Inspection on 07/06/05 for Hamilton House

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 05/07/05

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 Bucks MK18 1HL Lead Inspector Guy Horwood, Caroline Roberts and Rosemarie James. Unannounced 7 June 2005 15.50pm th 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 H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hamilton House Address West Street, Buckingham, Buckinghamshire, MK181HL 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) 01280 813414 Acegold Limited Mrs Elaine Groome Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number of places Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 Maximum 53 Nursing 40 years plus 2 Maximum 8 personal care Date of last inspection 24 December 2004 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 H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of Hamilton House Care Home took place on the 7th June 2005 between the 3.50pm and 7.30pm. The lead inspector was Mr Guy Horwood, who was accompanied by Mrs Caroline Roberts, (Inspector). During their visit the inspectors met with the nurse in charge and deputy manager. The inspection consisted of a tour of the premises; talking with residents, their relatives and staff; and viewing a selection of records pertaining to care provision. Due to concerns raised from the unannounced inspection on the 7th June, the inspectors returned for a second day on the 8th June 2005, and remained at the home form 9.30am until 4.30pm. On this second day of inspection the inspectors were accompanied by Mrs Rosemarie James, Regulatory Manager. On this second day of inspection the inspectors viewed care plans and care records; spoke further with residents, their relatives and staff; and toured the premises. The area manager, Mrs Jo McPartlane, was present at the home during the second day of inspection and received feedback from the inspectors at the conclusion of the visit. What the service does well: What has improved since the last inspection? What they could do better: The manager is to familiarise herself with the conditions and categories of registration pertaining to the home, and is to ensure that no breach of the homes registration occurs again. This report has highlighted serious concerns with regards to the health and welfare of residents. The report is extensively detailed in order to help the Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 6 organisation identify areas requiring immediate and on-going action in order to ensure that the standards of care improve to reflect the caring nature exhibited by staff members. Areas of concern include: • • • • • • • • • Staff to resident ratios. Insufficient staff time to meet residents identified needs. Poor reporting under regulation 37 of the Care Homes Regulations 2001. Poorly completed, maintained and reviewed care plans. Poor moving and handling techniques. Poor infection control measures. Poor practice with regards to tissue viability. Poor practice with regards to diabetic care. Questionable competency of trained nurses. The inspectors were concerned at the number of relatives who expressed their concerns and dissatisfaction over the care afforded to their relatives during the visit. Through direct observation, and discussion with relatives and staff members, it was apparent that there are communication deficits within the home concerning the provision of care. The findings of this inspection demonstrate that effective monitoring of the home is not taking place, and that poor standards of care, record keeping and staffing arrangements are not being noticed and responded to. The serious issues identified within this report are not reflected in the recent monitoring reports carried out by the organisation, and provided to the Commission for Social Care Inspection. Previous requirements for someone external to the line management of the home, who could give an objective and impartial view to monitoring quality of care within the home have not been met. 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 H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 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 H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 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: Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 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, 9. Care plans are not up to date, detailed, maintained or subject to regular review. As a result they do not provide staff with specific or up to date information which they need to meet resident’s health care needs. Residents have been inappropriately admitted to the home exceeding the conditions of registration. The home does not promote and maintain residents health care needs, therefore potentially placing residents health and welfare at risk. Medication is not given to residents as per prescription due to insufficient staffing, thus creating a potential risk to the health and welfare of residents. EVIDENCE: A random selection of care plans were thoroughly examined on the second day of the inspection. This highlighted serious concerns with regards to the poor documentation of residents healthcare needs. Examples of this include: • • • • Conflicting advice within the same care plan. Out of date moving and handling assessments. Incomplete tissue viability assessments. Incomplete nutritional assessments. H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 10 Hamilton House • • • • • A failure to follow care plans instructions – eg “refer and liase with dietician”, no evidence that this occurred. A failure to document specific health care needs – eg diabetes, pressure area care. Lack of evidence of liaison with healthcare specialists – eg diabetic specialist nurses. Lack of continence promotion programmes – eg no toileting regimes. Hard to interpret documentation due to poorly written English. At the time of the inspection the weather was hot and sunny. Five residents were observed sitting in the main lounge with lap tables. A jug of drink and some clean glasses were on a table in the corner of this room. None of the residents had drinks within reach, and none appeared able to help themselves to the drink in the room. For the 20 minutes that the inspector was in this room, no staff members entered to