Care Home: Hilltop

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Hilltop Hilltop 32 Trewartha Park Weston Super Mare North Somerset BS23 2RT two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Webb Date: 2 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Hilltop Hilltop 32 Trewartha Park Weston Super Mare North Somerset BS23 2RT 01934644875 01934613517 enquiries@homes-caring-for-autism.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Homes Caring for Autism Limited care home 8 Number of places (if applicable): Under 65 Over 65 8 0 learning disability Additional conditions: May provide a service for up to eight younger adults in the age range 16 - 18 years May provide a service for up to eight younger adults in the age range 18 - 40 years. People at the age of 45 may be admitted with the express consent of CSCI. Date of last inspection A bit about the care home The service is aimed at people whose behaviour can be challenging, and a high level of intensive one-to-one work is offered. The aim is to enable people to learn new ways of managing their own behaviour in order to live more independently or otherwise improve their quality of life. The home is in a quiet residential area, within easy reach of the town, the seafront, and other local amenities. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced inspection carried out over one day. We looked at records including care plans and assessments, risk management, the administration of medication, staff recruitment and training. We looked around the premises and spoke to one person living at the home, staff, the manager and senior management. A completed Annual Quality Assurance Assessment (AQAA) was received before this visit. Surveys were sent out to the people living at the home asking them for their views. Although they were in a symbolised and pictorial format, they were unsuitable for people and this will be recognised at future inspections. All the requirements, except one, have been met. However the outstanding requirement has been partially met. One requirement and two recommendations have been made through this visit. What the care home does well There are good pre admission processes for prospective people living at the home. Comprehensive assessments of peoples needs are carried out with the involvement of all agencies involved in their care. The home has worked hard in the development of a communication resource to help get the views of the people living at the home. Staff have a good understanding of peoples needs with comprehensive information to support staff with peoples lifestyles and well being. Staff are offered relevant specialist training to help meet peoples individual needs. What has got better from the last inspection What the care home could do better The inclusion of notice given to people in their service agreement will help to inform people better. Restrications imposed on people must be included in their plan of care so that these will be reviewed regularly. The home must carry out a risk assessment to show controls are in place in keeping people safe if their Criminal Records Bureau has not been received before they are employed. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sarah Webb 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People wishing to live at the home are given information to help choose a home that will meet their needs. Peoples needs are assessed before moving to the home to help ensure they can be met. Peoples needs are met through a staff team who are trained to understand and support them. People wishing to live at the home can visit the home to see what it is like. People are given a service user agreement. Evidence: The Statement of Purpose and Service User Guide have been updated to include relevant information about the home and new staffing. Since the last inspection accessible formats have been developed meeting a recommendation from the last inspection. These have been given to people living at Hilltop and new people wishing to use the service. A brochure is in picture format and a virtual tour of Hilltop was seen showing all areas of the home. This is good practice showing people are provided with appropriate information to help them understand information. The home has a robust assessment process for admitting new people to the home. Referrals are made to the organisations head office and an initial assessment is carried out of the persons needs. Records seen showed pre-assessments are also undertaken by staff to ensure peoples needs can be met. It was evident through documentation that staff are involved in visiting people before they are admitted with multidisciplinary meetings held to discuss the placement. If appropriate, visits are planned to include meeting other people living at the home. Records showed the most recent person had visits arranged before they started their placement. Review dates Evidence: are set to finalise if the placement is successful and peoples needs can be met. This was seen peoples care files. It is evident the home is meeting peoples needs. Staff have been trained in specialist areas of need. A recommendation has been met for the home to further develop communication systems so that people can make informed choices. The manager is aware of the need to communicate with people through various individual communication methods and that not all methods will suit all people. The manager has worked hard to set up communication systems to involve the people living at the home with their care. The home provides people with an agreement setting out the terms and conditions of their stay. Copies of this are kept in peoples rooms which they sign. A recommendation is made to include when notice may be given to people. Since the last inspection, one new person has begun a placement at Hilltop. There is currently one vacant bed. All the people currently living at the home are male. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care planning has improved showing how people want to be supported with their needs. Some areas still need to record any restrictions imposed on peoples lives. People are involved and assisted in making decisions about their lives. Risk assessments support people to take risks as part of their lifestyle. Evidence: Three care plans were seen. These were person centred and included aspects of peoples care needs, their preferences and how they should be supported. They also included a pen picture of the person, how they are helped to communicate, their behaviours and emotions, and personal care needs. A requirement for care plans to be person centred and include evidence of their agreement to their care and to the review of their care is partially met. The manager is aware that this is an ongoing area that needs to be continually promoted. There were some areas of peoples support that still need to be included in care plans. Some bedrooms have restrictions on the water supply to sinks and this needs to be recorded. Care plans had been reviewed on a regular basis helping to ensure any changes to peoples care can still be met. Written guidelines showed staff how people should be supported in various areas. Staff spoken to confirmed they are given enough information about peoples needs and the way they should be supported with their needs. People living at the home have a keyworker who play a more central role in coordinating the care they receive, and help to make sure their care plan is followed. Keyworkers monitor peoples health, daily activities and general well being. This provides meaningful staff support, which is important for those people who have more complex needs. One person is also supported by an external advocate. Daily records Evidence: are kept of how people are being supported with their personal care, activities, general well being, and the food offered. The majority of people need support with their communication, with some having no verbal communication. It is evident that the home is committed to developing individual communication systems to help people understand information and in making decisions. Staff explain information to people and support them with varying communication programmes and formats. These include verbal, written, symbolised, Makaton, objects of reference and Picture Exchange Communication (PECS). Records were seen of how people are involved in decision making. These included how people had been asked questions and what their response was. The manager showed a communication package he has developed in helping people to make choices. People are supported individually through a visual computer programme. A touch screen responds interactively to peoples responses. A requirement has been met to ensure people using the service are supported to participate in how their home is run. Service user meetings are held and a new format for involving people with making choices has been developed. A recommendation has been met for risk assessments to link into individuals care planning. Individual risk assessments have been developed for aspects of peoples lifestyle. These include restrictions that may be in place because of high risk outcomes. They also show how people are being supported safely with taking risks. However we recommended the manager completes a risk assessment for an individual who is supported with their epilepsy. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from educational, social and recreational activities. People benefit from being supported to keep in contact with their families. People are supported in making choices about their lifestyle and are helped to be part of the routines of the home. People are offered a varied menu and are helped to make choices about the food they want. Evidence: People are supported with active lifestyles through a range of activities. One person works in part time employment. They are more independent than the other people living at the home and are able to use the bus. They told us that they had been on holiday with staff which they had enjoyed. They told us they went to bingo and helped with the cleaning. Each person has a programme that showed differing activities people go to such as an outreach project, access to community facilities. These included karting, shopping, drives, cinema, swimming, and horseriding. The home provides transport to activities if needed. Two areas of the home have been designed specifically for those people who need a space to explore their sensory needs and an activity room for arts, craft and computer activity. However some staff felt people would benefit from more meaningful activites in being provided by the home. Staff support people to keep in contact with their families and records showed that some families visit their relatives and have good relationships with staff. Evidence: The homes daily routines reflect peoples individuality and diversity. Most of the people living at the home need visual references to support them in their daily routines. Peoples structures and routines are recorded and guidelines were seen for staff in care files including life skills support. People are encouraged and supported to clean their own rooms and are supported on 1:1 or 2:1 basis when preparing snacks, drinks and cooking in the kitchen. The kitchen is locked if it is not being used and the manager said this was because of health and safety issues. Staff cook meals that are offered to people at the same time. If people do like set meal then an alternative is offered. One person cooks their own food and prepares snacks. Menus seen showed that staff help to offer healthy options and know individuals choices. . Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples physical and emotional needs are met and they are supported with their care in a sensitive and respectful way. People benefit from access to appropriate health care services. People are supported safely with their medication. Evidence: People living at the home benefit from personal care provided in a sensitive way to respect their dignity. Staff were observed respecting peoples privacy and directing people in a quiet and calm manner. Some people are more independent and may require prompts rather than direct care. Since the last inspection Health Action Plans have been developed to help support people with promoting good health. We saw plans that included all areas of peoples health and included how specific communication needs should be met. People benefit from appropriate healthcare services to support them with their needs. The home is supported by the local mental health services and learning disability teams that provide advice and intervention if