Inspection on 26/04/05 for Hamilton House

This inspection was carried out on 26th April 2005.

CSCI 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 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 18/05/07

Hamilton House 02/06/06

Hamilton House 09/11/05

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 23 Houndiscombe Road Mutley Plymouth Devon PL4 6HG Lead Inspector Helen Tworkowski Announced 26 & 27 April 2005 9.00am 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 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 D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Hamilton House Address 23 Houndiscombe Road Mutley Plymouth Devon PL4 8HG 01752 265691 Telephone number Fax number Email 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 31 Category(ies) of Dementia - over 65 years of age 31), Old age, registration, with number not falling within any other category (31) of places Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 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 DEE) The home may accommodate up to a maximum of 31 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 Date of last inspection 22/2/05 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 31 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. The home is staffed 24 hours a day, including 2 waking night staff. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two full days on the 26 and 27 April 05. Mrs Glover was recently approved as the Registered Manager although she has worked at the home for 19 years, and this inspection was the first in her new role. The number of places in the home has recently increased from 29 to 31, by changing two large single rooms to double rooms. There are plans, yet to be agreed with the Commission to increase numbers still further. This inspection involved a tour of the building, two meals with Service Users, time with some of the Service Users, a look at some of the home’s records and feedback from three visiting professionals. What the service does well: What has improved since the last inspection? What they could do better: Hamilton house is a large building and consideration needs to be given to all aspects of the home to make it more suited to the needs of the residents and Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 6 specifically those with dementia. This includes reviewing the general layout so that it is easier to find your way around and improving lighting, and providing plain rather than highly patterned carpets, which some people find difficult to walk on thinking it is uneven. Service User Plans and risk assessments all need reviewing, so that they provide clear information about the needs of people in the home and how they are to be met. Staff training, including that provided to new staff needs to be reviewed. People come to Hamilton house because they have dementia, and may not be able to explain what their needs are. It is therefore important that staff know what these needs are, through agreed written documents, and that staff have the skills to meet these needs from the start. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Written assessments of prospective Service Users are received from Social Services too late for staff to properly provide and plan for meeting the needs of the individual. Staff from Hamilton House do visit prospective individuals in their own home or at hospital. This is very good practice, and can provide a wealth of information. However the home does not record this information in any systematic way. EVIDENCE: New Service User’s files contained a comprehensive assessment carried out by Social Services, and there was also a very basic assessment carried out by staff at the home. Whilst talking to the Registered Manager, Mrs Glover, it was clear that staff gained a lot of information from these visits and from talking to relatives, however this information was not recorded as part of the assessment. Mrs Glover said that the Social Services assessments were generally received the day before the planned admission. This means that staff at the home have little time to prepare for the individual and their needs. It also means that differences between the home’s and Social Service’s assessments cannot be clarified. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, and 9 Service User Plans lack specific detail about how needs will be met. This means that there is a risk that needs could be missed or not met consistently. Risk Assessments and Moving and Handling Assessments, which help ensure the safety of Service Users, are missing or not specific. Feedback from visiting professionals was that the home provides a very good standard of care. The current system used for managing and administering medication is not only time consuming but increases the risk of administering the wrong medication, compared with other systems. EVIDENCE: The Service User Plans, which should provide detailed information about what individuals needs are and the actions staff are to take, are vague about what exactly staff are to do. For example a Service User Plan may say that an individual needs assistance with their oral hygiene, but it does not say if they have false teeth or their own teeth, and exactly what the staff should do. The majority of the people in the home have dementia, and may not be able to explain themselves. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 10 Files contained some “risk assessments”, though these did not identify specific risks and the actions needed to mitigate these risks. There were no moving and handling assessments, these documents specify the way people can be assisted to move safely. All staff need to be aware of these so a consistent and considered approach to risk can be taken. The medication system in the home involves “double dispensing”, tablets are put in pots for other staff to administer the next day. This system is not only time consuming but is more “risky” than other systems. Checks of the administration showed that there were some anomalies, medication administered had not been recorded as given(antibiotics). The Registered Manager said that the GP had advised that some medication be crushed so that the Service User can swallow it, where this is the case, this should be included in the dispensing instructions. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 A limited range of activities are provided, however these need to be better focused on the individuals interests and hobbies, and should be accessible to people with dementia. Meals are of a good standard and enjoyed by Service Users. More consideration needs to be given to the needs of people with dementia at meal times. EVIDENCE: The Service User Plans contain little information about what an individuals interests are or how they wish to spend time. Some Service Users said that there were activities in the home, such as entertainers visiting the home. There were also some activities for Service Users to do with staff such as drawing and colouring. The Registered Manager is required to review activities, particularly for people with dementia, ensuring that they reflect individual’s hobbies and interests, and that they are age appropriate. The majority of Service Users eat in the dining room, one or two people, who need assistance, eat in the lounges. Service Users said that the food was good and there was plenty to eat. Where individuals need soft food, it was liquidised altogether. This practice must be reviewed, with a view to maintaining each element of the meal separate. This provides a more appetising meal and does Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 12 justice to the ingredients and cooking. The home has recently moved to providing supper mid-evening. This is good practice as some elderly people have small appetites and need to be offered small meals frequently. The radio and TV were on during the meals, this must be reviewed, as it can be an unnecessary distraction particularly where people have poor hearing or have dementia. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the standards were inspected at this inspection. EVIDENCE: Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25, and 26. The building is poorly suited to the needs of people with dementia, both in terms of layout and of décor. This adds to confusion and disorientation. Furnishings were domestic in character though not all was suited to the needs of the people in the home, some of the seating being too low. Bathing and toileting facilities are cramped and some are unused because they don’t meet the needs of the people in the home. Toilets and bathrooms need to be spacious so that people who need assistance, whether because of physical frailty or because of dementia, have sufficient space to be assisted safely and comfortably. EVIDENCE: Hamilton House consists of two large houses that have been converted into one. The accommodation is over three floors and can accommodate 31 people. The décor in the corridors is the same throughout the home. This combined with the size of the home and the maze like layout, means that it is difficult to Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 15 find your way around the home, even if you don’t have dementia. The home is required to review the layout of the home, and to look at “unitizing” so that people live in small groups, rather than as 31 people spread across the whole home. It is also required to review the décor, and where rooms are redecorated to do so on the basis of good practice in relation to dementia care, providing bright and contrasting colours. Some of the rooms have large patterned carpets, Mrs Glover confirmed current thinking around people with dementia that some Service Users have difficulties with such carpets trying to pick up the pattern or believing it to be an uneven surface. All new carpets should be chosen with the Service User’s needs in mind. Many of the corridors have no natural light, the lighting in these areas appeared somewhat dim, the lighting in corridors must be reviewed. Some furniture, particularly in the lounge areas is domestic, whilst this give a homely atmosphere, low sofas are not necessarily suited to people who have difficulties with their mobility. There are limited numbers of bathrooms and toilets in the home. On the lower ground floor there are three toilets, which are not large enough to assist a service user who uses a zimmer frame or who needs assistance because of dementia. The bathroom on the first floor has never been used as it apparently not suited to the needs of the people in the home. Some redecoration has been done, however the needs of people with dementia have not always been taken into account. Little colour contrast has been provided, e.g. a white toilet, with a white seat, against a magnolia wall, with beige vinyl flooring. Account must also be taken to make bathroom and toilet areas pleasant places to be. Some of the wash hand basins have recently been replaced. The tap rotates on a ball, and is not suited to the needs of people who have are more familiar with simple taps. All such equipment should be reviewed and only equipment that is appropriate to the needs of the home provided. The Registered Manager confirmed that the call bell system is about to be replaced. The new system will allow for the front door to be fitted with an appropriate alarm, rather than the three locks currently in place. Some hot surfaces have been covered, however these tend to be in communal areas where there is the lowest risk of someone falling and remaining against a hot radiator. A requirement that all service users have appropriate door locks to their room, so that they can be locked, is on going as is the provision of a lockable facility in each room. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The home has sufficient staff only if the Registered Manager is counted as part of the care staff, and therefore is not available to carry out her role as the manager of a large and complex unit. There are some gaps in the recruitment system that the Registered Manager has already identified and these are being closed. Staff induction training is minimal and means that staff initially may not know what they are doing. EVIDENCE: The Registered Manager outlined the staffing level in the home as: 9pm until 7.30 am- two waking night care staff 7.30am till 9am- two waking night care staff and two care staff, plus the Registered Manager 9am- 11am- four care staff, plus the Registered Manager 11am –5pm- five care staff, plus the Registered Manager 5pm – 7pm- five care staff 7pm- 9pm- four care staff In addition there is a cook and domestic staff. However staff are involved in washing up after meals. The Registered Manager, at present, is taking a full part in the rota and providing care. It is recognised that this may be appropriate in an emergency. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 17 However the Registered Manager must identify when she is part of the direct care in the home and when she is additional to the rota and carrying out her role as the Registered Manager. Staff files show that for recent staff 2 references were taken and an application made for a Criminal Records Bureau check, however there was no written contract. The Registered Manager had recently reviewed the files of existing staff and had found that a number of CRB checks were missing, and has just made an application for these. The induction system for new staff is minimal consisting of a simple tick sheet completed in one day. This is inadequate particularly given the complexity of the needs of the service users. Mrs Glover said she was aware of gaps in training and will be developing training plans for staff, initially focusing on senior staff. Some training in relation to dementia, mental health and incontinence is already planned. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 37 and 38 The Registered Manager, by working full time on the rota to provide care, has insufficient time to carry out her responsibilities as the Registered Manager. Service Users privacy is being compromised by the lack of suitable and accessible office space. A review of records in the home has been started by the new Registered Manager, however in the mean time some records- such as those relating to accidents are not complete. Good records help staff and managers reflect on what is happening and to plan how to do things better. EVIDENCE: Mrs Elizabeth Glover was approved as the Registered Manager shortly before this inspection. She has completed the Registered Manager’s Award and has many years of experience. Mrs Glover is currently working full time as a care Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 19 worker as well as managing a large home for very vulnerable people. Lines of accountability in the home were not clear; this needs to be resolved, so that everyone knows who is in charge. The majority of the records in the home are kept in the locked office, however when Mrs Glover or her deputy is absent from the home, staff do not have access. Staff generally do all recording in a small lobby or in the dining room. Confidential phone calls regarding Service Users have to be made in quiet corners. This is not appropriate, suitable office accommodation must be provided for staff to carryout these private tasks. Mrs Glover has started reviewing the records in the home. As has already been noted risk assessments on individual Service Users are in need of revision. No risk assessment was available in relation to Legionella, however a fire risk assessment had been completed, and regular fire training had been done. Lack of risk assessment can lead to additional unnecessary risks. Not all accidents were being recorded, where Service Users had fallen, or were found on the floor, no accident form was completed if no apparent injury had occurred. A record of all accidents must be kept, and a system set up to regularly review these. Reviewing accidents is important in understanding how and why they occur and in trying to prevent them in future. Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 1 2 2 2 2 3 2 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x x x x x 2 2 Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 21 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 OP3, OP4 Regulation 14 Requirement The Registered Manager must ensure that information about prospective Service Users is obtained in good time, so that an informed decision can be made as to whether needs can be met, and the individual can be informed of this in writting. All service users must have comprehensive Service User Plans which are based on an assessment of need, and detail the actions staff are to take. All Service Users must have risk assessments and moving & handling plans must be comprehensive. The home must obtain appropriately accredited training for staff that are engaged in administration of medication. (Similar requirement made at UI on 22/2/05 to be met by 22/5/05) The medication system must be reviewed , “double dispensing” of medication must cease. Dispensing practice should reflect the instructions on the medication. Service Users must be offered a D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Timescale for action 1 Sept 05 2. OP7, OP8 15 1 September 05 3. OP9 13 22 May 05 4. OP9 13 1 Sept 05 5. OP12 16 1 October Page 22 Hamilton House Version 1.20 6. OP15 12, 16 7. OP19, OP22 23 8. OP19, OP22 23 9. OP19, OP22 23 10. OP19, OP25 23 range of activities, suited to their interests and reflecting needs. Meals and meal times must better reflect the needs of Service Users including those with dementia. Meals must not be liquidised altogether unless specified by an appropriate professional. Having TVs radio and music on must be reviewed in the light of the needs of the people in the home who have poor hearing or who are easily distracted. The registered provider and registered manager must review the building’s overall layout and suitability to accommodate 31 people who may have dementia, and consider “unitising” or smaller groupings. The registered provider must provide a copy of the review to Commision by 1 July 05. All re-decoration in the home must be done to reflect the needs of people with dementia, including the use of bright and contrasting colours. The registered provider must provide to Commission information as to how this will be achieved by 1 July 05. All new flooring in the home must be such that they are appropriate to the needs of people with dementia. Swirley and large patterned carpets may cause individuals difficulties. The registered provider must provide to Commission information as to how this will be achieved by 1 July 05. Lighting in corridor areas, must be reviewed. A copy of this review and actions to be taken must be provided to Commission by 1 July 05. 