Inspection on 26/01/06 for Hamilton House

This inspection was carried out on 26th January 2006.

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 07/11/08

Hamilton House 12/04/07

Hamilton House 10/05/06

Hamilton House 05/07/05

Hamilton House 07/06/05

Hamilton House 24/12/04

Hamilton House 27/07/04

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

CARE HOMES FOR OLDER PEOPLE Hamilton House West Street Buckingham Buckinghamshire MK181HL Lead Inspector Caroline Roberts Announced Inspection 09:30 10 & 26 January 2006 th th 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 DS0000019227.V270397.R01.S.doc Version 5.0 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 DS0000019227.V270397.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hamilton House Address West Street Buckingham Buckinghamshire MK181HL 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) 01280813414 Acegold Limited (a wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Elaine Groome Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Maximum 53 Nursing 40 years plus Maximum 8 personal care For one resident with dementia, as identified in variation for registration form dated 27 06 05. 4th August 2005 Date of last inspection Brief Description of the Service: Hamilton House is situated a short distance from the town centre of Buckingham, a small market town served by local bus networks and possessing a variety of shops and other local amenities. The home is one of the Four Seasons Healthcare Group. The home provides personal care for up to 53 Service Users. Service users are accommodated in one of 39 single or 7 shared rooms, which are found over 3 floors. The home has 4 dayrooms and 1 dining room. These communal areas provide space for receiving visitors, participation in activities, watching television and dining for limited numbers. The front door to the building is accessed by two steps, and is therefore inaccessible to wheelchair users. Side entrances to the home can be used for wheelchair access. The home possesses two through floor lifts, which permit access to all levels of the home. Grab rails are found in toilets, bathrooms and bedrooms. The home possesses hoisting equipment to facilitate safe moving and handling practice, and the home has a nurse call system in place. The staff team consists of trained nurses, care staff, domestic, catering and laundry staff. The home has a manager who has been registered under the Care Standards Act 2000. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Each care home that is registered with the Commission for Social Care Inspection, receives one announced and one unannounced inspection each year and further additional visits as necessary. All inspections, both announced and unannounced are followed by a written report, which eventually become public documents. It is a requirement that inspection reports are made available within the home. This inspection was announced and took place on the 10th and 26th January 2006. The inspector present was Mrs Caroline Roberts (Lead Inspector). This inspection consisted of meeting with Residents and staff, viewing records and documents pertaining to the provision of care and the running of the home. The Inspector found staff polite, helpful and welcoming, and would like to thank them for their co-operation and assistance throughout the course of the inspection. The inspector met and discussed the inspection findings with the manager and regional manager before leaving, and would like to thank them both for their co-operation during both of the visits. What the service does well: What has improved since the last inspection? Regulation 37 notifications are being forwarded to the Commission without delay. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 6 Staffing levels have been reviewed and increased to ensure that resident’s needs are met. Mandatory training continues to be provided for all staff. Prescribed creams and lotions are stored appropriately. The level of detail within the care plans has improved. Staff appear to be working more as part of a team. 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. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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 DS0000019227.V270397.R01.S.doc Version 5.0 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 the following standard(s): 3,6 Resident’s needs are thoroughly assessed before they are offered accommodation in the home ensuring that staff will know the assistance each person will need on admission. EVIDENCE: Samples of care files were examined from each of the homes three floors. The files examined did have assessments undertaken by the home prior to admission of a new resident and these were supported by a care service order or nursing assessment. Intermediate care is not provided in this home. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 Individual care plans identify and set out how the resident’s health personal, and social needs are to be met. However the manager needs to ensure the review process is reflective of resident’s individual changes in health, personal and social needs and does not just become a paper exercise. Generally the medication system was well managed, but failure by one staff member to follow company procedures and pharmaceutical guidelines has potential for risk. The staff were very good at ensuring that the privacy and dignity of residents was upheld. EVIDENCE: Four residents care plans were viewed; three of these residents were also spoken with. The assessment following admission was comprehensive within all of the care plans and was based on identified needs following risk assessments. The care plans provided detailed information on the resident’s abilities and the level of support they need and this would suggest that resident’s independence is promoted. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 10 The content of the care plans and risk assessments was very clear, showing choice, consultation with residents and families and other professionals, but not all had been kept up to date. Review sheets had been signed as no change to care plan needed, however it was evident in some cases that the care received by residents far exceeded the detailed needs within the care plan. Care plans contained: Needs assessments Moving and Handling assessments Risk assessments Nutritional screening Tissue viability assessments Daily Reports Medical intervention progress notes Despite the Provider Organisation ensuring that all staff have current Moving and Handling Certificates, staff were still observed lifting residents, this was brought to the attention of the manager and regional manager who agreed to take immediate action. The receipt, storage, recording and handling of medicines was inspected on two floors within the home Both units possessed lockable storage rooms for medicines. Medication is stored appropriately. Any handwritten entries on the medication administration sheets (mar) are supported by a copy of the original prescription. A few unexplained gaps were noted on the (mar) sheets. It is recommended that the manager undertake a weekly audit of the (mar) sheets in order to monitor and take appropriate action against the failure to follow company procedure in the administration of medications. The inspector noticed a major shortfall in that a trained nurse attempted to give a staff member some pain relief tablets, which were prescribed to a resident. The inspector stopped this action and the nurse was informed that this was not acceptable practice; the manager was then informed who agreed to investigate this matter at once. This is extremely dangerous practice, and contravenes amongst others, the Royal College of Nursing’s Medication and Administration guidelines. Residents said that they felt well cared for, and that staff treated them well. Staff were observed during both of the days of this inspection to be treating residents with respect, and ensuring privacy by knocking on doors prior to entering and ensuring that any personal care is conducted behind a closed door. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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 the following standard(s): 12,13,14,15 Residents are encouraged to be as independent as possible when and where residents have the ability and capability to do so. Residents receive an appealing and balanced diet. EVIDENCE: Residents said that they could get up and go to bed when they wanted and confirmed that they spent the day were they wanted in a choice of lounge or bedroom. The home operates an open door policy, with visitors allowed access to all communal areas and their relative’s room. The home benefits from the services of an advocacy group who visit the home on a regular basis. Local church groups provide religious services within the home for residents. The homes cook was spoken with regarding the menus, which offer variety and choice. A teatime choice record is maintained which details what the main tea is and alternatives it was noted that as many as five different choices were available. It was recommended that the cook also keep a record of the Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 12 lunchtime menu and choices offered. The kitchen was found to be clean and well organised. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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 the following standard(s): 16,18 The home has a complaints policy, which is accessible to residents and relatives; complaints are listened to and acted upon. The home needs to ensure staff are trained in the Protection of Vulnerable Adults to further ensure that residents are protected from abuse. EVIDENCE: A complaints procedure is in place a copy is to be found in the front entrance area all residents have a copy included in their Information guide the complaints procedure is clear and gives the appropriate information as required. The manager has recently introduced a manager’s feedback form for staff to detail any concerns they may have that they wish to raise directly with her. The inspector saw evidence that this form has already been used several times by staff, who have raised concerns about staffing deployment and nursing issues, the manager was investigating these concerns during the inspection. Two anonymous complaints have been received directly to the Commission, one which was passed directly back to the home to investigate which was unfounded, and another which was reported under POVA with case conferences taking place. The manager must ensure she fully understands what is expected of her with regards to reporting issues under POVA. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 14 Some staff have commenced POVA training, however this training needs to have a higher profile within the home, a requirement is made that all staff receive this training by September 2006. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, The home is warm light and clean. EVIDENCE: The home has a number of lounges all are warm, light, well ventilated and clean. The home is starting to show signs of age, it was very pleasing to note that the Providers have recently undertaken an audit of the environment and as a result the home is being refurbished this year commencing in March 2006. Environmental standards will be assessed during the next inspection. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 The staffing levels provided are sufficient to meet the current residents assessed needs. EVIDENCE: Staffing levels on the first day of the inspection were 12 staff during the morning period and eight staff during the afternoon, The deployment of staff during the afternoon period had been changed two days prior to the inspection and the inspector was concerned with this new deployment that residents may be left unattended on the floors, staff themselves had raised concerns to the manager about the staffing deployment during the afternoon period stating that they were unable to manage the care needs of the residents. This was discussed with the manager and regional manager who agreed to change the staffing deployment immediately. On the second day of the inspection staffing was 11 staff during the morning period and 9 staff during the afternoon period; the deployment of staff on the floors had also been reviewed. Staff and residents confirmed this was much improved. Staffing rotas were examined and found to be satisfactory. The staff group have worked hard since the last inspection and this has resulted in them working much more as a team, this working together as a team was observed during the inspection staff spoken with said that there had been “a big improvement” however there was still some work to do with the staff and manager relationship. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 17 Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 The home has a registered manager who has a wealth of experience in the care sector. The home is run in the best interests of residents. Residents are safeguarded by the systems in place to look after their personal money. EVIDENCE: The manager has been employed at the home for many years, as a deputy manager and then as the registered manager. The manager is a Registered General Nurse. The manager is currently undertaking her RMA and hopes to complete this by March 2006. One of the observations made previously was that the manager could be seen as un-approachable, the manager has made Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 19 positive efforts to rectify this and ensures that her office door is left open for the majority of the day, (task permitting). A routine part of the manager’s day now also includes walking the floor and ensuring that she sees every resident each day. The home has recently had a full quality assurance audit conducted by The Care Services Director from Four Seasons. A copy of the findings of this was given to the inspector for inspection purposes. Resident and relative meetings are conducted 3 monthly with minutes maintained. Questionnaires are sent out to relatives and health care professionals. The home holds small amounts of money for residents; detailed records are maintained for all expenditure. The home has an administrator who is responsible for the up keep of these records. Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 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. 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 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X x Hamilton House DS0000019227.V270397.R01.S.doc Version 5.0 Page 21 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. 1 2 Standard OP18 OP38 Regulation 13(6) 13(5) Requirement All staff are to receive Protection of Vulnerable Adults training by September 2006. The manager is required to ensure that all staff follow correct moving and handling guidelines. Timescale for action 01/09/06 26/01/06 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 DS0000019227.V270397.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 DS0000019227.V270397.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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