Inspection on 29/05/07 for Hilton Rose

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hilton Rose 05/01/07

Hilton Rose 05/01/06

Hilton Rose 29/10/05

Hilton Rose 21/10/04

Hilton Rose 24/05/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Hilton Rose 30 Broadway North Walsall West Midlands WS1 2AJ Lead Inspector Keith Salmon Key Unannounced Inspection 29 May 2007 09:30 X10015.doc Version 1.40 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 Rose DS0000020812.V340749.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 Older People. 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 Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilton Rose Address 30 Broadway North Walsall West Midlands WS1 2AJ 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) 01922 622778 01922 645960 Mr John Rose Mr Hilton Thomas Smith Mrs Helen Evans Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2007 Brief Description of the Service: Hilton Rose Retirement Home is registered to provide care for up-to 23 elderly persons over the age of 65 years. Situated near to Walsall Town Centre the home benefits from easy access to all local amenities; a variety of shops, library, post office, and art gallery. Being adjacent to the famous Arboretum this attraction can be enjoyed at any time of year, including the opportunity to visit the famous lights display. Accommodation is provided on two floors, which can be accessed via stairs or passenger lift, and comprises 17 single and 2 double bedrooms, all fitted with wash-hand basins. There are communal lounge areas, one of which is on the first floor, and a dining room/conservatory, which overlooks the home’s garden and also used for social and leisure activities. There is car parking to the rear of the property. The home currently charges £327.15 per week for residency, with additional charges for hairdressing, chiropody, newspapers, toiletries, outings, and day centres. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Unannounced Inspection of ‘Key’ Standards commenced at 9.30am, concluded at 1.45pm, and was conducted by Mr Keith Salmon. Present on behalf of the Home was Mrs Helen Evans (Registered Manager). In addition to inspecting the ‘Key’ Standards, this Inspection also sought to review progress made in meeting ‘Requirements’ arising from the two immediately preceding Inspections, i.e. Unannounced ‘Key’ Inspection, held on 5 January 2007, and the ‘Random Inspection’ carried out by a Pharmacist Inspector on 24 January 2007. Further to those two Inspections, CSCI wrote to the ‘Responsible Person’ requesting a written ‘Improvement Plan’ detailing action to be taken by the Home in order to effect various improvements. The response to this was received by CSCI on 23 March 2007. This current Report is based on observations made during a tour of the premises, a review of care related documentation, staff duty rotas and staff files, plus a range of other documents/records reflecting the general operation of the Home. The Inspector also held individual discussions with 6 Residents, 2 Visitors, the Registered Manager, and several members of Care Staff. What the service does well: What has improved since the last inspection? At this inspection (May 2007) it was found all Requirements (encompassing ‘Outcome Groups’ of Health and Personal Care, Complaints and Protection, Environment, Staffing and Management and Administration, and including those issued by the Pharmacist Inspector) have been satisfactorily met. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Processes to ensure appropriate and thorough care needs assessment, prior to admission, are effectively applied. EVIDENCE: ‘Case Tracking’ involving the review of 4 Residents’ Care Plans/Files, (i.e. those relating to the two most recently admitted Residents, plus 2 selected at random), demonstrated all potential Residents have their care needs assessed by the Registered Manager prior to taking up residence. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The model of Care Plan utilised by the Home is of a comprehensive design and easy to read. The care provided by the Home is effective in meeting the Residents’ assessed care needs, and is delivered considerately and effectively. The storage, administration, and disposal of medicines are in accordance with accepted good practice. Residents’ privacy and dignity is respected EVIDENCE: At the previous ‘Key’ Inspection a number of Requirements were made in respect of Key Standards 7 and 9 within this ‘Outcome Group’ Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 10 The first area related to the care planning process, specifically: “The registered manager must ensure that all service user plans contain a recent photograph of the service user.” “The registered manager must ensure that all service users have a risk assessment for the use of bed rails.” and “Where service users have bed rails, protective covering (bumpers) should be provided.” All risk assessments must be reviewed at least on a monthly basis for each service user.” “All care plans must be reviewed at least on a monthly basis.” Review of 10 care plans, including those of the 4 ‘case