Inspection on 04/05/06 for Hilton House

This inspection was carried out on 4th May 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 33 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 26/07/06

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 4 & 15th May 2006 10:00 th Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 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.V293086.R01.S.doc Version 5.1 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.V293086.R01.S.doc Version 5.1 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 Syliva John Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 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) 18th November 2005 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.V293086.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over the period of 4th to 15th May 2006. In addition to the two days unannounced site visits, a total of 14 hours per Regulation Inspector, a record of inspection was collated prior and during the inspection process. There were two inspectors at each site visit, Regulation Inspectors Pauline Dean and Ray Finney. These visits involved speaking with service users and staff. Within the service user group there were a limited number of persons who were able to verbalise their views and feelings and therefore the inspectors relied on evidence gathered through observation on the site visits. Both Mr Gopaul and Mrs John the registered proprietors/managers were present during both site visits and assisted the inspectors on each occasion. Over the two site visits a tour of the premises was conducted and the inspectors observed care practice and staff and service user interaction. Where possible, the site visits focussed on the experience of a sample of three service users, a process known as case tracking. Both care and staff records were sampled and inspected, as were some policies and procedures. All key National Minimum Standards and National Minimum Standards detailed in the last inspection’s Requirements and Recommendations were inspected at this inspection. Overall, the service provided by the home was considered to be poor. What the service does well: What has improved since the last inspection? Since 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 done on redrafting both the Statement of Purpose and the Service Users’ Guide, further work is required. Furthermore the proprietors had given Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 6 thought to the redrafting on service users’ care plans and risk assessments, but until the home adopts a uniform, planned approach to record keeping and policies and procedure development they will not meet requirements. 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. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 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.V293086.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 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 all service users. EVIDENCE: Both the Statement of Purpose and the Service Users’ Guide have been reviewed and re-written since the last inspection. There has been some improvement, but further work is required. Whilst it can be seen that some attention has been paid to the guidance produced by the Commission for Social Care Inspection (CSCI), some omissions and shortfalls were noted. Within the Statement of Purpose there is reference to both service users and residents. To avoid confusion, the use of one of these terms only is preferable. There is some duplication in this document, namely the relevant qualifications and experience of the registered Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 9 providers/managers; referencing a care worker’s hotel management qualification twice; social activities listing; the home’s emergency admission procedure and the listing of adult abuse categories. There were some inaccuracies found in this document namely reference to the Residential Care Forum, which should be the Residential Forum Guidance and it was not clear as to the number of care staff working at the home. In addition an important omission noted was the number and size of rooms in the home; the age group and category of registration and details of any specific therapeutic techniques used in the home and the arrangements made for their supervision. None of these are detailed in this document. It should be noted that this is not an exhaustive list and a comprehensive review of this document is required to ensure that it meets requirements as detailed in the National Minimum Standards – Standard 1 and The Care Homes Regulations 2001 – Regulation 4 – Schedule 1. Revision is also required to the Service Users’ Guide. A copy was collected on the second site visit. Following a review of this document some omissions and shortfalls are noted, namely only Mrs Sylvia John is listed as the home’s manager; the terms and conditions and the fees charged and what they cover and what are ‘extras’ are also missing. Whilst an attempt has been made to present this document in a pleasing format, the content is not appropriate for the service user group especially with regard to the sections numbered 1 – 14 under the heading of ‘Aims and Objectives’. The inspector believes that current service users and prospective service users would have little understanding or comprehension of the detail of these sections. The home is reminded of the need to refer to the guidance as outlined in the National Minimum Standards – Standard 1.2 and The Care Homes Regulations 2001 – Regulation 5 – Service Users’ Guide. As stated at the last inspection, the provision of information in the prescribed format is a long-standing issue initially identified as requiring completion by 31st March 2005. An immediate review of these documents is therefore required with copies sent to the Commission for Social Care Inspection (CSCI) as stated in the Statutory Requirements. Of the three service users’ files sampled, there was some evidence of an assessment of needs possibly completed prior to admission. On at least two of the files inspected, paperwork was undated. Paperwork was also found in different formats, in one case the initial assessment was entitled – ‘Plan of care.’ This may create confusion. In addition it was not clear from reviewing this paperwork whether the prospective service user had been involved in this process or not. There was some evidence of completed risk assessments being completed, although once again these were not dated and had limited information. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 10 At this inspection the inspectors were shown a completed contract with terms of conditions. Whilst it is acknowledged that some changes had been made to this document, further work is required to ensure that this document is written in a format suitable for people living at the home and it is in either first person or in third person throughout. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 11 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 and 9. Quality in this outcome area is adequate. 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 and support them to take risks as part of an independent lifestyle. EVIDENCE: Both the initial assessment process and the development of care plans were sampled and inspected for three service users at Hilton House. Omissions and shortfalls were found in the care planning documentation. There were a variety of documents in place relating to care planning, some in better order than others. Within this documentation there was some evidence of care planning objectives and strengths and needs. However, records made were negative, with some entries by staff using inappropriate terminology and negative language. Thought should be given to devising a plan of care in a language and format that the service user can understand e.g. visual, simple Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 12 printed English, graphic etc. None of the files sampled had photographs of the service user. As at the last inspection, the plan of care did not evidence consultation with the service user, although there were several examples of where the service users and relatives had signed documents, for example a document entitled ‘Agreement of Management Guidelines.’ As noted at the last inspection one service user’s assessment, undertaken by the home, suggested that the service user required care and personal support by way of aggressive behaviour, irresponsible and anti-social behaviour, selfinjurious behaviour and was confirmed as having a past and present mental illness. Care objectives in place for this service user did not identify this need in full. Weekly record keeping was in place, but there was no review of care evident. There was no evidence of interventions or risk assessments to support and manage this behaviour. Care planning was inadequate either in the care and support provided or in it’s failure to monitor the situation relating to an initial identified care needs. Furthermore, this care service is not registered to provide care for a person with a mental health illness and is therefore providing a service to people whose needs fell 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 will be covered later in this report. From care planning record keeping it was difficult to see if service users rights to make a decision are considered and acted upon. Risk assessments seen were limited and did not appear to be linked to care planning objectives and records did not detail instances when decisions are made by the service user or others and why. During the two site visits, for the majority of the service users there was no evidence of service users making decisions about their lives. There was evidence to show that relatives of service users were endorsing decisions on behalf of service users and evidence to demonstrate that service users signed documents on their own behalf. However, good practice maintains that the service must assume capacity for service users to make their own decisions, with support from advocates or other suitable person, unless there is evidence to the contrary. This needs to be clearly detailed in record keeping and care planning. As stated earlier in this report, there was evidence of poor risk assessment practice. Risk assessments seen contained minimal information and did not have detailed risk management strategies agreed and set, linking into care planning outcomes for service users. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 13 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 and 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. Service users’ are not offered a healthy, nutritious varied and balanced diet to promote their health and well-being. EVIDENCE: From inspection of care planning record keeping and some discussion with some service users, it is understood that some individual community activities are undertaken, although record keeping did not clearly identify service users wishes and feelings on these matters. 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. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 14 An activity calendar is kept in the home. Individual record keeping in relation to social activities attended were seen, but was very limited and did not sufficiently detail this aspect of care. The inspectors were informed that the majority of service users have contact and involvement with family, relatives and friends. Unfortunately no visitors were present at the time of this inspection to test this out. Future survey work will be undertaken to ascertain the involvement of family and friends in the care of service users and care planning reviews. On the first site visit, the inspectors observed all seven service users having lunch around the dining table. Whilst service users were able to serve themselves from vegetable dishes, the assortment of serving dishes, crockery and cutlery did not enhance the setting. It was also the view of the inspectors that there was limited space at the dining table and an eighth