Inspection on 26/07/06 for Hilton House

This inspection was carried out on 26th July 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 37 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hilton House 21/02/08

Hilton House 13/04/07

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 26th July 2006 09:45 Hilton House DS0000017850.V308118.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.V308118.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.V308118.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilton House Address 175 Shrub End Road Colchester Essex CO3 4RG 01206 763361 N\A Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Wills Clarel Gopaul Mrs Sylvia John Mr Wills Clarel Gopaul Mrs Sylvia John Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 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) 4th May 2006 Date of last inspection Brief Description of the Service: Hilton House is a former family dwelling that has been extended and altered to form the current accommodation. The property is located approximately one mile to the west of Colchester Town Centre, in an established residential area. Public transport is frequent and a bus stop is within walking distance. The closest rail station is Colchester Town. The front garden provides off-road parking. The rear garden is of good size, but neglected. The accommodation comprises six single bedrooms and one double occupancy bedroom with ensuite bathroom facilities in the double room and a single room. This single room is currently 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. A further toilet and shower room are to be found on the ground floor. 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 detailed in an Inspection Questionnaire completed on 30th January 2006 is £500 - £700 per month. The proprietors confirmed that this was correct at the time of the inspection. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection covered all key National Minimum Standards and standards detailed in the last inspection’s Requirements and Recommendations. In addition consideration was given to all recent records relating to the service, including information sent to the Commission by the Providers. A record of inspection was collated prior and during the inspection process. A site visit to the home was completed on 26/07/06. Two Regulation Inspectors, Pauline Dean and Ray Finney completed this visit, which lasted 9 hours. The inspection was extended to 27/07/06 to focus on medication administration. Derek Brown, CSCI Pharmacist Inspector, accompanied Regulation Inspector, Pauline Dean. At the visit on 26/07/06, the inspectors were able to speak with service users, staff and the two registered managers. A partial tour of premises was completed and there was observation of care practice and the sampling of records. At this site visit all staff records with the exception of the two registered managers were inspected. Two service user files were sampled and inspected. What the service does well: What has improved since the last inspection? As at the last inspection there has been little improvement in the management and running of the care home. Whilst it is recognised that some work had been undertaken on redrafting the Statement of Purpose, this and the Service Users’ Guide, require further attention. The registered managers have developed an improved assessment and plan of care. This however was still in the developmental stage and had not been implemented for all service users. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 6 New kitchen fitments and appliances and new carpets have been fitted throughout the communal and bedroom areas of the home. Furthermore new lounge and dining room furniture have been bought for the home. Some decoration in the office of the home was in progress on the site visit. Menu planning and nutrition records showed some improvement, with choice and variety including fresh vegetables and fruit included in service users’ diets. What they could do better: As stated above, Hilton House is still required to ensure that accurate information is available to current and prospective service users about how the home is run e.g. the Service Users’ Guide and the Statement of Purpose. These documents require a thorough review to ensure that they reflect the service provided at Hilton House. Care planning and record keeping continue to require attention. Consideration of the newly devised format was given at the site visit and recommendations were made to ensure that these documents provide a clear plan of care. Risk assessments and detailed record keeping also requires attention. Within these systems there is a need to develop mechanisms to ensure that service users make choices and how these are managed. As at the last inspection staffing hours, staff recruitment practices, training and supervision continue to require immediate attention. The home must ensure that vulnerable service users are not exposed to unnecessary risk through staff working excessive long hours, lack of training and supervision. Medication administration, storage and record keeping continue to require attention. Medication training also requires attention. An immediate requirement notice in respect of administration was left following the site visit. Statutory Notices have been issued with regard to medication management. Whilst it is recognised that some attention has been paid to the environment of the home, with the fitting of a new kitchen, carpets, curtains and furniture, the decoration of the home still requires attention. It was noted that there has been a slight improvement in the cleanliness of the home, but there is still scope for improvement. Staffing levels have improved slightly. Additional staff have been brought in whilst new carpets and furniture were being fitted. The home should ensure in the future that sufficient staff are employed and on duty to cover all aspects of care, cleaning, laundry and other household tasks. Management, quality assurance and the promotion of health, safety and welfare of service users continue to require attention. Shortfalls were found in all of these areas, for there has been no progress and coordinated approach to this aspect of care. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 7 The category of registration as detailed on the current registration certificate no longer accurately reflects the present service user group. One service user is now over 65 years and the home is providing care for a person or persons with a mental health illness. Mr Gopaul and Mrs John have been advised of the need to make an application to the Commission for Social Care Inspection (CSCI) to vary the home’s conditions of registration to meet the needs of the current service users. At the time of writing this report an application has been received for consideration. 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 DS0000017850.V308118.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 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 the following standard(s): 1, 2 & 5. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Hilton House did not provide sufficient information for people living there, or prospective service users to make an informed choice about where to live. Hilton House did not undertake a full assessment to ensure that the care home can meet prospective service users’ needs. Valid contracts/statements of terms and conditions were not in place for service users. EVIDENCE: An updated Statement of Purpose was received by the Commission for Social Care Inspection (CSCI) on 18th July 2006. As agreed on the site visit, this would be reviewed and considered in this inspection report. On reviewing this document it was evident that it had been changed and developed in stages, for within the Statement of Purpose there was a change in tense and persons, using a mixture of words such as ‘they’, ‘service user’ and ‘you’ to denote service users. There was repetition and duplication in this document; this was particularly notable in the sections dealing with adult protection and complaints and concerns and in the social activities listings. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 10 Entries as highlighted in the last inspection report still require attention, namely referencing a care worker’s sport and hotel management qualifications and the reference to the Residential Care Forum, which should be the Residential Forum Guidance. The principal concern however, was the number of confusing and inaccurate statements found in this document. For example – the home does not employ a gardener; care staff and a service user complete these tasks. Tradesmen such as a plumber and electrician are employed on a task basis only; facilities for medication administration i.e. secure locked storage are not available as described and training opportunities are not as detailed in this document. The category of the current registration is not correct within this document and referencing to nursing qualifications is not appropriate and acceptable in this document. Furthermore, some of the terminology as used in this document is either inappropriate or not in current usage. It should be noted that these errors are not an exhaustive list. The Statement of Purpose does not clearly detail the aims and objectives of the home, the facilities and services, which are provided and the requirements as detailed in the Care Homes Regulations 2001, Regulation 4, Schedule 1. The registered proprietors must review and revise this document to ensure that it accurately and fully reflects this care service. Revision is also required to the Service Users’ Guide. A copy was collected at the last inspection in May 2006 and omissions and shortfalls were noted and detailed in the report of that inspection. It is concerning to find that neither Mrs John nor Mr Gopaul have taken the opportunity to review and revise this document following receipt of the inspection report. Immediate action must be taken to review and revise this document referring to the guidance as outlined in the National Minimum Standards and The Care Homes Regulations 2001, Regulation 5, Service Users’ Guide. These are long-standing requirements initially identified as requiring completion by 31st March 2005. An immediate review of both the Statement of Purpose and the Service Users’ Guide is therefore required with copies sent to the Commission for Social Care Inspection (CSCI) as stated in the Statutory Requirements. There have been no new admissions since the last inspection. With the exception of one newly devised care plan with an initial holistic assessment, the admission assessment paperwork remains as at the last inspection and fails to meet requirements. A contract for one service user was inspected. Within this document there were no fee details. Reference was made to the placing authority, however a Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 11 second reference to another local authority evidenced that this document had been taken from another service and amendments and alterations had not been made. Whilst there were some details of what the fees covered, the detail and information was confusing particularly with regard to who met the cost of eating out and payment for public transport. This document was signed by a registered manager and the service user, but was not dated. Further work is required to ensure that service user contracts fully detail requirements as detailed in the National Minimum Standards – Standard 5. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Care planning documents did not fully detail all health, personal and social care needs and records did not fully evidence all aspects of care required. They did not sufficiently reflect service user needs, aspirations or choices or support them to take risks as part of an independent lifestyle. EVIDENCE: Hilton House had one paper copy of a care plan, which had been revised and introduced. This care plan included an initial holistic assessment, which covered twelve profile areas, which were considered and divided into strengths and needs. From these needs eight care planning objectives had been created. The format used detailed a care planning need, short term and long term goals followed by a section on how the home cares and supports the service user. This latter section had been written in an essay form and as such would prove difficult to read and extract the care required. In the feedback to the registered managers and the key worker this was highlighted and recommendations made as to how this could be overcome. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 13 Following on from the care plan a progress report is completed. The one report seen was not dated. In addition a service user’s activity plan for the week has been devised, this detailed planned activities and needs to be included in the care planning document. A second care plan, which was only held on a computer, was seen. This was still in the process of being created and the need to include outside therapies and counselling for the service user was discussed. In addition, the need to draw up care plans with the involvement of the service user, their family, friends and/or advocate as appropriate, and relevant agencies/specialists was highlighted. As at the last inspection it was not possible to ascertain if service users rights to make a decision are considered and acted upon. It was difficult to assess whether service users make decisions about their lives with assistance as needed. Furthermore there continues to be no evidence of interventions or risk assessments to support and manage behaviours, with no detailed risk management strategies and links to care planning objectives. These are all issues that need to be included in the new care planning documentation. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Service users’ wishes and interests in respect of their lifestyle were not fully integrated into the service provided. Overall, service users’ receive a healthy, nutritious varied and balanced diet to promote their health and well being. EVIDENCE: From sampling the newly devised care-planning document, it was not possible to ascertain whether the service user has opportunities for personal development. Discussion took place as to the need for the service user to attend counselling and therapy sessions to manage behaviours. As at the last inspection none of the current service user group attends adult education courses or training centres. The only training attended by some service users was entry into in-house basic training courses. Staff and Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 15 management said that they had approached a local community college to see what courses are available in the coming academic year. As at the last inspection, it is understood that some individual community activities are undertaken. Those care plans and records sampled gave some insight into this, but they did not clearly identify service users wishes and feelings on these matters. Within the new care planning documents this aspect of care needs to be developed. The implementation of the individual activity plan could be incorporated into the care planning documents. On the day of the site visit, two service users played snooker and it was obvious on their return that they had enjoyed this activity. From survey work completed by CSCI there was evidence that the home supports service users to maintain links with family and friends. Four out of the seven comment cards sent had been completed and returned to CSCI by relatives of service users. All said that they were welcomed into the home on their visits and they felt they were kept informed of important matters affecting their relative. None of the current service user group has been offered a key or has a suitable locking device to lock their own bedrooms and none of them have their own key to the front door. The need to undertake detailed risk assessments to consider these matters was discussed with the registered managers and needs to be added to service user’s individual care plans. With the installation of new kitchen fitments, appliances, flooring and tiling, the cleanliness, tidiness and storage of food supplies had improved. Whilst food supplies were not vast, there was a variety of fresh fruit and vegetables, some frozen, tinned and dried food. The registered managers said that they prefer to shop frequently to replenish stocks. This was confirmed by two care staff members. Menu planning and nutrition records had been revised and these now clearly detailed both choice and selections made. At breakfast a selection of cereals was listed and at lunchtime there were two or three choices. On the day of the site visit this was evident with all three choices prepared and served to service users. With all the changes and decoration going on, lunch was served in the garden under a gazebo. Service users were seen to be enjoying their meal, which had been plated and served to them. A dessert of individual apple pies and fresh fruit was offered, with the majority of the service users choosing apple pies. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 16 Choice was more limited at teatime, the majority of entries referred to sandwiches and the occasional soup. Further expansion of this menu should be considered. With regard to a service user with a diagnosis of a chronic bowel difficulty, the inspector was informed that some PRN medication and sufficient vegetables and fruit in their diet managed this condition. The inspector was informed that a special diet was not necessary. This needs to be clearly detailed in their care plan. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 18, 19 & 20. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home’s arrangements for supporting the healthcare of service users were not satisfactory. EVIDENCE: As detailed in Standard 6, a revised care planning format has been developed. As this is in it’s infancy, it was not possible to ascertain if service users receive personal support in the way that they prefer. This will need to be detailed in care planning documentation. Some aspects of health care are covered within the initial holistic assessment and the newly created care plan. Within all documentation these will need to be clearly detailed to ensure that service user’s physical and emotional health care needs are met. Overall daily record keeping covering health care needs was satisfactory, although it was evident that some omissions were made regarding sun screening application. The inspectors were informed that ‘Health Action Plans’ have been completed by and on behalf of all service users and records Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 18 detailing appointments and visits to the