Inspection on 21/02/08 for Hilton House

This inspection was carried out on 21st February 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hilton House 13/04/07

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 Unannounced Inspection 21st February 2008 09:20 Hilton House DS0000017850.V360115.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.V360115.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.V360115.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 hilton_house@hotmail.co.uk 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) 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.V360115.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 13th April 2007 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 £520 - £1,200 per month. This was said to include funding for activities. Hairdressing, personal toiletries, additional bedding and furniture, newspapers and dry cleaning are charged at cost. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced inspection of Hilton House took place on 21st February 2008 over a nine hour and twenty minute period. The inspection involved checking information received by Commission for Social Care Inspection (CSCI) since the last inspection in April 2007, looking at records and documents at the care home and talking to the registered manager, care staff and the people living at the home. In addition the Annual Quality Assurance Assessment (AQAA) completed in January 2008 was considered as part of the inspection process and a tour of the premises was completed at the site inspection. Surveys were sent to the home prior to the site visit and they had been distributed to the people living at Hilton House. Furthermore staff surveys were sent, as were relative surveys. At the time of writing this report, six surveys had been received from the people living at Hilton House, ten staff surveys and six relative surveys had been completed and returned to the Commission for Social Care Inspection (CSCI). During the site visit three people who live at the care home, two care staff were spoken with. What the service does well: Initial assessment processes and admission to the care home follow an appropriate course to ensure the appropriate placements of residents. Care planning and record keeping are well managed, with care plans detailing the care needs and the support to be offered. Hilton House is light, bright and clean, with improved communal and bathing facilities now available at the home. Staff recruitment, induction and basic training requirements are in place with all staff encouraged to complete further training such as National Vocational Qualifications to improve their knowledge and understanding of their role. Hilton House DS0000017850.V360115.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.V360115.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.V360115.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 and 5. 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. Detailed information is found in the Statement of Purpose and the Service Users’ Guide to ensure that a prospective resident can make an informed choice. A comprehensive admissions process and agreed statements of terms and conditions ensures that people who come to live at Hilton House are assured that their needs are met. EVIDENCE: Both the Statement of Purpose and the Service Users’ Guide have been reviewed and revised in July 2007. An annual review date is set for each document of July 2008. At the site visit to Hilton House a copy of the Statement of Purpose and the Service Users’ Guide were collected and they have subsequently been considered. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 9 With regard to the Statement of Purpose it was evident that omissions and amendments identified at the last inspection have been amended and the document has been updated to reflect current facilities and staffing. This document clearly detailed the aims and objectives and the philosophy of Hilton House. The only shortfalls noted were the need to reflect the recent changes in the contact details of the Commission for Social Care Inspection (CSCI) and completion of Appendix 5 – Room Sizes is required. Omissions and amendments noted at the last inspection had been considered and included in the updated copy of the Service Users’ Guide. As with the Statement of Purpose, the contact details of the Commission for Social Care Inspection (CSCI) need to be changed and whilst the Service Users’ Guide spoke of the guide containing pictures of all staff and some useful information about their qualifications and experience, this was not evident in the copy given to the Commission for Social Care Inspection (CSCI) or seen on the files of two people living at Hilton House. Without this information the people living at Hilton House and their relative would be unable to contact the Commission for Social Care Inspection (CSCI) directly and they would not be aware of the skills and qualifications of the people caring for them. Within the survey work conducted by the Commission, six people living at the home had completed these surveys and two people said that they had been given enough information about the home before they moved in, sighting the Service Users’ Guide as a document available to them. The remaining four completed surveys from people living at Hilton House said that their family and social worker had assisted them in making the decision to live at Hilton House. The Annual Quality Assurance Assessment (AQAA) completed and returned on 8th January 2008 said that the Statement of Purpose and contracts had been improved in the last twelve months. Care planning files and assessments have been reviewed and collated for all seven people who live at Hilton House. Three files of the people who live in the home were sampled and inspected as part of the case tracking exercise. There have been no new admissions since the last inspection. Mrs John, the registered manager said that the home planned to use the admission procedure as developed by a consultant for Hilton House. This was reviewed in detail at the last inspection and found to meet requirements. As there had been no new admission since the last inspection this was not reconsidered at this inspection. The contracts for two people living at Hilton House were sampled and inspected at the site visit. With some small additions i.e. name added at the top of a page and room number added at the site visit, these were found to meet requirements. Copies were found on each individual’s file. Mrs John agreed to review all contracts in place to ensure they are completed in full. