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Cite as: [2008] 1239(EA)

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Hughes v Commission for Social Care Inspection [2008] EWCST 1239(EA) (20 October 2008)

John Lewis Hughes

– v –

The Commission for Social Care Inspection

[2008] 1239.EA

Before:

Mr. Stewart Hunter (Nominated Chairman)

Mr. Mike Flynn

Mr. David Tomlinson

Decision

Heard on the 25^th, 28^th, 30^th and 31^st July 2008 and the 1^st August 2008.

Sitting at the Great Yarmouth Magistrates Court, Magistrates Court House,

North Quay, Great Yarmouth, Norfolk.NR30 1PW

Representation

The Appellant appeared in person.

The Respondent was represented by Miss Lisa Sullivan of Counsel.

Appeal

This is an appeal by Mr. John Hughes under Section 21 (1) of the Care Standards Act 2000, against the decision of The Respondent dated the 10^th January 2008, to cancel his registration in respect of a Care Home known as F situated in Great Yarmouth.

Preliminary Issues

On the 22^nd April 2008 the President oft the Tribunal made a Restricted reporting order under Regulation 18 (1) of the Protection of Children and Vulnerable Adults and Care Standards Tribunal Regulations 2002 ("The Regulations") prohibiting the publication (including by electronic means) in a written publication available to the public, or in the inclusion in a relevant programme for reception in England and Wales of any matter likely to lead members of the public to identify any service users.

At the conclusion of the hearing the Tribunal reaffirmed that the Restricted reporting order should remain in force until further order.

Evidence

The Inspection reports prepared by the Respondent in respect of F indicate that it is registered as a Care Home for 4 people with learning disabilities. The registered proprietor and registered manager is Mr. J. Hughes and that F was first registered in 1990.

Norfolk County Council was the regulatory authority who originally considered Mr. Hughes's application for registration of F, and they made a decision to refuse to grant registration. Mr Hughes appealed against that decision. The Tribunal were shown a copy of the order made by the Registered Homes Tribunal following a hearing in September, 1989. The decision being to allow Mr. Hughes's appeal, and direct that Norfolk's County Council's decision to refuse registration should have no effect. In giving their reasons for arriving at this decision the Registered Homes Tribunal in considering Mr. Hughes curriculum vitae stated that it was clear that "in qualifications, experience and aptitude he is well suited to care for mentally handicapped persons and he has the support and assistance of his wife and other members of his family."

The Registered Homes Tribunal also considered the reasons put forward by Norfolk County Council for refusing Mr. Hughes's application for registration, including a concern that the proposed registered care home was not separate from the hotel and guest house facilities in the same premises. The Registered Homes Tribunal found that the existence of three points of access between the hotel and the care home did not threaten the privacy, dignity and security of residents to such an extent as to render the premises unfit to be used for the purposes of a care home. The Tribunal went on to state that:-

"This does not mean that the premises are ideal, and we anticipate that Mr. and Mrs. Hughes will have to exercise more than usual care in carrying on the home so as to ensure that the privacy, dignity and security of residents are not in fact infringed ……."

The Tribunal were reassured in terms of care home residents gaining access to the hotel, by Mr. Hughes's evidence that there would be a ratio of 1 staff member to 1 resident and a maximum of 4 residents at any one time.

The Respondents in their recent inspection reports have described the services being provided at F. This has included the following:-

"F is a family run business set up to provide accommodation for up to four adults with a learning disability. The home is a terraced property situated close to the centre of Great Yarmouth. All residents have a single bedroom and there is ample communal space. The Registered provider also owns and manages a house in multiple occupation ("HIMO") accommodating 29 people, in the adjoining properties. Access between the home and HIMO is provided through at least 3 connecting doors, which are usually kept unlocked."

The Tribunal received evidence from Ms. Alison Mallett who is employed by the Norfolk Community Learning Difficulties Team as an Assistant Practitioner and has held that position for approximately the last 8 years. She signed a written witness statement in these proceedings dated the 9^th July 2008 and also gave oral evidence. At paragraph 7 of her witness statement Ms. Mallett stated as follows:-

"I have worked with all four people who have been resident in F since I joined the Learning Difficulties Team. Only resident R BW was placed in the home by social services, although this was not by me. The other three people who have been resident in the home, RJW, (RW), SS and GM were placed in the home under what was known as preserved rights. Under this arrangement the care home fees were paid by the DSS and did not involve social services. Preserved rights came to an end in 2004 and residents were reassessed around that time to see if they met the criteria for social services to continue to pay their fees. We therefore became involved with service users SS, GM and RJW, (RW) following an assessment by the Preserved Rights team."

Ms. Mallett went on in her witness statement to provide information regarding RBW, RW, SJS and GM.

In respect of RBW Ms. Mallett described him as having a full scale IQ of 63 which indicated that he had a mild learning disability. She went on to state:-

"He has a criminal record mostly for petty matters such as setting fire to bins. He has deep rooted emotional issues and is a vulnerable person. He will get in with the wrong crowd and is impressionable. He puts himself in vulnerable positions and cannot always see the consequences of this. He has no personal care needs but does have emotional needs. RBW requires a flexible service to meet his emotional needs."

RBW was residing at F at the time of the Tribunal hearing. He had entered F on the 2^nd April 2002 and apart from a period away in 2003 had remained at F ever since.

In respect of RW Ms. Mallett stated that she had very little information on his background prior to his move to F. Ms. Mallett considered that from the assessments she had carried out that:-

"RJW, (RW) does not have any personal care needs nor does he appear to have a learning disability. His IQ has not been measured but it appears that he can read and write quite well."

She went on:-

"RJW (RW) does not see himself as a disabled person but he does not want to leave F. He enjoys going out drinking and being able to return to a safe place. If he lived independently he probably would not be able to afford this lifestyle."

Ms. Mallett stated that she had first met RJW (RW) at F on the 2^nd December 2004 and that RJW (RW) continued to reside at F at the time of the Tribunal hearing.

Ms. Mallett's first involvement with SJS was in the latter part of 2004 when she had carried out an assessment. In her witness statement she stated as follows:-

"He has epilepsy and is on medication but it did not appear to be an issue for him. He is unable to read and write. He is not a particularly vulnerable person and has a support network of friends a number of whom have children."

In June 2006 SJS moved out of F into a privately rented flat. It was Ms. Mallett's understanding that since moving out of F, SJS had successfully managed to live independently.

The fourth service user with whom Ms. Mallett had had contact was GM. Ms. Mallett described GM as having:-

"…..some literacy and numeracy skills but he had no daytime occupation and appeared a rather vulnerable person who could become emotional and tearful."

Ms. Mallett stated that she had received a telephone call from Mr. Hughes on the 2^nd December 2003 advising her that GM had left F and had since the 7^th November 2003 been living independently. Ms. Mallett was later advised in a letter from Mr. Hughes dated the 24^th February 2004 that GM had returned to F. At paragraph 21 of her witness statement Ms. Mallett stated that:-

"As far as I am aware GM remained living at F without funding for a period of time and then transferred to the home in multiple occupation next door where he still lives without requiring support from social services."

Included amongst the documents produced by Mr. Hughes in these proceedings were documents headed "Statement of Purpose", "Statement of Purpose (additions)" and "Service User Guide" all of which were said to have been received by the Respondent under the cover of a letter dated the 13^th August 2004. The Statement of Purpose document indicated that the purpose of the home was to:-

"…… provide accommodation and support for 4 adults who have varying degrees of learning difficulties."

and went on to state that:-

"Out of the current group of 4 male service users, 3 have low dependency (though this was not so on admission some ten years ago) and 1 recent admission who needs on-going support in the form of advice and counselling when depressed and frustrated by his perceived view of the world around him."

and later in the same document:-

"The prime object of the home is to continue working at the maintaining of a stable family atmosphere where each individual is encouraged to use reason, to listen to points of views put forward by members of the staff team. Service users are also encouraged to challenge points of view and to help adjudicate progressing objectives and policies of the home itself. The philosophy of the home is to help the service user feel he/she is an important family member with a real place within the family."

In describing the staffing arrangements at the home the Statement of Purpose indicated that:-

"The current staff support team consists of four males one of whom is employed on a part time basis, and also acts as a sleeper in."

and also:-

"The present staff complement is academically unqualified, although an application has been made for NVQ 3 places for two staff. The owner and Manager has a teaching certificate, a Dip Ed in the teaching of handicapped children and B.Ed degree with the main discipline being psychology. Within the future the Manager would hope to be accredited on his existing qualifications and to achieve NVQ4 which is a requirement."

In the most recent inspection report carried out by the Respondent in July 2008 under the section on staffing the Inspectors noted the following:-

"Mr. Hughes has told us that since 2004, two of the staff have completed National Vocational Qualifications, but have not been able to get their work validated so they could get certificates."

and also:-

"There have been no staff recruited for many years. Besides Mr. Hughes, there are three other staff. On the last four inspections, we have seen only one of them and that person has not done formal training. Mr. Hughes says they are looking at options to progress this."

In oral evidence Mr. Hughes said that he was now 70 years of age and in addition to being Manager of F he was also on the Teacher Supply Register. In the previous year he had done 8 hours a week teaching, but that was now reduced to 6 hours a week and he was not sure whether he would be given any more work. He also did home tuition. There was a staff rota for F, he and his two sons, each son working 37½ hours a week; they did not have other jobs. Another member of staff was Mr. Baker who was supposed to come on duty at 11.00pm and finish at 6.00am the following morning. There were also two part time members of staff.

F was inspected on nine occasions by Norfolk County Council between the 11^th of July 2000 and the 5^th March 2002. These included a full announced inspection on the 4^th December 2001, included in the report of the visit were the following comments by the Inspection Officer:-

"The Inspectors were very concerned by the condition of the Home and wish to emphasise that urgent action needed to be taken by the proprietor to bring the Home up to standard.

These matters have been noted before in past inspection reports and brought to the attention of the proprietors but the situation has not improved."

A number of follow up visits took place in January 2002 and March 2002 to check whether the requirements set out in the report of the 4^th December 2001 had been being carried out. The report from the visit on the 5^th March 2002 and the subsequent report indicated that some improvements had been made or were in the process of being made. The Inspectors praised Mr. Hughes for getting on with the job, but said that they would inspect in a month's time to see if the premises were completed. In the event the responsibility for inspections transferred in 2002 to the National Care Standards Commission.

The National Care Standards Commission carried out inspections on the 5^th June and 7^th October 2003. The Inspectors noted that there were 11 areas of Mr. Hughes's services which were in breach of the regulations and made a requirement that action should be taken to remedy these breaches. The areas in question included the following:-

• Production of a statement of purpose and a service user guide that fully complied with the regulations;

• service user plans to be up for each of the service users;

• Risk, real and potential to be assessed and within the context of the service user plans, appropriate strategies be put in place to minimise such risk;

• Staff take a proactive part in helping service users develop employment skills and to take up opportunities for further education and training;

• Service users helped to manage in an appropriate way their personal finances;

• Reasons for friends of a service user not being allowed to visit a service user to be recorded and kept under review;

• The service user plan to include a section relating to individual health care and how any needs were identified and acted upon;

• Robust procedures for responding to suspicion or evidence of abuse or neglect to be formulated;

• A full and accurate staff duty rota to be maintained and staffing levels to reflect the assessed needs of the service users;

• Applications to be made for CRB checks (enhanced) for the Proprietor and all staff working at the home;

• The Proprietor to consider all the topics set out in Appendix 2 of the report in relation to the standards and prepare written procedures that are comprehensive and relevant to F;

• Action to be taken to ensure that COSHH Regulations are understood and acted upon.

In relation to 7 of the breaches of the regulations identified by the inspectors, Mr. Hughes was required to comply by the end of December 2003, in respect of the remaining items the timescale for action was said to be "immediate and ongoing".

The Respondents have carried out a number of inspections of F which took place on the 28^th April 2004 then 30^th September 2004, 17^th November 2004, 7^th July 2005, 7^th November 2005, 1^st June 2006, 12^th February 2007, 7^th August 2007, 26^th March 2008 and the 11^th July 2008. Copies of the reports in relation to these visits were produced to the Tribunal.

On the 28^th April 2004 the Respondents carried out an unannounced inspection of F. The lead Inspector was Ms. Hilary Shepherd and she was accompanied by Mr. Jerry Crehan, the inspection took place over two days. It lead to the Inspectors identifying 14 areas where they considered that Mr. Hughes was in breach of the Care Home Regulations 2001, ("care home regulations") and in addition made 7 recommendations for work to be required to meet various aspects of the National Minimum Standards.

