Inspection on 18/06/05 for Hilton House

This inspection was carried out on 18th June 2005.

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

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

Other inspections for this house

Hilton House 21/02/08

Hilton House 13/04/07

Hilton House 26/07/06

Hilton House 04/05/06

Hilton House 18/11/05

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 Marion Angold Unannounced 18th June Final The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hiton House Address 175 Shrub End Road Colchester Essex CO3 4RG 01206 763361 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Wills Clarel Gopaul Mrs Sylvia John Mr Wills Clarel Gopaul Mrs Sylvia John Care Home 8 Category(ies) of Learning disabilty (8) registration, with number of places Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, with learning disabilities (not to exceed 8 persons) Date of last inspection 22nd February 2005 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 but neglected. The accommodation comprises single bedrooms and one double occupancy bedroom with an en suite bathroom. Communal rooms (sitting room and dining room) are situated on the ground floor, with toilet and bathing facilities on both floors. 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. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on two separate occasions. The first inspection visit was made on a Saturday 18th June 2005 and lasted 2.5 hours, until staff and management left the premises to accompany service users on outings. The second inspection took place on Thursday 30th June 2005 and was conducted by two inspectors and lasted six hours. At the initial visit the inspector spent most of the time talking with six of the seven service users. Menus and nutrition records were also inspected on this occasion. The second inspection covered a tour of premises, records of service users’ finances, nutrition records and a sample of care plans and staff records. The inspectors also spoke with service users, staff and management. This inspection gave rise to a number of concerns, not least the difficulty of gaining access to the home on three separate occasions. Each time windows were open but there was no answer from within. On the third occasion, the inspector heard doors closing inside. The manager only appeared after being called through the open laundry window at the back of the house. Her reasons for not answering the door were inconsistent. A number of inconsistencies emerged through the course of the inspections and led the inspectors to believe that management was not being totally honest with the Commission. The providers are reminded that it is an offence under Section 31.2 of the Care Standards Act 2000 to obstruct entry to the premises of anyone authorised by the registration authority to carry out an inspection. The registered persons deny they attempted to obstruct an inspection by ignoring the inspector’s attempts to get the attention of any person or persons on the premises, or of being subsequently dishonest with the Commission for Social Care Inspection about the matters. Twenty one of the National Minimum Standards were inspected over the two days. Of these 1 was met and 10 were nearly met. The remaining 10 Standards presented major concerns and therefore received a rating of 1. All the ratings, as well as the changes the home has been required or asked to make, are listed at the end of this report. What the service does well: The home has a stable and committed team of staff, with whom service users feel comfortable. A mini bus is provided for outings and taking service users to different venues. Both managers have taken steps to gain the National Vocational Qualification in Management and Care, Level 4. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The people who own and run the home need to ensure that the information they have put together about Hilton House gives a true picture of what people living there can expect and does not give them false expectations. They also need to ensure that care plans show how all the needs of service users are being met and any risks to them are recognised and addressed. Service users themselves thought that records should be kept by the home of any involvement they had with people’s personal money. Although the inspectors saw some records, these were not altogether accurate or consistent with available receipts. The managers should make sure that they respect the confidentiality of information they have about individual service users and so set a good example to others in the home. They also need to ensure that all records are kept for the required length of time and remain confidential. Service users said they would like to be able to have their favourite foods even if other service users did not like them. They also said they were having leftovers from lunch for tea and would prefer to have sandwiches again. One service user did not like having their cups of tea restricted. The home should be offering a broader range of planned menu options, including fruit and salad, which take account of service user’s individual preferences and nutritional needs. They should give service users the option of hot and cold drinks Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 7 throughout the day and work with one particular service user towards having the same menu options as other service users. The managers need to take steps to improve the quality of the environment in some areas, especially particular service users’ rooms and the garden. The managers need to ensure they always have enough staff on duty to promote the safety and wellbeing of the people living at Hilton House. They should also work cooperatively and openly with the Commission at all times. The managers must always allow inspectors, authorised by the registration authority, to enter the premises for the purpose of an inspection and make sure they do not hide anything that is happening in the home. 