check the well being of residents, or to offer drinks. The inspector attempted to locate a staff member on the ground floor to request that they check on the well being of residents in this lounge, but was unable to locate a member of the staff team. During a tour of the building, it was noted within several rooms that drinks had not been provided, or were not to hand for residents. One resident on the first floor asked the inspector to get her a drink as she had not had one for quiet a while. This resident was in bed, and there was no evidence of a drink within her room. The inspector attempted to locate a member of staff to provide a drink for this resident, which again took a considerable amount of time. Whilst seeking to find a member of staff on this occasion the inspector was approached by a distressed relative, who had also been looking for a member of staff for some time to attend to her mother. At the same time the inspector was required to assist a resident who was confused, distressed, in a state of undress, and was attempting to climb out of his bed over the attached cot sides. The inspector spoke with a relative visiting a resident, who informed the inspector that their relative had fallen from a sling whilst being hoisted that morning. The resident had sustained a head injury, including a laceration. Whereas staff had contacted the residents General Practitioner for advice, they had not by 6pm that evening completed an accident report, informed the Commission for Social Care Inspection or sought advice as to whether this incident should have been reported under R.I.D.D.O.R. During the tour of the premises, the inspector happened across a resident on the floor of his bedroom, with his daughter trying to assist him to sit up. The residents daughter said that she had found him on the floor when she arrived to visit. Staff were called via the nurse call bell and attended and assisted the resident to his chair. The resident was given a cursory and hurried “once over” Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 11 by the nurse in charge, had his evening meal placed in front of him and was encouraged to eat this despite his apparent agitation. Following his fall the resident appeared to be experiencing pain and to be agitated. As the nurse in charge appeared to be busy with other duties, a member of care staff was spoken to and it was suggested that the nurse in charge might consider liasing with the General Practitioner. Through discussion with the residents daughter, it was ascertained that he fell frequently, and that this had been the case prior to his admission. She informed the inspector that she had previously turned up to visit her father only to find him on the floor, sometimes with his bedroom door closed, and was concerned that he may have been in this position for some time. At the time of inspection the resident appeared to have large bruises to his right eye and a recently healed wound to the occipital region of his head. The homes accident book was viewed and several reports of falls pertaining to this resident were noted. None of these incidents have been reported to the Commission for Social Care Inspection under Regulation 37 of the Care Homes Regulations 2001. This same resident was noted to have fallen at least 3 times on the morning of the 8th June 2005. Through viewing this residents case file, his care plan indicated that he should be checked on an hourly basis. Records provided to the inspectors did not evidence that this action was taking place, hence an immediate requirement was served. Given the residents history of falls, his current frequency of falls, and his apparent injuries from these falls, it is concerning that the home has not sought to provide one to one care, and that this was not recognised as a care need for this resident prior to Hamilton House agreeing to his admission. Other areas of poor care practice noted during this visit included, poorly shaven residents; dentures sitting in dry pots on tables; soiled clothing and cold cups of tea being served to residents at teatime. On the first day of the visit, the inspectors arrived at 3.50pm. The majority of residents were found to be in bed and wearing night time attire. The use of nappy style incontinence aids on residents was noted in many cases. Upon further investigation it transpired that residents with pressure ulcers to their sacral area were also wearing these nappy style aids. During the first day of the visit, no evidence of regular turning of those residents being cared for in bed was witnessed. One resident spoken with expressed that she did not receive regular turning. One relative spoken with expressed that her relative had not received any personal care or turning during the duration of her visit. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 12 A file was viewed which contained details of residents wounds. This file held photographs and dressing information. The inspectors were distressed and shocked to see photographs within this file which not only showed the wound, but intimate areas of the residents body. These photographs appeared to have been taken with no regards to the privacy, dignity and respect of the resident. The area manager, Mrs Jo McPartlane, was shown these photographs. She was asked to remove specific photographs from the file, and was directed to retain them in a secure area for possible future reference. The inspectors observed one of the nurses attending to a resident who was distressed and in pain, this examination was not undertaken in a caring and considerate manner. The nurse, whilst examining the resident, had hold of a tray of medication pots and was attempting to examine the resident with only one hand. The nurse questioned why the resident had not informed her earlier of her discomfort, to which the resident replied that she had , but that the nurse “doesn’t listen”. The inspectors had the opportunity to meet with a visiting healthcare professional. This person expressed her concerns at discovering her confidential and private meeting with a resident and their relative, had taken place in front of another resident who was in bed within the same room. A screen had been placed around this bed, but the staff had failed to inform the visiting healthcare professional of this residents