05 I Sept 05 1 Sept 05 1 Sept 05 1 Sept 05 1 Sept 05 Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 23 11. OP19, OP21 23 12. OP19, OP24 12 13. OP21 23 14. OP19, OP38 23 The registered provider must review the provision of bathrooms and toilets, so that they are sufficient and suitable for the needs of the Service Users in the home. A copy of this review and the actions to be taken must be provided to the Commission by 1 July 05. A phased programme of appropriate bedroom door- lock installation must be undertaken. Each of these locks must have an must individual key, supported by a master key system. The locks be easy and simple to use, suited to the needs of the people in the home.This requirement was made first in 2002, extended in 2003, then again in 2004. At the last inspection the requirement was made again with a timescale of 3/11/05. The style of wash hand basin taps in use must be reviewed, so that they better suit the needs of service users in the home.A copy of this review and the actions to be taken must be provided to CSCI by 1 July 05. The home must have a front door system that ensures:·The security of the service users, maintains the integrity of the fire protection system and only uses restriction where necessary.·That all visitors are admitted to the home by the homes staff.·That service users who are safe to leave the home independently are enabled to do so without the involvement of staff.·That Service Users who would be unsafe to leave the building without support only leave building with an escort.This requirement has been in place D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc 1 SePT 05 3/11/05 1 Sept 05 1 Sept 05 Hamilton House Version 1.20 Page 24 15. OP27 18 16. OP29 19 17. OP30 18 18. 19. OP30 OP31 18 19,12 20. OP37 17, 12 21. OP38 23,13 22. OP38 13 since November 2003, was to have been completed by July 2004 and has now been agreed to be completed by July 2005. Staffing levels must be reviewed to ensure that there is sufficient care staff and managerial support in the home.A copy of this review and the actions to be taken must be completed by 1 July and forwarded to CSCI. The Registered Manager must ensure that all existing staff (including kitchen and ancillary staff) have applied for Criminal Records Bureau checks. All new staff must undergo a period of induction and foundation training, which meets Nation Training Organsiation workforce training targets. A training plan for the home must be developed so that all staff are appropriately trained. The Registered Provider must review the managerial arrangements, including lines of accountability, to ensure that the Registered Manager to ensure that the individual has sufficient time to be in full time day to day control of the home and to fulfil responsibilities as a Registered Manager. All records must be kept securely, and confidential phone calls and discussions should be held in private.The Registered Provider must provide a plan of how this will be achieved by 1 July 05 A Legionella risk assessment must be completed and implemented, as per guidance from the Health and Safety Executive. All accidents must be recorded, and a system set up to review 1 Sept 05 1 Sept 05 1 Sept 05 1 Sept 05 1 Sept 05 1 Sept 05 1 Sept 05 1 Sept 05 Page 25 Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 these. 23. 24. 25. 26. 27. 28. 29. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP8 Good Practice Recommendations Policies on dementia care, emergency admission under the Mental Health Act 1983, and health support services that come into the home, should be developed.(This was recommended at the last inspection 22 February 05) The home should develop a management of service users personal money policy and procedure. (This was recommended at the last inspection in 22 February 05) Additional furnishings as necessary should be added to service users bedrooms to comply with standard 24.2. All service users bedrooms should have lockable storage available. (This was recommended at the last inspection in 22 February 05) Design solutions should be put in place to ensure that water is provided at close to 43c at all points of use available to service users. (This was recommended at the last inspection in 22 February 05) A procedure on open sluicing should be added to the infection control policy. The laundry walls and floor should have surfaces that are easily washable. (This was recommended at the last inspection in 22 February 05) A quality assurance system and annual development plan should be implemented. (This was recommended at the last inspection in 22 February 05) A quality assurance system and annual development plan should be implemented. (This was recommended at the last inspection in 22 February 05) A formal staff supervision system should be developed and implemented. (This was recommended at the last D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 26 2. 3. OP14 OP24 4. OP25 5. OP26 6. 7. 8. OP33 OP34 OP36 Hamilton House 9. OP38 inspection in 22 February 05) The homes management should ensure that the risk assessments for non-physically adapted hot surfaces, hot water outlets and window openings are maintained comprehensively. (This was recommended at the last inspection in 22 February 05) Hamilton House D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 27 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: 0845 015 0120 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 D52-D04 S3480 Hamilton House V215201 260405 Stage 4.doc Version 1.20 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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