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care planning documents were comprehensive detailing health, personal and social care needs so that appropriate care could be given. Regular reviews are in place to ensure that the people who use the service receive the care they wish and require. Risk assessments enable the people living at Hilton House to take manageable risks. EVIDENCE: As found at the last inspection, care plans cover a range of aims and objectives which cover all aspects of personal and social support and healthcare needs. Both long and short-term goals were set. Three care plans were sampled and inspected as part of the case tracking exercise and these contained 5-9 care plan objectives covering all care needs. They were clearly written in a positive style. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 11 The home has attempted to incorporate the views of the individual whose care plan it was and their key worker completes monthly progress reports on the care planning objectives. All three care plans had been revised and developed in August/September 2007. Following discussion Mrs John said that the care plans would be reviewed and updated at least every six months. Mrs John was aware that Social Care was conducting care reviews for her residents. Daily records referred to topics covered in the individual’s care plan. There was evidence of choices being made around the activities the individual chose to do. Comments from people living at Hilton House in the surveys further confirmed this. Comments such as ‘They give me help and support hair washing, cooking food and taking me to town – to Aqua Springs’. Three people living at Hilton House said that they liked to get up late and this was accommodated. One person said that they were able to have breakfast in their room. Ten staff members had completed and returned surveys sent by the Commission. In this survey work, care staff were asked if they had up to date information about the needs of the people they support and care for. All ten said that this information was always available and comments such as ‘ Care plans are always up to date’ and ‘The care plans explain in great detail the needs of each service user, their dietary and social needs’ were made. Reference was made to other ways of obtaining up to date information such as through induction training for new staff, handovers at shift changes, daily records, risk assessments, staff meetings and supervision, individual discussion and being involved in review meetings. Within the care plans sampled, evidence was seen of risk assessments and risk management. A variety of risk assessments were in place, each personal to the individual and often linked to care planning objectives such as issues around concentration for one person. A risk assessment score had been given and strategies identified to manage the risk. During discussion with the registered manager it became evident that whilst consideration had been given to an individual leaving the home unescorted, the need for a risk assessment should be considered and implemented if a risk is identified. In another care plan such a risk assessment had been completed and a management strategy developed. Mrs John agreed to review and consider whether such a risk management strategy was required. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. 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. People who use this service are supported to make choices with regard to their daily routine and leisure activities and contact with their family. People who use this service are provided with a varied and healthy diet to promote good health. EVIDENCE: Within record keeping there was evidence that the people living at Hilton House are able to make choices around their spiritual needs. Four people said that they go to church regularly and one said that they did not wish to go to church. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 13 One person living at Hilton House was said to attend an Advocacy Course at a local college. When asked they were unable to give an explanation as to what they did on the course. A carer confirmed that they attend such a course, but they believed that they did not enjoy this course as much as a craft course they attend, for there was a more practical aspect to this training course. None of the people living at Hilton House have employment, but four people attend college courses. One person attends a music course, another attends a computer training course, a third attends a course entitled –‘Helping Others’ and a course on English literature/language and a fourth person attends their Advocacy class and an Arts and Craft course. Within the survey work conducted by the Commission for Social Care Inspection (CSCI), all of the people attending these courses confirmed that they attended college. One person attending a Computer training course was keen to show us their folder of completed work and another had evidence of the work they had completed at their arts and craft course. A monthly Activity Record had been designed and developed and was on display in the hallway near the small lounge/activity room. This record detailed the activities undertaken by the people living at Hilton House. It included collage courses, outings, visits by and to relatives and activities, which had taken place in the home. A ‘star’ scoring system had been implemented