Ms. Shepherd provided a witness statement in these proceedings dated 12^th July 2008 and also gave oral evidence. Ms. Shepherd stated that on the first day of the April 2004 inspection Mr. Hughes had not been present and the Inspectors had met with a Mr. Philip Baker who had described himself as "the Assistant Night Manager" and said that he lived on the premises and worked from 11.00pm to 7.00am. Mr. Baker had also told Ms. Shepherd that he worked during the day when Mr. Hughes and the other members of staff, being Mr. Hughes's sons Karl and Glyn, were out. He had said that Mr. Hughes taught every day from 8.30am to 4.30pm Monday to Friday, but was in the home at the weekends and lived on the premises. Mr. Baker went on to say that Karl cooked the food for the residents in the care home and for the people in the HMO, whilst Glyn Hughes did the maintenance.

Ms. Shepherd stated that when she and her colleague had returned to F on the 30^th April 2004 they had been able to meet with Mr. Hughes and Glyn Hughes. They had spoken to Mr. Hughes about the service users in the home. This included a discussion about RBW, Mr. Hughes had said that RBW had been at F for two years, but kept changing his name. RBW had been described to the Inspectors by Mr. Hughes as being "deeply disturbed". Mr. Hughes had gone on to say that after RBW's case was due to be reviewed by his social worker the following Friday and that Mr. Hughes hoped that RBW would be referred to a psychiatrist or a psychotherapist.

As part of the inspection Ms. Shepherd indicated that she had reviewed the file for service user SS. The file had included an assessment by Norfolk County Social Services dated 10^th December 2002 and there was a copy of a risk assessment which had been carried out in July 2002. Ms. Shepherd went on in her witness statement at paragraph 14 to state as follows:-

"There were details of his GP and next of kin of the file but the file did not contain a plan of care formulated by the home. Mr. Hughes advised us that he did review the service user needs but these were not documented."

The inspectors made 14 requirements arising from the April 2004 inspection these included 7 which were repeated from previous inspections. Ms. Shepherd stated there were a number of particular concerns arising from the inspection which included the following:-

• The Statement of Purpose and Service User Guide still did not meet the requirements

• The home had still not developed service user plans. There were also no daily care records to show how any planned care was put into practice

• The provider had not developed any independent life skills training programme for the residents or provided any opportunities for residents to become involved in any kind of formal programme where they could learn independent living skills or improve their education or take up employment

• The residents were expected to manage their own health care needs with intervention from staff as necessary

• The home's adult protection policy had not been amended to include details of how to report issues of abuse and the home also did not have a copy of the Norfolk Adult Protection Strategy Procedure

• There were also health and safety issues in relation to the residents. Both kitchen doors were being wedged and tied open creating a potential for any fire to rapidly spread. The interconnecting doors between the care home and the HMO were found to be unlocked. This meant that the people in the HMO who were obviously unchecked could easily access the care home.

• The décor in the home looked worn and in need of improvement. The carpet tiles in the games room were very dirty.

Ms. Shepherd stated that feedback had been given to Mr. Hughes at the inspection on the 30^th April to the effect that the home had achieved quite a lot but it had a long way to go in order to meet the care home regulations. Ms. Shepherd had provided Mr. Hughes with some further information which it was hoped would improve the home's compliance.

On the 13^th April 2004 Mr. Hughes wrote to the Respondents enclosing his Action Plan in response to the outstanding statutory requirements and recommendations set out in the inspection report following the April 2004 visit. Of the 14 requirements Mr. Hughes stated that he had completed 12, the improvement to the flooring in the kitchen and the games/dining room had not been completed because no decision had been arrived at regarding the type of flooring to be laid and in respect of the requirement to consult with service users prior to admission and to confirm in writing the home's ability to meet that person's assessed needs, Mr. Hughes stated that he did not understand the deadline of the 31^st August 2004. In responding to the requirement that he was to make proper provision for the treatment of service users' mental health needs, Mr. Hughes stated in the Action Plan as follows:-

"The present service users have no mental health needs. New admissions with mental health needs only will not be admitted. There must be a degree of learning difficulty."

A further unannounced inspection visit was carried out on the 30^th September 2004 again by Ms. Shepherd and Mr. Crehan. The report was written by Ms. Shepherd which made 24 requirements in relation to breaches of the care home regulations which it was said had not been complied with by Mr. Hughes. In respect of those 24 requirements, 15 were repeated from earlier inspections. Ms. Shepherd's evidence was that she and her colleague had been let into the premises at 9.15 am by Mr. Philip Baker, Glyn Hughes had arrived at 9.30 am and Mr. Hughes himself at midday. The Inspectors had looked at the service users' files, Ms. Shepherd stated in her witness statement at paragraph 18 as follows:-

"When we did inspect the files, there was no change from the previous inspection. They still did not contain proper care plans. The information on service users was insufficient and out of date. There was no written evidence about how the home was supporting residents with their decisions. The home had failed to develop and implement a risk management strategy for residents. The files did not identify residents' healthcare needs and how they were to be acted upon."

A number of issues relating to the environment were also identified by the Inspectors, including the damaged dirty flooring in one of the kitchens and in the games room, the leaking corrugated plastic roof over the laundry area and concerns about the ability of residents from the HIMO to enter the care home through the exit door from the laundry. The downstairs toilet was said to smell strongly of urine and there were two tiles missing from the wall. It was also noted that there was no hand washing facilities.

It was also pointed out that F had not correctly amended its adult protection procedure, Ms. Shepherd accordingly written to Mr. Hughes on the 4^th October 2004 in relation to this issue. A further letter followed on the 6^th October dealing with the Statement of Purpose and explaining the further matters that needed to be included in this document.

Mr. Hughes responded to the September 2004 inspection report by submitting various documents to the Respondent under cover of a letter dated the 24^th November 2004. The response provided by Mr. Hughes set out his comments in relation to the requirements made by the Inspectors in their September report. In response to the requirement that he was to ensure that staff took a proactive part in helping service users develop employment skills and took up opportunities for further education and training and also that service users were helped to manage their personal finances. Mr. Hughes commented as follows:-

"You have noted that one service user attended Norwich City College for some months, but his attendance fell off, as his course was too difficult. This service user is now being helped to find voluntary work – see care plan.

Another service user has visited the job centre on numerous occasions looking for part time work, which he might be able to do. Thus far, he has been offered nothing. I believe I have told you this."

and with regard to the requirement concerning "management of service users' money" Mr. Hughes stated in his response as follows:-

"At this care home the procedure is simple and well established. It is simply owing to the fact that the service users have little money (currently £17.50 per week plus bonuses for extra work done as agreed with and by, DWP). No service user has savings or any known assets. It is not possible for any service user to be financially abused."

And in relation to care plans he stated:-

"I believe that the care plans, which currently exist, meet the needs of the individual service users presently in residence at this care home.

I acknowledge that you disagree here and quote the Care Standards Act 2000 and the appropriate section.

Bearing in mind that this care home is run as a family unit, as you know, and as you have seen, would all the standards in Section 6 really be applicable?"

As far as service users taking part in appropriate activities was concerned, Mr. Hughes in his response referred to a programme which included swimming, golf, fishing, water skiing and camping both in this country and in Spain.

On the 17^th November 2004 an unannounced inspection took place conducted by Ms. Shepherd and Mr. Crehan. It was also attended by Mr. Mark Andrews, who was described as one of the Commission's specialist pharmacy inspectors. Ms. Shepherd gave evidence that he had been asked to attend part way through the inspection because of concerns over medication. Ms. Shepherd stated that Mr. Hughes, his sons Karl and Glyn as well as Mr. Baker were also present at the inspection. Ms. Shepherd gave evidence in her witness statement that the home did seem cleaner than at the time of her last inspection, but that very little work had been carried out towards meeting any of the requirements and recommendations made at previous inspections. The Inspectors had found that only 2 of the 24 requirements made at the previous inspection had been met. The inspection report for the visit on the 17^th November 2004 made 25 requirements for Mr. Hughes to comply with of which 19 were repeated from previous inspections. Ms. Shepherd stated that her particular areas of concern arising from this inspection were as follows:-

• The continued lack of care planning, assessment and recorded evidence that the home had assessed and made arrangements for any of the resident's health care needs;

• There was a continued lack of records regarding risk management and support for residents taking risks and making informed decisions;

• There was a lack of support for one resident who no longer met the criteria for social services funding, but was still living at the home;

• One resident was taking medication for epilepsy, but in the view of Ms. Shepherd this was not being properly managed and although he had some problems about his health needs regarding the epilepsy, staff at the home had not helped him with his doctor appointments. All medication charts had been signed by Philip Baker who had not had medication training.

On the 20^th January 2005, Mr. Hughes wrote to the Respondents with his comments. Mr. Hughes expressed a concern about the way in which the inspection on the 17^th November 2004 had been carried out, equating it as "more akin to being a raid". In responding to the indication from the Respondents that they were in discussion with their legal department regarding Mr. Hughes's none compliance with issues that affected the health, welfare and quality of the lives of the service users, Mr Hughes stated as follows:-

"Regardless of the existing bureaucracy in the form of legislation, that pertains to the health, welfare and quality of the lives of the service users, the provider is satisfied in real terms (i.e. living a daily, happy life) there is no neglect or risk to either the health or welfare of any service user living in this care home ….."

On the 18^th March 2005 the Respondent's then Regulation Manager Ms. Gillian Warren wrote to Mr. Hughes requiring him to attend a meeting on the 22^nd April 2005 to discuss the future of F. The concerns which it was said the meeting was going to discuss, was the significant number of repeated requirements where the home was said to be in breach of the care home regulations.

In the event Mr. Hughes was unable to attend a meeting on the 22^nd April 2005 and the meeting was re-arranged for the 17^th May 2005. Following the meeting on the 17^th May 2005 Ms. Warren wrote to Mr. Hughes indicating that the Respondent intended to reduce the registered numbers at F to 3 as a result of their concerns about the home and the poor quality care and resources available to meet identified needs. It was also stated that further inspections would take into account the improvements that Mr. Hughes had said were currently being made to the environment and any such improvements would be noted in further inspection reports. On the same date Ms. Warren wrote to the Chief Environmental Health Officer at Great Yarmouth Borough Council concerning various issues about health and safety which had been raised in previous inspection reports.

In a further letter to Mr. Hughes from Ms. Warren dated the 24^th May 2005, she recorded the fact that the Respondent had been told by Mr. Hughes at the meeting on the 17^th May 2005 that although his sons Karl and Glyn had taken the NVQ3 training, the assessor could not verify their practice because F did not have public liability insurance. Ms. Warren reminded Mr. Hughes that there was a requirement at Regulation 25 (2) (e) of the care home regulations that such insurance was in place and displayed.

On the 7^th July 2005 Ms. Shepherd carried out an unannounced inspection of F, on this occasions she was accompanied by Ms. Warren. The Inspectors' report noted some improvements to the environment, in that the lounge, hallway, stairs and one bedroom had been redecorated and a new carpet fitted to the lounge. The report made 14 requirements in relation to the remedying of breaches of the care home regulations of which 12 requirements were repeated from previous inspections. Ms. Shepherd in her evidence indicated that the particular concerns that were identified at this inspection were:-

• The home still lacked a pre-admission and planning procedure;

• The home did not have written evidence regarding residents' care needs, decision making and risk management and managing residents' money;

• The home was not providing residents that were moving out, with any help learning independent living skills. Ms. Shepherd stated that she and Ms. Warren had been advised that SS was due to move out and was waiting for a flat. Ms. Shepherd had asked Mr. Hughes if he had done a plan to assist/develop SS to live independently. Mr. Hughes said that he had not done this as it was not his responsibility, it was Alison's (the social worker);

• Medication was badly managed and one resident was left to self administer without being assessed as being safe to do so. Mr. Hughes had said that the home would not administer medication in the future, because his insurance bill would be too high;

• There was no training for staff in adult abuse awareness and no progress made in amending the home's policy. Mr. Hughes said that he had not read the Norfolk Adult Protection Protocol.

Ms. Shepherd went on to state that at the end of inspection she and Ms. Warren had given feedback to Mr. Hughes and told him that the home did well in relation to providing stability for residents in a non judgmental way. The home provided a family atmosphere and Ms. Shepherd stated that the residents clearly respected Mr. Hughes and referred to him constantly for advice. There had also been some improvement in the décor. Ms. Warren during the course of her feedback advised Mr. Hughes that F was not providing care as interpreted by the Care Standards Act. She had advised him that one option would be for him to temporarily de-register and to discuss running an adult placement scheme with the local authority.

After the inspection visit, Ms. Shepherd wrote to the Norfolk Fire Service on the 15^th July 2005 raising her concerns that a hole in the fire exit door on the top floor of the home had not been filled and also that the home had continued its practice of tying and wedging open fire doors. Mr. Roger Brown from Norfolk Fire Service responded in a letter dated the 5^th August 2005 indicating that the Fire Authority was not satisfied with the existing fire safety standards/arrangements at F. As a result Ms. Shepherd herself wrote to Mr. Hughes on the 10^th August 2005 reminding him that requirements had been made in relation to fire safety in the inspection report and also reminding him of his obligations under the care home regulations. She required compliance with the fire safety requirements by the 30^th August 2005.

