Inspection on 18/05/07 for Hamilton House

This inspection was carried out on 18th May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hamilton House 02/06/06

Hamilton House 09/11/05

Hamilton House 26/04/05

Hamilton House 22/02/05

Hamilton House 03/11/04

Hamilton House 16/04/04

Hamilton House 11/11/03

Hamilton House 23/07/02

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Hamilton House Residential Home 23 Houndiscombe Road Mutley Plymouth Devon PL4 6HG Lead Inspector Jane Gurnell Unannounced Inspection 18th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamilton House Residential Home Address 23 Houndiscombe Road Mutley Plymouth Devon PL4 6HG 01752 265691 01752 662367 lizglover@yahoo.co.uk 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) Penton Homes Limited Mrs Elizabeth L Glover Care Home 32 Category(ies) of Dementia - over 65 years of age (32), Old age, registration, with number not falling within any other category (32) of places Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered as a care home only (PC), providing care for older people not falling within any other category (OP) over 60 years of age, and also for service users with Dementia over 65 years of age DE(E) The home may accommodate up to a maximum of 32 service users at any one time. One named service user under the age of 60 years One named Service user out of category and under the age of 60 years Bedroom 3, on the lower ground floor, can only be used by service users who are ambulant and can safely manage stairs. 02.06.2006 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Hamilton House is a large care home owned by Penton Homes Ltd. and situated within walking distance of Mutley Plain shopping precinct. The home can accommodate 32 service users at any one time and can accommodate elderly people who may have dementia. Hamilton House consists of two large houses that have been converted into one. There is a lower ground floor - with two lounges and two dining rooms. Some of these rooms have limited natural light. On the ground floor there is a further lounge. There are bedrooms and bathrooms on all three floors. A passenger lift provides access to all floors however there are two single steps in the hallway by the dining rooms and this may pose a difficulty for residents with restricted mobility. The home is staffed 24 hours a day, including 2 waking night staff. The current fees for the home range from £333 to £368 a week. Not included in the fees are the costs of chiropody, hairdressing, transport and residents’ personal items. Information regarding the services provided at Hamilton House can be obtained directly from the home. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and undertaken between 9.30am and 4pm on 18th May 2007. Both Mrs Glover, the Registered Manager and Mr Dawson, the Registered Provider were present. The inspector made a tour of the building and spoke to many of the people currently living at the home as well as 6 relatives, 6 care staff and the Registered Manager and Provider. A social worker from Plymouth Social Services Review Team, who has responsibility for those people funded by the local authority was consulted prior to the inspection and she confirmed that residents’ needs were being met and that she was kept informed of changing care needs. Significant time was spent with the people who live at the home and observations were made of how people spend their day and their relationship with the care staff. The care plans for 6 people were examined in detail and medication records and documents related to the running of the home and the recruitment of staff were examined. What the service does well: What has improved since the last inspection? The care plans were well written and provided a clear description of each person’s care needs and the actions required by staff to meet those needs. Care staff have undertaken in-house training relating to the needs of people Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 6 with dementia providing them with information about how to support people who may be confused or anxious. The home’s Statement of Purpose, the document that describes the services provided at Hamilton House, has been updated to provide details of the home’s management structure and staff qualifications. Radiators are covered to reduce the risk of burns and a programme to fit valves to control the temperature of the hot water to reduce the risk of scalding has been commenced. New central heating and hot water boilers have been fitted and the fire alarm system have been upgraded indicting the Registered Provider’s commitment to ensuring the efficiency of these systems. The refurbishment of the 2nd floor shower room has been completed and provides additional facilities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Pre-admission assessments and visits to the home enable people to have confidence that their personal care needs can be met at Hamilton House. EVIDENCE: Pre-admission assessments completed by social services were available for 3 newly admitted people to Hamilton House. These assessments provided a clear description of each person’s care needs, including their emotional, social, cultural or religious needs, and as well as staff with the information they require to be able to provide appropriate support. Either the Registered Manager or her deputy had visited each person prior to their admission to ensure their needs could be met at the home. The Registered Manager described how people who are considering moving to Hamilton House and their families are invited to spend time in the home to Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 9 meet the staff and the other people who live there before making a decision about its suitability. Since the previous inspection, care staff have undertaken in-house training, “Insight into Dementia”, the manual for which was provided by an external training organisation, providing them with the information they need to support people with confusion and anxiety. The Statement of Purpose has been updated to provide a more clear description of the management roles within the home and the qualifications of the staff team, as well as the services provided by the home. This document is available to people currently living in the home and those considering moving in. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live at Hamilton House are having their health, personal and social care needs met and are treated respectfully. Medication practices are safe. EVIDENCE: Many of the people living at Hamilton House were, due to their level of confusion, unable to comment directly about the quality of the care and support they receive. The time spent observing the daily life in the home and care staff practices found the staff were very patient and the inspector witnessed those people with confusion being treated gently and with respect by the Registered Manager and the care staff. Those who were able to comment, including 2 of the newly admitted people, said that they are well supported by kind and friendly staff. One lady described the home as “marvellous”. The inspector spoke to six relatives and all confirmed that they are very satisfied with the care their relatives receive. They said they had every confidence in the staff and were kept fully informed. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 11 Two said how their relatives’ health and level of confusion and anxiety had improved significantly since moving to Hamilton House. The care plans for 6 people who the inspector had spoken to and spent time with were examined. These provided clear descriptions of each person’s care needs and the action required by staff to meet those needs. Any risks associated with mobility, pressure area care, nutritional intake or relating to the person’s anxiety or confusion were identified and instructions provided to reduce the risk of deteriorating health. The District Nursing Service visits Hamilton House at least 3 times a week to support the care staff with meeting people’s health care needs. People with terminal illness may remain at the home if the staff team and the District Nursing Service can continue to meet their needs. Medication was stored safely and the records, including those for controlled drugs, were accurate. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily activities provide interest and stimulation for the people living at Hamilton House. Meals are of good quality and nutritious. EVIDENCE: Those people who are able to do so are encouraged to continue with their interests and hobbies both in and outside of the home. One lady described how she had recently obtained a computer and staff were assisting her with it. She said that the Registered Provider had said that he would have Internet access installed for her. Many people at Hamilton House however have dementia that affects their ability to socialise independently. A member of staff organises regular social activities to provide interest and stimulation. The Registered Manager said this staff member regularly consults with people and has developed a weekly timetable for care staff to follow, a copy of which was available. Activities are provided every afternoon and include games, quizzes and musical entertainment. The staff confirmed that those people who were unable to participate in group activities are provided with one-to-one activities such as Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 13 hand massages, they also said that they recognised the importance of spending time in conversation. Those relatives spoken to confirmed activities are offered daily and have witnessed people being supported by staff to join in. They said that both the Registered Manager and her staff team were very friendly and easy to talk to and issues or concerns were dealt with promptly. Those people spoken to said they enjoy the meals and that there was always a choice. The inspector observed those people who needed help to eat being assisted by care staff in an unhurried manner. A glass of sherry or whisky is offered after supper and this is provided by the home at no extra cost. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at Hamilton House and their relatives can be confident that concerns will be listened to and resolved promptly. EVIDENCE: Those people who were able to comment directly about making known any concerns said that they had confidence in the Registered Manager and her staff to deal with these promptly and to their satisfaction. Relatives also had the same confidence. The Registered Manager has an “open door” policy and throughout the inspection the inspector observed people meeting with her on numerous occasions. Neither the Registered Manager nor the Commission had received any complaints about the services provided at Hamilton House prior to this inspection. None of the relatives spoken to had raised any concerns. Care staff had received training in the protection of vulnerable adults ensuring they are aware of their responsibilities should they suspect a person is at risk of abuse. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Hamilton House provides a pleasant home that is comfortable and well maintained and which provides sufficient facilities to meet the needs of those currently living there. EVIDENCE: Those people spoken to said that they found the home spacious and comfortable. The home was very clean and well maintained and the inspector detected no unpleasant odours. There are 3 lounge rooms, plus a large conservatory and two dining rooms which provide ample communal space and a feeling of living in a much smaller home. A further lounge room is available for residents who may wish to smoke. A passenger lift provides access to all floors however there are two single steps in the hallway by the dining rooms and this may pose a difficulty for people Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 16 with restricted mobility. A stair lift is fitted to the stairs in the mezzanine landing. People were seen to move freely around the home and as all the exits were fitted with an alarm staff would be alerted should these be opened enabling them to accompany anyone with confusion outside into the garden, which provides a very pleasant seating area. The front door has been fitted with a video-link entry system allowing staff to view visitors from a monitor adjacent to the dining room on the lower ground floor and allow them entry. Bedroom doors are fitted with locks of a type that although were locked from the inside by turning a knob, did not have to be unlocked