Inspection on 13/04/07 for Hilton House

This inspection was carried out on 13th April 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hilton House 21/02/08

Hilton House 26/07/06

Hilton House 04/05/06

Hilton House 18/11/05

Hilton House 18/06/05

Hilton House 22/02/05

Hilton House 26/04/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Hilton House 175 Shrub End Road Colchester Essex CO3 4RG Lead Inspector Pauline Dean Key Unannounced Inspection 13th April 2007 09:30 Hilton House DS0000017850.V336968.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 Hilton House DS0000017850.V336968.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. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilton House Address 175 Shrub End Road Colchester Essex CO3 4RG 01206 763361 N\A 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) Mr Wills Clarel Gopaul Mrs Sylvia John Mrs Sylvia John Care Home 8 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1), Mental disorder, excluding of places learning disability or dementia (2) Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 8 persons) One person, over the age of 65 years, who requires care by reason of a learning disability whose name was made known to the Commission in October 2006 Two persons, under the age of 65 years, who require care by reason of a learning disability and who also have mental health needs, whose names were made known to the Commission in October 2006 The total number of service users accommodated in the home must not exceed 8 persons 26th July 2006 Date of last inspection Brief Description of the Service: Hilton House is a former family dwelling that has been extended and altered to form the current accommodation. The property is located approximately one mile to the west of Colchester Town Centre, in an established residential area. Public transport is frequent and a bus stop is within walking distance. The closest rail station is Colchester Town. The front garden provides off-road parking. The rear garden is of good size, and is currently being landscaped and planted. Current registered accommodation comprises of six single bedrooms and one double bedroom with en-suite bathroom facilities in the double room and a single room. This single room is vacant and is being used as staff sleep-in accommodation and bathroom. Communal rooms (sitting room and dining room) are situated on the ground floor. Additional accommodation of two single bedrooms, an activity room and a toilet, bathroom and shower room, staff room/office and manager’s office have been added to the present accommodation and are to be registered upon completion. The home is registered to care for adults between the ages of 18 and 65, who have a learning disability. It does not purport to accommodate any person who has very complex or challenging behaviours. At the time of this inspection there were seven service users living at Hilton House. The current range of monthly fees as discussed at the site visit is £500 - £700 per month. Hairdressing, personal toiletries, additional bedding and furniture, newspapers and dry cleaning are charged at cost. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit of Hilton House was carried out on 13th April 2007 commencing at 09.30 hours and finishing at 18.05 hours. Pauline Dean and Ray Finney, Regulation Inspectors carried out this inspection. The inspection involved checking information received by the Commission for Social Care Inspection (CSCI) since the last inspection in July 2006, looking at records and documents at Hilton House and talking to Mrs John, the registered manager, care staff and people who live at Hilton House. Mr Gopaul – joint proprietor visited the home during this visit. The inspection closed on 1st May 2007. During the site visit all seven people who live at Hilton House were spoken with. All seemed to be pleased with the service and happy about way they are supported and assisted by the staff. All key standards were inspected alongside the standards, which were part of the Statutory Requirements from the last inspection. Overall there has been an improvement in the care service offered. Eleven Statutory Requirements remain, five of which are outstanding from previous inspections remain. In addition there is one recommendation. Observation and evidence found on the site visit showed the improvement. This however is marred by the continuing ongoing disagreements with the two business partners – Mrs John and Mr Gopaul. These matters heighten the Commission’s concern as to the fitness of the proprietors. In line with the Commission’s vision and values of ‘putting people who use the services first’ the remainder of the summary to this report is to be found in an attached separate ‘easy read’ summary. Copies of this summary are to be made available to the people who live in the home and they are created using The Inspection Picturebank which is based on themes within the National Minimum Standards. What the service does well: Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Hilton House DS0000017850.V336968.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 Hilton House DS0000017850.V336968.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 & 5. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall clear detailed information, by the way of the Statement of Purpose and the Service Users’ Guide, is available. Some amendment and revision is required to ensure that people who wish to use this care service have sufficient information to enable them to make a choice of whether they wish to live at Hilton House. Contracts/statement of terms and conditions, which have been issued in August 2006 need to be individualised to fully reflect the care and services offered. EVIDENCE: Both the Statement of Purpose and the Service User Guide have been revised and updated as part of the Improvement Plan from the last key inspection on 26th July 2006. Whilst a great improvement was found, some omissions and amendments are required: Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 9 Statement of Purpose • Section 2.1.2 states ‘Hilton House has recently extended it’s registration to include provision for adults over the age of 65.’ This is incorrect. A condition of registration has been granted to accommodate a service user currently residing in the home who is over the age of 65 and who the home can continue to meet their needs. • Section 2.3.1 speaks of compliance with regulatory requirements such as Fire and Environmental Health, but there is no reference to training requirements related to these and other regulations. • Section 2.3.1 does not make reference to compliance requirements relating to completion of risk assessment and management in the care home. • Section 2.6.4 states ‘All service users are offered a single room.’ This is not correct, for the home does have shared accommodation. • Section 2.6.6 needs to clarify that the care home is not registered to provide nursing care. • Section 2.7.1 – Appendix 3 – Hilton House Organisational Structure needs to be updated to reflect staff changes. • Section 2.7.1 – Appendix 4 – Hilton House Staff Profile needs to be completed. • Section 2.7.2 – Detail is required of staff competencies, experience, qualifications and development and training plans. • Appendix 2 – The telephone number given is not the Commission for Social Care Inspection (CSCI) local office number and by giving the O800 number there maybe confusion • Appendix 2 – The Commission for Social Care Inspection (CSCI) does not investigate complaints – See the ‘Concerns, Complaints and Protection’ section of this report for more details. Other issues, which need to be added to the Statement of Purpose are the arrangements regarding transport and staffing, additional services for relatives and friends e.g. availability of drinks, snacks and meals and adult protection concerns and how these are managed. All of the above should not be seen as an exhaustive list. The registered manager is advised to undertake a review of the Statement of Purpose referring to the Commission’s guidance available of our website. Service User Guide • There was no reference to laundry arrangements in the care home and as to whether these arrangements are covered within the fees charged or are an extra cost. • There was no reference to who provides bedding and towels in this document. • As with the Statement of Purpose the action of given the local office details of Commission for Social Care Inspection (CSCI) and a 0800 number could be confusing. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 10 • • The guide makes reference to service users being able to bring in their own pets, but there is no reference to the two current pets at the home, the rabbits. Details of qualifications and experience of the registered provider, manager and staff need to be added to this document. As with the comments relating to the Statement of Purpose, the above should not be seen as an exhaustive list. The registered manager should undertake a thorough review of the Service User Guide taking full consideration of all guidance available within the National Minimum Standards and Requirements. People who lived at Hilton House had a copy of the Service User Guide. This did not have a ‘picture of all of the staff that work at Hilton House, with some useful information about their qualifications and experience.’ This was as stated in the Statement of Purpose and needs to be introduced. Care planning files and assessments have been reviewed and collated for all seven people who live at Hilton House. Five files of the people who live in the home were sampled and used as part of this case tracking exercise. There have been no new admissions since the last inspection. All five files inspected had a comprehensive assessment that covers communication, psychological needs, social skills, family and friends, mobility, physiological needs, personal care, eating and drinking, perception, safety needs, work and leisure, sleep and rest. The assessment identifies needs, but also recognises the strengths of the individual. With the assistance of a consultant, Hilton House now has an admission process which is separated into eight sections, moving from an initial enquiry, to eligibility, visits, a review, a three month trail period and an offer of a placement. Without any new placements this still has to be brought into use. Contracts/statement of terms and conditions were found on the care planning files inspected. The contracts are signed by the manager and the individual or their representative and are written in a clear, easy to read style. However, the contracts are in a standard format and areas of individual differences such as room numbers are not completed. Further consideration is also required with regard to the statement relating to the rights and responsibilities of both parties. Within the current template for the Service User Contract, the home clearly states that the home is ‘not be responsible for the service user once they are outside the premises if the service user leaves the premises and is not accompanied by a member of staff at the home’. The Regulation Inspectors advises that the validity of this statement is checked out and arrangements around risk assessment need to be considered. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 11 A policy statement detailing the issuing and reviewing of contracts for people who live in the home has been drafted by the home’s consultant. This details five stages to the production and issuing of contracts between the care home and the person who lives at Hilton House. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 12 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 & 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care planning documents detailed health, personal and social care needs and records evidenced all aspects of care required. People who live at the home are enabled to make decisions through risk assessments and risk management. EVIDENCE: The care plans of five people who use the service were examined. Care plans have greatly improved since the last key inspection. They are clear, written in a positive style and identify both short term and long term goals. The care plans cover “How we Care and Support” and the “Service User View”. The care plans examined contain evidence of input from relevant health professionals such as the Community Mental Health Team. There is also some evidence of advocacy input. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 13 An individual holistic assessment of needs was found on file. This is completed using the sixteen ‘Activities of Living’ framework, which include assessments around communication, eating and drinking, psychological needs, social skills and working and playing. High, medium and low care needs were identified from these sixteen and care plan objectives set. There was evidence of involvement by the person who lives at Hilton House, their key worker, relatives and social workers through a care plan reviews. Daily records linking in with the care plan objectives were seen. They were both positive and informative, enabling positive monthly reviews to take place. Paperwork was also in evidence for planned reviews, which are to consider the effectiveness of the care plan. Both daily records and care plan review records had evidence of some decision-making by the people who live at Hilton House. This was evidenced by records relating to staff support on trips to Colchester and attendance at inhouse training courses. During the inspection visit, the inspector observed one person who lived in the home making a definite choice about where to eat. This person chose to have a very late breakfast after having an extremely long and relaxing bath. Staff spoken with were able to demonstrate how people living in the home make choices about what they like, such as activities and food. Care plans examined contain a “Service user View” section, which indicates that the views of people living in the home are taken into account when planning care. There was some evidence of risk assessments in an individual care plan. This does need to be developed further to incorporate risk assessment and management relating to staff support for people living at Hilton House when they go into Colchester. Records examined show that risks are identified during the assessment process. Recording of risk assessments has improved since the last key inspection, although a risk that had been identified through a Protection of Vulnerable Persons issue had not been clearly documented in a separate risk assessment, but had been included in a risk assessment about the person’s mental health. A separate risk assessment for this person covering this issue would ensure staff are clearly aware of the issue and would give greater protection to the person using the service. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 14 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): 11, 12, 13, 14, 14, 15, 16, & 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service are supported and assisted by staff to participate in educational, training and community activities, as they are able. People who use this service are supported to maintain family links & friendships. People who use this service are assured that their rights are respected and responsibilities are recognised. EVIDENCE: Within the sampled care plans there was evidence seen of some consideration given to the spiritual needs of the people who live at Hilton House. One care plan made reference to the promotion of assertion and confidence, however Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 15 training relating to these qualities had not been considered and were identified as requiring attention. Three of the people who live at Hilton House now attend training courses at the local adult community college. Two attend a music course, two painting and pottery courses, one a writing course and another a gardening course. Evidence was seen in care planning objectives, which related to these training courses. Records examined show that people living in the home are encouraged to take part in some of the in-house training courses available to members of staff and are given certificates of attendance. From sampled care plan files and records there was some evidence of people who live at Hilton House accessing the local community. Records showed visits to Colchester library, shops, pubs and leisure facilities such as Colchester Leisure World. In the main these were not regular visits, but arranged spontaneously. Whilst this is recognised as appropriate on many occasions the need to plan and support regular social and leisure activities