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. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 5 Prospective service users might be misled by some of the information contained in the Statement of Purpose and Service Users Guide. Service users’ contracts did not accurately reflect all situations pertaining in the home. EVIDENCE: Since the previous inspection the home’s Statement of Purpose and Service Users Guide had been amended and forwarded, as required, to the Commission. On the whole, these were comprehensive documents but they contained omissions, inconsistencies and inaccuracies and, therefore, were not a full and true reflection of the service offered by Hilton House. The documents demonstrated a familiarity with the Care Homes Regulations 2001 and National Minimum Standards but inspection of the service revealed that much of what they contained had not been translated into practice. Service users’ contracts indicated that they would be responsible for a number of items not covered by their fees. However, it was established that the home had included other items, not included in their contracts, such as contributions towards the cost of running the mini bus, the purchase of toilet rolls and cleaning materials. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9, 10 Care plans did not fully reflect service users’ needs, routines or the expectations placed upon them. The home’s arrangements for assisting service users with their personal finances did not protect them from abuse. Some risks being taken by service users were not covered in their care plan. The culture of speaking openly about matters pertaining to individual service users was contrary to the principles of confidentiality and, at times, the dignity of the service users concerned. EVIDENCE: Four care plans were sampled. These focussed on three identified needs, relevant to the individual. One care plan contained fortnightly progress reports and six monthly reviews. Although care plans written in the first person suggested that service users had been involved in their completion, the use of complex phrases indicated that the wording had not come from the service users themselves, for example, ‘For me to behave in a civilised manner and be accepted by my peers in the home’. Statements, such as this, were found to Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 11 contain value judgements, denoting a limited understanding of the behaviour described. A second example of this from the same care plan was, ‘very unpredictable person, cannot be trusted; can get very moody at times’. Another service user’s record provided some good examples of care planning but, again, contained some subjective language about ‘good’ and ‘bad’ behaviour. One of the managers also spoke inappropriately about the issue of incontinence in terms of good and bad behaviour. The files inspected did not identify any triggers for the challenging behaviour or details about effective communication with the people concerned. A third care plan, did not include reference to the service user disinfecting their own mattress, which had become part of their expected regime. Similarly two service users’ recent medical history and contacts were not documented or addressed as part of their care plan. Service users stated on 18th June 2005 that their personal money was looked after by the owners and given to them on request. One person expressed a view that these transactions should be written down. Others also indicated that they were not recorded. They also said that they paid for their own meals and refreshments when they went out. On 30 June 2005, management informed one of the inspectors that they looked after only two people’s pocket money, the others taking care of their own, which was paid directly into their bank accounts. One service user’s receptacle for money was inspected and discrepancies found between the receipts they were holding and records retained by management. Receipts could not be found for all the transactions recorded and it was not possible to track from available evidence what had happened to the service user’s money. Records also showed that the service user had paid for toilet rolls and 4 packets of soap powder. Mrs John justified this as expenditure on ‘toiletries’. They were also paying £20.00 per month towards the cost of running the minibus, although Mrs Johns stated that only four service users were contributing in this way. The Statement of Purpose referred to ‘Helping residents take reasonable and fully thought-out risks’. One care plan sampled evidenced appropriate risk assessments in relation to a number of daily living activities. However, another did not include a risk assessment in relation to a person, spending a full day in town by themselves several times a week, even though their referral had indicated a need for twenty-four hour supervision and monitoring. Although in the Statement of Purpose the home purported to uphold service users’ confidentiality, this did not occur consistently. For example, both managers imparted confidential information about particular service users within the earshot of others. Service users themselves demonstrated their familiarity with other people’s situations, such as what they were ‘allowed’ to do and why. Medication Administration Records from the previous year were found being used for rough notes. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14, 16, 17 Service users did not consistently enjoy person centred activities and outings. Routines were sometimes inflexible and service users’ lives controlled by constraints of staffing levels and arrangements imposed by management. Service users experienced a limited choice of menu and some restrictions were imposed on what they could eat and drink. EVIDENCE: Management described how they were exploring ways of developing one person’s gardening activity and encouraging another service user to take an interest in birds. On 18th June 2005 service users indicated that they had not had outings in the previous week, although one person gave an example of helping to shift furniture in the manager’s home and two service users had been into town by themselves, which was their usual form of outing. During the inspection the owners arrived and arrangements were made to take all service users out. Some thought was given, on this occasion to choice, and three different Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 13 activities were arranged. On 30 June 2005, 2 service users spent all day in town on their own as, it was reported, they had the previous day. The presenting risks were not covered in the care plan sampled at this inspection. Feedback given to the inspectors indicated that these service users were encouraged to stay out all day. It was evident from speaking to staff and service users that usually outings in the mini bus could not take account of individual preferences and that, due to the limited availability of staff, service users often remained in the bus for the outing or were taken in the mini bus to enable staff to run necessary errands, or while people were being dropped off. On two occasions, coinciding with inspections, service users were taken out as a group. One member of staff stated that they asked service users where they wanted to go once they were on the bus. This practice would not allow for individual preference. Service users indicated that they had to clean their own rooms and had various tasks allocated to them and that they could expect a telling off if they did not comply. Routines around mealtimes were clearly limited on some occasions by staff availability. When the inspection commenced at noon on Saturday 18th June 2005, lunch was already over and cleared away, apart from 2 service users at the table finishing ice cream. The preparation of this meal and clearing up had been the responsibility of the only member of staff on duty at the time. Service users said they were served porridge every day routinely, although one person had cornflakes. They said they were not offered toast. They could have a cup of tea for breakfast and a hot beverage before bed; otherwise they were given squash to drink. This was contrary to the Statement of Purpose, which indicated that service users could choose what they ate and drank. Observation confirmed that service users were not offered a choice of drinks and one person, much to their distress, was not ‘allowed’ tea, for reasons, which everyone knew about. This person did not like squash and, therefore, had water to drink. It was also evident from service users’ comments that another person was not ‘allowed’ biscuits and it was not clear, following observation of the service user concerned, that this was a necessary restriction. Neither did subsequent inspection of the care plan show that any appropriate remedial action had been taken to enable the person to have a full choice of menu. Service users confirmed that they no longer assisted with meal preparation. The home did not work to menus for the main meal of the day. One member of staff said they asked service users what they would like. This was not the case on the 30 June, where service users were offered limited options from already prepared food. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 14 On 18th June 2005, service users stated that tea consisted of leftovers from lunch and that it had been better when they had been given sandwiches. Lunch that day had consisted of potatoes and a chicken hotpot. Two pans containing significant amounts of leftovers were on the stove. The member of staff had indicated that all service users had chosen this meal. However, service users themselves spoke about the sorts of foods they would like but which were not available to them because not everyone liked them. Daily records of food eaten by service users were inspected. These did not include reference to leftovers at tea time. The manager stated that leftovers were offered in addition to the other items listed. Entries for May and June 2005 indicated that service users had eaten quiche, pizza, spaghetti on toast, ham, cheese or tuna sandwiches. No fruit or salad or was included with these items. Records of all hot food temperatures for May and June were identical (80 degrees Farhenheit). In explanation, Mrs John stated that there must be something wrong with the thermometer and that she would obtain a new battery for it. The records had not been signed by the person making them but it was reported that Mrs John did most of the cooking. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these Standards were inspected. EVIDENCE: Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Neither of these standards were inspected. EVIDENCE: One member of staff confirmed the practice of withholding cups of tea from one service user as a sanction. The person concerned was unhappy about not being able to enjoy a cup of tea when they wished. The use of this sanction was not documented in their care plan. It was concerning that everyone knew why tea was withheld from this person and that the language used by management, staff and service users to describe their situation was degrading. Service users, speaking about the people who cared for them, mentioned all the staff in turn. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28 Although much of the home was fit for purpose, some parts, both inside and out were in a state of disrepair or appeared neglected. EVIDENCE: The premises were found to be clean at the second visit on 30 June 2005 and there were no unpleasant odours. There was evidence from the washing line that some pillows and duvets were in good condition and being kept clean. Bricks had fallen away from the wall at the front of the house and at the bottom of a pillar supporting the porch. The installation of the doorbell and some of the interior decorating showed poor workmanship. The gate to the side entrance, wide enough to admit vehicles, was held in place by a concrete slab. This led to the back garden, where the original lawn had given way to a large expanse of uneven bare earth scored with tire marks. Mr Gopaul stated that this area would be upgraded when the proposed extension to the property had been completed. However, assorted rubbish and piles of used bricks had collected near the house and the clothes prop was broken, so that the long line of drying clothes kept falling to the ground. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 18 Service users’ rooms varied considerably in standard. The room downstairs was clean and bright, suitably furnished and personalised. The bed had been stripped, so the bed linen here could not be inspected. By contrast, one of the upstairs rooms was overdue for redecoration, the furniture was in a state of disrepair, the hot tap at the wash hand basin did not work and the duvet and pillow were very worn and stained. Other rooms were also in need of refurbishment. It was reported that one member of staff had brought in bed linen from home and this should not have been necessary. Service users confirmed that the shower in the shared room was used not only by the occupants but by at least one other service user. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34, 36 Staff roles and responsibilities were set out in their job descriptions but did not altogether match what they were doing. Service users were put at risk and their quality of life impaired by inadequate staffing levels. Recruitment procedures had not been robust. Staff were not consistently receiving supervision and training. EVIDENCE: Rosters did not accurately reflect actual staffing arrangements, which were often below agreed levels and involved staff covering consecutive shifts. Staff and management gave conflicting reports of who had been on duty on the day of inspection (30 June 2005). There was only one member of staff on duty when the inspector arrived for the unannounced inspection on 18th June 2005. One service user confirmed that this had been the case for most of the morning. On 30 June 2005, 5 service users returned in the mini bus having been supported by only one member of staff. It was confirmed that the second member of staff on the duty roster that morning was not with them. Verbal evidence from several sources indicated that there was commonly only one member of staff on duty during the night. This was supported by the Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 20 presence of a bed frame on top of the bed, supposedly used by the member of staff sleeping in. On the initial day of inspection, three people were available to support outings, enabling service users to exercise some choice in where they would go. It was evident that staffing arrangements led to service users being taken out as a group, or having to go for the ride when people were being dropped off for specific errands or activities. The managers had developed a recruitment policy since the last inspection but there had yet to be any new recruits for this to be put into practice. Three staff files were sampled. One member of staff had commenced employment on 16 January 2005 but their CRB disclosure was dated 22 April 2005. Another member of staff commenced work in February or