On the 18^th July 2005 Mr. Hughes had sent a fax to the Respondents enclosing a copy of his Certificate of Employers Liability Insurance which commenced on the 15^th June 2005.

On the 31^st August 2005, Ms. Shepherd and Ms. Warren made an unannounced visit to F to see whether Mr. Hughes had in fact complied with the fire safety requirements. Ms. Shepherd's evidence was that they found the door in the kitchen was tied open and that the fire exit door on the top floor HIMO side adjacent to SS's small sitting room had a hole in it.

On the 31^st August 2005 Mr. Hughes wrote to Ms. Shepherd and indicated that it was news to him that the fire service was not satisfied with fire safety at F and that he and his staff had been present at all fire inspections at the premises since 1991. Included in Mr. Hughes's letter was the following paragraph:-

"There was no disregard to fire safety in this home, nor has there ever been. You have personally witnessed the installation of the latest fire/protection alarm system currently being worked on to a finish by the electrical contractors – and this throughout the entire building let alone the care home. Disregard of fire safety? You must be talking about someone else."

Mr. Hughes also stated that after the inspectors had left the premises on the 31^st August 2005 a Yale lock had been fitted to the back lane door. This followed concern having been raised by the inspectors of access into F by that back door.

Ms. Shepherd wrote to Mr. Hughes on the 6^th September 2005 acknowledging his letter of the 31^st August and reiterating her concerns and that of the fire officer, regarding the fire safety arrangements in place at F. This was followed by a letter to Mr. Hughes from Ms. Warren of the 7^th September 2005 included in her letter was the following:-

"Given that the Commission has, on several occasions through its normal inspection processes, required you to cease tying open your fire doors and given that the latest request to you to cease this practice by the 30^th August was ignored by you, I feel the Commission has now reached a stage where this requirement must be enforced by means of a Statutory Enforcement Notice and I will shortly prepare this and get it sent to you."

A Statutory Requirement Notice followed, dated the 13^th September 2005 indicating that Mr. Hughes was in breach of Regulation 23 (4) of the Care Homes Regulations 2001 and requiring him within 12 hours to cease the practice of tying open, wedging open or holding open the doors to ground floor kitchen area or the door leading to the adjoining hostel by any means not approved by the fire officer. Ms Shepherd stated that this was delivered by hand to Mr. Hughes on the 13^th September 2005.

On the 13^th September 2005 Mr. Hughes sent a fax to the Respondents' Regional Director, Mr. Colin Hough in which Mr. Hughes stated that the fire precautions at the care home were excellent and that fire doors were not routinely held on, he then went on to list how F was complying with Regulation 33 (4).

On the 16^th September 2005 Ms. Shepherd and Ms. Warren visited F to check whether or not Mr. Hughes had complied with the Statutory Enforcement Notice. Ms. Shepherd gave evidence that they observed that the kitchen doors were closed and the door from the games room to the HIMO was also closed. They were advised by Philip Baker that the home was still keeping the kitchen door open between 7.30am and 8.00pm and between 2.30pm and 3.00pm when carrying through hot tea. It was noted that the hole in the door on the top floor had been filled. At the end of the visit the Inspectors noticed that the lounge door was wedged open and there were a number of ashtrays in the room with three of them containing cigarette ends.

Ms. Shepherd stated that she had attended the premises again on the 19^th September 2005 this time accompanied by the Fire Safety Officer, Mr. Roger Brown. Mr. Brown prepared a report of this inspection which Ms. Shepherd sent to Mr. Hughes by a letter dated the 29^th September 2005 requiring compliance with one of the recommendations by the 1^st November 2005 and all the other recommendations by the 31^st December 2005.

Mr. Hughes responded to the September visit by writing to Ms. Warren on the 20^th September 2005 indicating that on the day of the visit the home were awaiting a delivery of building materials to replace the roof covering in the laundry area at the home and that Mr. Baker had held open the lounge door as the materials from the lorry were to be unloaded into the lounge in the first instance. As regards smoking in the lounge, Mr. Hughes confirmed that it was a smoking area and that service users did smoke there.

On the 7^th November 2005 Ms. Shepherd and Ms. Warren carried out an unannounced inspection of F. Ms. Shepherd in her witness statement noted that improvements had been made to the décor at the home including replacement of the damaged corrugated plastic roof in the laundry area. New furniture and curtains had been put up in the lounge, loose wobbly floorboards in the utility area had been made safer, part of the games room had been painted and one bathroom had been partly redecorated. Some effort had been made to comply with the recommendations made by the Fire Officer. Concerns remained in relation to the lack of recorded evidence regarding residents' health care needs and there was also no change to the service users' care plans. In Ms. Shepherd's view the home was continuing to fail to work with residents' in teaching them independent living skills. In support of this Ms. Shepherd quoted correspondence between Mr. Hughes and Andrew Palmer, from the Community Learning Difficulties Team regarding RW moving to independent living.

Mr. Hughes had written to Mr. Palmer on the 5^th October 2005 indicating that RW had decided that he would like to access support from Mr. Palmer. There had then been a meeting with RW and Alison Mallett on the 7^th October, followed by a further meeting between RW, Alison Mallett and the Housing Services Department in Great Yarmouth on the 10^th October. Mr. Palmer wrote to Mr. Hughes on the 10^th October saying that this meeting had been positive and that RW had been given a list of accommodation providers. An arrangement had also been made for an occupational therapist to carry out an independent living skills assessment of RW on the 19^th October 2005. On the 18^th October 2005 Mr. Hughes wrote to Mr. Palmer saying that the meeting that RW had had with the council's housing services had been a disaster and that RW had simply been given a list of possible bed and breakfast accommodation.

Mr. Hughes went on to refer to a comment in Mr. Palmer's letter that RW had told Alison Mallett that he wished Mr. Hughes to support him in contacting accommodation providers, to which Mr. Hughes responded in his letter as follows:-

"I am sorry to have to tell you that I will, in no way, "support" RW in contacting "them" as, in the first instance I do not believe that RW should be moving on from this care home at this time, and in the second instance I have no wish to be responsible (as you are responsible) for what I predict to be a negative stumble in to a dark and gloomy future where RW is likely to find himself increasingly at risk in many ways. Positive help in moving RW from this care home must be organised by your good self and "the team" at Ferry House. I will not be a party to your plans as I perceive them to be at this time."

Mr. Hughes then went on to list a number of requirements which if put into place would in his view be helpful to RW.

Ms. Alison Mallett in her evidence confirmed that she had taken RW to the housing and homeless service at Great Yarmouth Borough Council. RW had been provided with a list of B&B's, but there were a number of other options open to him.

On the 27^th October 2005 Ms. Mallett stated that she had received a letter from Mr. Hughes indicating that he would in no way help RW to find alternative accommodation. Ms. Mallett commented:-

"This is not a response that I would expect from care home providers."

At the end of the November 2005 inspection the Inspectors identified 17 areas in which they stated Mr. Hughes was in breach of the care home regulations of which 12 of those requirements were repeated from previous inspections. Ms. Warren wrote to Mr. Hughes on the 18^th November 2005 following the inspection, pointing out that there had been some superficial improvements to parts of the décor but that the majority of areas of non compliance with the care home regulations remained. Ms. Warren's letter included the following:-

"Therefore the Commission is left with no other option than to consider the cancellation of the home's registration as we feel the lack of appropriate care is harmful to the future health and welfare of the current residents whose imminent aim is to move to more independent living."

Mr. Hughes wrote in response to Ms. Warren letter on the 28^th December 2005, denying that the improvements to parts of the décor were superficial and stating that the moving of residents to "more independent living" was an idea that had probably come from the Commission and the East Norfolk Community Team who were intent on preserving resources.

Mr. Hughes also wrote to Ms. Shepherd on the 28^th December 2005 commenting on the findings of the inspection of the 7^th November 2005. This included stating that all the recommendations of the Fire Officer had been complied with and to say that none of the residents at the care home were at risk. In relation to service users' independence skills, Mr. Hughes stated as follows:-

" …… that I do not believe that the two residents earmarked, so to speak, for an untimely exit from this care home are likely to survive within the community given the apparent lack of professional support they are likely to receive as things stand at this time."

An issue had been raised by the Inspectors regarding a failure to ensure that hot water temperatures were properly regulated, which as a result placed residents at risk from scolding. Mr. Hughes's response was that:-

"Clearly you have a poor image of the abilities of my residents. All my residents know when water is warm, hot and very hot, although in this home the water temperature never reaches scolding level. How does the final sentence on this page equate with an independent living scenario in the "outside" world?

Do you really imagine that water temperatures in bed-sit land or HIMO land are "regulated"? Or do you believe that when my residents leave the support of residential care they are to be projected into some kind of Utopia which is going to be better than that which they have enjoyed at F?. And this over a dozen or more years?"

Ms. Shepherd stated that she found the contents of this letter from Mr. Hughes as being "rude and insulting".

On the 31^st January 2006 Ms. Shepherd responded to Mr. Hughes's letter of the 28^th December 2005 on a paragraph by paragraph basis.

The next inspection took place on the 1^st June 2006 and was unannounced. It was carried out by Ms. Shepherd and Ms. Warren. In her evidence Ms. Shepherd indicated that at the time of the inspection Mr. Hughes, Philip Baker, Karl Hughes, RBW and RW were away on holiday in Spain. Resident SS remained in the home. Glyn Hughes had not gone on holiday but was not present in the care home. The inspection was carried out with the assistance of the resident SS. Ms. Shepherd said that in conversation with SS the Inspectors were told that he had a flat as from the following Monday, but he had not as yet received a grant through and so had no furniture. SS had told Ms. Shepherd that Mr. Hughes had not helped him to get ready for his move with money or his pills or anything. SS had expressed his anxiety on a number of occasions about not having any furniture.

Ms. Shepherd stated that there had been some improvements made since the previous visit and these included the installation of a new fire alarm system, a smoke alarm linked to the fire alarm system, a fire door having been fitted at the top of the basement stairs, the updating of the adult protection procedure, the renewal of the flooring and ceiling in the utility room, the repainting of the walls and the redecorating of the toilets on the first floor.

As part of the inspection the Inspectors assessed 20 standards from the National Minimum Standards, of the 20 inspected, 10 had not been met and 10 were almost met. The Inspectors found 14 areas where the care home regulations had been breached, all of which were repeated from previous inspections. In the summary to the report the Inspectors stated that the registered provider and staff had not helped or assisted residents in preparing them to undertake independent living in the community. In their view the history of the home showed that the registered provider only made improvements to the home if instructed to do so by the authorities. The summary then listed the areas that required improvement which set out the position as follows:-

"The Commission feels it has done everything within its power to assist the home to improve and to avoid the need for enforced cancellation. However, no further options are available so work will shortly commence in cancelling the home's registration".

On the 14^th August 2006 Mr. Hughes submitted his partial response to the June 2006 inspection report. The response repeated comments that Mr. Hughes had made in relation to earlier reports, namely that the suggestion that residents should seek an independent living solution had come not from the care home, but from Norfolk Learning Disabilities Team and that:-

"The registered provider continues to hold social services responsible for requesting two residents to move out. In fact, before I was able to advise social services on the way to help vulnerable adults move towards independence, one resident found himself under threat of a by-proxy eviction."

As far as SS moving to a flat was concerned it was said to have been arranged by the Housing Association the day after the staff and residents at F were due to go to on holiday in Spain. Mr. Hughes commented that in the event SS had not moved into his flat for some weeks after the holiday party had returned from Spain and as a result had missed out on a holiday. As regards SS's medication, Mr. Hughes stated in his response to the report:-

"SS has been self medicating his Epilim 500 tablets for 15 years. The care home simply kept them locked away until SS needed to take them. This practice ceased many months ago as SS needed to keep them safe himself as he was getting ready for independent living."

In respect of SS's move generally, Mr. Hughes stated that he had tried to put SS off the entire idea as Mr. Hughes did not consider that SS was ready for such a big move, "…… as he was not scheduled to get any help whatsoever from those principals who had bent over backwards in their encouragement of him."

Mr. Hughes stated that all residents past and present were encouraged to maintain appropriate relationships with friends and family and then proceeded to give details as to how he had assisted them in doing that.

One of the general comments that Mr. Hughes made about the care home and its inspection related to whether or not improvements had been made. Mr. Hughes stating that:-

"What has not changed, in anyway whatsoever, is the unashamed agenda adopted by the CSCI Inspectors involved with this care home whereby the focus seems to be not to safeguard the wellbeing of the residents, but to rubbish almost anything in sight to bring about the closure of one of the most unique care home's ever to come within the experience of the said Inspectors."