service user (should the home be full) would mean there was even less space at mealtimes. Records were seen of meals provided by the home. From these records it was evident that there was little variety. This was particularly the position regarding lunchtime desserts, which were regularly ice cream and rice pudding. There was no evidence of fresh fruit on the menu and fresh fruit was not seen on the day of the second site visit. This was particularly concerning for as food supplies for the week were said to have been purchased only three days before. Furthermore there was no evidence of fresh vegetables in the home other than potatoes. Service users were said to have frozen and tinned vegetables instead. Food supplies seen in the fridge, freezer and kitchen cupboard was sufficient. Own brand labels from different supermarket stores were seen. Prepared foods, such as lasagne and quiches were on the menu, but roast lunches were noticeable in their absence. This was highlighted with the registered providers. Heavy reliance on convenience foods can mean that meals are deficient in vitamins, particularly C and D and this can have an effect on service users’ health. The tidiness and arrangements in the kitchen were poor. Food supplies were stored in cupboards around the kitchen and there appear to be no logical system of storage. Food supplies, which had been opened i.e. flour, were not stored in enclosed containers and opened food in the fridge was not labelled or dated. Both the fridge and freezer were kept locked. The only consideration to a specialised diet was for one service user who was diagnosed with a chronic bowel difficulty. Liquid diets were detailed on display in the kitchen for this service user, although it was unclear from the record keeping whether these considerations are taken into account. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 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: At both site visits management/service users interaction was observed. During these visits the inspectors noted two examples of rudeness observed between both the managers and service users. On both of these occasions management were inconsiderate and insensitive to service users and their needs. Whilst there were some records relating to health care issues, these were not found in care planning objectives or followed up in the record keeping and reviews. A new Health Assessment Care Plan had been devised for one service user, but this was purely a list of health care needs with no detail of how the service will meet the current and changing needs and achieve goals. As at the last inspection there was no medical or nutritional screening detail on the records of a service user diagnosed with a bowel problem and as previously Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 16 mentioned, the mental health needs of at least one service user were not adequately addressed. Medication administration, storage and record keeping was sampled and inspected for three service users. Medication is dispensed in a dossett box for each individual service user. All of the dossett boxes were labelled, but several of the labels were faded and worn and they were not always clear and readable for both service users and care staff to ensure medication is administered correctly. The managers spoke of a new system being introduced and the inspectors were informed of a recent pharmacy assessment being carried out at the home. Three service users were said to be self-medicating and they are encouraged to sign the record sheets on taking medication. This medication is kept with other medication administered by staff in the office. Medication administration record sheets were sampled and inspected for three service users and whilst a medication for a service user was said to have been taken at lunchtime, records had not been completed to record this. Two service users were found to be prescribed Controlled Drugs (CD). They were held in a domestic bathroom cabinet, which was locked with a small padlock and key. The managers were advised to review the storage and administration of these Controlled Drugs to ensure that they are administered and stored as detailed in the guidance issued by the Royal Pharmaceutical Society of Great Britain. In addition to the above shortfall, the home should review the management and protocol for the administration of PRN (as needed) medication, to ensure that medication is administered correctly. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 17 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 and 23. Quality in this outcome area is adequate. 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: The goals and aspirations of service users were not detailed in their individual care plans and therefore it was difficult to ascertain whether service users make decisions about their lives. Whilst it is acknowledged that there are documents with service user’s and relative’s signatures on to evidence that the home is meeting this standard, service users did not have independent advocates to support them in making decisions about their lives. At the second site visit, both the complaints procedure and the adult protection policy were inspected. On reviewing copies of these procedures found in the Statement of Purpose and the Service Users’ Guide some shortfalls were noted in these procedures . The complaints procedure in the Statement of Purpose requires amendments for there are inaccuracies regarding the referral of complaints to the Commission for Social Care Inspection (CSCI), reference to the National Minimum Standards and insufficient detail regarding the management of complaint investigations and response timescales. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 18 In the Service Users’ Guide, the Complaints procedure is presented in a different format and is more in keeping with the requirements as detailed in National Minimum Standards – Standard 22. As at the last inspection the home’s policy in respect of adult protection as found in the Statement of Purpose states ‘robust procedures are in place for responding to suspicions of abuse’, but it does not state what these are. In addition there is no reference to the responsibility of staff to report suspicions or to the local authority procedures. Within the Service Users’ Guide there is no reference to adult protection and as to how service users may make referrals or what action they should expect to happen having raised a concern. Whilst this is concerning, two staff interviewed had some understanding of adult protection and adult abuse, although it was not entirely clear whether they understood the stages of referral and investigation. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 19 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Hilton House was not well maintained with much of the accommodation and furnishings of poor standard. Hilton House was dirty with offensive odours in bathroom areas and a service users’ bedroom. EVIDENCE: Since the last inspections both the front wall and the forecourt of the home have been repaired and replaced. Some internal decoration had taken place. This however was incomplete for woodwork still remains stained, chipped and dirty. This was particularly noticeable in the hallway. Further decoration is still required in a number of bedrooms and bathrooms, laundry and kitchen. Regarding the latter, the registered providers said that the kitchen fitments were being replaced at the end of May 2006. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 20 The overall impression of the home was that it was shabby, with a mis-match of old, outdated furniture alongside new bedroom furniture. The managers said that the service users had purchased the new furniture and they were reluctant to get rid of the old furniture. In the home there were several school/office type computer desks and office chairs. These desks did appear out of place for none of the service users had computers. Within the bedroom accommodation there was little evidence of personal possessions such as framed pictures and photographs. One service user who had a television in his room told the inspectors that it was not working. This was pointed out to the managers. There was some evidence of new bed linen and duvets, although the reasoning for having both a day duvet and a night duvet in spite of questioning staff was not clear to the inspectors. All bedroom doors were not lockable. The need to clearly detail the reasoning for this shortfall should be considered in each individual’s care plan. There was an odour of urine in one of the bedrooms. Bathroom, shower facilities and toilets in the home were of a poor standard. All were worn and stained, with the exception of the shower room toilet, which had a new cistern fitted, which appeared to be leaking. This was drawn to the attention of the managers. The cleanliness in all of the bathrooms and toilets was of a poor standard. There was an odour of urine in two of the bathrooms and evidence of faeces in one of the bathrooms. It was clear that the bathroom and toilets are not cleaned regularly. In both the en-suite bathroom in the double bedroom and the main first floor bathroom there were no toilet rolls, towels or soap. Toilet roll holders and towel rails were broken in both of these bathrooms. The en-suite bathroom used by staff was in a slightly better condition, although this bathroom had a dirty, stained bath and a worn toilet seat. All of the above shortfalls were raised with the managers and whilst it is recognised that individual toiletries are purchased and provided by each service user, the need to have communal toilet requisites as listed above and clean bathing and toilet facilities is a paramount need. The laundry facilities remain as found at the last inspection. There is one washer and one dryer of domestic type. The storage of bleaches and cleaning materials gave cause for concern. These were found in an unlocked cupboard, which was easily assessable by service users. Laundry baskets located outside the laundry were broken, one having sharp jagged edges which presented as a safety hazard. These shortfalls were raised with the managers as requiring immediate action. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 21 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, 34, 35 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There was not sufficient staff at the home to carry out all of the necessary roles (cleaning, decorating, cooking, laundry and care) and to adequately meet 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: 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 particularly noticeable with regard to appropriate management and care and record keeping in care plans when dealing with anti-social behaviour. Terms such as ‘lies’ were used in these notes. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 22 The staff recruitment files of two care workers were sampled and inspected. One of these staff members was the key worker to one of the service users whose care was inspected in detail. As at the last inspection there were some training certificates held on file. Many of these were ‘in-house’ courses. In the two care workers files inspected, training certificates seen included abuse and fire training, both completed in 2005, medication, food hygiene and training on maintaining confidentiality completed in 2004. The majority of these certificates did not include details of areas covered, of how competency was assessed or the learning implemented or monitored. There was no apparent link between training and practice. One care worker when interviewed said that training in medication is planned in the near future. The managers confirmed this. Both care workers (one of whom had been employed for nearly three years and one, one year) had started the induction training produced by the Learning Disabilities Accredited Framework (LDAF). They had however failed to complete this training. In addition, there was no evidence of these staff members completing National Vocational