Inspection on 05/07/05 for Hamilton House

This inspection was carried out on 5th July 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 07/11/08

Hamilton House 12/04/07

Hamilton House 10/05/06

Hamilton House 26/01/06

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 MK18 1HL Lead Inspector Guy Horwood Caroline Roberts Unannounced Visit 5th July 2005 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 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hamilton House Address West Street, Buckingham, Bucks MK18 1HL 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) 01280813414 Acegold Ltd Elaine Groome (Mrs) Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number of places Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2005 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 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced additional inspection carried out at Hamilton House Nursing Home on the 5th July 2005 commencing at 10.15am. The lead inspector was Mr Guy Horwood who was accompanied by Mrs Caroline Roberts (Inspector). The 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 inspectors toured the building, gaining permission from a number of residents to enter their bedrooms and viewing a further number from the doorway. The inspectors met and discussed the inspection findings with the manager, Mrs Elaine Groome, and the responsible individual, Mrs Pauline Lawrence, before leaving. The inspectors would like to thank the staff for their co-operation and assistance throughout the course of the inspection. The inspectors would especially like to thank the residents for their time and for allowing the inspectors into their home. What the service does well: What has improved since the last inspection? What they could do better: Staff need to be more diligent in the reporting of accidents and incidents that may affect the well-being of a resident to the Commission as is required under Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 6 Regulation 37. Staff performance with regard to movement and handling techniques needs to be better monitored and training updates given as necessary. Prescription creams should be stored more appropriately. The recruitment of staff must always adhere to the Regulations. 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 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 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 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 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) EVIDENCE: These standards were not assessed at the time of this unannounced inspection visit. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 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 The home has a care planning system in place, which is currently under review. Once residents needs have been fully identified and documented, staff will be enabled to provide the most appropriate care. EVIDENCE: During this visit three residents care plans were viewed. It is pleasing to be able to report that staff have commenced a review and updating programme, which will allow these documents to give a fuller and more accurate picture of care needs and the necessary action of care staff. It is acknowledged that updating 53 care plans is a long and time consuming task the progress of which will be monitored at future inspections. It is hoped that once this major task is completed, keeping these records up to date will be easier. From viewing a specific residents care plan, it was established that following an incident on the 7th of June, 2005, relating to this residents moving and handling needs, the resident had been cared for in bed due to the home awaiting further moving and handling guidance from an external source. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 10 Through discussion with this resident care manager during the visit, and through viewing the residents care plan, it became evident that the residents relative had some concerns in that their general condition had deteriorated, and that they were not receiving adequate stimulation while being confined to their room. This issue was discussed with the homes manager, and the homes responsible individual. The manager stated that they had attempted to contact the moving and handling consultant that the home uses, however this had not been successful due to this person being on holiday. The manager confirmed that a referral had been made to community physiotherapists and occupational therapists on the 28th of June 2005. It is frustrating for the home that they are prevented from fully meeting a resident’s healthcare needs because of a situation largely out of their control. However, under these circumstances reviewing the care plan to limit any negative effects on a resident should help. From the evidence available at the time of the inspection this does not appear to have been completely successful and lessons can be learned from it. During a tour of the premises, a resident was seen sitting in an armchair in their bedroom, wearing their nightclothes. This resident’s bedroom felt cold and the window was open. The resident was cold to the touch. This was brought to the attention of staff, which promptly addressed the situation. Prescribed creams were observed on display within resident’s bedrooms. The manager needs to ensure that such items are not left accessible to residents / visitors within the home, and are to be stored appropriately. At the time of the inspection, the home was being visited by a diabetic specialist nurse and community dietician. The diabetic specialist nurse was attending the home following receipt of resident referrals from staff members. The community dietician was conducting a review of resident’s nutritional assessments and needs, and expressed that she found the home prompt in referring residents that they had concerns with regards to nutritional needs. During the tour of the premises it was pleasing to note that drinks were positioned within reach of residents; that staff were offering hot and cold drinks; and that supplementary drinks were available. It was pleasing to note that the home has utilised the homes domestic support team to assist residents with their meals where required. This has meant that residents can now have one to one attention when needing help with their meals or not have to wait for long periods should they need help with feeding. An added bonus to this new way of working has been greater job satisfaction for the members of staff concerned. The manager is advised to offer training to any ancillary staff member who is unsure or needs advice on appropriate feeding techniques. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 11 Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: These standards were not assessed at the time of this unannounced inspection visit. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 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) EVIDENCE: These standards were not assessed at the time of this unannounced inspection visit. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 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) EVIDENCE: These standards were not fully assessed at the time of this unannounced inspection visit. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 15 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 Finding the correct numbers of staff to meet resident needs still needs to be addressed. Until this is done the home may struggle to reach its high standards of care objectives. The homes recruitment policy and practices were not always being followed which could place residents at risk. EVIDENCE: On the 8th June 2005 an immediate requirement was served on the home to increase staffing levels in the afternoon and evening periods. At this inspection the rotas covering the period from the 6th June until the 17th July 05 were examined. Through discussion with the deputy manager and examination of the rotas it was evident that the immediate requirement was not always being complied with. This was not acceptable. It is acknowledged that Four Seasons wished to challenge the immediate requirement and had requested a meeting with the Commission to facilitate this. At the time of writing this report it is pleasing to be able to report that the meeting between Four Seasons and CSCI has taken place and revised and agreed staffing levels are now in place to enable the home better meet residents needs. Three random staff recruitment files were viewed. Two of these held the required documentation, however, the third file viewed clearly demonstrated a failure to comply with regulations. This file identified that a member of staff had commenced employment on the 27th of September 2004, 2 weeks prior to the date of her PoVA First check, and with only 1 reference, which again was Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 16 dated after the commencement of employment. The Criminal Record Bureau check was dated 21st of December 2004. The procedures for the recruitment of staff given in the Regulations are there to protect residents and should be followed at all times. This issue was discussed with the responsible individual who agreed to undertake an audit of the recruitment systems and records within the home to ensure all checks are in place and that correct procedures will be followed in the future. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 17 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) 38 Examination of records and observed practice indicated that the health, safety and welfare of residents and staff was not always promoted and protected. EVIDENCE: The homes accident records were viewed. Between the 27th April and the 3rd July 05 only one of all the accidents recorded were reported to the Commission as required under Regulation 37 of the Care Homes Regulations 2001. The Regulation states: The registered persons shall give notice to the Commission without delay of the occurrence of…….any event in the care home which adversely affects the well-being or safety of any service user. The home were advised to review their practice with regard to reporting under Regulation 37 and in the interim were asked to report all accidents and incidents. This will be reviewed. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 18 During the visit two members of staff were observed conducting the moving and handling of a resident using an inappropriate and unacceptable technique. This incident was discussed with the manager and responsible individual. It became apparent through discussion with a visiting care manager and staff, that one resident has a tendency to leave the building unnoticed. This issue was discussed with the manager and responsible Individual, and it was recommended that they review the security systems for the external doors. Staff were reminded of the importance of recording such incidents. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 2 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 x x x x x x x 2 Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 20 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 38 Regulation 37 Requirement An immediate requirement was served on the 07.06.2005 that accidents and incidents affecting the well being of residents are to be reported to the Commission for Social Care Inspection without delay. This requirement is reinforced. An immediate requirement was served on the 08.06.2005 that staffing levels are to be maintained at 2 trained nurses and 8 care staff throughout the waking day. This requirement is reinforced. The organisation must ensure that staff are employed in line with Regulation 19 and schedule 2 of the Care Homes Regulations 2001, and as per the homes policies and procedures. All staff are to receive updates in moving and handling procedures. Prescription creams and lotions must be stored appropriately. Timescale for action 05.07.05 2. 27 18(1) 05.07.05 3. 29 19 31.12.2005 4. 5. 38 9 12(1) 13(2) 31.12.05 31.12.05 Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 21 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 8 Good Practice Recommendations Training / guidance is provided to staff assisting residents with meals. Hamilton House 20050507 Hamilton House X00015 UI Stage 5 S19227 V241692 H53.doc Version 1.40 Page 22 Commission for Social Care Inspection Cambridge House 8 Bell Business Park Smeaton Close Aylesbury, Bucks 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. 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