and each month a prize was given to the highest scorer. The care worker who had devised this record chart said that all of the people living at the home are encouraged to take part and to ensure all are included both leisure activities and daily domestic tasks such as cooking, making beds and cleaning are included. In addition to the monthly Activity Record, individual written activity records are kept for each person living at Hilton House. This was seen on the three files sampled and comments were made as to their participation and interest the individual took. In addition an Activity File was kept. This held records of outings and activities, which had taken place and assisted with completion of the activity scoring system. During the site visit we were shown scrapbooks being completed by two people living at the home. These were topic related to things of interest to the individual. Staff were sourcing and copying pictures for them to stick in their book. The staff member had added simple words of text to expand on the content. One scrape book was of birds and the other was of castles and old buildings. The majority of the people living at Hilton House have bus passes and a resident told us that they are able to travel into town by bus. In addition the home has a people carrier and cars for transporting them. On the previous day all of the residents had visited Clacton on sea for the afternoon travelling Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 14 in by car and people carrier. They said that it had been cold and windy, but they had enjoyed a trip to the Pier and a cup of tea out. From speaking to residents and staff it was evident that the people living at Hilton House are encouraged to pursue their own interests. Two people said that they enjoyed knitting and one showed us their work, which they were very proud of. A third person said that they enjoyed working in the garden and they were proud of the new flowerbeds and raised beds in the garden. Seeds for sowing in the spring/summer were in the home. Within the AQAA it was stated that the home would like to improve their risk assessments for holidays and outings. Whilst residents do go on outings, it was said that currently none of the residents had been on holiday and Mrs John said this was something the home wished to progress in the future. Mrs John said that links with families are encouraged. At Christmas they had held a Christmas Party and all of the residents had had relatives attending. During the site visit, when residents were sorting and looking at recent photographs, photographs of relatives at this event were seen. Six relatives had completed and returned the survey sent by the Commission. Four relatives said that the care home always gave them enough information to help them make decisions about their relative’s care and two said that they usually had enough information. Two relatives said that when they visited the home they were always updated on ‘current developments’ and if the registered manager were there they would discuss their relative’s care. A comment made by a relative was that they ‘would like to know more about the team at Hilton House as Sylvia often leads when I do visit. A photo board or more information about them would be welcome (maybe a newsletter)’. These maybe suggestions that the home might like to look into. During the site visit, people living at Hilton House were seen to come and go from the main house into the outbuilding used as an activity room, the new lounge/activity room and into their bedrooms. One resident held a key to their bedroom door and when they went out they chose to lock this door. Whilst the people living at Hilton House used the dining room and main lounge it was noticeable that this was only when staff were present and an activity was taking place e.g. sorting photographs, watching television and having meals. Residents were reluctant to use this room alone choosing to use the outside activity room or the internal activity room instead, moving from one to the other in a group or in the case of one resident alone. Within care planning objectives and the activity records, reference was made to the people living at Hilton House being involved in domestic tasks and during the day residents spoke of completing these tasks such as making their Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 15 bed and tidying their room and washing up after lunch. The latter was seen at the site visit. At the site visit, lunch was served at the dining room table. Five of the residents chose to have their meal there, whilst the remaining two had their meals served on a tray in their room. One person living at Hilton House said in their survey ‘I eat food in my bedroom in peace’. People sitting at the table were able to chose and serve themselves from Chicken Kiev and lasagne, salsa and mixed vegetables. It was evident from observation that the practice of the residents serving themselves is not the normal daily practice. The registered manager confirmed this and said that more often meals are served on to individual plates from the kitchen. Food supplies were found in the kitchen cupboards, fridge and freezers. There was a mixture of own brand and branded label goods in tins and packages, some fresh and frozen food. Mrs John said that the home shops at local supermarkets weekly and because of their location they are able to access local shops with ease. Fresh vegetables had been purchased by the home and prepared and frozen ready for use. Cabbage and carrots served at lunch were sourced this way. A large bowl of fresh fruit was seen in the kitchen on the top of the freezer. This was said to be offered to residents as they requested, although it must be said that the fruit was both out of reach and not in direct sight for all residents to see and choose from. However, fruit was seen to be offered to a resident and biscuits were served with the mid morning drink during the site visit. Within the AQAA there were little detail regarding the arrangements for catering in the home. It was said that ‘there is a full choice of nutritional home-cooked meals, taking into account their individual choices and free access to additional drinks and snacks’. The main meal of the day during the week is at lunchtime with two choices offered on the planned menus for lunch and teatime meals. Menu planning is for ten weeks at a time, but changes are made to accommodate particular preferences, likes and dislikes. This was evident on the day of the site visit. Mrs John said that they complete and uses the Environmental Health publication – ‘Safer Food, Better Business’ as a daily diary and to record the kitchen duties completed to ensure that safe food hygiene practices are followed. These records were seen at the site visit. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 16 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 and 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. People who use this service receive personal care and support in a sensitive and respectful way and their physical and emotional health needs are met. The home has satisfactory systems in place for the safe handling of medicines. EVIDENCE: Evidence was seen with care planning objectives and record keeping that the people living at Hilton House are able to make some choices around the time they get up in the morning and the time they go to bed. Two people who were able to get up late, shower or bath and have their breakfast as they wished confirmed this. Some residents were able to access and make choices as to the clothes they were wearing, but it was evident for at least two people that once they had put on their clothes in the morning, their wardrobe, chest of drawers and cupboards were locked. Mrs John was asked why this was and she said that Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 17 one resident was likely at night to get into these cupboards and rip the clothing there. It was suggested to Mrs John that the current practice of locking wardrobes, cupboards and chest of drawers throughout the day and night is too restrictive. The need to complete a risk assessment and adopt a risk management to elevate the risk is required and should be carried out immediately to facilitate personal choice at all times. All of the people living at Hilton House use a local GP surgery. A record sheet of visits to the GP, opticians, chiropodist, nurses and consultants was held on each care plan file and this evidenced healthcare visits and their outcomes. Weight charts were seen for one person living at Hilton House. On the day of the site visit, they had a visit from a dietitian who considered their diet and lifestyle in view of recent weight increases and the problems it could give for their mobility. Medication storage and administration continues as found at the last inspection. All medication is held in a secure wall-mounted cabinet in the staff office/computer room. The home prints off their own Medication Administration Records (MAR) sheets, which had clear, tidy entries. A senior staff member is responsible for booking medication in and producing the MAR sheets and a monthly audit of the medication management is undertaken by the home. Seven care staff were said to be responsible for giving medication and all were said to have received medication training. Medication records, storage and administration was sampled and inspected for three people living at Hilton House. This was found to be in good order with a clear audit trail. These medication practices support the people living at the care home to have good health care. A recommendation was made that the start date when a medication is opened and used should be noted on the package, bottle or tube. Mrs John agreed to advise her staff to do this in the immediate future. No Controlled Drugs were in the home or being administered at the time of the site visit. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 18 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. The home has systems in place, which ensure that the people living at the home are listened to and acted upon. The home has systems in place, which help to ensure that the people living at the home are protected from abuse and these are supported by staff training. EVIDENCE: At the site visit a copy of the home’s complaints procedure was inspected. Some amendments had been made to this document since the last inspection and overall it was found to meet requirements. As with the Statement of Purpose and the Service Users’ Guide changes are needed to reflect the recent changes in the contact details of the Commission for Social Care Inspection (CSCI). Mrs John agreed to do this immediately, so that accurate information is available when needed. Within the survey work completed by the Commission a question was asked of residents if they knew how to make a complaint. Four said that they sometimes knew how to make a complaint and two said that they always knew how to make a complaint. Three people had commented on that they were only able to raise a complaint verbally and a fourth person said ‘I speak for myself’. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 19 In the survey work completed by relatives, four said that they knew how to make a complaint about the care provided, whilst two said they did not know how to make a complaint. One person had added that they had no complaints. When asked if the care service had responded appropriately if concerns had been raised, three said that the home had always responded appropriately, one said they usually responded appropriately and two said that this had not arisen. Survey work completed by care staff (10) said that all would raise any concern they had with the home’s manager and three staff made reference to regular review meetings with the people who live at Hilton House. Five staff members spoke of referring complaints to the Commission and one person referred to the home’s complaints procedure. When speaking to care staff at the site visit, reference to