During 2006 there were a number of fires at the HIMO and various correspondence was produced between the Respondent, the Fire Service and Mr. Hughes. In respect of a fire that took place on the 9^th September 2006 it was reported by the Fire Brigade officers who attended that Mr. Baker had been drinking heavily and showed signs of being drunk. There was also an anonymous letter suggesting that Mr. Baker had a conviction for arson.

Mr. Roger Brown, a Fire Safety Adviser employed by the Norfolk Fire and Rescue Service signed a written statement in these proceedings dated the 9^th July 2008 and also gave oral evidence. He indicated in his statement that he had inspected the care home and the HIMO on the 27^th September 2006. He went on:-

"It was found that a new fire warning/detection system was in place. I drew Mr. Hughes's attention to the fact that the intumescent fire and smoke seals on some of the fire doors had been incorrectly fitted. The fitting of intumescent fire and smoke seals should be done by a competent person."

Mr. Hughes submitted copy CRB enhanced disclosures for himself, his sons Glyn and Karl and for Mr. Baker. The enhanced disclosure in respect of Mr. Baker indicated that there were no recorded police convictions, cautions, reprimands or warnings. On the 4^th October 2006 Mr. Hughes wrote to Ms. Shepherd in relation to the fire on the 9^th September 2006 stating that Ms. Shepherd had been misinformed by fire officers as Mr. Baker had neither been drinking heavily nor was drunk.

On the 12^th February 2007 Ms. Shepherd carried out an unannounced key inspection of F together with Ms. Judith Last. As a result of this inspection 16 requirements were made including 13 repeat requirements, of which two were said to have been repeated for the ninth time and four for the seventh time. The three requirements which were said not to be repeats related to ensuring that residents were protected from potential harm by preventing access to the home from people who lived in the HIMO, to continue to improve the décor and furnishing within the home and ensuring that hot water temperatures in resident areas were individually controlled to provide hot water close to 43 degrees centigrade.

Ms. Shepherd stated that on this visit it was noted that Mr. Hughes had purchased a good quality audit manual for use in the care home, but had not used this manual to assess and to make improvements in the home. He continued to write narrative accounts about the progress of the residents, these did not cover all of the residents' healthcare needs. There was no guidance on how to manage any risks or support them. Ms. Shepherd went on to state that there was no evidence that the home was assisting the residents, namely RBW to work towards his personal goals and his aspirations, which were said to be a significant part of the care that a person with learning difficulties would require.

In the summary to the inspection report it was noted that:-

"Residents continue to receive very low inputs of care mainly consisting of board and lodging and some emotional support. The home offers such a low level of care input to residents that it can not in any way be described as providing care that meets the needs of people with learning difficulties.

The Commission is currently preparing a notice of cancellation in order to cancel the home's registration so it will no longer function under the Care Standards Act."

A meeting took place with Mr. Hughes following this inspection when Ms. Shepherd said that her line manager, Frances Chatten had told Mr. Hughes that the Respondents were preparing a notice to cancel his registration, as he had failed to show that he could provide good care to his residents and this would be sent to him in approximately four weeks time. On the 16^th May 2007 Mr. Hughes wrote to Ms. Shepherd, in that letter he said that he would personally take on board all the outstanding requirements by the 31^st July 2007 and went on to state that:-

"I acknowledge, however, that the improvement plan is meant to help with the planning of solutions to the requirements and I thank you for sending this."

Ms. Shepherd stated that as a result of having received this letter a decision was taken by the Respondents to inspect after the 31^st July 2007 to see whether in fact the requirements had been carried out.

The last inspection carried out by Ms. Shepherd of F took place on the 7^th August 2007 when she was accompanied by Ms. Judith Last. The inspection was carried out on an unannounced basis. Although Mr. Hughes had indicated that he would comply with the outstanding requirements from the previous inspection by the 31^st July 2007, the Inspectors made a total of 17 requirements on the basis Mr. Hughes's non compliance with the regulations of which 16 were repeated from previous inspections. Ms. Shepherd stated that they had however noted some improvements to the décor and that Mr. Hughes had also attempted to re-write residents' care plans and there was more information in those documents. The inspectors went on to state that:-

"However Mr. Hughes continues to write narrative accounts of residents' emotional states and the plans still do not accurately or fully assess the residents' care needs nor do they provide clear guidance of how their care needs were to be met."

The Inspectors were also concerned about the state of one of the resident's bedrooms, Ms. Shepherd stated that they had found a shelf on the floor that had been on the floor at the time of the last inspection. The resident's bed was extremely dirty, the mattress was threadbare and the pillows were so flat that they had no substance. Ms. Shepherd recorded Mr. Hughes stating that:-

"…… he was unaware of the state of the resident's bedclothes as he had not entered the resident's bedrooms."

There also remained issues about the safety of service users in that hot water temperatures had not been regulated and the interconnecting doors between the home and HIMO were still unlocked.

In the summary to the Inspectors' report they noted the following:-

"Residents continue to receive very low inputs of care mainly consisting of board and lodging and some emotional support. The home offers such a low level of care input to residents that it cannot in any way be described as providing care that meets the criteria in the Department of Health's Guidance on Supported Living and Sheltered Housing issued in August 2002, for a care home.

The Commission is currently preparing a notice of cancellation in order to cancel the home's registration so it will no longer function under the remit of the Care Standards Act."

The lead Inspector for the Respondents inspections of F from March 2008 onwards was Ms. Judith Last, she signed a written witness statement in these proceedings dated the 10^th July 2008 and also gave oral evidence. Ms. Last indicated that she had first become involved with F in February 2007 when she had been asked to assist the former link Inspector Ms. Shepherd and had attended visits with Ms. Shepherd to F in February and August 2007.

As Mr. Hughes had not complied with the outstanding requirements from the inspection in February 2007 by the inspection in August 2007, a decision was taken by the Respondent to serve a notice on Mr. Hughes giving Notice of Proposal to Cancel, this was dated the 27^th November 2007 and was sent to Mr. Hughes. In a letter dated the 10^th January 2008 Ms. Frances Chatten wrote to Mr. Hughes stating that as he had not made an appeal against the Notice of Proposal to Cancel then the Respondent was now going to issue a Notice of Decision to Cancel his Registration.

In the Respondent's Notice of Decision to Cancel Mr Hughes's registration they cited 12 requirements which Mr. Hughes had failed to meet arising from the Care Homes Regulations 2001, and then proceeded to set out which regulations it was said that he had breached, together where appropriate with the corresponding national minimum standard. The requirements were as follows:-

1. to be of good integrity and character.

2. to carry on or manage the care home with sufficient care,

competence and skill.

3. to compile a statement of purpose and Service User Guide.

4. to conduct the home so as to promote and make proper provision

for the health and welfare of the service users.

5. to make arrangements for service users to receive treatment,

advice and other services from any health care professional.

6. to make arrangements in relation to medicines received into the

care home.

7. to identify and remove hazards and risks to service users.

8. to keep under review an assessment of service users needs.

9. to prepare service users' plans.

10. to ensure sufficient suitably qualified, competent and experienced

staff are working in the care home.

11. Requirement relating to fitness of premises.

12. to evaluate quality of services.

Ms. Frances Chatten was employed by the Respondents as a Regulation Manager from the 1^st April 2004 to the 1^st April 2008, she signed a witness statement in these proceedings dated the 9^th July 2008, but did not give oral evidence. In her statement she set out the regulation history so far as F was concerned, indicating that Gillian Warren had been the Manager responsible for line management of the Inspectors who had visited F between April 2004 and April 2006. Ms. Warren had gone on long term sick leave in October 2006 and at that point Ms. Chatten had assumed management responsibility for Ms. Shepherd who was the link inspector for F at the time.

In paragraph 8 of her witness statement Ms. Chatten said that she was aware that Ms. Warren had had discussions with the Respondent's legal advisors and:-

"…… it had been agreed in view of the number of repeat requirements and the fact that the proposed quality rating for the service was poor that the Commission should seek to cancel the registration of Mr. Hughes with respect to F."

At the inspection in February 2007 Mr. Hughes's description of the type of environment that he was providing at F was not considered sufficient for F to qualify as a residential care home for people with a learning difficulty. Ms. Chatten said that she had started to draft the Notice of Proposal to Cancel the Registration after the February 2007 inspection, but that the notice had been delayed because Mr. Hughes had said that he would comply with all of the requirements by the end of July 2007 and accordingly he was given additional time. However, the August 2007 inspection had identified that he had not met the requirements from the previous inspection and therefore a decision was taken to serve on Mr. Hughes a Notice of Proposal to Cancel the Registration with respect to F. The decision was taken on 10 January 2008.

Mrs. Last gave evidence that she had made an unannounced inspection of F subsequent to the Notice of Proposal to Cancel in March 2008 when she was accompanied by another Inspector Mrs. Prettyman. At paragraph 36 of her witness statement Mrs Last stated as follows:-

"At the inspection in March 2008, we could not conclude that he had made any progress to address the outstanding requirements in relation to health, welfare and safety of people living at the home, and therefore the breaches of regulations. Mr. Hughes himself told us that nothing had changed."

The Inspectors did however notice some changes in that the outside of the home was being refurbished by a community regeneration project and the kitchen floor, bathroom and first floor WC were cleaner than Mrs. Last had seen previously. There did however remain concerns about the overall maintenance, cleanliness and hygiene of the home.

The Inspectors viewed the records for one resident and found that no action had been taken to update his care plan in order to show the support that that particular resident needed. Mr. Hughes could not for example show that the resident's identified need for support with dental health was being met. Mr. Hughes was unable to show how the treatment plan from the dentist had been clarified, when appointments had been made or the outcome of those appointments. The Inspectors made two immediate requirements arising out of their visit. One was to do with storage of spirit based paint in a cupboard under the stairs and the other was to do with Mr. Hughes's failure to notify the Respondent of his absence from the home and of the arrangements he had made to ensure that it operated satisfactorily in his absence. Mr. Hughes had told the Inspectors that he had been away from the home for 9 weeks in hospital.

At the conclusion of the inspection a report was written by Mrs. Last making 21 requirements of Mr. Hughes, 17 of which were said to be outstanding from previous inspections. Mr. Hughes was told that he must produce an improvement plan by the 24^th June 2008.and told what he was required to do and the reasons why he needed to do it. An improvement plan was not received from Mr. Hughes by the 26^th June and a letter was sent to him by Mrs. Last on the 3^rd July indicating that if his plan was not received by the 11^th July 2008 then enforcement action would be considered.

On the 4^th February 2008 Mr. Hughes appealed to this Tribunal against the decision of the Respondent on 10 January 2008 to cancel his registration in respect of F. Attached to Mr. Hughes's Notice of Appeal was his response to the Notice of Decision to Cancel his registration served by the Respondents. In relation to the 12 requirements Mr. Hughes was said not to have met his response was as follows:-

"1. To be of integrity and good character.

Mr. Hughes stated that the care home had been providing a residential care experience in the form of a family orientated living style since 1989.

The resident referred to in the inspection on the 7^th July 2005 had at that time been about to move out and had been seen twice by the county occupational therapist who had said that the resident's skills that were tested had shown competence. Mr. Hughes stated that the resident concerned could use various domestic appliances at the care home. Mr. Hughes went on to say that his expressed misgivings regarding the resident moving out had been vindicated in that the residents move into the community had not so far as Mr. Hughes was concerned been successful.

As regards the thermostat controlling the water temperature was concerned, this was to be found at the boiler. The temperature was higher than 43 degrees centigrade as the residents regarded this as being "too cold".

In reference to service user SS being left in the home when the rest of the service users had gone to Spain on holiday, Mr. Hughes said that the resident concerned was trained and ready for independent living and should have moved out before the group went on holiday to Spain, where there resident had himself been some five times previously. Mr. Hughes went on to state that:-

"The member of staff who refused to attend the home during the Inspectors unannounced visit, attended during mealtimes and during the evenings and strongly objected to the expectation that he attend during such an unannounced visit. Had the visit been announced he would have appeared at the premises earlier."

Mr. Hughes considered that he was a person with considerable integrity.

2. Requirement to carry on or manage the care home with sufficient, care confidence and skill.

Mr. Hughes stated that there were now 2 residents in the home and that his teaching commitments usually involved approximately 8 hours per week with the Visiting Teacher Service, which left him with 160 hours to execute his management responsibilities. Mr. Hughes went on:-

"At this care home staff are caring and warm hearted. Staff skills are great skills for vulnerable adults who respond in a most rewarding way. Confidence is linked to skills where care is of paramount importance."

3. Requirement to compile a statement of purpose and service user guide.

Mr. Hughes commented that there was a statement of aims and objectives, the care fees were those decided by Norfolk County Council and there were no other charges. The care home was available to adults of either sex. Social activities, hobbies and leisure pursuits could be arranged according to inclination and abilities.