chiropodist, dentist and doctor were seen on those files sampled. As stated earlier in this report, there is a need to detail both the medical and nutritional screening detail within care planning records of the service user diagnosed with a bowel problem. In addition the mental health needs of at least one service user needs to be addressed in the new care-planning format. Service users’ medication had been removed to a kitchen cupboard whilst the office was being re-decorated. At the first site visit, the administration, storage and record keeping was not inspected, for a second visit with a CSCI Pharmacist Inspector was made the following day – 27th July 2006 and the management of medication was inspected in full. An immediate requirement was left at this visit and Statutory Notices were sent subsequent following this inspection. Written policies and procedures were provided on the inspection but these were not available in the home’s policy and procedures folder. These are reasonably comprehensive but are not signed or dated to indicate they are current. There is evidence that staff do not follow these written procedures. The described procedures for obtaining repeat prescriptions and medicines are fairly robust. The home staff have sight of the original signed prescription before it is dispensed but a copy is not retained. Three service users are currently self-medicating to a limited extent. They are not permitted to store their medication in their own rooms; it is stored centrally with all the other medication in use in the home. There is no formal risk assessment process in place for service users who self medicate despite this being a requirement of the home’s policy. Medication record forms detailing current medication are completed by staff each month but these were inaccurate; examples include, but are not limited to: • Medication supplied and administered which was not recorded. • Medication labelled to be taken twice a day but recorded on the form as once a day • Medication for which the dose to give was not stated • Medication labelled to be given daily but recorded as twice a day. • Medication signed as being administered, but where the corresponding dose remained in the container. An immediate requirement notice was served to ensure medication is administered in accordance with the prescriber’s instructions and that medication is recorded accurately and correctly. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 19 Two service users are prescribed medication on a ‘when required’ basis. There are protocols in evidence specifying the circumstances when this medication is used, but on one occasion when this was used for one service user, the daily records gave no indication that the service user’s behaviour meant that its administration was justified. There is also no indication of who completed the medication record or when. Records of the receipt and disposal were also incomplete giving no clear audit trail, despite this being a requirement of the home’s own policy. Records of the results of medical and health related contact made in the care notes were acceptable. The office area is currently being refurbished and so temporary storage has been provided in the kitchen for medicines in current use. The storage cupboard was unlocked and accessible to service users at the time of the inspection. This is an unacceptable security risk as it puts service users at risk of taking medicines not prescribed for them. Medication is provided mainly in Medidose containers by the supplying pharmacy. Some of the medication containers carried faded identification labels, which were difficult to read and one Medidose container held two different types of medication, but only one identifying label. An immediate requirement notice was served to ensure that the container is correctly labelled to enable staff to identify what medication is being administered. Some medication had bought for use on a discretionary basis for the treatment of minor ailments of service users. There were no detailed protocols or records for the use. No separate facilities are provided for the storage of medicines controlled under the Misuse of Drugs Act 1971. There is no dedicated register used for the recording of controlled drugs. No controlled drugs were currently in use. The provision of a suitable cupboard and register should be considered as stated in the home’s own policy documentation. Basic training on the safe use of medicines has been provided for some staff authorised to administer medicines. Relevant attendance certificates were seen for two staff members and were retained in the training file. It was reported that staff are supervised before being permitted to administer medication, but there is no documentary evidence of an assessment of competence. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Records and observation did not evidence that service users’ views were listened to or acted upon. Policies and practice do not sufficiently protect service users from abuse, neglect or self-harm. EVIDENCE: As at the last inspection, the goals and aspirations of service users were not detailed in the newly formatted care planning documentation and therefore it continues to be difficult to ascertain whether service users make decisions about their lives. Whilst it is acknowledged that service user meetings are held and they do provide a venue for service users to make their views known, minutes and records of these meetings were not found to evidence this aspect of care. A copy of the home’s complaints procedure was found in the Statement of Purpose entitled – ‘Concerns and Complaints.’ Timescales regarding the management and completion of a complaint investigation were shorter than those proposed by the National Minimum Standards. This document did not detail the procedure and practice as to informing the complainant of the outcome of the investigations and the action to be taken. Within this procedure there was reference to the Commission for Social Care Inspection (CSCI) investigating the complaint. The registered managers were Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 21 informed that this is not the role of CSCI and changes are needed to the home’s complaints procedure to fully reflect the regulation and inspection role of the Commission for Social Care Inspection (CSCI). A second edition of a ‘Complaints Procedure’ is to be found in the Service Users’ Guide. This was again in a different format and contradicted both the process and timescales for investigation as detailed in the other complaints procedure in the Statement of Purpose. Both care staff spoken with were aware of the home’s complaints procedure, although one staff member was unsure where to find a copy of the procedure. This was not surprising considering the contradictions and variant in the detail of the procedures. Immediate action is required to ensure that the home has a clear and effective complaints procedure. As with the home’s complaints procedure a copy of the home’s adult protection procedure entitled – ‘Abuse and Neglect’ was to be found in the Statement of Purpose. This document was found to be equally confusing and inaccurate. Clear clarification is required to detail the differences between following the home’s complaints procedure and following Protection of Vulnerable Adults (POVA) procedures. A second policy entitled – ‘Policy on Abuse’ was handed to the inspectors at the site visit. Whilst the information and detail in this document bear a greater resemblance to those referred to in the National Minimum Standards, this too was confusing. It would appear to be two procedures, one for care staff and one for service users. Hilton House is advised to review and revise their adult protection policies and procedures to fully meet requirements, ensuring the safety and welfare of service users. Management and care staff spoke of the receipt of a DVD adult protection training package as produced by Essex Vulnerable Adults Protection Committee. Management and staff need to review this package and also resource external adult protection training to consolidate the home’s understanding and awareness of the protection of vulnerable adults. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 22 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 the following standard(s): 24, 25, 26 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. There had been some improvement in the furnishings and furniture in the home. There has been some improvement in the cleanliness of Hilton House. EVIDENCE: A partial tour of the premises was conducted at the site visit. It was evident that considerable changes are taking place in the home. New carpet had been fitted the previous day in the communal areas, hallways, staircase and bedrooms. The home’s office was being decorated on the day of the site visit. The registered managers said that the home had purchased a new larger, dining room table and chairs, new sofas for the lounge and new office furniture was to be purchased. On a second site visit the following day, the home had taken delivery of the new sofas and dining room table and chairs. New curtains had been hung in the lounge and dining room. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 23 As stated earlier in this report, new kitchen fitments and appliances have been added, with new kitchen wall and floor tiling. A new extractor fan was waiting to be fitted over the oven. Two service users were keen to show the inspectors their new bedroom carpet, which had been fitted the previous day and a third service user wished to show us their bedroom with new carpet and a new wardrobe. The inspectors were informed that new bathroom suites are to be installed in the immediate future, prior to starting the building work on the new extension. On the second site visit day, work had commenced on replacing a bathroom suite. Whilst it is acknowledged that the new furniture and furnishings do provide a cleaner, brighter environment, attention is still required to the decoration of the home, walls and paintwork still remain stained, chipped and dirty. The home needs to devise a planned maintenance and renewal programme for the fabric and decoration of the premises, with records kept on completion. Some consideration has been given to the bedroom furnishings and fitments. Some bed linen and duvets had been replaced, although old duvets were still being held within service users’ cupboards. At the time of the site visit, some service users rooms were being reorganised and it is hoped that this could be completed for all service users with an audit completed of furnishings and furniture to ascertain whether the home is meeting requirements as detailed in National Minimum Standards – Standard 26. Service users’ bedroom doors were not lockable. This was discussed with the registered managers. There is either a need to clearly detail the reasoning for this shortfall within the individual’s care plan or a risk assessment needs to be implemented to indicate when staff may use an override device. The laundry facilities remain as found at the last two inspections. There is one washer and one dryer of domestic type. The storage of bleaches and cleaning materials continues to give cause for concern, for these continue to be stored in an unlocked cupboard, which was easily assessable by service users. Several of the laundry cupboards and units are broken and without doors. The laundry baskets located outside the laundry have been removed. Whilst it is acknowledged that the laundry area will undergo considerable change with the building of the new extension, the need to make safe these health and safety hazards continues to be a major shortfall. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. It was not clear that there were sufficient staff at the home to carry out all of the necessary roles (cleaning, decorating, cooking, laundry and care) and to adequately meet the needs of service users. Hilton House’s recruitment policy did not meet requirements and therefore does not support and protect service users. There was not sufficient evidence to demonstrate that staff were adequately supervised, trained or supported in their roles. EVIDENCE: As at the last inspection, roles and responsibilities were not clearly defined in the home. Whilst staff were willing, it was clear that they had limited knowledge and understanding with regard to the care of service users. This was highlighted by the lack of basic training relating to health and safety work practices completed by care staff. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 25 In addition care staff had not been provided with the necessary training and information to care for service users. This was demonstrated on the day of the site visit by both management and staff in the handling of a situation regarding the ownership of an item of a service user’s property. Whilst it was acknowledged that this was a dispute over ownership, staff and management did not have or follow agreed, identified management strategies to manage this situation. Within eight staff records sampled only two contained references to staff holding the General Social Care Council (GSCC) Code of Practice and no job descriptions were held on file. A total of eight staff files were inspected by the two inspectors and only one of the eight contained any evidence of NVQ training, despite the fact that the Inspection Questionnaire completed in January 2006 stated that three care staff had completed NVQ Level 2 or above. One care worker did have a diploma of Higher Education in Health & Social Care and a BTEC in Health & Social Care. Staff rotas were inspected and copies were taken of the three weeks from week beginning 10th July 2006. It is noted that overall there had been an improvement in the staffing levels in the home; on the rota there were three care workers and a person in charge in the morning, with two care workers and a person in charge during the afternoon shift. At night the rota detailed one awake and one asleep care worker. Additional staff had been rostered to assist with furniture removal etc. during the recent changes to the premises. Whilst there has been a decrease in the number of staff working excessively long hours, it was noted that one care worker was rostered as having worked every day over the three weeks and in addition was covering five nights a week of which thirteen were sleep-in duties and two were awake nights. As stated in the last inspection report, concerns are felt for not only the care worker, but also the care service users receive when staff are working such long hours. These are matters that the management needs to review immediately. In addition, staff rotas did not detail staff duties with regard to catering, laundry and maintenance tasks. As stated in the last inspection these need to be detailed to fully record care duty hours and auxiliary duty hours. Whilst the staff team during the daytime hours reflected the gender composition of the service users, this was not the case at night for only male carers were rostered. This was as found on the three week rotas collected at the site visit. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 26 The registered managers said that the home has both staff and service user meetings. Management said that the most recent service users meeting was June 2006, but care staff spoke of a meeting taking place in July 2006. Management were unable to find minutes of either meeting. Staff meetings were said to be held and copies of minutes were seen for January 2006 and May 2006. The need to hold staff meetings more frequently (minimum of six per year) was highlighted at this inspection. Of the eight staff files sampled and inspected, the following omissions were noted: • • No photographs. Criminal Record Bureau (CRB) Disclosure – three files contained CRB certificates, one contained an applicant’s copy instead of an employer’s copy, one contained a photocopy of the applicant’s copy and the remaining files did not contain CRB certificates. For the latter there were no records kept as to whether these disclosures had been completed and destroyed following the appropriate timescale and inspection. Incomplete employment history found on an application form. Three files did not contain application forms. Three files contained contracts, one was blank and the other two were not completed and signed. Only one reference on the file of one staff member; another contained two references but both were from colleagues and none was from an employer. • • • • The registered managers were advised to review all staff files to ensure that these meet requirements. A new format for an employment application was shown to the inspectors and it was said that this was to be introduced. As at the last inspection there was no evidence of a staff development training programme and the induction training that was seen was incomplete. Of the eight files sampled and inspected, three had only either an in-house induction training record sheet or an incomplete Learning Disabilities Accredited Framework (LDAF) induction training record. Of the eight staff files sampled and inspected only four staff members had any records relating to supervision. On one of these files the records related to supervision sessions in October and December 2005 and February 2006. They were brief and did not meet National Minimum Standards requirements. On two staff files there were completed annual appraisal forms. One of these was of previous years, 2004 and 2005 and the other was not signed or dated by the care worker or the home. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 27 Overall the staff files examined contained a variety of information that was not well organised. Many of the records relating to training were out of date, such as Moving & Handling in February 2004, Fire training in September 2004 and Abuse training in March 2005. One staff file contained evidence of Moving & Handling in February 2005, Fire Safety in March 2005 and Health & Safety/COSHH training in January 2005; other certificates were from training with a previous employer. One staff file contained an application form in which the applicant had answered ‘yes’ to the question “Do you require a work permit?” but there was no evidence of a work permit on file. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Hilton House is not satisfactorily managed. EVIDENCE: As at previous inspections, the Commission for Social Care Inspection (CSCI) continues to have concerns regarding the management and care practice within the home. Once again the number of standards inspected are assessed as having major shortfalls, which calls into the question the leadership and management skills of the registered managers. Since the last inspection, arguments and disputes have led to the Police being called to the home. This clearly cannot continue for this situation has led to lower staff morale and a poor care service. Both Mr Gopaul and Mrs John were made fully aware of the Commissions concerns at this inspection. As noted at the last inspection this care service is not registered to provide care for a person with a mental health illness and it continues to provide a Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 29 service to people whose needs fall outside of its current registration. It was also noted that one service user is over 65 years and this will need to be detailed in a condition of registration. These are issues, which have been raised with the proprietors under separate letter and a variation application had been received at the time of writing this report. As at the last inspection, survey work had been completed. This was based on the National Minimum Standards. Relatives, staff and service users had completed these surveys. The need to develop an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and objectives for service users was discussed with the registered persons. Staff records sampled showed a lack of basic training. Evidence was seen of some training, the most recent being care planning in May 2006. Staff interviewed confirmed that this training had taken place; one felt that this training had been useful, whilst the other care staff member felt it had not been useful. Staff interviewed were not aware of any further planned training. Training relating to safe working practices as detailed in National Minimum Standards – Standard 42 were considered. On three of the eight files sampled there was evidence of both moving and handling training and first aid training. These were certificates, which stated they had a lifespan of three years, and will require renewal in 2007. On the files sampled and inspected there was no evidence of fire safety, food hygiene and infection control training, although two files had evidence of fire training in 2004. A certificate detailing the visit for annual fire extinguisher certification was put forward as fire safety training, when this was clearly not it’s intended purpose. A Food Hygiene and Health & Safety Inspection had taken place in July 2006. An invitation had been given to the home to attend a training course for the introduction of the ‘Safer Food, Better Business’ risk assessment process. No one from the home at attended this session. The registered managers were advised of the need to pursue this training as soon as possible. As stated earlier in this report, the lack of basic training for all care staff does give CSCI concern. Poor care practice, lack of knowledge and understanding by care staff and management are all issues, which need to be overcome in the immediate future. Practices and procedures in place regarding the health and safety of service users was sampled and considered at this inspection. Still outstanding from the last inspection, is the need for the home to record hot water temperatures on a weekly basis. Mr Gopaul said that this had not been actioned since the last inspection, as a recording format had to be devised. Immediate action is required to complete this outstanding requirement. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 30 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 1 2 1 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 2 26 2 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 1 32 1 33 1 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 X 1 X LIFESTYLES Standard No Score 11 1 12 1 13 1 14 1 15 3 16 1 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 X 1 X 1 X X 1 X Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4, Schedule 1 Requirement The registered persons must ensure that the Statement of Purpose provides information required by the Care Home Regulations 2001. Copies are to be sent to CSCI. This is a repeat requirement from the last four inspections. Previous timescales of 31/03/05, 01/05/06 and 17/07/06 were not met. The registered persons must ensure that the Service Users’ Guide provides information required by the Care Home Regulations 2001. Copies are to be sent to CSCI. Timescale for action 22/09/06 2. YA1 5 22/09/06 3. YA2 14, 15 This is a repeat requirement. Previous timescales of 31/03/05, 01/05/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving prospective service DS0000017850.V308118.R01.S.doc Version 5.2 Page 32 Hilton House users, using appropriate communication method and with an independent advocate as appropriate. This is a repeat requirement. Previous timescales of 17/07/06 was not met. The registered persons must 22/09/06 ensure that clear, accessible statements of terms and conditions are in place for each person living at the home. This is a repeat requirement. Previous timescales of 01/03/05, 01/05/06 and 17/07/06 were not met. The registered persons must 22/09/06 review and revise the current service users plan of care and records to ensure that all aspects of the health, personal and social care needs of the service user are met. This is a repeat requirement. Previous timescales of 31/08/05, 01/05/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that care plans cover all needs, aspirations and risk and that action plans are fully documented. This is a repeat requirement. Previous timescales of 31/08/05, 01/05/06 and 17/07/06 were not met. 22/09/06 The registered persons must ensure that arrangements are made to promote the health and wellbeing of service users. This is a repeat requirement. Previous timescale of 31/03/06 and 17/07/06 were not met. DS0000017850.V308118.R01.S.doc Version 5.2 Page 33 4. YA5 5 5. YA6 14, 15 6. YA7 YA9 YA11 YA12 YA13 YA14 YA16 13, 15, 18 7. YA18 YA19 12,13 Hilton House 8. YA20 12,13 The registered persons must 22/09/06 ensure that medication is only administered in accordance with the prescriber’s instructions. This requirement is the subject of a statutory requirement notice. This is a repeat requirement. Previous timescales of 01/03/05, 31/03/06 and 17/07/06 not met. The registered persons must 22/09/06 ensure that an accurate record is kept of all medication received, stored, administered (or not administered) to service users, and disposed of. This requirement is the subject of a statutory requirement notice. This is a repeat requirement. Previous timescales of 01/03/05, 31/03/06 and 17/07/06 not met. 22/09/06 The registered persons must ensure that medication is stored securely to prevent unauthorised access. This requirement is the subject of a statutory requirement notice. This is a repeat requirement. Previous timescales of 01/03/05, 31/03/06 and 17/07/06 not met. The registered persons must 22/09/06 ensure that protocols exist for the use of medicines administered on a discretionary basis and the reason for their administration recorded. 