presence. The use of an alternative room had not been offered. The medication storage fridge, located in the staff office, was found unlocked throughout the first day of inspection. The nurse on duty on the first day of inspection was noted as failing to administer medications at prescribed times. This was a consequence of only having 1 trained nurse on duty, who also had overall responsibility for the running of the home during the afternoon/evening shift. Medication administration record sheets contained unexplained gaps. It was evident through direct observation and discussion with residents, through viewing care plans, pre-admission assessments and care service orders, and from talking with staff, that a number of residents were suffering from various levels of confusion and dementia type illnesses. It was identified that the home had failed to adhere to its conditions of registration, in that it had admitted residents with a dementia type illness. This issue was discussed with the area manager who was informed to complete a variation application form to accommodate those residents with a diagnosis Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 13 of dementia, and requirements are made to address this situation within this report. The manager is to familiarise herself with the conditions and categories of registration pertaining to the home, and is to ensure that no breach of the homes registration occurs again. The home currently has no registration category for the accommodation of residents with a dementia type illness, and is therefore not permitted to admit residents with this diagnosis. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 14 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 this visit. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 15 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 this visit. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 16 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) 22 The homes nurse call bell system was not working effectively, or was inappropriately placed out of the reach of residents. Residents are unable to call for the assistance of staff. EVIDENCE: It was noted that the nurse call bell system was malfunctioning in areas, and staff confirmed that this was a known problem. Staff expressed that this issue had been raised with the homes management. Call bells were noted as being out of the reach of residents in several instances. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 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 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 Staffing numbers and skill mix of qualified/unqualified staff are not appropriate for the assessed needs of residents, therefore residents needs are not being met fully. EVIDENCE: At the time of inspection the homes manager was on leave, but the inspectors were able to meet with the homes deputy manager and area manager during their visit. On the first day of the inspection, (7th June), the staffing during the afternoon/evening period stood at 1 trained nurse and 5 care staff. This was clearly insufficient to meet residents needs. The rotas were examined for the current week. These were difficult to interpret. The deputy manager, who the inspectors were informed was visiting the home in her own time in order to attend to record keeping duties, confirmed staffing levels to the inspectors. She stated that these were set at: 2 qualified nurses and 8 care staff for the morning shift. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 18 1 qualified nurse and 5 care staff for the afternoon/evening. On the day of the inspection the home had an occupancy of 47 residents. Staff provided details of how many residents required double handed care, (ie 2 staff members), for all personal care needs. This totalled 25 residents. Simple logistics demonstrate that in the afternoon/evening, should 3 residents require double handed care at any one time, no staff would be available for the remaining 44 residents. This was clearly the case at times on the first day of the inspection. Other indicators of insufficient staffing included; • Visitors and relatives approaching the inspectors looking for assistance and unable to locate staff members. • The 6pm medication round being commenced at 4pm and still being undertaken at 7pm, (only 1 trained nurse on duty). • Residents not receiving personal care. • No evidence of a turning regime for residents being cared for in bed. • Members of staff attempting to feed multiple residents at the same time. • Residents not receiving drinks. • No toileting programme evident during the visit. • Care plans not up to date, maintained, or subject to review. • Residents found on floor by relatives and inspector. The area manager was spoken with on the second day of the inspection with regards to the apparent lack of staffing during the afternoon/evening period. Clarification was sought from the area manager as to the breakdown of the morning staffing levels, and the question posed as to why the afternoon staffing numbers were significantly less than the morning, that is reduced from 10 staff down to 6. An immediate requirement was served with regards to increasing the afternoon/evening staffing levels in line with the numbers of staff on duty throughout the morning. During both days of the inspection poor practice was observed in the following areas: • Moving and handling techniques. • Pressure area care. • Diabetes care. • A lack of regard to privacy, dignity and respect. • Infection control. • Care plans not detailed, up to date, maintained or subject to review. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 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 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 The home is not run in the best interests of residents, therefore the health, safety and welfare of residents and staff are not promoted and protected. EVIDENCE: It was noted that the nurse call bell system was malfunctioning in areas, and staff confirmed that this was a known problem. Staff expressed that this issue had been raised with the homes management. First and second floor window restrictors and closure devices were noted as broken. Poor moving and handling techniques were observed. A hoist was noted as being charged in a corridor, presenting a fire risk and obstructing a means of escape. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 20 A trained nurse failed to provide basic first aid to a resident who had fallen. Poor infection control measures were observed. Staff were unclear as to specific infection control issues within the home, and therefore measures to prevent the spread of infection were not in place. An immediate requirement was served to address this issue. A bag of clinical waste was found open on the floor of one toilet. The external clinical waste bin was not locked. Accidents and incidents affecting the well-being and safety of residents are not reported to the Commission for Social Care Inspection as required under regulation 37 of the Care Homes Regulations 2001. An immediate requirement has been served with regards to this issue. First aid boxes were noted as located throughout the home, with a list displayed of first aid trained staff members. Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 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 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 1 8 1 9 2 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 2 x x x x STAFFING Standard No Score 27 1 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 x x x x x x x 2 Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 22 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 10(1) and 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. An immediate requirement was served on the 07.06.2005 that the resident identified at the time of the inspection receive hourly monitoring checks as per his care plan. These checks are to be documented and signed by staff. An immediate requirement was served on the 07.06.2005 that staff are reminded as to good practice with regards to infection control; and that all staff are to receive updated training in infection control within 3 months of the 07.06.2005. 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. An immediate requirement was served on the 08.06.2005 that a Timescale for action 07.06.2005 2. 8 10(1), 13(4c) and 13(6) 07.06.2005 3. 38 10(1) and 13(3) 07.06.2005 4. 27 18(1) 08.06.2005 5. 8 12(1) and 13(1b) 08.06.2005 Page 23 Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 6. 7 10(1) and 15(1) 7. 8 13(4a and c) 8. 8 13(4c) 9. 8 13(5) 10. 8 12(1) 11. 12. 8 8 12(1) 12(1) 13. 8 12(1) diabetic specialist nurse or doctor be contacted and asked to visit and advise as to the care afforded to the female resident identified at the time of the inspection. Care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet residents health and welfare needs. Residents care plans must be kept under review. Residents identified as at risk of pressure area damage, are to have skin integrity care plans developed. These tissue viability assessment are to be reviewed on a monthly basis. Where a specific risk is identified, an individual risk assessment must form part of the care plan. Moving and handling assessments are to be reviewed on a monthly basis to ensure that they reflect any changes in residents needs. Medical intervention sheets are to record, in detail, any instruction given with regards to health care needs by a health care professional. Nutritional assessments are to be complete, maintained and up to date. Professional advice about the promotion of continence is sought and acted upon, with records maintained as to this, by the registered manager. Hot and cold drinks are to be available at all times for residents, with adequate staff available to assist residents with these drinks. Staff are to be aware of the need to promote, assist and encourage fluid intake 28.07.2005 28.07.2005 14.07.2005 14.07.2005 14.07.2005 14.07.2005 28.07.2005 14.07.2005 Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 24 in residents. 14. 8 17(1) and schedule 3(3k) 13(2), 18(1a) and 10(1) As a measure of good practice with regards to pressure relief care, a record is to be kept detailing the turning of residents whilst in bed. The registered manager shall make arrangements for the recording, handling, safe keeping and safe administration of medications within the care home. Medication is to be administered as prescibed. The registered manager must ensure that the home is conducted in a manner which respects the privacy and dignity of residents. The nurse call bell system is to be functional at all times, with call bells placed within reach of residents. Regular maintenance checks are to be undertaken of the nurse call bell system with records of this kept. Window restrictors on the first and second floor of the home are to be in good working order. Regular maintenance checks are to be conducted with regards to window restrictors, with records maintained of this action. Arrangements are to be made for the suitable storage and disposal of clinical waste. 14.07.2005 15. 9 14.07.2005 16. 10 10(1) and 13(4a) 08.06.2005 17. 22 23(2) 14.07.2005 18. 22 23(2) 28.08.2005 19. 20. 38 38 13(4a and c) 13(4a and c) 14.07.2005 28.07.2005 21. 38 22. 23. 24. 38 38 8 10(1), 13(3), 23(2c) and 23(2i) 23(4) and Hoists are to be stored behind a 23(2i) closed fire door whilst being charged. 23(4) Fire escape routes are to be kept clear of obstructions. 10(1) and A requirement is made that the 12(1) registered manager and provider ensure that the care home is conducted so as to promote and make proper provision for the H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc 14.07.2005 14.07.2005 14.07.2005 14.07.2005 Hamilton House Version 1.30 Page 25 health and welfare of residents 25. 33 10(1) and 26 Visits carried out as required under regulation 26 of the Care Regulations 2001, are to be carried out by someone external to the line management of the home, who can give an objective and impartial view. Regulation The registered manager and provider are to ensure that they 10(1) of the Care do not breach the conditions and Regulation categories of Hamilton Houses s 2001 registration. and Section 24 of the Care Standards Act 2000. 14.07.2005 26. 3 08.06.2005 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 Good Practice Recommendations Hamilton House H53_H02_S19227_Hamilton House_UI_V229622_070605_Version 3.doc Version 1.30 Page 26 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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