4. Requirement to conduct the home so as to promote and make proper provision for the health and welfare of the service users.

The response from Mr. Hughes was that he had enabled the service users to make use of adult learning through "Meriden East" and to also make contact with the Adult Learning Scheme through the education office in Great Yarmouth. In relation to the service user who was interested in computers, Mr. Hughes stated that he had made contact and had enrolled the resident on to a course at Great Yarmouth College which the resident had attended regularly and had improved his IT skills. As regards to the service user who was moving from the care home and was referred to in the July and November 2005 inspections, Mr. Hughes stated the resident concerned had nothing to move expect a few items of clothing in a plastic bag. All the furniture in the flat occupied by the resident belonged to Mr. Hughes and was part of the fabric of the care home.

5. Requirement to make arrangements for service users to receive treatment, advice and other services from any health care professional.

It was stated by Mr. Hughes that he had not been informed by the East Norfolk Disabilities Team about arrangements for a particular resident to be referred to specialist services. As regards the resident who had epilepsy, Mr. Hughes commented that this resident had made his own arrangements with his GP regarding his epilepsy. The resident had never been seen by Mr. Hughes to have a fit in a period spanning 15 years.

In relation to the resident with a dentistry programme, Mr. Hughes stated as follows:-

"I do not understand the plan as I am not a dentist, although I have accompanied the resident to the dental surgery on four occasions."

6. Requirement to make arrangements in relation to medicines received in to the care home.

Mr. Hughes confirmed that there was one resident who self administered Epilim 500 on a daily basis. This was said to be kept locked in the medical drawer until needed. No other resident was on medication. After a visit by two inspectors and a pharmacist Mr. Hughes stated that he had decided to

"….. opt out of keeping regularly taken medicine on the premises in the event that a resident might suffer a mix up in his medication."

7. Requirement to identify and remove hazards and risks to service users.

In response Mr. Hughes stated that the entire premises had a certificate from both the electrician and the Great Yarmouth Borough Environmental Health Department and that this had always been the situation and the Respondents knew this. The hygiene practices in the kitchen were described by Mr. Hughes as being so good that the Borough Council's Environmental Health Department had regularly praised the practice. No residents were said to self medicate unsupervised until they could do so safely. When residents left the home for any reason other than routine then staff would be told. Residents from the HIMO did have access to the kitchen, but had their own dining room. They did not have direct access to the care home. The care home was staffed for most of the day and night in any event and that was why Mr. Hughes said that interconnecting doors did not need to be locked except at night.

8. Requirement to keep under review assessment of service users' needs.

Mr. Hughes denied that he was in breach of the relevant regulation.

9. Requirement to prepare service users' plans.

The service users at F were said by Mr. Hughes to devise their own plans in conjunction with Mr. Hughes and other staff. The Inspectors had read the care plans. Mr. Hughes stated that he was assisting with the development of independent living skills. As far as the resident who was alleged to have expressed a desire to move away from the home, Mr. Hughes stated that the resident did not know that he had wanted to move until he was told that he did by the Learning Difficulties Team. There were other people involved in his move including a worker from the housing charity and an occupational therapist to the extent that Mr. Hughes considered that:-

"…… there was scarcely a need for staff to become involved in the resident's move out."

10. Requirement to ensure sufficient suitably qualified competent and experienced staff while working in the care home

No comment was made by Mr. Hughes in relation to this particular requirement.

11. Requirement relating to the fitness of the premises.

In his response Mr. Hughes included the following:-

"The CSCI know full well that the fire precautions and "fire equipment" on the premises are very much in order, and always have been. Equipment is updated regularly and recently alarms have been installed in every room including every room in the adjoining premises. CSCI itemised the points on page 18 as if they are all breached. In reality, nothing whatsoever is being breached and CSCI know this."

Mr. Hughes went on to state that the premises had been inspected by the Borough Council Environmental Health Department and by the Fire Brigade. He acknowledged that at the time of a CSCI inspection one door to the residents' lounge was wedged open. He also acknowledged the comment from the Fire Officer in a report dated the 19^th September 2005, that wedged open fire doors cause fire precautions to be ineffective and that staff and residents had been advised not to continue wedging open the door in question.

12. Requirement to evaluate the quality of services.

The comment from Mr. Hughes was as follows:-

"The Quality Assurance assessment document was supposed to have been read by the CSCI in which case there was little point in writing out a separate document which says the same thing."

Mr. Hughes continued:-

"There is no level of risk to the residents as the residents would tell the Tribunal should the Tribunal choose to ask both of them. In fact the residents see the CSCI Officers (who attend this Care Home) as being the biggest threat to their lives."

In a further post decision inspection on the 11^th July 2008 the Respondent carried out a further unannounced inspection with the leading Inspector being Mrs. Last. Mrs. Last told the Tribunal that there had been by the time of this inspection improvements to the outside of the buildings and laminated flooring installed in the hall and TV lounge. The statement of purpose remained unchanged from previous visits making no reference to information about the fees payable and that medication would not be administered by staff in the home. One care plan had been missing for RW the other was unchanged. There was one service user who was travelling widely and Mr. Hughes had been asked about risk assessments for that person, to which Mr. Hughes is said to have responded that he thought they would go to the bus company and ask about arrangements, which Mrs. Last did not consider was an answer that had been thought through. One of the service user's sink was dirty and stained as had been the case on the two previous inspections. It did not appear to Mrs. Last that checks had been made in relation to the service user's room for a couple of weeks. The Inspectors also noted that two rooms had been designated as smoking areas, but that it was clear from ashtrays and cigarette debris that people smoked in other areas of the home as well.

In relation to personal and healthcare support, Mrs. Last noted that the service user who had been on a dental plan had now been taken off the plan because they had failed to keep an appointment. Mr. Hughes told the Inspectors that he had not been in to the appointment with the service user and had instead stayed in the Dentist's waiting room. This meant that he had not been able to confirm what point the service user had reached on the dental plan and what was to happen next. Mouthwash was found in this person's room by the Inspectors which had been prescribed by the Dentist. The pharmacy label showing a date of the 12^th October 2006, but the bottle remained full. In the inspection report it was noted that the Inspectors were aware from past visits that one person at the home had not taken medication (antibiotics) in the way which was prescribed and had not understood the purpose of medicines prescribed for pain relief.

In relation to the NVQ3 qualifications of Mr. Hughes's sons, Mr. Hughes told the Inspectors that an assessor had been and taken their portfolios away for accreditation. However, Mr. Hughes was not able to confirm the name of the assessor or the training company who was dealing with this. Mr. Hughes said that there had been no staff training during the preceding year.

Mrs. Last said that her overall view as regards F was that not sufficient support was being provided for the service users, particularly personal healthcare, in order for F to function as a care home. The summary to the report indicated that were 18 matters that needed to happen by law, which were all outstanding from the previous inspection. 12 of these were still just within the timescale that the Inspectors had imposed on the last visit namely the 31^st July 2008, but the Inspectors had seen little or no evidence of progress. 8 of the items had been repeated at least six times, but had not yet been complied with. One requirement had been made on eleven separate occasions.

Mrs. Last in answer to a question from Mr. Hughes said that she was aware that the kitchen at F had been inspected by the Environmental Health Department, but was not aware that they had said that food did not need to be dated. Mrs. Last said that she had a food and hygiene qualification and in her view food should be dated.

Mrs. Last also said that she was not aware of there ever having been a problem with people going from the HIMO into the care home.

Mrs. Prettyman, a locum Inspector of care services for the Respondents signed a witness statement in these proceedings dated 4^th July 2008 and also gave oral evidence. She indicated that her contact with Mr. Hughes and F had been limited to accompanying Mrs. Last on the inspection that had taken place on the 26^th March 2008. Mrs. Prettyman gave evidence that during the inspection she had opened a cupboard under the stairs and saw several pots of flammable paint stored there, together with finding a fire door propped open with a piece of wood, prompted Mrs. Prettyman to express her concerns, given that there had been a recent fire in the adjoining HIMO. Mrs. Prettyman stated that Mr. Hughes had seemed surprised at the contents of the cupboard and had made arrangements for them to be removed.

Mrs. Prettyman said that she had also noticed the kitchen area which had appeared different to the rest of the building in that it was clean, tidy and well organised appearing to meet Environmental Health standards, whereas the rest of the care home was poorly decorated, untidy and did not appear to have been cleaned for sometime. Mrs. Prettyman also went on to say that she had been shocked by Mr. Hughes's attitude regarding basic fire safety, and also when he had said that he did not know about the Care Standard Regulations. Mrs. Prettyman confirmed that she had read Mrs. Last's inspection report and stated that it was a true and accurate record of their findings.

Ms. Mallett, when giving oral evidence was asked about a meeting that RBW had had with a supportive employment agency about April 2006 which she had arranged. RBW had been accompanied to the agency meeting by Mr. Hughes, during the meeting, Mr. Hughes was alleged to have said that RBW could not commit to 20 hours of work per week. He had other things to do. Ms. Mallett acknowledged that RBW might not have been able to commit to 20 hours a week, but that there might have been ways around that. She was also aware that RBW could have lost his state benefits if he had not turned up for the arranged work, but again she thought that was a problem that could have been overcome.

There was one other witness that the Tribunal heard from namely Mr. Roger Brown from the Norfolk Fire and Rescue Service who as already indicated had signed a written witness statement dated the 9^th July 2008. In oral evidence he told the Tribunal that it was not acceptable for fire doors to be wedged open, there should be a mechanism that closes the door automatically connected to the fire alarm or that shuts the door automatically when the fire alarm goes off. Mr. Brown said that having carried out a recent inspection of F all outstanding requirements had been complied with and there had been a big improvement. Everything that had been identified in the schedule to the inspection on the 10^th April 2008 had been completed. The standards now achieved at F were satisfactory. However, the most important part of any fire safety precautions was the management control to ensure that fire safety measures were always followed.

A written witness statement was submitted by the Respondents from Sarah Flatman, an Environmental Health Officer with Great Yarmouth Borough Council dated the 29^th May 2008. She did not give oral evidence. She stated in her witness statement that she had visited the property on the 6^th December 2006 to carry out "a slips and trips visit" and met with Mr. Hughes. She was told by Mr. Hughes that he had three employees, which she stated meant that documented risk assessments and safety policies were not required in the premises. She had prepared a report arising from her visit in which she noted that carpets were worn and lifting and should be secured and that on the second floor there was a window at low level which created a risk that a person could fall through it and as such Mr. Hughes had been advised to put bars across the lower half of the windows. After her visit on the 6^th December 2006 Ms. Flatman stated that she had had no further involvement with Mr. Hughes or F.

Mr. Hughes did not provide a written witness statement, but it was agreed at the hearing that his response to the Notice of Decision to Cancel his Registration would stand as his written evidence. Mr. Hughes did however give oral evidence at the Tribunal hearing. In giving oral evidence Mr. Hughes commented on the 12 requirements that he was alleged to have breached as set out in the Respondents' Notice of Decision to Cancel the Registration of F. In doing so he gave evidence that F was a loss making venture because of the wages that were needed to be paid to the staff. It was about how the care home could help the residents. As far as service users receiving treatment from healthcare professionals was concerned, SS had had epilepsy before he came to the home and Mr. Hughes had told him to go to his GP to increase the medication and this was part of teaching independent living skills. Mr. Hughes had never seen SS have a fit. He had not understood the dental plan.

On the question of access between the HIMO and the care home that was not allowed and the doors were locked at night. There were always staff around in any event. There were self closers on the two fire doors, only one had ever been wedged open and that was for cleaning purposes. Fire and safety at the home was excellent, every room had its own fire alarm. There was no poor hygiene in the kitchen, if there had been a problem Mr Hughes would have been informed by the Environment Health Department. In relation to the water temperature, there had been complaints from the residents that the water had been too cold, so it had been turned up to 52 degrees, but that was not hot enough for baths. There was no danger that anyone would get scolded.

The two care plans that Mr. Hughes had written had an emphasis on care needs. The plans were fairly comprehensive.

Mr. Hughes was confident that both his sons would shortly be able to produce NVQ certificates. The other member of staff Mr. Baker had agreed to try for NVQ2 although he could not read or write. The NVQ people thought he would be able to manage.

As regards the incident involving SS being left while the other residents went to Spain this was because he was waiting for other accommodation to be sorted out by Social Services. Mr. Hughes stated that SS was allowed to stay as he was deemed fit and able to fend for himself otherwise why would he have been moving out. Mr. Hughes's son had in any event been around at mealtimes. There were two part timers in the kitchen and laundry.

As far as the building was concerned, laminated flooring had replaced some of the carpets in the main area, the room carpets would be replaced when the contractor concerned had time. The service users' rooms would have carpets and the games room carpet would be replaced. The outside of the building was in a pristine condition due to the work carried out as part of an external project.

