The development of a business plan that is reviewed annually would show how the registered person plans the finances for the running of the home. Evidence: Prior to the inspection an Annual Quality Assurance Assessment (AQAA) was filled in and sent to the Commission. Advice was given that more information could have been added to demonstrate how the home meets the standards. The proprietor/registered manager is experienced and has an NVQ 4 qualification. She has been running the home since it opened. In October 2006 the proprietor/registered manager notified the Commission that she was reducing her hours on site, was appointing an acting manager and that a registration application for the acting manager would be submitted. To date the application for the acting manager has not been received by the Commission and the acting manager has been in day to day control of the home for over two years. During this time the acting manager has achieved NVQ 4 and the Registered Managers Award. The proprietor/registered manager and acting manager said that this arrangement has worked well. The registered person must review the management arrangement for the home and make sure that if the acting manager stays in day to day control of the home that an application to be registered is submitted. In discussion with the registered manager and acting manager it was found that although they receive good information and support from professionals about service users mental health needs neither has had any formal training in the mental health issues that affect the service users. As raised under standard 32 this should be mandatory training for all staff. The home has a number of ways that it seeks feedback from service users, a quality assurance questionnaire, service user meetings, key worker meetings, reviews and day to day consultation. There us currently no annual development plan for the home and other stakeholders are not surveyed, it is recommended that this is reviewed. The Annual Quality Assurance Assessment (AQAA) shows that a range of appropriate and up to date policies and procedures are in place. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Records sampled were well kept and up to date. Some records are now kept in an office area in the homes hallway that is accessible to service users. These need to be re sited to improve security and confidentiality and to keep communal areas free for service users use. The Annual Quality Assurance Assessment (AQAA) shows that equipment is regularly maintained and serviced. Staff are trained in health and safety and monthly health and safety audits are carried out. Fire safety, hot water temperature and accident records were sampled and were up to date. Records show that staff are trained in health and safety. Some health and safety issues were identified during the tour of the premises. The home currently use gates to restrict service users access to the kitchen and dining room and some trailing electrical wires were seen in communal areas and a bedroom. At present there are no risk assessments in place regarding these identified risks. The use of the gates impinges on service users right to have access to the communal areas of their home and detracts from the homely appearance and ethos of the home. The registered person must seek advice from the Environmental Health Officer and the Fire Safety Officer on the best way to manage these identified risks. In discussion with the registered person and the acting manager it was clear that funds are made available to support the running of the home and that the services of an accountant make sure that proper accounts are kept. The registered person said that she does not set formal budgets for the home and there is no business and financial plan that is open to inspection and reviewed annually. This is an area that needs further development. Care Homes for Adults (18-65 years) Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 32 18 18 (c) Ensure that the persons employed by the registered person to work at the care home receive (i) training appropriate to the work they perform. Basic or introductory training in Mental Health should be mandatory training for all staff and managers working with service users with mental health issues to make sure that staff fully understand service users mental health needs. 02/04/2009 2 42 13 The registered person must 15/02/2009 after consultation with the Fire Safety Officer and Environmental Health Officer review the use of gates to restrict service users access to the kitchen and dining room To see if there is a better way of managing the identified risks. Care Homes for Adults (18-65 years) Page 28 of 31 Risk assessments must be in place to support any restrictions on service users choice and right to access to communal areas of their home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 Care staff would benefit from having more information about about service users mental health history to help them meet their needs safely. That individual bathing risk assessments are reviewed to show that the risks of drowning and scalding have been fully assessed. Restrictions on service users access to kitchen facilities be reviewed to make sure service users freedom and choice is not unnecessarily withheld. That the medication cabinet is re-sited to an area accessible only to authorised care staff to ensure better security and confidentiality and to keep communal space free for service users. Should the home in the future need to store Controlled Drugs, all Controlled Drugs, including Temazepam, should be kept in a cupboard which complies with the Misuse of Drugs (Safe Custody) Regulations 1973. 2 9 3 17 4 20 5 23 That the acting manager and manager attend a POVA level 2 course aimed at staff who may be involved in the reporting of suspected abuse. That the registered person review the management arrangements for the home and make sure that if the acting manager stays in day to day control of the home that an application to be registered is submitted. That the registered person reviews how the views of family, friends, advocates and other stakeholders are sought on how the home is achieving its goals for service users. That there is an annual development plan for the home based on a systemic cycle of planning action and review, reflecting outcomes for service users. 6 37 7 39 Care Homes for Adults (18-65 years) Page 29 of 31 8 41 Review the siting of records currently kept in the hallway to make sure they are kept secure and confidential and that communal areas are kept free for service users use. A business and financial plan should be developed and reviewed annually to show that sufficient funds are set aside for the running of the home. 9 43 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!