March 2004 and their references were dated May and June of that year. Only one of the three files contained a contract of employment. Supervision records evidenced inconsistency. The member of staff commencing in January 2005 had none, only an ‘appraisal’ record, dated 30 January 2005. Mrs Johns stated that supervision had not commenced because the staff member was still completing their LDAF induction. Another file showed six supervisions since March 2004, not all signed by the supervisee and some of the remaining signatures appearing to be in a different hand. A written submission has subsequently been receieved from the supervisee stating that all the signatures are her own. The person concerned was not aware of having had more than one meeting for supervision and their LDAF induction booklet had not been started. These two files lacked evidence of continuing training. One member of staff recalled that in the past year they had received training in first aid and a fire lecture. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 41 The managers attempted to obstruct the course of the inspection and were not entirely open or transparent with the inspectors. Some aspects of the management approach were found to be controlling. Records could not be relied upon for accuracy or validity. They also raised issues surrounding confidentiality and how long records must be retained. EVIDENCE: The initial inspection on 18 June was brought to an end when all the service users were taken out. Whilst the Commission would support outings, there were a number of indications at the time that the plan to vacate the premises had been made after the inspector’s arrival. On 29 June 2005, the inspector got no answer in the morning, or the afternoon. Different windows were open on each occasion and, if the home had been unoccupied, then this would have invalidated the insurance in the event of theft. Again there was no answer Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 22 when the inspector called on 30 June 2005, despite evidence that the home was occupied at the time. After much persistence on the part of the inspector, eventually calling through the open laundry window at the back, Mrs Johns emerged. Over the course of the day (she stated at that point that she had to go out and arrangements were made for the inspector’s return) she gave four different reasons for not opening the door and these differed from the account given by Mr Gopaul. There were also strong indications, from piecing together various verbal, circumstantial and conflicting evidence, that she was not, as she had declared, the only person present in the house at that time. The registered persons deny they attempted to obstruct an inspection by ignoring the inspector’s attempts to get the attention of any person or persons on the premises, or of being subsequently dishonest with the Commission for Social Care Inspection about the matters. Reference has been made in other sections of this report to service users experiencing limited choice in relation to matters affecting them on a daily basis, such as what some were ‘allowed’ to eat or drink, or where they went in the minibus. The matter of them being ‘told off’ for not completing their chores also suggested some constraint. It also appeared from various conflicting statements that staff felt constrained about what they should say to inspectors. This was particularly apparent in relation to their comments about supervision and accounts of what had actually taken place on the morning of 30 June 2005. This is denied by the registered persons who, subsequent to the inspection, have provided written statements from four memebers of staff stating that managers have never dictated to them what to say to inspectors. The managers had put in a lot of work developing policies and procedures in line with the Care Homes Regulations and National Minimum Standards and reflecting their management training (National Vocational Qualification Level 4). However, as indicated in other sections of this report (in relation to food consumed by service users, hot food temperatures, service users’ personal money, staff rosters and supervision) policies and records were not always consistent with verbal evidence received by the inspectors. The validity of service users signatures on records they did not fully understand was also questioned. Although records requested were available for inspection and satisfactorily secured, it was evident from the fact that recent Medication Administration Records were being used by staff for rough notes, that the managers were not fully cognisant with requirements pertaining to the confidentiality and retention of records. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x 2 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 1 x 2 1 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x 2 2 3 x x Standard No 11 12 13 14 15 16 17 x 2 x 2 x 2 1 Standard No 31 32 33 34 35 36 Score 2 x 1 1 x 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hilton House Score x x x x Standard No 37 38 39 40 41 42 43 Score 1 1 x x 1 x x I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4, Shedule 1 5 Requirement Timescale for action 31 August 2005 2. 5, 17, 41 3. 6, 9 4. 