Mr. Hughes confirmed that he had bought a quality assurance manual which was a thick bundle of documents and he regarded it as an ongoing task. He was doing it on a piece meal basis.

Mr. Hughes also commented that he took the residents on an annual holiday to Spain at his own expense and encouraged them to meet other people. When at the care home the residents had four meals a day including making their own meal in the evening. Mr. Hughes lived in the basement of the property and there was access to staff for service users all the time. The service users could come and go as they wished, they had their own keys.

When cross- examined Mr. Hughes had said that he had dipped into the Care Home Regulations and had not read them from cover to cover. He read them when he received an inspection report. He accepted that there may be parts of the regulations that he had not read. He also said that he had read the National Minimum Standards in so far as they were relevant to the inspection reports that he had received. He relied on the inspection reports to point out what he had not done. He accepted that the care home should be self checking whether or not they were complying with the regulations and he believed that he had done that. He accepted that both the Care Home Regulations and the National Minimum Standards had been supplied to F.

Mr. Hughes said that he did a lot for the service users, including attending meetings such as the one with RBW and the employment agency. He had also assisted RBW in relation to attending an education office to investigate literacy and numeracy classes, but Mr. Hughes acknowledged that none of this had been written down in any service user plans. Mr. Hughes said that what he had produced were proper plans, although he had accepted that not everyone would understand them. He had not been aware that it was a requirement to put plans into a language that service users understood. Mr. Hughes told the service users what were in the plans.

Mr. Hughes accepted that the records kept by the care home did not show if a service user had refused medicine or if medicine had actually been taken. In regard to SS he was already taking medication when he came into the care home. Mr. Hughes had asked him at various times why he had not taken his medication and SS had told him that he could not be bothered. Mr. Hughes accepted that some training on medication could have been arranged for the staff, but the insurance premiums would then have been too high. There had been no assessment of the service users to see if they could administer medication safely themselves.

In relation to the service users requiring independent living skills Mr. Hughes did not see that it was his duty to have supported resident SS moving to other accommodation, because Mr. Hughes did not believe that SS would cope and he was trying to protect him.

It was accepted by Mr. Hughes that the care home should support the service users in maintaining their rooms, but the staff did not go into service users' rooms without an invitation. Mr. Hughes also accepted that he should have supported one of the residents in obtaining a new pair of trainers when they were clearly worn out.

In relation to the premises there had been occasions when the kitchen door had been propped. It was normally closed. There had been in use an iron to wedge open the door between the games room and the dining room. As regards the water temperature it was only after the February 2007 Inspectors' report that Mr. Hughes had seen a mention of the possibilities of legionella arising because of water temperatures. Mr. Hughes had not addressed the problems that had been pointed out in relation to carpets at the home in 2004, when requirements had been made particularly in relation to the hall, because he was waiting for the outside of the premises to be completed first.

As far as staffing was concerned Mr. Hughes said that he had not done an NVQ Level 4 training and there had been no management training in the last six years in relation to working with people with learning disabilities. The two part time staff to which he had referred earlier helped out with the cleaning. They were not part of the care home staff, they were part of the HIMO. They did food preparation for the care home residents and the residents of the HIMO. They had not had CRB checks. They could not be described as working in the care home. Mr. Baker had no training apart from food and hygiene, fire procedures and first aid training. F did not arrange an annual training programme for staff.

Mr. Hughes said that the two service users left living at F were not subject to any risks and never came to any harm. They felt they belonged. They were loved. Mr. Hughes treated them no differently from his own sons.

The Findings of the Tribunal on the Evidence

F has been registered as a care home since Mr. Hughes succeeded in his appeal to the Registered Homes Tribunal in 1989. The home has been described in the various inspection reports as a terraced property situated close to the centre of Great Yarmouth. Mr. Hughes also owns and manages a house in multiple occupation accommodating 29 people in the adjoining properties.

The care home is registered for 4 service users with learning difficulties. As at the date of the hearing there were 2 male service users in residence RBW and RW. We were given a description of the needs of RBW, RW and two earlier residents SS and GM by Ms. Alison Mallett of East Norfolk Community Learning Difficulties Team who has an NVQ Level 3 in supported living and is also a registered NVQ assessor in care. We accept her evidence that RVW has a mild learning disability and that he has deep rooted emotional issues and can be described as a vulnerable person, although he has no personal care needs. Her assessment of RW is that he does not have any personal care needs nor did he appear to Ms. Mallett to have a learning disability. In the case of service user SS he has epilepsy and during his time at F was on medication. He was unable to read and write, but was not considered to be a particularly vulnerable person. He had a support network of friends around him. In the case of GM, the description given to us by Ms. Mallett in relation to him was that he had originally been placed by the Probation Service and appeared to be a rather vulnerable person who becomes emotional and tearful.

F has been inspected on numerous occasions since it was registered, initially by Norfolk County Council, then by the National Care Standards Commission and since April 2004 by the Respondents. We calculate that since April 2004 there have been 10 inspection visits leading to reports. In respect of the visits between April 2004 and August 2007 these were led by Ms. Hilary Shepherd from whom we heard evidence and from then until the 11^th July 2008 by Ms Judith Last. We also had the benefit of seeing the copies of the various inspection reports.

The Respondents in cancelling Mr. Hughes's registration submit that he failed to comply with a number of requirements set out in the Care Home Regulations 2001. We propose to consider each of the requirements relied upon individually in the context of the care home regulations and the National Minimum Standards.

1. Requirement to be of Integrity and Good Character (Regulation 7 (1) (2) (3) ).

Mr. Hughes is undoubtedly a very caring person and a number of the inspection reports reflect the family style environment that he has provided at F. It is also recorded that he has provided the residents with emotional support and he undoubtedly considers that he has their best interests at heart. Although we had no direct evidence from the residents, we conclude from the comments made by the inspectors in their reports that the present residents RBW and RW have a good relationship with Mr. Hughes and rely on him for help and support. There were various examples from Mr. Hughes's own evidence that he treats RBW and RW like members of his own family, for example he takes them to Spain on annual holidays at his own expense.

There was nothing to suggest in the evidence presented that Mr. Hughes is anything other than of good character. He told us about the senior positions of authority that he has held in the past and he has a number of impressive qualifications, also we had sight of his enhanced CRB check confirming that he has no convictions.

However, Regulation 7 (3) refers to a person not being only of good character but also being of integrity. The question of integrity must in our view be considered in the context of the running of a care home and more particularly in complying with the relevant regulations and the National Minimum Standards as well as their relationship with the relevant regulatory and statutory authorities. This is not to say that if a person running a care home should at any time fall short of a particular regulation or the National Minimum Standards that in itself means that they are not a person of integrity and good character.

A person's conduct needs to be considered in the light of all of the circumstances. In this case Mr. Hughes has repeatedly failed to comply with the requirements laid down by the Respondents and the National Minimum Standards over a long period of time. At the end of the March 2008 inspection for example, there were twenty one requirements made by inspectors for Mr. Hughes to comply arising from the care home regulations and the National Minimum Standards. Two of those requirements were being repeated for the tenth time and three for the ninth time. Mr. Hughes's view on some of the requirements was that he was already meeting them in his own way or for whatever reason the care home regulations underpinning them were not relevant to his home. Whether or not Mr. Hughes agrees with the regulations is not relevant. The Respondents have a responsibility to ensure that the regulations are complied with as required by the legislation. It might be said that the inspectors were unreasonable in their interpretation or lacked an understanding of the way in which Mr. Hughes was seeking to run the home. We do not accept that.

There is no evidence that Mr. Hughes has attempted to enter into a meaningful dialogue with the inspectors to try and resolve the position, despite the inspectors, in many cases, having made helpful suggestions as to how Mr. Hughes could comply, including indicating where information could be obtained which would assist him. For example the need for properly drawn up care plans for each resident is a vital part of running any care home in order to ensure that resident's needs are properly documented and reviewed. Mr. Hughes was clearly not complying with this requirement in the way in which he prepared his care plans which in the main were a historical narrative of how he saw a particular service user and could in no way be described as a care plan as envisaged by the National Minimum Standards. This was explained to Mr Hughes in inspection reports on numerous occasions, but no attempt was ever made by Mr. Hughes to change his practices. That is not to say that every care home needs to be run in exactly the same way, but it does require the regulatory authority to be able to have a dialogue with those running care homes in a professional and meaningful way. We therefore consider that Mr. Hughes's continual failure to comply with the requirements that were made of him over a long period of time is evidence of a lack of integrity on his part.

It must also be necessary for anyone running a care home to be familiar with what is required by the care home regulations and the National Minimum Standards in order that they can ensure compliance. Mr. Hughes in his evidence told us that whilst he occasionally "dipped into the regulations" he had not read them throughout. He said that he had an expectation that the Respondents would point out to him breaches of the regulations, that in our view is not sufficient. A care home owner needs to be aware from the outset of the care home regulations and the National Minimum Standards with which they have to comply. This should be an ongoing process of review and self checking in order to ensure that the all the relevant requirements are being complied with. The views expressed by Mr. Hughes in this regard further our view, that in the context of running a care home he cannot be regarded as somebody of "integrity".

Finally on this particular requirement, the regulatory authority should also be able to have confidence that assurances given by a care home owner as to future compliance with regulations will be carried out. In a letter dated the 16^th May 2007 Mr. Hughes said that he would personally take on board the requirements from the February 2007 inspection by the 31^st July 2007. However at the inspection on the 7^th August 2007 whilst some improvements had been made there was no real evidence of a change of attitude on his part and the August inspection finished by sixteen of the previous requirements being repeated because Mr. Hughes had simply not complied with them.

2. Requirement to carry on or manage the care home with sufficient care, competence and skill, (Regulation 10(1).

In relation to this requirement the Respondents allege a breach of Regulation 10 (1) which requires a registered provider having regard to the size of the care home, the statement of purpose and the number and needs of the service users to carry on the care home with sufficient care, competence and skill.

In their Cancellation Notice the Respondents relied on a number of breaches of this regulation. It was said that as Mr. Hughes was also employed as teacher with the Visiting Teacher Service this brought into question his management of the home. Whilst Mr. Hughes in evidence confirmed that he did do this work, he nevertheless spent a considerable amount of time at the home and indeed lived on site. We do not consider that the fact that he had a part time job in itself related to his care, competence and skill in running F.

There were however a number of issues which did cause us concern regarding the way in which Mr. Hughes runs F.

Section 3 of the Care Standards Act 2000 defines a care home as being

"……….. an establishment as a care home provides accommodation, together with nursing or personal care ……..".

In the context of F that means a requirement to provide the residents with "personal care". This in our view means more than simply adopting a caring attitude towards residents, it requires the taking of a much more proactive approach.

There were a number of examples used by the Respondents in support of their contention that in several key areas personal care was not being provided by Mr. Hughes. Firstly in relation to the cleanliness of the residents' rooms, during the August 2007 inspection, inspectors expressed concern about one of the resident's bedrooms, in particular that the bed was extremely dirty, the mattress was threadbare and the pillows were so flat that they had no substance. This was put to Mr. Hughes, who stated that was unaware of the state of the residents 'bedroom as he had not entered the residents' bedrooms. This was clearly not an isolated situation in that the inspectors on this visit also found a shelf on the floor which had been on the floor on the last time they had visited, implying that Mr. Hughes was not in the habit of visiting the residents' rooms. Whilst we accept that it may not be part of Mr. Hughes's function to necessarily clean the residents' rooms, but there was no evidence that any steps were being taken to facilitate the residents in keeping their rooms clean themselves and ensuring that they were safe to use.

Another example was the question of medication. As long ago as the inspection of November 2004 it was identified that one of the residents was taking medication for epilepsy, but the home had no system in place to manage this safely. The subsequent response from Mr. Hughes was that the home would no longer administer medication because his insurance bill would be too high. Even if this was a course of action open to Mr Hughes, no steps were taken by him to carry out any risk assessment in relation to the resident who was self medicating or to make appropriate enquiries of any medical professionals to ascertain and establish an appropriate regime in which the resident could safely and reliably take his medication. Mr Hughes simply relied on the fact that the resident had been self medicating for a number of years. We do not consider this satisfactory in the context of the resident being in a care home and being entitled to personal care.

Finally, the Respondents pointed to the management of the residents' money by the care home. Mr. Hughes's response to this issue had in effect been that the residents had such a limited amount of money that there was little point in trying to assist them with the management of it. This was an issue that was raised by the Respondents as long ago as 2003 and yet there had not been a positive response from Mr. Hughes. We endorse the comments made by Miss Sullivan during the course of the hearing, that when someone has very little money it is even more imperative that they are assisted with its management It also needs to be seen in the context of the residents ongoing development and the possibility that in the future they may move to more independent living, when management of money will be absolutely vital.