the home’s complaints procedure was made and all spoke of raising concerns with senior staff or the registered manager. One person gave an example of how they had raised a concern and how the registered manager had dealt it with satisfactorily. As at the last inspection, Hilton House has a comprehensive document outlining the roles and responsibilities with regard to safeguarding adults. Whilst these documents had been reviewed and revised in July 2007, there is still a need to amend the local Social Services address, the detail of the referral processes adding the Essex Safeguarding Adult Unit telephone numbers and the recently revised contact details for the Commission. These details were given to Mrs John who agreed to add to the policy immediately. Two care staff spoke of adult protection referrals. They were aware of the need to raise concerns with the registered manager and they had some understanding of safeguarding matters. One carer said that they had some understanding of adult protection matters through their induction training and their NVQ training. Since the last inspection a referral has been made to the Safeguarding Adults Unit. The concerns raised by the anonymous complainant had been investigated by Essex Social Care and recommendations had been made around the use of a wooden shed as the outside activity room. This had ceased and is now used for storage with an external brick built building recommissioned as the outside activity room. Mrs John was fully aware of these investigations confirming that visits had been made to the home. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. 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. Hilton House provides comfortable and safe surroundings, which are kept clean and tidy. EVIDENCE: A tour of the premises was conducted at the site visit. This included the current registered accommodation and the new accommodation. Mrs John said that an application for the registration of a further two single bedrooms with en-suite facilities had been made to the Commission and a site visit had been booked for early March 2008. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 21 The property was clean and bright with evidence of some changes in furniture since the last inspection e.g. storage in the dining room. The main lounge was in pristine condition. As stated earlier in this report, people in the home did not frequent this room unless they were invited or engaged in an activity in this room. Survey work conducted by the Commission for Social Care Inspection (CSCI) had positive comments relating to the environment. When asked if the home was fresh and clean all six residents had said that it was always fresh and clean and two commented that they liked their rooms. Surveys completed by relatives had also commented on the environment, three people praised the new extension and the garden facilities and one commented on how clean the premises were. The people living at Hilton House were seen to use the smaller lounge/activity room at the rear of the property. At the start of the site visit, dining room chairs were being used in the small lounge/activity room, but by the end of the day, two new sofas had been delivered and installed in this room. The external activity room also used by residents is housed in a brick built building at the bottom of the garden. Mrs John said that it had recently been decorated and the sofas which had been in the small lounge had been moved to this building. There were curtains at the windows and paintings, collage work and photographs on display. A fireplace and fire had been positioned in the room. Mrs John said that this was not fitted and the fire was not operational, it was for decoration only. A freestanding portable heater heated the building. Mrs John was advised to get advice from the Fire Service as to the suitability and safety of this heater. The external door has a handle on the outside, but it does not have an internal door handle. To keep the door shut and to be able to open the door a piece of card had been slid in between the door and the lock. Mrs John was advised of the immediate need to install a door handle internally and she agreed to do this, for the current arrangements made it difficult for a person to open and then shut the door behind them. All of the bedrooms in the home had been decorated in the last two years and occupied rooms were personalised with pictures, notice boards and music centres. Five people living at Hilton House had a television in their room, but two people sharing the double room did not have a television. Mrs John said that four televisions had been broken in this room in the last year and consideration was being given to how to replace and manage this situation. Currently a vacant bedroom is being used as a sleep-in accommodation. With the addition of the new accommodation new bathroom facilities have been added to the home and the people living at Hilton House now have a choice of a bath or a shower. With the new extension, the kitchen has been re-fitted and a new laundry/utility room built. This is found at the rear of the extension on the ground floor. There was a washer and a dryer and a Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 22 cupboard for the storage of cleaning materials under Control of Substances Hazardous to Health Regulations 1999 (COSHH). Initially this cupboard was found to be unlocked, but when notified, Mrs John locked the cupboard. Floor surfaces and work surfaces are impermeable and easily cleaned. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. 