must not be overlooked in the day-to-day planning. As stated above there was some evidence that people who live at Hilton House are able to access and choose from a range of appropriate leisure activities. There was evidence that they are encouraged to pursue their own interests and hobbies, although it was evident from one care plan that risk assessment and further planning is required to ensure staff support is available. On the day of the inspection visit a number of supported activities were taking place within the home. A student volunteer was supporting people who live in the home with activities relating to reading and writing and staff were also involved in helping people with musical activities. The inspectors observed that people taking part in these activities showed obvious enjoyment and it created a relaxed and lively This was an improvement on the atmosphere observed at the previous key inspection, when people appeared more restless and were less occupied. Within the sampled care plans there was evidence of links with family. Evidence was seen of some relative involvement in care plan reviews and Mrs John spoke of encouraging and supporting links with families through telephone calls and visits. Evidence was also seen of people living at Hilton House attending a weekly social club where they are able to meet up with their friends. New bedroom doors have been fitted throughout the house and bedroom and bathroom doors now have keys. Within care plans people who live at the home were seen to be offered a key to lock their doors. None of those sampled had taken up this offer. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 16 Throughout the day of the site visit, people who live at Hilton House were seen to wander around the home accessing the new activities room, lounge and dining room and the rear garden. They were also able to come and go from their bedroom as they wished. Menu planning and nutrition recording had improved greatly since the last inspection. Mrs John said that the home had had an independent survey of the catering service within the home. This had been conducted in August 2006 and had identified many of the shortfalls noted by Commission for Social Care Inspection (CSCI) inspectors at previous inspections. A copy of this report had been made available to the Commission as part of the home’s Improvement Plan. Menus are planned for four weeks with two choices listed at both lunchtime and the evening meal. Consideration has been given to carbohydrates in the diet and these are now detailed in the menu planning. Records had been collated of the likes and dislikes of food of the people who live at Hilton House and these were considered in the menu planning. Fresh vegetables are now part of the menu planning. Nutrition records were completed of the food eaten by individuals in the home and it was possible to see from these records a variety of foods served and selected at breakfast, lunchtime and teatime. At the site visit, lunch was served at the dining room table. Six of the seven residents choose to eat their meal at the table. Matching china crockery was used with residents being able to serve themselves at the table. Overall, there has been a great improvement in the management and presentation of food at mealtimes. The only shortfall was the lack of matching serving dishes/terrines used to serve food up at the table. The current practice of using an assortment of Pyrex dishes, plates and bowls does not enhance this process. Food supplies were evident, with both branded and own store labels in evidence. Shopping was said to be completed both daily and weekly using major supermarkets and the freezer shop – Iceland. Within the home there was evidence of forward planning with fruit and vegetables ready for planned meals. Mrs John stated that eight staff are to attend a basic food hygiene training course in May 2007. Currently only one staff member has certification. As all care staff members could be called upon to prepare meals, this training is required. During the site visit, there was evidence of snacks and drinks being available. Care staff were seen to serve drinks during the day. It was not possible to ascertain if this practice continues in the evening and at night and whether the practice of locking the kitchen at night continues. It is hoped that this practice Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 17 has ceased to enable the people who live at Hilton House to have snacks and drinks at anytime throughout the day and night. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 18 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): 18, 19 & 20. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s arrangements for supporting the healthcare of people who live at Hilton House was satisfactory, with the record keeping and medication administration well managed. EVIDENCE: Within the sampled care plans there are examples of care planning objectives relating to health care issues, such as assistance with bathing, dressing etc. There was also evidence of people living at Hilton House being assisted and supported to access healthcare professionals. Alongside personal care issues, a care plan objective was seen for the introduction of self-medication. This was seen as a long-term goal for one person but was not dated. All of the people living at Hilton House have a GP from a local surgery and there is evidence of input from relevant health professionals including the Community Mental Health Team. Records of one person using the service had Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 19 evidence of CPA (Care Plan Approach) review. This is a formal approach to ensuring people with mental health needs receive appropriate support. Since the last inspection, there have been changes and improvements made to medication storage, record keeping and administration. All medication is held in a securely wall-mounted purpose built medication cabinet in the new staff office/computer room. New policies and procedures for the safe handling of medicines have been introduced. All new medication brought into the home is recorded in the ‘Receipt of Medicines (ROM) stock control record book and upon receipt medication is checked to ensure that it is clearly labelled. Copies of prescriptions are used to verify medication received. Medication records, storage and administration was sampled and inspected for three people who live at Hilton House. Medication and the records were found to be in good order with a clear audit trail. The management and record keeping of controlled drugs was also inspected and this too was in good order. Clear policies and practice ensure the safe transfer of medication storage keys and detailed Medicine Information Sheets listing side effects of medication are held in the Medication Administration file. Medication Return record sheets are used for the return of medication with records kept in good order. Amongst the records examined, the care plan for one person living in the home contains guidelines for the administration of PRN (as required) medication. This would give staff clear procedures to follow so that PRN medication is administered appropriately, which ensures the person only receives medication when necessary. Seven care staff have completed a Safe Handling Medication Training course and following this training they have been assessed and observed to ensure compliance. Records were seen of all staff members completing this process from August to October 2006. Mrs John said that further medication training is planned in 2007 as a refresher course. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 20 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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, people who live at Hilton House were well treated and listened to, with complaints and adult protection procedures in place. EVIDENCE: The home’s Comments, Compliments and Complaints policy and procedure has been revised and reviewed as part of the Improvement Plan from the key inspection on 26th July 2006. Mrs John confirmed that the copy supplied to the Commission was as held and distributed in the home. The complaints procedure was a comprehensive document, which clearly set out the process of making a complaint. Detail was giving as to making a complaint, the investigation and recording and the management of the outcomes of a complaint. Reference was made to the Commission for Social Care Inspection (CSCI), which was said to ‘investigate certain complaints about these services.’ This is not correct, for it should be noted that the Commission is not a ‘complaints agency’ and does not have statutory powers to investigate complaints. The Commission will use their powers of inspection to undertake enquiry so that we can make a judgement as to whether the provider is complying with the regulations. Additional information regarding the former Commission Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 21 National Care Standards Commission (NCSC) held in this policy was seen as confusing and not appropriate for this document. Mrs John removed this information immediately. During the course of this inspection process, the Commission has become increasingly alarmed by the disagreements and discord between the two proprietors. It was evident briefly at the time of the site visit, when Mr Gopaul came into the home. It is further evident following the site visit, when both parties have been disagreeing, bringing the Commission into these disagreements and making serious allegations as to staff recruitment practices and placing barriers when a proprietor is trying to undertake a Regulation 26 visit. On one occasion, raised voices were heard in a telephone call to the Commission, in earshot of the people who live at Hilton House. All of these matters are increasing the concerns of the Commission and a management review of these matters as to the fitness of the proprietors is being considered. The home’s policy and procedures on the Protection of Vulnerable Adults has been revised and reviewed as part of the Improvement Plan from the key inspection on 26th July 2006. It comprises of three sections – 1. Policy and Procedures. 2. Practice Guidance for all Staff and 3. Service User Guidance. The Policy and Procedures was a comprehensive document giving an outline of the home’s roles and responsibilities with regard to adult protection highlighting the types of abuse, training and care practices in place to prevent abuse. The process of making a referral was detailed in the final section of this document – 2.3.Identification and intervention. A telephone number for making a referral was detailed in this section and whilst it was a 0845 telephone number it was found to be different from the attached Appendix 1 – the Protection of Vulnerable Adults (POVA) referral form to be used by the home. It would also appear that the details and address given on this form of the local Learning Disabilities team was out of date and incorrect. Within both the Practice Guidance for all Staff and the Service User Guidance there is reference to the Commission for Social Care Inspection (CSCI) and once again different telephone numbers are given on each document. In neither document is there reference to local offices of Social Services or the Commission, which may prove of more assistance for all parties concerned. The registered manager is advised to undertake a review of all documents relating to Complaints and Adult Protection policies and procedures. At the time of the site visit a Protection of Vulnerable Adults (POVA) investigation was ongoing. This was with regard to the care and management of a person living at Hilton House who goes into Colchester town centre alone. Concerns had been raised as to the vulnerability of the individual, particularly as two incidents of concern had been raised when the individual was found to be in Colchester town centre alone and distressed. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 22 Their Care Managers had conducted a review of this person’s care. Mrs John had assisted with this process. Both Mrs John and the individual had being interviewed and care plans and recordkeeping were inspected. These matters were also considered at this inspection site visit and inconsistencies as found by the Care Managers were evident. It was not possible from records seen to ascertain a clear record of the events of the two incidents. Following the care review, changes had been made to the support given to the individual. A clear record of the investigation was in place and planned action detailed. This had resulted in some restriction in their outings and Mrs John was advised of the need to undertake a thorough review of their care with regard to these matters implementing risk assessments and care plans to fully cover the care offered and required by this person. See the section entitled ‘Individual Needs and Choices’ in this report for more detail. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 23 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, 25, 26 &30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Overall, the Hilton House provides a safe environment that is accessible to the people who live at the home. It is homely and meets individuals needs. EVIDENCE: A tour of the premises was conducted during the site visit. This included the current registered accommodation and the new accommodation, which is nearing completion. When complete Hilton House will have two new single ensuite bedrooms, bathrooms and toilets, an activity room and office/staff accommodation. Currently the home is registered for eight people and with the new accommodation registration is to be sought for a total of ten persons. New carpets, flooring and furniture was evident in the home, particularly in the communal areas. The majority of the rooms had been decorated with new Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 24 bathroom and toilet fitments in evidence. The cleanliness of the home was markedly improved. A new paved front garden offered space for several cars and the rear garden was currently being landscaped and improved. Mrs Johns showed plans and designs that she has for the garden. Some of these had been achieved, such as raised flowerbeds and a new pathway. One of the staff group and a resident at the home had been involved in designing and building the garden. They were very pleased with garden and spoke of future plans for seating and grass in the garden. Bedroom accommodation was light and bright. There was some evidence of new furniture and furnishings, with new bedding evident. Mrs John said that all of the residents at Hilton House had two sets of bedding. As with the communal areas, new flooring and carpets had been fitted and ensuite bathroom fittings and toilets had been replaced in the existing bedroom accommodation. Overall the cleanliness and condition of the home had improved. Overall, individual bedrooms were greatly improved since the last key inspection. One person spoken with liked their room. Bedrooms contain a number of personal items such as videos or music CDs and photographs and pictures that reflect the individual tastes of people living in the home. At the time of the last inspection one person had a broken television and CD player. Since then, new televisions have been purchased and have been installed in some of the rooms. The manager told the inspectors that new individual televisions have been bought for all people in the home, but some need to be fixed to the wall rather than free-standing and that work was to be completed soon after the inspection visit. A tour of the premises shows that people living in Hilton House now benefit from a much cleaner environment than was observed at the previous inspection. In particular, bathrooms are cleaner than previously and the laundry room is greatly improved. A new laundry was now located in the new extension. New washers and dryers have been fitted in this room as has a sink unit for hand washing and cupboards for storage of washing and cleaning materials. Mrs John confirmed that services and facilities now comply with the Water Supply (Water Fittings) Regulations 1999 and detailed policies and procedures are in place with regard to Infection Control. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 25 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): 31, 32, 33, 34, 35 & 36. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff were roistered in sufficient numbers to keep the people who live at Hilton House safe and address their basic needs. Hilton House is creating a good staff team and overall people who live at the home are protected by the home’s recruitment practices and training. EVIDENCE: Mrs John, the registered manager said that all care staff have clear job descriptions on file and this was evidenced from those files sampled. As a registered manager, Mrs John had a job description, which outlined her roles and responsibilities clearly. From speaking to two care staff working in the home it was evident that staff felt supported and enabled by the manager to carry out their duties. One care worker spoke of in put from a nutritional expert and the assistance this had given them in planning meals. They and a second care worker spoke of an Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 26 improved atmosphere in the home. This was evident on the day of the site visit, for staff were seen conversing and instigating conversations with the residents and the people who live in the home were seen to be relaxed and engaged in their company. Out of ten care staff, five staff have National Vocational Qualification (NVQ) level 2 or above in care and a further two care workers have started a NVQ level 2 in care training. Therefore the home is currently meeting the requirement of 50 of care staff who have achieved a NVQ level 2 in care. From inspection of staff rotas from January 2007 to April 2007, the inspectors noted that the home operates with three care staff on duty during daytime hours with one awake and one asleep care staff on duty at night. Mrs John spoke of some flexibility within staffing levels in the home to ensure that 1:1 staffing is offered for doctor and hospital appointments, college trips and outings to Colchester and Aqua Springs. Hilton House currently has ten staff members. Mrs John said a full-time employee is employed for 48 hours with a maximum of 58 hours offered and worked each week should it be needed. Staff files for two care workers were sampled and inspected in detail and they were found to have improved. Omissions noted however were, dates were not recorded in the employment history of a care worker and in the other employment was just listed. Both of the staff files examined had appropriate enhanced CRB checks. Whilst the referee details were given for both care workers, one file only had evidence of two personal references and the second had given details of two referees, but the references were from co-workers at a previous care setting. Mrs John was advised of the need ensure that where applicable a reference relating to the person’s last period of employment is obtained. In addition the home is reminded that there is a need to obtain a statement by the person as to his or her mental and physical health. Evidence was seen on one file of this declaration, but only a declaration with regard to physical health was found on the other file. Both of the staff files examined had evidence of LDAF (Learning Disability Awards Framework) induction having been completed. A personal development plan was also in place in both these staff files. Evidence was seen on one staff file of basic training courses in Infection Control, Health & Safety, Fire Safety, Food Hygiene and First Aid. Other training courses attended were on Adult Protection, Advocacy, Dealing with Difficult & Challenging Behaviour, Relationships and Sex, updated Care Planning training and Health & Safety Care Standards 1 & 2. This was confirmed by the care worker who highlighted further planned training in 2007 Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 27 on Food & Hygiene, a review of Medication Training, a review of Adult Protection Training and training in the Mental Capacity Act. Records examined show that the supervision process has improved; both staff files examined contained evidence of regular supervision. With an annual appraisal and further planned supervisions it is anticipated that the home will meet requirements with regard to the frequency of the supervisions offered. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 28 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, 38, 39 & 42. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Mrs John demonstrated a good understanding of her roles and responsibilities as the registered manager of Hilton House. Hilton House has developed a quality assurance and quality monitoring system to help ensure that the home is run in the best interests of those people living in the home. Safe working practices are promoted through ongoing training. Health and safety certification promotes a safe working environment. EVIDENCE: Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 29 At the site visit it was noted by both inspectors that there was a marked improvement in the day-to-day management of the home. Mrs John had a clear understanding of her role and responsibilities and with improvement documentation was able to evidence action taken. As stated earlier in this report, policies and procedures have been reviewed and revised and were in place to ensure that practice in the home was consistent and appropriate. However, it was noted at the site visit that when Mr Gopaul visited the home there was a noticeable decline. Issues around compliance with completion of a Regulation 26 visit and report were raised by Mr Gopaul and friction was noted when this was raised with Mrs John. Both proprietors were reminded of the need for the registered provider to complete such visits and reports. Following the site visit communications with the home’s proprietors have highlighted further disagreement and concerns regarding staff recruitment and Regulation 26 visits and reports. This is detailed earlier in this report