The inspectors recorded on a number of occasions in their reports that residents of F were receiving very low inputs of care mainly consisting of board and lodging and some emotional support. We agree with those views and believe that the examples given above demonstrate that to be the case. While Mr. Hughes may be providing a caring environment, he is not providing the personal care envisaged by the Care Standards Act. and the relevant guidance. We therefore conclude that he is in breach of this requirement.

3. Requirement to compile a statement of purpose and service user guide (Regulation 4 (1) and Regulation 5)

The statement of purpose whilst in theory a relatively straightforward matter is hugely important as it should set out the physical environment standards met by the home in relation to National Minimum Standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2. This gives basic, but essential information about the physical aspects of the home itself including such matters as toilets and bathroom facilities and those parts of the buildings that are available for shared activities. It would also be expected to deal with the type of services residents could expect to find in terms of medicine administration, the cleaning of their rooms and help with financial matters. Schedule 1 of the Care Homes Regulations 2001 sets out some specific information that needs to be included in the statement of purpose.

Mr. Hughes had produce a statement of purpose dated the 13^th August 2004 which contained some of the information required by the care home regulations and the National Minimum Standards, but there were a number of omissions. It did not for example deal with the age range and sex of the service users for whom the home was registered nor did it set out details of the arrangements for social activities, hobbies and leisure pursuits. These were matters that could easily have been rectified, as could the other issues already mentioned in relation to medicine administration, cleaning and finance. The deficiencies in the statement of purpose were pointed out to Mr. Hughes at an early stage and on a regular basis. Despite this requirements to comply with the regulations still remained outstanding at the time of the July 2008 inspection, the requirement having been repeated there for the fifth time. Mr. Hughes is therefore clearly in breach of the requirement to compile a statement of purpose which meets the regulations and National Minimum Standards.

The other part of this requirement was to have in place a service users' guides, the detail of what should be included in such a guide as set out in Regulation 5. Again Mr. Hughes had prepared a service users' guide, but there were a number of clear deficiencies with it. For example, it failed to include information about fees and it did not in the view of the Respondents meet the requirements of Standard 1 of the National Minimum Standards that it was not a guide which "sets out clear and accessible information for service users ……". The whole purpose of the guide is to enable service users themselves to be able to ascertain what support and provision is available and the fees to be charged, the document should also incorporate existing service users views of the home. Again the document produced by Mr. Hughes went some way towards fulfilling the relevant standard, but despite numerous requirements from inspectors, Mr. Hughes has failed to amend the service user guide to make it comply with the regulations. In relation to the requirement of Regulation 5 (1) (bb) to give details of fees, Mr. Hughes has simply stated "fees charged are at the rates set by Norfolk County Council". As the inspectors have pointed out on numerous occasions that is not sufficient. It may be for example that new residents to the home would always be charged at that rate, but in any event a prospective service user reading the document would not necessarily know what the rates were that were set by Norfolk County Council. The information would be of vital importance to them so that they could make an informed choice about whether F was the home that they were looking for. This remained a requirement of the Respondents at the time of the July 2008 inspection. We can only conclude that Mr. Hughes has taken the view that he will simply not comply with the statutory requirement. We therefore find him in breach of the relevant regulations.

4. Requirement to conduct the homes so as to promote and make proper provision for the health and welfare of the service users (Regulation 12 (1) (a))

This in effect requires the registered owner to make proper provision for the health, welfare and care of service users and where appropriate the treatment, education and supervision of service users.

A number of examples of Mr Hughes failings in this regard were given by the Respondents in their Notice of Cancellation. We have looked at these individually and also in the context of the evidence as a whole. Amongst the issues arising from the April 2004 inspection was that Mr. Hughes had not developed any independent life skills training or had provided any opportunity for residents to learn independent living skills, improve their education or take up employment. During the course of this visit the inspectors noted that one service user had advised that he would be interested in undertaking a computer course. Mr. Hughes's evidence to the Tribunal was that in fact he had made contact with their local college and enrolled the resident on to a course, which the resident had attended regularly and this had improved his IT skills. We accept that in relation to this particular point Mr. Hughes had assisted the service user, but there was no written evidence of such assistance being given in the service user's care plan or in any other documentation.

In the September 2004 inspection it was identified by inspectors that one of the service users was undertaking some voluntary work and that another had a part time job. The criticism on this occasion was that Mr. Hughes and his staff had not seen it as their role to support the residents in pursuing these work opportunities or developing other opportunities for them. This in our view is part and parcel of running a care home and is what it is envisaged by the regulations.

There were also a number of occasions when steps were being taken by residents in conjunction with outside agencies to move out of F and live independently. It was clear from Mr. Hughes's written and oral evidence that he vehemently disagreed with these proposals. In October 2005 RW was being assisted by Alison Mallett to move into a more independent living situation. Mr. Hughes in correspondence with the Community Learning Difficulties Team had made it absolutely clear that he would in no way support RW in contacting potential accommodation providers as he did not believe that RW should be moving from F at that time. Mr. Hughes may or may not have been justified in his concerns regarding RW's move. However there is no appreciation in the letter written by Mr. Hughes's at the time or in his oral evidence to the Tribunal that he saw any role for a care home provider in trying to facilitate a resident developing independent living skills which might involve them moving to other accommodation. There was no suggestion of any facilitation on the part of Mr. Hughes in identifying the goals of residents, such as developing independent living skills and helping them formulate a plan in order to allow those goals to become reality.

On the 28^th December 2005 Mr. Hughes wrote to Ms. Shepherd in response to the inspection that had taken place on the 7^th November 2005. The November inspection report had referred to the fact that since June 2005 the care home had been aware that two residents would be moving out once accommodation could be found for them. Mr. Hughes's response in his letter was that he did not believe that the two residents were likely to survive within the community, "……. given the lack of professional support they are likely to receive as things stand at this time." Again there is a lack of understanding by Mr. Hughes of the role of a care home in this situation, namely that it is one of the service providers who should be operating with other professionals to assist in achieving and promoting the ability of residents to develop independent living skills.

There was also an occasion where resident SS was anticipating a move into independent living and as such had not gone with the other residents and staff at F on their annual holiday to Spain. We understand Mr. Hughes's view that there was an assumption that this move would have been completed prior to the holiday taking place. In the event one member of staff remained in this country but did little to support SS, despite SS having told the inspectors that he was concerned that his grant had not come through and that he had been unable to buy any furniture, which was causing him great anxiety. This is a good example of a situation where a care home resident ought to be able to turn to staff members for support to help them through this process. On this occasion SS was not offered any support. Whether or not social services were at fault is in our view irrelevant to the well being of SS, this was a important stage in SS's life in which he should have been assisted and encouraged by Mr. Hughes and his staff.

In the case of RBW, it was recorded in the February 2007 inspection that he was spending a lot of time on a computer in a local library. Mr. Hughes thought that he had been taught to use the computer by the library staff. Despite this there was no evidence that Mr. Hughes had identified RBW's aspirations and goals in relation to this activity or taken any steps to promote RBW's independent living skills in this connection or indeed more generally.

We have come to the conclusion that whilst Mr. Hughes is undoubtedly concerned in his own way for the health and welfare of the service users, he has not regarded it as his responsibility to participate in any way in making appropriate provision to help service users identify opportunities, to have aims and aspirations and in the context of education and employment, to help them develop these aims and objectives. Therefore we accept that Mr. Hughes has breached this requirement.

5. Requirement to make arrangements for service users to receive treatment, advice and other services from any healthcare professional (Regulation 13 (1) (b))

This requirement is self explanatory in that a registered proprietor needs to ensure that service users receive where necessary, treatment, advice and other services from a healthcare professional. A number of examples were given by the Respondent in the Notice of Cancellation.

In the April 2004 inspection report it was noted that one service user, GM had complex mental health needs, which Mr. Hughes had recognised, but there had been no intervention had been arranged from an appropriate professional and a requirement was made that Mr. Hughes should make proper provision for the treatment of service users mental health needs. The July 2005 inspection reports referred to a resident being referred to a psychiatrist by Magistrates after a Court appearance. The referral was undertaken by the East Norfolk Learning Difficulties Team. The criticism of Mr. Hughes being that despite the earlier requirement relating to service users mental health in the April 2004 inspection report he had done nothing to be proactive in this area of the residents care. It was only by the intervention of a Magistrate that a referral to a psychiatrist happened.

There was another example in the case of RBW of a lack of support in relation to the arranging of health treatment. In that it had been identified that he required dental treatment and he had been to see a dentist who had drawn up a dental plan for him. In March 2008 Mr. Hughes was unable to demonstrate to the inspectors how RBW's dental plan was being implemented. In his response to the Notice of Cancellation, Mr. Hughes had stated that he had not understood the dental plan as he was not a dentist, but that he had accompanied RBW to the dental surgery on four occasions. Whilst we acknowledge that in attending the dentist with RBW, Mr. Hughes was providing him with some support, in our view his responsibilities go much further. It was incumbent on Mr. Hughes to take steps to enable clarification to be obtained of the dental plan, possibly in consultation with the dentist, so that RBW was facilitated to understand his plan and helped by the home to put it into practice. In this case the dental care plan was simply not followed through.

One of the residents SS had epilepsy for which he had been prescribed medication. Mr. Hughes advised the inspectors on their visit in November 2005 that the service user concerned had been prescribed medication from his GP, on whom the service user attended regularly without assistance from the home. The service user had reported to Mr. Hughes that he was experiencing sedative effects which he thought might be attributable to the medication. There was no indication that Mr. Hughes was involved in any way in monitoring the service user's visits to the GP or assisting the service user in attending and discussing with his GP possible side effects from the medication.

These are all examples of where in our view Mr. Hughes has not been proactive in making arrangements for service users to receive treatment and advice, in circumstances where it was clear to him that the service users did have medical needs which required intervention from a healthcare professional. Mr. Hughes's response in relation to the epilepsy was that the resident with epilepsy made his own arrangements with his GP and that Mr. Hughes had never seen the resident have a fit during a period of 15 years and that in relation to the referral to a psychiatrist that he had not been informed by the East Norfolk Disabilities Team about the referral. In our view these comments go nowhere near demonstrating an understanding of the role of a care home in meeting this requirement. We therefore conclude that Mr. Hughes has breached the relevant regulation.

6. Requirement to make arrangements in relation to medicines received into the care home – (Regulation 13 (2) )

The Inspection reports in 2002 and 2003 identified concerns about the management and administration of medication, in particular the failure on the part of Mr. Hughes to keep a full record of all medication received into the home and administered to service users.

Following the inspection in July 2005 further comments were made about the medication regime at the care home. It was following this inspection that Mr. Hughes indicated that the home would no longer be involved in the handling of service user's medication. It might be argued that Mr. Hughes was within his right to take this decision, but only if he was able to make appropriate alternative arrangements to ensure that there was a regime in place to comply with the relevant regulation to ensure amongst other matters the safe handling, administration and disposal of medicines. There are a number of examples to show that this did not take place.

In the February 2007 inspection report it was recorded that a packet of antibiotics with a resident's name on had been found on top of a cabinet in the residents bedroom, 15 tablets had been dispensed on the 6^th February 2007 with a prescription of one tablet to be taken 3 times a day. Seven tablets remained in the box when seen by inspectors indicating that the resident had not completed the course which should have finished after five days. Mr. Hughes had told the inspectors that he had seen the resident taking two tablets the previous week, but that he had not been involved in reminding the resident to take his tablets in accordance with the prescription, and that the home was continuing with their earlier decision not to administer any medication. This in our view is completely unsatisfactory and did not comply with Mr. Hughes' responsibility to ensure the safe administration of service user's medication.

In evidence Mr. Hughes indicated that he had proposed in August 2007 that the responsibility for residents' medication should pass to their GP's, who would then assess whether a resident at F could safely self administer. However there was no evidence presented to us that this proposal had been progressed, that GPs had been consulted or there was anything in place that might be considered a proper risk assessment of the service users ability to self administer. We conclude that Mr. Hughes was in breach of this requirement.

7 Requirement to identify and remove hazards and risks to service users. Regulation 13 (4) (a)(b) and (c).

The Tribunal were presented with a considerable amount of evidence in relation to this particular requirement, particularly in relation to fire safety measures. As well as evidence from the Respondent's inspectors the Tribunal also heard and received a witness statement from Mr. Roger Brown a Fire Safety Officer with the Norfolk Fire and Rescue Service. There have clearly been considerable concerns in this area, particularly in circumstances where there is an adjoining HIMO in which it is accepted that there have been a number of fires. However Mr. Brown's evidence was that he had recently carried out an inspection of F and that all outstanding requirements so far as he was concerned had been complied with and there had been a big improvement. He told the Tribunal that the standards now achieved at F were satisfactory.