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 in the home are competent to care for the needs of the people living at the home and have a range of skills. The home has recruitment procedures in place that protects the people living at the home. EVIDENCE: Within the AQAA it was stated that 75 of the care staff are working towards or hold a National Vocational Qualification (NVQ) Level 2 or above. Mrs John said that nine care staff had NVQ Level 2 or above, with Mrs John and a senior carer holding the Registered Manager’s Award (RMA). A third senior staff member is currently working on their RMA. This is seen as a way of ensuring care staff have the skills needed to care for the residents. Within the staff surveys, carers spoke of being offered or attending NVQ Level 2 training. In addition, it was said that care staff are offered ‘training and Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 24 courses relevant to our role’ and ‘Hilton House provides an extensive programme of training to match the skill requirements’. One care staff member spoken to confirmed that whilst they were still in their probationary period, they had completed their induction training and had started their NVQ Level 2 in Care. From observation and record seen, staffing levels were appropriate to meet the needs of the people living at Hilton House House. They were able to have opportunities for small group activities and escorts for college trips were arranged during the day. Within the staff surveys all ten staff surveys said that there is always enough staff to meet the individual needs of all the people who use the service. One commented that the ‘We have enough staff who worked daily to meet individual needs of the service users. We have one to one support for service users going to college, outdoor activities such as trips to town and other places, indoor activities such as cookery sessions, art and craft and gardening.’ Two carers said that there was always at least three staff on duty, with one to one support as needed. Staff files for three care workers were sampled and inspected. Overall they were found to be in good order, with detailed employment history, two references, copies of passport and proof of identity and Enhanced Criminal Record Bureau disclosures completed. Evidence was seen on files of qualifications and courses completed before entering employment at Hilton House and courses attended since commencing work at Hilton House. In the last year there had been in-house training on Basic Fire Safety, Health, Safety & COSHH & Team Building. Within the files sampled there was evidence of Sector Skills training courses including induction training and foundation training. These were completed along side Learning Disabilities Accreditation Framework (LDAF) training. A personal development plan was seen in place for each person with both completed and planned training identified. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 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. The management of the home has improved and is more stable. People who use this service have good quality assurance systems. People who use this service can expect their health, safety and welfare to be promoted and protected. EVIDENCE: The partnership between Mrs John and Mr Gopaul has been dissolved and Mrs John is the sole proprietor. She said that she feels that this will lead to a more stable and settled management of the home. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 26 As the manager of Hilton House, Mrs John said that she had looked towards improving her management skills through completing the RMA and she has attended a seminar on Management Coaching and a training session in Adult Abuse. She said that she felt this would improve the management of the home further. A quality assurance and quality monitoring system has been developed and used within the home. Relatives, people living at Hilton House and care staff in 2007 – 2008, have completed surveys. Whilst some work on analysis and depicting the results has commenced, Mrs John said that with the latest results collected in February 2008, the home was looking to using a graph to detail the results. Evidence of the survey work completed was seen, with simple text and symbols used to enable the people living at Hilton House to understand and complete these surveys. As stated earlier in this report personal development plans have been developed and implemented for all staff members and evidence was seen of some basic training courses attended in the year. Some safety certifications were sampled and seen at the site visit. Evidence was seen of hot water temperature record keeping, Fire records check completed daily, weekly and monthly, Portable Appliance Testing (PAT) completed in March 2007 and Fire inspection – Fire Appliance checks were completed in March 2007. Both the Electrical installation certification and the Gas safety and servicing checks are due in March 2008. The ongoing practice of checks and safety certification ensures that residents’ welfare is safeguarded. Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 27 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 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 3 X X 3 3 Hilton House DS0000017850.V360115.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 YA24 Regulation 23(2)(p) Requirement People who use the service must be assured that the heating in the external activity room is both safe and suitable for the environment. Timescale for action 15/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA1 YA16 YA18 YA23 Good Practice Recommendations To aid identification and ease of reading, photographs and pictures should be added to the Service Users’ Guide as planned e.g. staff photographs and qualifications. People who live at the care home should have freedom of movement in the house, particularly in all communal areas – the lounge and dining room. People who live at the care home should have freedom of choice at all times e.g. being able to select and access their clothes at all times. The home’s safeguarding adults’ procedures should have clear and accurate details of the Safeguarding Adults Unit, updated Commission for Social Care Inspection (CSCI) details and local social care offices. DS0000017850.V360115.R01.S.doc Version 5.2 Page 29 Hilton House Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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