tracked’ Residents, demonstrated all files now contain a recent photograph and documented evidence that Residents have received risk assessment for the use of bed rails, that protective covering (bumpers) are available for use where needed, and care plans are subject to frequent review, at least on a monthly basis. The above Requirements are all met. The second area provided Requirements specifically relating to the management and administration of medicines, and arose mainly from the unannounced ‘Random’ Inspection conducted by the Pharmacist Inspector in January 2007. A review of policies/procedures/practices found the following response by the home to the issues raised The need for the ‘Homely Remedy’ procedure to agreed by GP’s . Evidence was seen of signed agreement by GPs who have patients at the Home. The need for improvements to procedures relating to the management of Controlled Drugs Controlled drugs are now properly stored and the Home has protocols in place regarding the security of medicine keys. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 11 The need to improve monitoring of drugs fridge temperatures The Home now has a ‘minimum/maximum thermometer, with daily records of the internal refrigerator temperatures, and the room temperature. Related records are properly maintained. The need for risk assessment documentation for Residents who are selfmedicating Care plans demonstrated Residents who self-medicate have been ‘riskassessed’. The need to ‘date record’ medicines when first opened Dates of first opening were found on the sample of medicines examined. Ensuring there are no omissions in the maintenance of Medicine Administration Records (MAR sheets) . MAR Sheets were found to be properly maintained. In summary, the Inspector found policies/procedures relating to the management/administration of medicines, are now in accordance with good practice, and all of the medicines related Requirements have been met. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Leisure opportunities provided are consistent with Residents’ capabilities. The Home facilitates achievement of desired lifestyle through Residents conducting the pattern of their day, where possible, as they wish, including contact with family and friends. There is a daily choice of attractive and nutritious meals. EVIDENCE: Discussion with Residents confirmed the home provides a variety of activities and pastimes, including; exercise and ‘musical movement’ sessions, bingo, traditional games (cards, dominoes), a range of jigsaws puzzles (several were in use at the time of the Inspection), seasonal card making, outings, and visiting entertainers. Residents commented to the Inspector they were able to take part in whichever activities interested them, and were encouraged, though not pressurised, to do so. The home welcomes visitors, and one relative, who visits most days, commented, ”They look after my Relative very, very, well and treat me like one of the ‘family’.” Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 13 Advocacy details are displayed in the corridor by the front door. The home operates a four weekly menu, giving Service Users a choice of two meals each day for dinner, with the opportunity for drinks and snacks throughout the day. Residents commented to the Inspector how much they enjoyed the food, both quality and quantity. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The interests of Residents are protected through ready access to information relating to advocacy services and the Home’s Complaints Procedure. Staff are aware of their role in protecting Residents from abuse and of taking appropriate action should it be necessary. EVIDENCE: Two Requirements in respect of this ‘Outcome Group’ were cited at the previous ‘Key’ Inspection “The registered manager must: Develop written policies to ensure that service users are protected from abuse and that robust procedures for responding to suspicion or evidence of abuse or neglect are in place. These policies must be in line with local adult protection guidelines and the Department of Health’s guidance No Secrets, and develop strategies to enable staff to undertake training in adult abuse awareness.” Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 15 The registered persons must ensure that Walsall Councils’ adult protection procedures are easily accessible to staff. These must be complimented by a quick reference flow chart to allow staff access to names and telephone numbers for contacts in case there is an incident or allegation of abuse.” Discussions with the Manager and Staff, plus a review of staff training records, ‘Adult Protection’ documentation and guidelines, provided evidence that The Home has relevant and robust policies and procedures, which are in accordance with current local authority ‘adult protection’ practices. Staff are aware of their responsibilities in respect of the prevention of adult abuse, ‘whistle-blowing’ and action they should take should they see, or be concerned that, such abuse was taking place. Both the above Requirements are met. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25, & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a generally safe, well-maintained environment with communal rooms and bedrooms, which are satisfactorily decorated with furnishings being in good order and presenting a ‘domestic’ ambience. Some previously noted areas of concern have been addressed, making Hilton Rose a safer and more comfortable environment. However, there remain various aspects relating to the fabric and décor of the Home, which require attention. Specialist equipment, consistent with meeting the assessed care needs of service users and the demands of tasks carried out by Care Staff, and is appropriately serviced and maintained. The home is clean and there are satisfactory standards of hygiene. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 17 EVIDENCE: A total of 6 Requirements had been cited at previous Inspections in respect of ‘Environment’. These contained several sub-components, and during a tour of the Home the Inspector observed the following had been addressed: Debris previously reported at being deposited at the front and rear of the premises has been removed. The carpet in the hallway has been replaced, and the Inspector was informed that other ground floor corridor areas have been ‘measured up’ and price quotes are awaited. The extractor fan in the sluice has been replaced and is working effectively. The sluice was found to be clean and tidy. All radiator covers were firmly fixed to the adjacent wall. Areas of loose/damaged tiling in the shower room have been repaired. The sluice room now has a lock fitted, and remains locked when not in use. The Inspector observed this to be fact during his tour of the home. The hoist in the first floor bathroom appeared stable, and safe for use, with evidence seen of maintenance by a qualified contractor. Evidence was seen of weekly temperature checks of hot water from outlets accessible to Residents. A random sampling of 10 outlets during the tour found all to be satisfactory, i.e. ‘about 430 Celsius’. On visiting the laundry room the Inspector found – The ventilation fan has been replaced with a more efficient model. The wall coverings and floors were clean and tidy. A laundry-room cleaning schedule on display. Hand wash signs now displayed – as at hand-wash basins in all other areas. Red disposal bags are in use (for soiled/contaminated linen). Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 18 On visiting the Kitchen the Inspector found All foods were date labelled to show when they had been opened. Daily records of freezer and refrigerator internal temperatures were recorded. All mops used in the home are now colour coded and there is a programme in place for their daily cleaning. It is accepted the Home have been committed to addressing these shortfalls, and have made excellent inroads into resolving issues relating to the quality of the environment, and this area of care provision can now be considered as generally much improved. However, some items of furnishing, and carpet areas continue to look rather worn. Therefore, to clarify the Home’s plans for on-going refurbishment and redecoration of the premises, and to facilitate completion of such plans, it is Recommended the Home develop an on-going programme with proposed target dates for completion. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers on duty, and skill-mix, were sufficient to meet the assessed care needs of current Residents. Recruitment and employment practices are consistent with the safeguarding of Residents. He commitment of the Home in providing training for Care Staff is satisfactory, and in accordance with individual Staff Member’s learning needs. EVIDENCE: The current staffing rota, plus those from the immediately preceding weeks, were examined and compared to staff numbers on duty at the time of the Inspection. These demonstrated staffing numbers, and skill-mix (minimally 3 carers on duty both morning and evening and 2 carers during the night, with the Manager usually supernumerary), enable a service provision, which meets the care needs of the Service Users. A Requirement, cited at the previous ‘key’ Inspection, in respect of ‘Staffing was “The registered manager must review the induction programme to ensure that it meets the Skills for Care Standards for all new employees.” Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 20 A review of staff personal files and discussions with staff provided evidence they receive thorough induction, with mentor support from the Manager, plus foundation training, e.g. moving and handling, first aid, fire safety, food hygiene, infection control, ‘on-going’ training development training, e.g. NVQ, and the Manager undertakes regular ‘supervision’ of each staff member. In the light of this evidence the Requirement is met. Records further demonstrated all but two of the 17 Care Staff have attained NVQ Level 2, or higher, which is well in excess of the 50 required by the Standard. The Home has a very stable staff group, and, as a result, the home has not recruited any new workers since the last inspection. However, a review of staff employment records for four staff (selected at random) presented well organised systems and detailed records, containing all the information necessary to demonstrate potential staff are well screened, before deemed suitable to commence work at the home. During the Inspection numerous incidents of positive inter-action between Staff and Residents were observed. All appeared friendly, professional, and respectful. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home is well managed by the Registered Manager and is operationally well organised, with lines of accountability being clearly defined and observed. The ambience is warm, friendly, and inclusive, with the central purpose being ‘the best interests of Residents’. Views of Residents, and other interested parties, are actively sought by the Home, and acted upon. Service Users are safeguarded by the financial procedures operated within the Home. All Staff are subject to effective support with regular supervision, and appeared involved and happy in their work. Health and Safety Policies/Procedures/Practices are satisfactory. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Registered Manager, Mrs Helen Evans, is experienced and well qualified having completed the NVQ Level 4 in Management and Care. Observation by the Inspector, and comments from Residents, Staff and Visitors, suggest the Home is currently being well managed. Discussion with the Manager, inspection of the premises, and review of relevant documentation, demonstrated evidence of commitment, and subsequent excellent progress, in meeting Requirements cited at the previous Unannounced ‘Key’ Inspection, and the Unannounced ‘Random’ Inspection conducted by a Pharmacist Inspector, both held during January 2007. In outline the Requirements related to the following aspects of Management/Administration The development of quality assurance systems, so as to address more effectively, audits of medicines management, and the environment Evidence was seen of the twice-yearly implementation of a questionnaire aimed at gaining the views, of Residents and visitors, in relation to the quality of care provided at Hilton Rose. The completion of Regulation 26 visits by the Responsible Person together with written reports Reports evidencing unannounced visits by the Responsible Person were seen. The systems employed in the management of Residents personal moniesDuring the visit the Inspector observed a transaction with regard to the personal monies of one Resident (the Home manages funds for only two Residents) – all practices, including necessary signatures, were found to be satisfactory and in accordance with the Regulation. The Staff training programme Staff training records demonstrated all staff receive training relevant to their personal learning needs. Action in response to requirements of the Environmental Health Office The Inspector reviewed the Home’s response to these requirements during the tour of the Home and is assured all have been met. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 23 Fire safety issue (e.g. staff training, functioning of automatic door closures) Staff training files provided evidence (backed by discussions with staff) of all staff having received necessary fire safety training. With regard to the automatic door retainers/closers, the retainers are of a battery operated design – the issue being to ensure the batteries are not ‘flat’. The Inspector observed evidence to confirm regular checking of it is part of the manager’s routine. In summary a review of relevant documentation, discussion with the Manager and other staff, plus a tour of the premises, provided clear evidence to conclude that during the period January 2006 to the present, relevant action necessary to meet these Requirements had been taken. In addition, the Home was ‘Required’ to forward to CSCI the current ‘Gas Landlords Safety Certificate’ and ‘Electrical Installation Certificate (5year)’. Receipt of these certificates has been recorded on CSCI’s Records as during March 2007. All of the ‘Management’ Requirements referred to above have been met. Finally, the Home’s practices in the context of health, safety and welfare of Residents, Visitors, and Staff were seen to be in accordance with the Regulations. COSHH requirements were satisfactory, with maintenance and servicing of equipment regularly undertaken, and appropriately documented. Other ‘health and safety’ records examined related to fire risk management, lighting, nurse call bells, Legionella, portable electric equipment, hoists, and all were found to be satisfactory. Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 X 3 Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP19 Good Practice Recommendations It is Recommended that the Home develop an ongoing programme for refurbishment and redecoration of the premises, with proposed completion target dates. The Manager should consider the introduction of a training matrix that readily identifies when staff are due for updates in mandatory training. 2. OP30 Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hilton Rose DS0000020812.V340749.R01.S.doc Version 5.2 Page 27 - 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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