However fire safety is not simply about having the right equipment. Mr. Brown recognised in evidence that the most important part of fire safety precautions is having the right management controls in place to ensure that fire safety measures are always followed. In this case we heard evidence from the Respondent's inspectors that there had been a persistent failure on behalf of Mr. Hughes and the staff at F to carry out all the necessary fire safety precautions. In particular the use of wedges and ties to keep open the fire doors. This in itself constitutes a risk to service users.

As well as fire safety there were other aspects of the regime at F that inspectors identified as potentially likely to cause a risk to service users. One of those was the failure by Mr. Hughes to regulate the hot water temperature in the home. Mr. Hughes did not dispute that the water temperature was not kept at the temperature recommended by the inspectors because in doing so residents would complain that the water was too cold. The proposal put forward by Mr. Hughes in August 2007 to regulate the hot water was to set the immersion for the whole system to between 40 to 42 degrees did not address all the inspectors concerns. By dealing with the matter in this way it meant that the water was of such a temperature in the system that there was a risk of legionnaires disease. The procedure suggested by the inspectors in August 2007 was for the hot water taps to be individually controlled, we consider this to be a perfectly reasonable way forward. We heard no evidence that Mr. Hughes had, even by the date of the hearing, addressed the matter or had fully understood the potential problems.

The other issue raised by the inspectors under this requirement was concern about poor hygiene practices in the kitchen. We note the inspectors' comments on this and also the written evidence from Environmental Health Officer Sarah Flatman, who did not raise any issues in her statement regarding food hygiene. We accept that she did not give oral evidence however given her professional qualifications and experience we consider that we should nevertheless give weight to her views. It is also true to say that the purpose of her inspection in December 2006 was "a slips and trips visit" and not primarily to look at issues of food hygiene. Nevertheless she does at paragraph 4 of her statement indicate that "other areas were discussed, but not in as much detail as would have been covered on a full inspection." If Ms. Flatman had detected serious problems in relation to food hygiene we would have expected her to have raised them notwithstanding that that was not the main purpose of her visit. We also take into account the evidence we heard from Mr. Hughes regarding the regular visits that the home had received from the local authority's Environmental Health Department. Again we would have expected if there were problems they would have been identified by that department and the Respondents informed. Accordingly we do not accept that there were poor hygiene practices in the kitchen.

The question of service users self –medicating we have already made findings upon. There was evidence that Mr Hughes and his staff do not always know the precise whereabouts of the service users when they are out of F, in the context of the needs of the current service users and given their relationship with Mr Hughes we do not consider that there is a substantial risk, although with different service users there might well be a need for a more robust system. We heard a considerable amount of evidence about the HIMO owned by Mr Hughes in the adjoining premises and the potential risks posed by the access arrangements between the HIMO and F. Whilst the situation was far from ideal, we are satisfied that service users were not placed at a substantial risk.

However the position in relation to the fire safety regime and the use of hot water at the home are sufficient for us to consider Mr. Hughes to be in breach of this requirement.

8. Requirement to keep under review assessment of service users' needs (Regulations 14 (2))

This is a requirement that to some extent relates to a review of service users' needs in circumstances where those needs should have already been identified. It was accepted that Mr. Hughes had prepared some care plans, the August 2007 inspection report noting that Mr. Hughes had, "….. made an attempt to rewrite care records", but it went on to state that, "there is no needs assessment format and the provider continues to be unable to demonstrate that the home is capable of meeting the needs of the residents he plans to care for." The inspectors went on to state with reference to the rewritten care records that whilst they did contain some information about residents' emotional needs, "……. the content is too vague and wordy and contains a considerable amount of psychology terminology, which the residents would be unlikely to understand." Having seen the care plans that were produced in evidence we agree with the inspectors' conclusions on this point. An example would be that the care plan of RW in which Mr. Hughes has stated as follows:-

"Robert is unequivocally enjoying the most stable and progressively character building part of his life at the present time. However, certain factions would inadvertently attempt to massage this stability and progress out of sync by believing themselves to be under pressure to persuade Robert to move out of the care home (thus saving the County Council x amount of pounds in resources as a result of snatching future care fees from Robert's budget to which he is entitled) and to take up residence somewhere else."

Such statements in our view form no part of an appropriate care plan and are not part of a detailed assessment of a residents needs. Although there was some evidence of care plans being re-written, given that such re-writes do not effectively review a proper assessment of needs, Mr. Hughes must be considered to be in breach of this requirement.

9. Requirement to prepare service users' plans (Regulation 15 (1) & (2))

As indicated in our findings on the previous requirement such care plans as Mr. Hughes has prepared for service users are not in our view appropriate. They do not identify for example a service user's goals, aspirations or needs. Whilst Mr. Hughes himself might retain that personal knowledge, anyone else inspecting the care plans would not be able to identify what a service user's needs were or how those needs should be met. These are matters that have been brought to Mr. Hughes's attention in numerous inspection reports. Although in 2006 Mr. Hughes purchased a quality assurance manual, which included guidance on development of care plans, it does not appear that it has enabled Mr. Hughes to write adequate care plans. A number of examples were given by the Respondents in their Cancellation Notice of what Mr. Hughes ought to have included in individual service users plans such as requiring more support in acquiring daily living/social skills/independence skills. The need for such support has already been identified in our comments on earlier requirements. We therefore again conclude that Mr. Hughes has not met this requirement, because of the inadequacy of the service user plans that he has provided. Moreover and perhaps most importantly the plans were not in a format we consider could easily have been understood by any of the service users.

10. Requirement to ensure sufficient suitably qualified, competent and experienced staff are working in the care home (Regulation 18 (1))

The only member of staff from whom we received any direct evidence was from Mr. Hughes himself. Mr. Hughes was described by the Registered Homes Tribunal in their decision of September 1989 as being "……… in qualifications, experience and aptitude he is well suited to caring for mentally handicapped persons ……." That was some 8 years ago and since then there is little evidence that Mr. Hughes has updated his training, so that he is in the position to understand and fulfil the requirements of a care home owner, in particular he has not undertaken an NVQ Level IV, and he gave evidence that he had not read the Care Home Regulations or all the National Minimum Standards. In addition there had also been no management training in the last 6 years in relation to working with people with learning disabilities.

As far as other members of staff are concerned there was no evidence that Mr. Baker has had any relevant training, apart from in food and hygiene, fire procedures and first aid training. Mr. Hughes's sons Glyn and Karl we were told had taken their NVQ Level III courses, but to date no accreditation had been obtained. Given that they took the course sometime ago, further training would probably now be required before any accreditation could now be given.

It may well be that if Mr. Hughes had received the appropriate training in relation to running a care home, he would be better able to comply with some of the earlier requirements which we have already determined he has not met.

We heard evidence that were two part time members of staff who had not had CRB checks. Mr. Hughes said that they could not be described as working in the care home, but given that they did food preparation for both the care home residents and the residents of the HIMO, we consider that they do fall within the definition of care home staff and that CRB checks should have been obtained.

In view of the lack of CRB checks for the two part time workers, the fact that Glyn and Karl Hughes have not obtained accreditation for their NVQ Level training and that Mr. Hughes himself has had no up to date training in relation to the running of a care home, we do not consider that Mr. Hughes has met this requirement.

11. Requirement relating to fitness of premises (Regulation 23)

The principal aspects of this requirement relates to the state of repair of the care home, its cleanliness and appearance and its compliance with the relevant fire regulations.

We have already dealt in some detail with the provision of the fire equipment and are satisfied from Mr. Brown's evidence that the appropriate equipment is in place. As for the external appearance we heard evidence that as a result of a community regeneration project the exterior of the premises has been recently renovated. As regards the internal decoration and state of repair, there appears to have been no scheme of planned maintenance, such that the inspectors have raised continually areas of the care home that were in a poor state of repair and giving cause for concern, including the carpeting, and general decoration, photographs of which were provided to us. However it would be fair to say that over time Mr. Hughes has made progress in improving these aspects of the internal environment.

What has not been addressed is the state of the service users bedrooms which have not been maintained to a satisfactory level. The inspection report of August 2007 commented on one of the resident's bedroom being in a very poor state, with a shelf that had fallen off the wall and the resident's bedding being in what can only be described as a disgraceful condition. As already indicated whilst it may be appropriate for Mr. Hughes to have a policy of not entering into resident's rooms uninvited, there must be in place a mechanism, if not arrange for the cleaning of residents' bedrooms, to at least have a plan which assists them in carrying out their own cleaning. This was clearly not happening at F and to that extent Mr. Hughes must be considered to be in breach of this requirement.

12. Requirement to evaluate the quality of service (Regulation 24)

We found no evidence that indicates that there was a quality monitoring programme operating at F, despite Mr. Hughes having purchased a quality assurance manual in 2006. Mr. Hughes in his response to the Notice of Cancellation indicated that the quality assurance assessment that he had obtained was "supposed to have been read by the CSCI in which case there was little point in writing out a separate document which said the same thing." Clearly this demonstrates a complete misunderstanding of quality assurance, which needs to relate specifically to the particular care home in question. The fact that we have found so many breaches of the Regulations is clear evidence that there was no quality monitoring programme in place. This requirement therefore cannot be said to have been met.

The Law

Section 14(1)(c) of the Care Standards Act 2000 provides that the registration authority may cancel the registration of a person in respect of a care home, on the ground that the establishment or agency is being, or has at any time been, carried on otherwise than in accordance with the relevant requirements. The relevant requirements are defined in section 14(3) of the Act as meaning, any requirements or conditions imposed by or under the 2000 Act and the requirements of any other enactment which appears to the registration authority to be relevant.

The relevant regulations are the Care Homes Regulations 2001.

Section 23 of the Care Standards Act 2000 gives the appropriate Minister the power to publish statements of national minimum standards, which section 23(4) requires the registration authority and the Tribunal to take into account when making any decision.

The registration authority and, on appeal, the Tribunal must be satisfied that the registered person has breached either the Act or the regulations made under it or some other relevant statutory provision. If so satisfied, the registration authority and, on appeal the Tribunal must exercise a discretion as to whether to cancel the registration and, in effect, decide whether the breaches proved are sufficient to merit the closure of the care home.

The registration authority and on appeal the Tribunal must adopt a proportionate approach having regard to the effect of closure upon public health agencies, social care agencies, the users currently at the home, potential future users, owners and staff, ( as per the Tribunal in Joyce v NCSC [2003] 190 NC).

The standard of proof to be applied is "the balance of probability" which in essence means that a tribunal is satisfied an event occurred if the tribunal considers that, on the evidence, the occurrence of the event was more likely than not.

Conclusions

In summary, we conclude that Mr Hughes has breached a substantial number of the 2001 regulations, as set out above, including Regulation 7, relating to the fitness of the provider and Regulation 10, relating to his ability to carry out the management of the home with care, competence and skill. The breaches have been serious and in many cases have continued over a long period of time. This non compliance is sufficient to warrant the closure of the home.

Mr Hughes may well have opened the home with the best of intentions, but he has adopted a cavalier attitude towards compliance with the regulations. The regulations are in place to ensure that residents are protected and receive the appropriate level of care, taking into account the guidance provided by the relevant standards. Mr Hughes may well consider that the regime he has put in place provides the appropriate support for the current residents, however if he wishes to run a care home, he must comply with the regulations, which he has manifestly failed to do.

We consider it appropriate at this juncture to pass some comment on the actions of the Respondent in this case. Since taking over responsibility for regulating F they have inspected on a regular basis. At the end of each inspection a set of requirements are drawn up with which Mr Hughes was required to comply by a given date. In many cases requirements were repeated from previous inspections, in some instances they were repeated as many as 10 times. We find it astounding that given the serious nature of some of the breaches of the regulations that the inspectors found, coupled with Mr Hughes continual failure to comply over a number of years, enforcement action was not taken at a much earlier stage.

In reaching our decision, we have given careful consideration to the effect that a closure of F will have upon the staff, the local agencies, and the service users currently at F and potential future users. We acknowledge that the current users appear to be content living at F, however for the reasons already given, we are of the view that F is not providing the type of care that service users have a right to expect from a registered care home. It has been some considerable time since any agency has placed any new service users at F. It would need a complete change of philosophy on Mr Hughes part for the Tribunal to have any confidence that he would comply with the care home regulations in the future. Mr Hughes' did not demonstrate to us that he has necessary understanding of what is required to run a care home or that he would comply with the requirements of the Respondent in the future.

The Tribunal therefore decided to DISMISS the appeal.

The decision of the Tribunal was unanimous.

ORDER

1 The appeal against the Respondent's decision made on the 10^th January 2008 to cancel the Applicant's registration in respect of F shall be dismissed and that decision shall be confirmed.

Stewart Hunter

(Nominated Chairman)

Mr. Mike Flynn

Mr David Tomlinson

Date: 21^st October 2008