Qualifications (NVQ). The Inspection Questionnaire completed in January 2006 stated that three out of the five care staff had completed NVQ level 2 or above. Staff rotas were inspected at both site visits. The layout and the detail were difficult to read. Some discussions took place with the managers on the first visit and some action had been taken to remedy this by the second visit. More work however, is required on the rotas to fully detail accurately staff duties. There was confusion as to whether the night staff hours were asleep or awake and duties other than care were clearly completed by care staff e.g. cooking, laundry, maintenance and cleaning, but not recorded on the staffing rotas. Staffing levels were said to be calculated according to the Residential Forum Guidance and whilst this was not examined in detail, the managers must continually be aware of the need to have staffing levels which ensure they can meet service users’ dependency needs. In addition the managers must be able to demonstrate that the allocation of tasks other than care tasks do not impinge on the quality of care offered to service users. Equally, concerning at this inspection was the practice of staff regularly working excessively long hours. An example of this was noted on the first site visit for one care worker was working a long day until 20.00 hours, working an awake/asleep night shift which was followed by a shift working until the following afternoon. From examination of the staff rotas and discussion with care workers this was found to be a regular occurrence. Both managers were advised of the need to consider the Working Time Regulations, with particular regard to staff working in excess of 48 hours a week and working at night. There was no evidence of staff signing an opt-out agreement. Concerns are felt for not only the care workers, but for the care service users receive when staff are working such long hours. These are matters that the management needs to review immediately. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 23 Staff recruitment records for the two sampled care workers were reviewed and inspected. Overall these met requirements with the exception of two written references for one care worker, which were very brief, not dated and of the ‘To whom it may concern’ formula. Neither staff files had copies of recent photographs. As referred to earlier in this report, there was no evidence of a staff training and development programme. Induction training courses were not completed and there was no evidence on staff files of individual training and development assessments and profiles. Staff records relating to supervision were inspected. Within the records held it was stated that supervision was to take place every six weeks. However, staff interviewed said that they have supervision sessions either weekly or fortnightly. Supervision records seen evidenced this, although they were very brief and did not meet requirements as detailed in National Minimum Standards – Standard 36. Annual appraisals had also been set and whilst a date was set for April 2006, it was not evident that this had taken place for no records were found. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 24 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): 27, 29 and 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 the last inspection this inspection has raised a number of concerns about areas of practice within the home. Some of these have been issues raised at previous inspections. A number of the standards inspected are assessed as having major shortfalls, which call into question the leadership and management skills of the Registered Managers. Differences of opinion between the two managers were clearly evident at the two site visits and from telephone calls since the visits to CSCI. These circumstances cannot continue for they impair the care offered to service users and lower staff morale by not providing a stable, secure environment in which to work. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 25 As at the last inspection, Hilton House continues to provide a service to people whose needs fall outside of its current registration i.e. people with a mental health illness. The need to make an application for a change to the condition of registration was discussed with the home and is outstanding at the time of writing this report. Furthermore at this inspection it was found that one service user is over 65 years and this too will need to be detailed in a condition of registration. Some surveying work had been completed by the home in 2005. Evidence was seen of a service users’ survey, which were based on the National Minimum Standards outcome groups. Relatives and service users had completed these. Two service users had also completed a more appropriate survey, but these were not signed or dated. Further survey work had been completed with relatives, but whilst the questions asked were more appropriate, this survey work was not dated. The need to develop an annual development plan for the home, based on a systematic cycle of planning- action-review and reflection on the aims and outcomes for service users is highlighted. Reference to the lack of induction and basic training courses to ensure that there are safe working practices in the home has already been referred to in this report. Whilst not inspected in full, it was unclear as to the procedure and practice of checking hot water temperatures in the home. Weekly checks were considered desirable. The most recent Food Hygiene and Health & Safety Inspection by the Environmental Health Officer (EHO) dated 20/07/05 raised concerns regarding the kitchen facilities, highlighting the need for repair and replacement. Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 26 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 2 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 1 25 2 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 2 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 2 1 X 1 X LIFESTYLES Standard No Score 11 1 12 1 13 2 14 2 15 1 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 1 X X 1 X Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 27 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. Standard 1. YA1 Regulation 4, Schedule 1 Requirement The registered persons must ensure that the Statement of Purpose provides information required by the Care Home Regulations and National Minimum Standards. Copies are to be sent to CSCI with the Action Plan. (This is a repeat requirement from the last three inspections. Previous timescales of 31/03/05 and 01/05/06 were not met.) The registered persons must ensure that the Service Users’ Guide provides information required by the Care Home Regulations and National Minimum Standards. Copies are to be sent to CSCI with the Action Plan. (This is a repeat requirement. Previous timescales of 31/03/05 and 01/05/06 were not met.) The registered persons must ensure that service users are admitted only on the basic of a full assessment undertaken by people competent to do so, DS0000017850.V293086.R01.S.doc Timescale for action 17/07/06 2. YA1 5 17/07/06 3. YA2 14, 15 17/07/06 Hilton House Version 5.1 Page 28 4. YA5 5 5. YA6 14, 15 6. YA7YA9YA11 YA12YA13YA 14YA15YA16 13, 15, 18 7. YA17 12,16,17 8. YA18YA19 12,13 involving prospective service users, using appropriate communication method and with an independent advocate as appropriate. The registered persons must 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 and 01/05/06 were not met.) The registered persons must 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 and 01/05/06 were not met.) The registered persons must 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 and 01/05/06 were not met.) The registered persons must ensure that people living at the home are provided with diets that promote their health and wellbeing. (This is a repeat requirement. Previous timescale of 31/03/06 was not met.) The registered persons must ensure that arrangements are made to promote the health and wellbeing of service users. (This is a repeat requirement. Previous DS0000017850.V293086.R01.S.doc 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 Hilton House Version 5.1 Page 29 9. YA20 13 10. YA22 16,24 11. YA22 22 12. YA23 18,13 13. YA24YA25 23 timescale of 31/03/06 was not met.) The registered persons must ensure that in all matters relating to the administration of medication, they adhere to the requirements of the relevant legislation and guidelines from the Royal Pharmaceutical Society. Particular attention is required to the management and storage of Controlled Drugs. (This is a repeat requirement. Previous timescales of 01/03/05 and 31/03/06 were not met.) The registered persons must take steps to ascertain and respond to the views of people living at the home. (This repeat requirement, which had a timescale of 31/05/06.) The registered persons must review and revise the home’s complaints procedure to ensure that it meets requirements as detailed in the National Minimum Standards – Standard 22. The registered persons must ensure that service users are protected from abuse, neglect and self-harm. This is with regard to the Adult Protection policy and procedure. (This is a repeat requirement, which had a timescale of 31/05/06.) The registered persons must 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, which had a DS0000017850.V293086.R01.S.doc 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 Hilton House Version 5.1 Page 30 14. YA26 23 15. YA30 16,23 16. YA31YA33 18, 19, 24 17. YA32 18, 19 18. YA34 17, 18, 19, 24 19. YA35 17, 18, 19 timescale of 01/07/05 and 31/05/06.) The registered persons must provide each service users with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. The registered persons must 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 storage of hazardous materials and broken laundry baskets, which present as a hazard. The registered persons must ensure that staff are available in sufficient numbers and with sufficient skills to meet the needs of service users. (This is a repeat requirement, which had a timescale of 30/04/06.) The registered persons must ensure that service users are supported by competent and qualified staff. (This is a repeat requirement, which had a timescale of 30/04/06.) The registered persons must ensure that there is a thorough recruitment procedure in place to support and protect service users. The registered persons must ensure that there is a staff training and development programme, which meets Sector Skills Council workforce training targets. This is with DS0000017850.V293086.R01.S.doc 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 Hilton House Version 5.1 Page 31 20. YA36 18 21. YA37 Registration Regs. 22. YA37 12 23. YA39 24 24. YA42 12, 13, 17 particular regard to induction and foundation training. (This is a repeat requirement, which had a timescale of 30/04/06.) The registered persons must ensure that staff receive support and supervision they need to carry out their jobs. . (This is a repeat requirement, which had a timescale of 30/04/06.) The registered persons must make an application to the Commission to vary the home’s condition of regis-tration to meet the needs of current service users. (This is a repeat requirement, which had a timescale of 30/04/06.) The registered persons must ensure that the home is run in such a manner as to meet the needs of service users. (This is a repeat requirement, which had a timescale of 31/05/06.) The registered persons must develop effective quality assurance and quality monitoring systems to ensure that the best interests of the service users are met. The registered persons must 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. 17/07/06 17/07/06 17/07/06 17/07/06 17/07/06 Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hilton House DS0000017850.V293086.R01.S.doc Version 5.1 Page 33 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.V293086.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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