in the ‘Concerns, Complaints and Protection’ section. A quality assurance and quality monitoring system has been developed and implemented since the last key inspection. Hilton House has a Quality Management System in place which highlights a four-stage process of service users’ needs and wishes – service user satisfaction – analyse and improvement. In September 2006 service user survey work was completed and in 2007 survey work of relatives and parents is planned. Service users meetings and staffing meetings are also seen of methods to gain information as to how the home is performing. Records of monthly residents meetings were seen and topics such as activities, the new extension and the building work have been considered. Care plans play an equally important part in the quality monitoring process for they are seen as a document that drives and records the services and support offered. As stated earlier in this report personal development plans have been developed and evidence was seen of basic training opportunities in food hygiene, infection control, fire safety and health and safety. Overall care practice and environmental conditions provided further evidence in this aspect of care. Some safety certifications were sampled and seen at the site visit. Evidence was seen of Legionella testing in September 2006 and this met requirements. Whilst it was noted that hot water temperature regulators had been fitted to all new bathroom and wash hand basin fitments used by the people who live at Hilton House, the need to conduct regular hot water temperature testing was raised with Mrs John. Mrs John said that she would consider these checks with other health and safety checks completed by the home. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 30 Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 31 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 X 5 2 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 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X X 2 X Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 32 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 YA1 Regulation 4, Schedule 1 Requirement People who wish to use the service and their representatives must have the information they need in the home’s Statement of Purpose. This is to enable them to make an informed choice about where to live. This is a repeat requirement. Previous timescales of 31/03/05, 01/05/06, 17/07/06 and 22/09/06 were not met. 2. YA1 5 People who use the service and wish to use the service must have a Service Users’ Guide, which provides clear and accessible information of the care service. People who use the service must have an individual written and agreed contract/statement of terms and conditions in place. This is a repeat requirement. Previous timescales of 01/03/05, Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 33 Timescale for action 03/07/07 03/07/07 3. YA5 5(c) 03/07/07 01/05/06, 17/07/06 and 22/09/06 were not met. 4. YA9 13 People who use the service (4)(b)(c), must be enabled to take 14 (2)(a)(b) responsible risks through clear risk assessments and risk management in their care plan with regard to unescorted outings to Colchester. 16(2)(m)(n) People who use the service must be supported and enabled to access regular social and leisure activities as they wish. 22(4)(5) People who use the service must be assured that the home’s complaints procedure clearly details the role and responsibilities of the Commission for Social Care Inspection (CSCI). This is a repeat requirement. Previous timescale of 17/07/06 & 22/09/06 were not met. 7. YA23 13(6), 21 People who use the service must be assured that the home’s adult protection procedure holds clear and accurate details of local social work teams and referral routes. This is a repeat requirement. Previous timescales of 31/05/06, 17/07/06 and 22/09/06 were not met. 8. YA34 19, Schedule 2 People who use the service must be assured that they are supported and protected by the home’s recruitment policy and procedures. This is with particular regard to obtaining DS0000017850.V336968.R01.S.doc 03/07/07 5. YA13 YA14 03/07/07 6. YA22 03/07/07 03/07/07 03/07/07 Hilton House Version 5.2 Page 34 complete staff employment history and references relating to the person’s last employment. This is a repeat requirement. Previous timescales of 17/07/06 & 22/09/06 were not met. 9. YA37 12(5)(a) People who use the service 13/04/07 must be assured that the registered provider and the registered manager maintain a good personal and professional relationship with each other and with service users and staff. People who use the service 03/07/07 must be assured that Regulation 26 visits and reports are completed and produced as part of the ongoing monitoring of the care service. Hot water temperatures from 03/07/07 hot water taps access by people who use the service must be monitored and checked to ensure that appropriate risk management is in place to safeguard these residents. 10. YA37 26 11. YA42 13(4)(a) 23(2)(b) 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. Refer to Standard YA11 Good Practice Recommendations People who use the service should be assisted (as far is practical) to be supported and enabled to have opportunities for personal development. This is with DS0000017850.V336968.R01.S.doc Version 5.2 Page 35 Hilton House regard to the promotion of assertion and confidence training. Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Hilton House DS0000017850.V336968.R01.S.doc Version 5.2 Page 37 - 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!