as using the door handle as normal unlocks the door. These locks are particularly suitable for people who may suffer from confusion and can be overridden by care staff in an emergency. It was evident that the Registered Provider is committed to maintaining the property in good order and a member of staff is employed to see to day-to-day repairs and redecoration. Two new central heating boilers and the fire alarm system were being fitted and/or upgraded on the day of the inspection. The main entrance way and one of the dining rooms were being redecorated and the refurbishment of the 2nd floor shower room has been completed. As the layout of this large building could be confusing, particularly for people with dementia who may wander freely around the home, the wallpaper in the main entrance way and hallway is being changed from that in the other areas of the home to distinguish this area of the building. Radiators are covered to protect people from burns should they come into contact with them when on. The hot water temperature to the baths is controlled to prevent the risk of scalding. Now that the new boilers have been fitted the Registered Provider confirmed that he would be fitting temperature control valves to those bedroom sinks where there may be a risk should these be used by people who require assistance from staff and who perhaps would not recognise the risk if they used the sinks alone. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are motivated and caring and employed in sufficient numbers to meet the needs of those currently living at the home. Recruitment practices protect vulnerable people. EVIDENCE: Those staff files examined, including 2 newly employed staff, contained the required pre-employment checks, including 2 written references and a Criminal Record Bureau Disclosure, ensuring as far as possible only suitable staff are employed. People who live in the home as well as the relatives spoken to said that staff assisted them promptly indicating that there are sufficient care staff on duty each day. Two waking night staff work from 9pm to 9am which means that 6 care staff are on duty from 7.30am to 9am, a further member of staff is on duty from 11am to 7pm. These numbers do not include the Registered Manager or the deputy manager who both work 5 days a week including at the weekends. Care staff are supported by catering, domestic and laundry staff each day. The Registered Manager has a very positive approach to training. The majority of care staff, 90 , have a National Vocational Qualification either at level 2 or 3: this is a nationally recognised qualification that is awarded by an external Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 18 training body after staff have demonstrated their knowledge and skills in caring for older people. Training records indicated there is an ongoing training programme to ensure care staff remain up to date in fire safety, first aid and manual handling ensuring they have the knowledge and skills necessary to deal with emergencies. Many of the care staff have attended an external training day in supporting people with dementia who may have behaviour that is challenging: further training has been booked for 2 staff to attend on 22nd May. This training will provide staff with the knowledge they need to support people who may become verbally or physically aggressive due to their anxiety or confusion. Newly employed staff undertake the “Skills for Care” induction training programme (a nationally recognised induction programme for new staff) that ensures staff are given information regarding the principles and values of care practice, the rights of the residents and their responsibilities towards provided a high standard of care. The home was been awarded “Investors in People”; an award that recognises the Registered Provider’s committed to train and develop the staff team. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Hamilton House is a well-managed home. Consultation with people who live there, their relatives and other visitors to the home ensures a good standard of care is provided. EVIDENCE: Mrs Glover has over 20 years experiencing in working at the home and has been the Registered Manager for 2 years. As stated in the section for complaints and protection she has an “open door” policy and this promotes an atmosphere of co-operation and openness. A quality assurance system has been developed to consult with people living in the home, their relatives and others such as GPs and Community Nurses. These surveys had been sent to relatives and GPs in March of this year, the Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 20 results of which were available. All those surveys returned by both relatives and GPs were very positive regarding the services provided and included comments such as, “since moving to the home I have noticed a big improvement in my mum’s wellbeing and happiness” and “I cannot recommend the home highly enough”. Surveys are available at all times in the main entrance way and allow people to comment anonymously about their experiences of the home. Each member of staff had had an appraisal to assess their work performance and their training and development needs. The Registered Manager has recently introduced a formal staff supervision process and she and her deputy share the responsibility of supervising all staff. Staff meetings are held every 4-6 weeks and surveys are sent to staff every 6 months asking for their views on the running of the home and the support they receive to do their job. Regular consultation with staff ensures staff can contribute to the running of the home and are aware of the home’s aims and objectives, philosophies of care and promotes consistency and improvement. Money is held for safekeeping for a number of people living in the home and individual records were well maintained. Sampling of records indicated equipment is serviced regularly and maintained in good order. Staff have received training in fire safety, moving and handling and first aid ensuring they have the knowledge to deal with emergencies. Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hamilton House Residential Home DS0000003480.V331189.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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