needed. These services have included support for people through psychologists, speech and language therapists. Medical appointments are recorded including visits to the dentist, opticians and other routine check ups. A communication log shows when any contact takes place with either professionals, families, or advocate. This record generally helps to inform staff and to update them with current changes. The staff have strategies for defusing and de-escalating potentially challenging situations as some people may become anxious and agitated. Staff ask for support and advice from healthcare specialists if behaviours change and impact on others living at the home. Regular medication reviews also help to monitor peoples well being and behaviour. Evidence: Medication is kept in peoples own rooms. The records and stock levels of medication were checked and found to be correct. Records showed that one person needs a specific medication to be administered regarding their epilepsy. Currently there are four staff who have been trained to administer this medication. We were told of the current action to be taken if untrained staff were on duty. We advised the manager to record this information in their care plan. A training matrix showed that staff receive training in Medication in a Care Home. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from policies and procedures to manage complaints and allegations of abuse. The home actively listens to people through the development of communication aids. People are protected by a staff team trained in safeguarding vulnerable adults to help keep people safe. Evidence: A recommendation has been met for complaints to be fully recorded including the outcome for complainants. The complaints log was seen and showed that since the last inspection, complaints received have been recorded with the outcomes. These have been from neighbours and the manager has responded appropriately and has built good relationships with neighbours. The home has an accessible complaints form to help people understand how to complain. This meets a recommendation for this to be developed. It is evident that people have benefited from a new computerised programme helping them to show staff if they are happy or unhappy with living at Hilltop. The organisation has a Safeguarding policy. This meets the recommendation to review the previous abuse guidelines and ensure it complies with the local safeguarding procedures. This ensures there is a consistency in the way vulnerable people are protected. Staff have been trained in safeguarding and how to recognise and prevent abuse. Staff spoken to had a good awareness of peoples vulnerablity and how abuse may occur. The home has a whistleblowing policy. Staff are provided with this information when first employed. People may display various behaviours that challenge when anxious or distressed. It was evident staff support people away from triggers of anxiety and incidents. Peoples behaviour is monitored and this was seen through records documenting behaviours that linked into specific incidents. This helps to monitor and see patterns and cycles of behaviour. A spread sheet was also seen showing when incidents had happened and how the home use this information to help prevent further anxiety and challenges. Evidence: Comprehensive Risk assessment and Management Plans were seen in care files. These set out triggers and how staff should be supporting people in helping to prevent challenges. The manager is a trainer in Positive Response Training (PRT) and trains the staff team. The home have not had to use physical intervention techniques for some time. Two new staff have not been trained but are booked to attend training. This was seen through a training matrix. The majority of people are supported with handling their finances and there are controls in place to keep their finances safe. Since the last inspection bank accounts have been opened in peoples names. Financial controls are in place to safeguard people from financial abuse. The manager and deputy manager are the only staff who have access to financial details. There are appropriate arrangements for people who are able to deal with their own money. A requirement is met for a clear and accurate record to be kept of all money held for safekeeping. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from a comfortable, safe and clean environment that suits their needs. Evidence: Hilltop is situated in a quiet residential area within easy reach of the town, seafront and other local amenities. The home was refurbished to a high standard before its registration. It is a large home providing suitable space for the people living there and appropriate to their needs. Communal space consists of a large lounge, conservatory and dining areas. Some areas of the communal spaces, such as the lounge, have decoration on the walls. Hallways and corridors have no decoration and the manager said health and safety issues have had a considerable impact on how the home can be decorated. An environmental hazard analysis has been completed for the communal areas. These have identified possible hazards and have been and risk assessed. Two rooms have been created for recreational activities. An activities room provides space for people to try out arts and craft and use the computer. A sensory room has recently been designed for people to listen to music and have some time on their own. This is good practice and has taken into consideration peoples preferences and needs. Windows have been fitted with appropriate restrictors helping to ensure peoples safety. People are provided with single bedrooms with four having their own ensuite bathroom. The remaining four bedrooms share two bathrooms. Bedrooms are lockable but only one person uses a key to their room. People are encouraged to personalise their rooms and make choices about decoration. Medication is kept in peoples rooms in a metal cabinet. This was discussed with the manager and that it was not homely. The manager advised he has been unsuccessful in using other storage spaces and that these have not been as robust and safe as the metal cabinets. The home was clean and tidy with the staff being responsible for daily cleaning duties. Evidence: There is a garden to the front and to the back of the property. The rear garden has been landscaped to provide a safe environment for people to use. Raised beds have been covered with wood shavings and is set off with a water feature. People can use a trampolene and there are plans to develop the garden shed into a wet room. Homes Caring For Autism employ a maintenance manager who is resonsible for ensuring maintenance requests are completed. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from clear staff roles and responsibilities and by a trained and supervised staff team. There are enough staff to meet the needs of people living at the home. People would benefit from further protection if the homes recruitment policy and practice included new staff being risk assessed prior to appropriate checks being received. Evidence: Staff spoken with had a good understanding of their role and were able to give examples of how people are supported with their care, communication, and behaviours. There are sufficient staff on duty to support the people living at the home with eleven care staff employed. Both the manager and deputy are also hands on if needed. The rota showed there are four to five staff on duty during the day and with one waking night staff and one sleep in staff. Since the last inspection there is a change to how staff are rotered. Shift times now take into consideration when people may wish to access recreational activities in the evening. Staffing files seen included application, two references, terms and conditions of employment, supervision and appraisal record and a Protection Of Vulnerable Adults(POVA) check. It was evident that some staff have started their employment before a Criminal Records Bureau(CRB) check has been received by the home. Although we were assured that if this was the case new staff do not work unsupervised with people until their CRB has been cleared and new staff shadow an experienced staff member. Since the inspection, guidelines in place have been sent to us. However to help safeguard the people living at the home further, the manager was recommended to complete a risk assessment to show controls in place to help protect people. New staff are provided with a three week induction with one week based at the organisations head office. Staff spoken to confirmed they are taken through the relevant policies and procedures and the aims of the organisation. New staff have a two week period when they shadow permanent staff Evidence: to help learn about peoples needs and the routines of the home. Training records showed staff have attended mandatory training in health and safety, first aid, fire safety, manual handling, and food safety. It is evident that staff are provided with training that is relevant to peoples needs. Staff records showed that they had attended training in introduction to epilepsy, autism and communication, and positive approaches to supporting people with autistic spectrum disorders. Currently there are seven staff who have completed a National Vocational Qualification Level two with one in the process. Three staff have a qualification in level three and two have an Advanced Health and Care Qualification. Staff supervision is shared by the manager, deputy and a senior staff member and records of these were seen in staffing files. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People benefit from a well run home. The management team has a positive approach to the running of the home. People can be assured that their views will be asked for and acted on. Peoples rights and best interests are safeguarded by record keeping protocols and procedures. The health and safety of the people living at the home and staff is promoted. Evidence: Since the last inspection, a requirement has been met for the manager to be registered to provide the management and leadership to the home. The manager is competent to run the home and was positive in his approach in supporting the people living at the home with their individual needs. He has previous experience and has a NVQ Level Four. Staff spoken with said there had been positive changes since the last inspection and that the staff team were a good team communicating well with each other. We were told the manager was approachable and that they were happy with the management of the home. A recommendation has been met for a quality assurance system to be introduced that helps monitor practice and asks for the views of those with an interest in the service. Surveys have been sent out to staff, families and placing authorities from the organisational head office. Families are informed of the results thorugh a Parent and Family Forum that meet on a quarterly basis. The home has demonstrated that the views of people living at the home are being asked for through new communication systems. Evidence: It is evident that the home have improved in keeping records of peoples care and support, showing that monitoring is ongoing. There was documented evidence to help demonstrate that the home has begun the process of evidencing it is being run in the best interests of the people living at the home. The home has kept us informed of any incidents that people using the service may be affected by. The manager and deputy manager carry out risk assessments of the premises and monitor health and safety procedures in the home. These were seen through health and safety audits and fire records. A senior manager visits the home to monitor the general management of the home. A record is kept of these visits. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 6 12(2)(3) 15(1)(2) The care plans for people 29/01/2008 using the service should be person centred and must include evidence of their agreement to the plan and involvement in reviewing the plan for success. Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 17 The registered person shall 28/02/2009 keep a record of any limitations agreed with the service user as to the service users freedom of choice, liberty of movement and power to make decisions. Include in care plans the restriction of water supply to peoples bedrooms. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 5 34 Include in the service user agreement when notice may be given to people. Carry out a risk assessment to show controls in place in keeping people safe if they are employed before a CRB is received. 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