Inspection on 11/06/09 for Hamilton House

This inspection was carried out on 11th June 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hamilton House 12/07/07

Hamilton House 17/05/06

Hamilton House 08/02/06

Hamilton House 04/10/05

Hamilton House 30/01/05

Hamilton House 07/10/04

Hamilton House 02/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Hamilton House 10 Crescent Road Bromley Kent BR1 3PN Lead Inspector Ms Rin Saimbi Key Unannounced Inspection 11th June 2009 10:00 Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamilton House Address 10 Crescent Road Bromley Kent BR1 3PN 020 8460 9046 020 8460 8898 rachelcurl@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Bromley Autistic Trust Stephen O`Brien Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 5 30th September 2003 Date of last inspection Brief Description of the Service: Hamilton House is a detached residence located in Bromley North. It is close to the shopping area and is well served by public transport including main line rail services. Although Hyde Housing Association owns the building the 24-hour care and support is provided by Bromley Autistic Trust. The home provides care and support in a home-like environment for five people; Each person has their own bedroom and there are a number of communal areas. The home is for people who have autism. The home is generally staffed for 24 hours a day there are also sleeping in staff. People who use the service are assisted to develop daily living skills within a home-like environment. Integration into the community, attending day centres and adult learning facilities are all incorporated into daily routines. Maintaining family contact and open visiting is encouraged. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. Which means people who use the service experience adequate quality outcomes. This was the home’s first key inspection since 2006 and was unannounced. The inspection started on the 11th June and was concluded on the 26th June 2009. On the first visit we looked at various documentation which related to the running of the home; we also case tracked information relating to two people who use the service, this is to check all documentation thoroughly. We made a second visit to the home as we had not had the opportunity to talk to people who use the service. We had an opportunity of have a tour of the building including some of the bedrooms. We also needed to visit the home when either the manager or deputy were available so that we could access certain records such as staff files and training records As part of the inspection process we considered all information coming into the Commission from the home. This includes an Annual Quality Assurance Assessment which the home completes telling us what has changed over the previous year. We were at the home for a total of four and half hours, during which time we were able to speak and observe four out of the five people who use the service; we spoke to two members of staff in detail, this includes the deputy manager who made herself available for the second visit. We also made telephone contact with three sets of family members to discuss with them what they thought of the service. Although we were able to meet and speak to four people who use the service, there was a reluctance of their part to communicate. This is not unexpected or unusual given that it was the inspector’s first visit to the home and who was in reality a stranger to them; many responses were therefore ‘yes’ or ‘no’. Quotes used in this inspection report therefore come from relatives. Relatives were generally positive about the home; one person stated about their relative ‘they can’t wait to get back after a visit to us’. There was a very positive response to the staff team with comments received such as ‘staff all good, some are wonderful’, and someone else commenting that ‘all staff are very good and fabulous’. There was an acknowledgement that the staff team had a range of skills and experience, and needed some help to work together. We wish to thank the people who use the service and staff for their time and co-operation during the inspection process. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Lack of managerial oversight regarding several issues could compromise the welfare of people who use the service. There is very little training being undertaken within the home, and apparently no overview of what maybe required in the future. The lapses in training include the home’s First Aider with training that expired in 2006; staff administering medication though they have not been trained to do so; no refresher courses for health and safety, or vulnerable adults. Staff levels of training are laid out in the National Minimum Standards as at least five days per year; there was no evidence that any member of staff had undertaken the required number of days within recent years. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 7 It is also of concern that supervision of staff is inadequate, with one member of staff receiving two sessions in the previous year. This lack of investment in staff will ultimately affected the provision of care provided to people who use the service, unless drastic action is taken to rectify the situation. The Commission is also concerned that the lack of Regulation 26 visits, which are a way of an organisation internally monitoring themselves have also not taken place at the required level. This also needs to be addressed with some degree of urgency. Within the environment there are a number of issues regarding the décor which detracts from the home having a comfortable, homely atmosphere. The condition of the bathrooms needs to be reviewed and there was a strong odour emanating from the laundry. There was also a number of health and safety issues which need to be addressed the most important of which was that the medication cabinet was not secured to the wall and the water system had not been tested for Legionella. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home goes through an appropriate process before admitting anyone new into the service; this includes a chance to visit the home several times before a decision is made to move in permanently. This should ensure that any new person does not feel that they are just being slotted into a vacancy, but that it is the right place for them. EVIDENCE: We looked through documentation relating to two people who use the service; this included someone who had been admitted to the home within the last year. The process for the admission into the home is that once Hamilton House has been identified as a possible placement then the manager gathers information from the person themselves and other interested people. The person is then invited into the home for a look around and for meals visits and overnight stays before a final decision is made about the home being suitable. In the case of the most recent person admitted to the home, they already knew the home and staff. There were still a number of meal visits to the home Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 10 and a final review meeting before a decision was made. There was evidence of information gathered from other professionals and an assessment form completed by the home itself. The assessment had been translated into a care plan which was clear and well written; it included information about weekend routines, anxiety behaviours and triggers. The staff within the home have a range of experiences and skills, and are from a variety of minority ethnic groups. There is currently only one male member of staff and that is the manager; this is unfortunate as the four out five people who use the service are male. People who use the service are all able to understand verbal communication; they are able to make their needs know through gestures. Makaton symbols were in evidence but not really used by people who use the service. We viewed the Statement of Purpose which is well written and clear; it is reviewed regularly. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Plans are developed for people who use the service; people are supported to make decisions, they are consulted on and participate in all aspects of their lives. Risk assessments are made to enable people who use the service to take risks as part of an independent life style. EVIDENCE: We looked at two care plans in detail and found that they hold a lot of information about each person; reading them it is easy to visualise the whole person. The home has Person Centred Plans (PCP’s) for all of the people who use the service. The plans are compiled with the person themselves and identified goals and aims for the future, for one person it included going to the zoo and a Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 12 Cliff Richard night. There was evidence that PCP is reviewed on a regular basis and the meetings include the person themselves and their representatives. For people who live and work in the home there are risk assessments; the risk assessments for people living in the home are designed to encourage independence. There were general environmental assessments and those specific to the individual; these assessments were updated annually. Information that relates to people who use the service is kept within the main office in locked cabinets; individuals can access their own files if they wish, although in reality this tends not to happen. In discussions with staff, there was an understanding and awareness of confidentiality and how to put this into practice. People who use the service are encouraged to make decisions and be as independent as possible. These decisions range from preparing and choosing their own breakfasts, keeping their own rooms tidy and wherever possible travelling independently. The home holds house meetings on a regular basis, at these meetings people are encouraged to have their say and the issues raised are discussed at staff meetings. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Hamilton House are offered opportunities for personal development and they are able to take part in a varied program of appropriate leisure activities and are part of the local community. They are supported to keep in contact with their families and to make friends, their rights are respected and upheld. EVIDENCE: People who use the service have moved away from using day centres run by the London Borough of Bromley, and instead use specialist provision arranged by Bromley Autistic Trust. There they can attend a range of recreational and educational activities. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 14 In addition the home makes use of its location near to Bromley town centre, and people who use the service go shopping, to the pub, theatre or just for a coffee. One of the people who use the service has opted out of attending the day centre and instead he is supplied with a one to one to support him during the day; extra funding as had to be agreed for this to happen. He and one other person within the service are independent to come and go, and arrange their own activities which include attending football matches and museums. They also have jobs delivering local newspapers. People have chosen to go on a number of summer holidays this year, at the time of the inspection, one person was on holiday in Greece being supported by staff; three were planning a trip to North Wales and one had chosen to go with their family. Everyone within the service has parental involvement to some degree. Parents come to the home for organised events such as barbeques and parties. People who use the service are supported to visit relatives and some are able to travel independently. It was positive to note that on files relating to people who use the service there were lists of family birthdays. It was positive to note that the contact between people who use the service and staff was open and friendly. People were given choices in their day to day lives to be involved in the responsibility and chores of shared living. This included cleaning bedrooms, shopping and helping with the laundry. One person within the home attends church on a regular basis. Meals are chosen by people who use the service, although there is a seasonal rota in operation which means more salads in summer and hot food in winter. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides people who use the service with the support that they need regarding their healthcare. The support provided by staff is undertaken in a way that should enhance people’s privacy, dignity and independence. EVIDENCE: Care Plans and individual Person Centred Plans are detailed and set out how people want to be supported in their every day lives and with their personal care. They also explore ways that the person can be supported in areas that they do not always want to co-operate in, but that need to be addressed because of health needs, for example visiting the dentist. It is particularly important in this home that staff know how each individual likes to receive support as they have all been assessed as having various levels of Autism and value the security of having a stable and predictable life style of Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 16 which they are in charge. The staff spoken with during this Inspection appear to have a good understanding of the needs of people with Autism. We viewed information relating to health services and found that people who use the service see various health professionals such as their GP, dentist and opticians on a regular basis. There was also a record of an annual health check for everyone in the home. The NHS has just introduced a ‘personal health profile’ for everyone with a disability; the home is in the process of introducing these. We viewed medication within the home and looked at its administration, storage and recording. Medication comes into the home on a weekly basis in Dossette packs from the chemist. It should be stored in a metal cabinet which is secured to the wall; on the first date of inspection the cabinet had a broken lock which could seriously compromise the welfare of people who use the service. On the second day of inspection, some two weeks later, a cabinet had been purchased but had not been fixed to the wall. A requirement has therefore been made in this regard. We checked the records of the administration and found that there were no omissions; each persons chart had a photograph of them and listed all their allergies. Staff have been trained by the Boots Pharmacists to understand the medication and its administration, however there have been no refresher courses undertaken for several years. In addition, some staff are administering medication having had no training. This practice could compromise the welfare of people who use the service and must cease for with. A requirement has been made in this regard. The issue of training in general, will be examined in the staffing section. Hamilton House offers a home for life, given that the majority of people who use the service are in their 50’s, plans are already being made by Bromley Autistic Trust for their future care. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a policy available to people who use the service, their friends and family allowing them to make complaints about the service. This should ensure that people who use the service feel that their views are heard and taken seriously. Policies and procedures are in place to minimise the risks and protect people from harm. EVIDENCE: We looked at the complaints log; the last one was listed as March 2008 and appeared to have been dealt with appropriately. The complaints log and policy are set out in a way to allow complaints to be tracked from start to finish including timescales. We spoke to several people who use the service and their families about who they would talk to if they had a complaint, they identified a variety of individuals, but all stated that they would approach someone. The home has a policy and procedures for protecting vulnerable adult and whistle blowing. During staff interviews there was an awareness and understanding of the issues relating to vulnerable adults; Staff were given a scenario and were asked to respond, all were able to give an appropriate response. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 18 Staff do not receive regular vulnerable adults training; this needs to be addressed by the manager as it must be regarded as a mandatory course that should be refreshed a least every three years for the staff team; senior staff should undertaking a more in depth course so that they are equipped with the knowledge and understanding should an incident arise. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their individuality within their environment. In general it appears that the home is structurally sound, however, there are many areas regarding décor that need to be improved, as the current state of the interior detracts from a homely environment. EVIDENCE: The home is located within walking distance of Bromley Town Centre and is in keeping with its general surroundings. There is a small, well used garden to the rear of the property and front drive which allows for limited parking. The sitting room has some original features of the house still remaining. There is some skilled and imaginative artwork done by people who use the service Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 20 which has been professionally framed and displayed on the walls. The carpet however, is very dirty; this issue has been addressed at the previous two inspections. The condition of the carpet must be reviewed for with. A recommendation is therefore being made in this regard. There is a large kitchen/diner to the rear of the property with French doors that open onto the garden. An extension has been built to the rear of the property allowing for a further bedroom and bathroom area. There are additional bedrooms on the first and second floors. In general it appears that this home is structurally sound, although in décor and maintenance there is much work needed in order for the people who use the service to have a homely environment to live in. Whilst there are sufficient toilet and bathrooms to accommodate the needs of the people who use the service. The condition of the bathrooms could be improved. One bathroom had a shabby bath panel; another bathroom was dirty and in need of redecoration behind the toilet; there are no homely touches such as pictures. The condition of all the bathrooms need to be reviewed, therefore a recommendation is being made in this regard. The home does benefit from a separate laundry room; however, there was an overwhelming odour emanating from the laundry which was unpleasant. A recommendation is being made that the source of this smell is located and rectified. The home need to monitor the condition of the kitchen which will need to be renewed in the near future. The home would not be suitable for a wheelchair user or any one who was physical frail. This is because of the narrow corridors and flights of stairs. The management of the home need to seriously consider the medium to long term suitability of the home for the people who currently use the service as they become older. We viewed a number of the bedrooms with the permission of the people who use the service. People had their own possessions, and each room was decorated to reflect peoples own choices. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is continuity and stability of staff, and the staffing levels are sufficient to meet the needs of the people who use the service. Staff are not supported through supervision or training to a sufficient level to ensure that people who use the service receive quality care where their needs are met. EVIDENCE: We were informed that there are always two members of staff on duty at any given time; we examined the staff records for weeks selected randomly which confirmed that this was the case. No agency staff are used within the home at all; instead there are sessional staff that are employed by the Bromley Autistic Trust who are used. This is recognised as good practice any home, but is particularly important for people who are autistic. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 22 We spoke in detail to two staff members who were clear about their roles and responsibilities; displayed a good knowledge of the people who use the service and the homes practice and procedures. Staff records were made available on the second day of inspection. We looked at two sets of records in detail which had all the required information. This included the application form, evidence of identity, two references and up to date Criminal Record Bureau checks. We examined training records which raised a number of concerning issues. In the initial stages staff do undergo an induction period. However from then onwards there does not appear to be clear expectations of the training required. There are no mandatory refresher courses undertaken, so for example health and safety and administering administration are not completed annually. The appointed First Aider for the home had an out of date certificate which expired in 2006; there are some staff within the home who are administering medication having received no training in this area. The home does not have an overall training needs assessment which informs future training given the changing needs of people who use the service. Staff do not receive the required level of training per year, which is to say, five paid days pro rata. A number of requirements have therefore been made that the issue of training must be urgently addressed. We examined supervision notes of staff, one person had supervision twice in the last year, another had supervision three times; this was confirmed when we spoke to staff directly. The National Minimum Standards require that staff should have supervision at least six times a year. Staff within this home are not receiving the support and levels of supervision that they require to undertake their roles. A requirement has therefore been made in this regard. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place which in general should minimise the risks to people who use the service. The lack of managerial over-sight regarding several issues could compromise the welfare of people who use the service. EVIDENCE: There are a number of quality assurance systems in place; there are weekly meetings held for people who use the service. These are rarely recorded and therefore a recommendation is made that notes are taken. We were informed that there are annual surveys sent out of people living in the home and their Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 24 representatives. We spoke to a number of relatives who all confirmed there involvement in the home and their sometimes daily contact. It was noted that the regulation 26 visits which should be undertaken by someone not involved in the day to day running of the home, is somewhat patchy. There was evidence of a visit in August and December 2008, and January and March this year. This is not to the required level which must be monthly. A requirement is therefore made in this regard. With regard to health and safety issues, we checked a number of certificates which were up to date. There were two outstanding issues; firstly that the Legionella certificate could not be located, it is particularly important that this is completed given the age of the house. Secondly, the COSHH cupboard must be locked at all times. There are areas where the home is well run; paperwork was generally up to date with risk assessments in place. There are policies and procedures in place in order to minimise the risks to people who use the service. The role of the manager is in part to ensure the quality of the care provided to people who use the service. Lack of training and supervision of staff could potentially compromise the standard of care and therefore needs to be addressed urgently within this home. The usual safeguard of Regulation visits in order to monitor the care given to people who use the service has also been compromised as they have been so infrequent; these visits must be reinstated to the required level. Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 x 2 X 2 3 3 2 x Version 5.2 Page 26 Hamilton House DS0000006944.V375717.R01.S.doc no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The medicine cabinet must be secured to the wall. This is to ensure the safety and well being of people who use the service. No staff should administer any medication unless they have been appropriately trained to do so. This is to ensure the safety and well being of people who use the service. All staff must have training regarding vulnerable adults and also receive refreshers at regular times. This is to ensure the safety and well being of people who use the service All staff must receive at least five days training (pro rata) per year. This is to ensure the quality of the care provided to people who use the service The home must develop a DS0000006944.V375717.R01.S.doc Timescale for action 26/06/09 2. YA20 13(2) 26/06/09 3. YA23 12(1)(a) 26/09/09 4 YA35 18(1)(c) 26/09/09 5 YA35 12(1)(a) 26/09/09 Page 27 Hamilton House Version 5.2 training development plan which identifies future training needs of its staff This is to ensure the quality of the care provided to people who use the service All staff must receive the required level of supervision This is to ensure the quality of the care provided to people who use the service Regulation 26 visit must be undertaken on a monthly basis. This is to ensure the quality of the care provided to people who use the service 6 YA36 18(2) 26/07/09 7 YA39 26 26/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard YA30 YA30 YA30 YA39 YA42 YA42 Good Practice Recommendations The condition of the carpet in the should be reviewed The odour of dampness within the laundry room should be identified and eliminated The condition of all the bathrooms should be reviewed Residents meetings should be recorded The COHSS cupboard should be locked at all times Legionella testes should be conducted annually Hamilton House DS0000006944.V375717.R01.S.doc Version 5.2 Page 28 Care Quality Commission South East The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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