9. YA20 12,13,17 10. YA20 13 11. YA20 12 Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 34 This requirement is the subject of a statutory requirement notice. This is a repeat requirement. Previous timescales of 01/03/05, 31/03/06 and 17/07/06 not met. The registered persons must ensure that staff adhere to the written policy and procedures for the safe handling of medicines. The registered persons must ensure that a full risk assessment and risk management plan are completed for those service users who self-medicate. The registered persons must ensure that all staff authorised to administer medicines have been trained and assessed as competent to do so. The registered persons must take steps to ascertain and respond to the views of people living at the home. 12. YA20 13 22/09/06 13. YA20 13 22/09/06 14. YA20 13 22/09/06 15. YA22 16,24 22/09/06 16. YA22 22 This is a repeat requirement. Previous timescales of 31/05/06 and 17/07/06 were not met. 22/09/06 The registered persons must review and revise the home’s complaints procedure to ensure that it meets requirements Care Home Regulations 2001. This is a repeat requirement. Previous timescale of 17/07/06 was not met. The registered persons must 22/09/06 ensure that service users are protected from abuse, neglect and self-harm. This is with regard to the Adult Protection policy and procedure. DS0000017850.V308118.R01.S.doc Version 5.2 Page 35 17. YA23 18,13 Hilton House 18. YA24 YA25 23 This is a repeat requirement. Previous timescales of 31/05/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that the premises are kept in a good state of repair and decoration, externally and internally, and that they provide satisfactory furniture and bedding for service users. This is a repeat requirement. Previous timescales of 01/07/05, 31/05/06 and 17/07/06 were not met. The registered persons must 22/09/06 provide each service users with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. Particular consideration must be given to the provision of bedroom door locks. This is a repeat requirement. Previous timescale of 17/07/06 was not met. The registered persons must 22/09/06 ensure that the premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. Particular attention is required to the laundry and storage of hazardous materials. This is a repeat requirement. Previous timescale of 17/07/06 was not met. 19. YA26 23 20. YA30 16,23 Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 36 21. YA31 18, 19, 24 The registered persons must ensure that staff have clearly defined job descriptions and understand their own and others’ roles and responsibilities. 22/09/06 22. YA32 18, 19 This is a repeat requirement. Previous timescales of 31/04/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that service users are supported by competent and qualified staff. This is a repeat requirement. Previous timescales of 30/04/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that staff are available in sufficient numbers and with sufficient skills to meet the needs of service users. This is a repeat requirement. Previous timescales of 31/04/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that there is a thorough recruitment procedure in place to support and protect service users. This is a repeat requirement. Previous timescale of 17/07/06 was not met. The registered persons must 22/09/06 ensure that there is a staff training and development programme, which meets Sector Skills Council workforce training targets. This is with particular regard to induction and foundation training. 23. YA33 18, 19, 24 24. YA34 17, 18, 19, 24 25. YA35 17, 18, 19 Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 37 26. YA36 18 27. YA37 12 This is a repeat requirement. Previous timescales of 31/04/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that staff receive support and supervision they need to carry out their jobs. This is a repeat requirement. Previous timescales of 31/04/06 and 17/07/06 were not met. The registered persons must 22/09/06 ensure that the home is run in such a manner as to meet the needs of service users. This is a repeat requirement. Previous timescales of 31/05/06 and 17/07/06 were not met. 22/09/06 The registered persons must develop an effective quality assurance and quality monitoring systems to ensure that the best interests of the service users are met. This is a repeat requirement. Previous timescale of 17/07/06 was not met. The registered persons must 22/09/06 ensure that so far as is reasonably practicable the health, safety and welfare of service users and staff is safeguarded through the promotion of safe working practices, ensuring basic training opportunities are offered and compliance with health and safety legislation. This is a repeat requirement. Previous timescale of 17/07/06 was not met. 28. YA39 24 29. YA42 12, 13, 17 Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 38 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. Refer to Standard YA20 YA20 YA33 Good Practice Recommendations The registered persons should ensure that the policy and procedures are signed and dated to indicate they are current. The registered persons should consider retaining a copy of the signed prescription in order to validate the prescriber’s instructions. The registered persons should ensure that regular staff meetings take place (minimum of six per year) and they are recorded and actioned. Hilton House DS0000017850.V308118.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex 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 DS0000017850.V308118.R01.S.doc Version 5.2 Page 40 - 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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