7, 41 The registered persons must include in the Statement of Purpose the size of rooms in the care home and, in the Service Users Guide, details of the Commission. They must also ensure that these documents accurately reflect the situation in the home. (TIMESCALE OF 31/03/05, IN RELATION TO THE SERVICE USERS GUIDE, NOT MET.) 17 The registered persons must Schedules ensure that all the records 3 and 4 required by the Care Homes 19 Regulations 2001 are Schedule maintained, accurate and clear. 2 THIS IS A REPEAT REQUIREMENT. TIMESCALE OF 01/03/05 NOT MET. 15, 13, 17 The registered persons must Shedule 3 ensure that care plans cover all 3(l) needs and risks and that action plans are fully documented. 16 (2) (l), The registered persons must 17 keep accurate records of Shedule 2 transactions and purchases (2) 9 made by service users, which have necessitated the involvement of staff. THIS IS A REPEAT REQUIREMENT. I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc 31 August 2005 31 August 2005 31 July 2005 Hilton House Version 1.30 Page 25 5. 10, 41 17, 12 (4) (a) 6. 20, 10, 41 13 7. 24, 26 23, 16 8. 28 23 9. 34 19 Schedule 2 TIMESCALE OF 01/03/05 NOT MET. The registered persons must ensure that records are kept securely in the care home and retained for at least 3 years from the date of the last entry. They must also ensure that the home is conducted in a manner which respects the privacy and dignity of service users. The registered persons must ensure that in all matters relating to the administration off medication, they adhere to the requirements of the relevant legistlation and guidelines from the Royal Pharmaceutical Society. THIS STANDARD WAS NOT INSPECTED BUT NEW EVIDENCE WAS FOUND THAT THE REQUIREMENTS WERE NOT BEING FULLY MET. TIMESCALE OF 01/03/05 NOT MET. The registered persons must ensure that the premises are kept in a good state of repair and decoration, externally and internally; that grounds are safe for use and appropriately maintained; that they provide satisfactory furniture and bedding for service users. The registered persons must ensure that accommodation provided for staff sleeping in is suitable for their needs. The registered persons must adhere to the recruitment procedures required by the Care Homes Regulations 2001 and not employ staff without enhanced disclosures from the Criminal Records Bureau. THIS IS A REPEAT REQUIREMENT. THE REGISTERED PERSONS HAD NOT HAD OPPORTUNITY TO DEMONSTRATE THE SECOND 31 July 2005 31 August 2005 31 July 2005 31 July 2005 31 July 2005 Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 26 10. 39 24 11. 37, 38 CSA S 31 (2) PART OF THIS REQUIREMENT BY TAKING ON NEW STAFF. THEY MUST, HOWEVER, ENSURE THAT ALL STAFF HAVE APPROPRIATE CONTRACTS OF EMPLOYMENT. The registered persons must ensure that an effective quality assurance and quality monitoring system is in place to measure success in achieving the aims, objectives and statement of purpose of the home. THIS REQUIREMENT WAS NOT INSPECTED BUT THERE WAS SOME EVIDENCE THAT THE HOME WAS NOT MEETING ITS STATED OBJECTIVES. The registered persons must allow any person, so authorised by the registration authority, to enter and inspect premises, being used as a care home. They must not, in any way, obstruct the process of inspection. 31 August 2005 Immediate effect RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 1 5 6 12, 14, 33 17 Good Practice Recommendations The registered persons should ensure that the Service Users Guide contains all the elements oulined under 1.2 of this Standard. The registered persons should review service users contracts/statements of terms and conditions and ensure that they contain all the information listed under NMS 5.2. The registered persons should ensure that their approach to service users, as reflected in their care plans and daily records, is not oppressive. The registered persons should ensure that service users engage in a person-centred programme of learning and activities. The registered persons should ensure that a range of both I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 27 Hilton House 6. 23, 38 7. 8. 27 41 hot and cold drinks are available at such times as may reasonably be required by service users. They should also ensure that service users contribute to menu planning and that their meals are more varied and include a range of fruit and salad. The registered persons should ensure that any decision to introduce sanctions, restraints or restrictions is made only in consultation with appropriate specialists, is clearly documented in the service users care plan and kept under regular review. The registered persons should ensure that en suite bathing facilities are used only by the occupants of the room. The registered persons should record accidents to staff in the format issued by the Health and Safety Executive and ensure that acidents to service users are documented on separate pages. THIS RECOMMENDATION WAS NOT INSPECTED AND HAS THEREFORE BEEN BROUGHT FORWARD FROM THE LAST REPORT. Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 28 Commission for Social Care Inspection Fairfax House Causton Road Colchester CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hilton House I56_I05_s17850_Hilton_House_v217390_ui140605_Stage_4.doc Version 1.30 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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