Inspection on 09/11/05 for Hamilton House

This inspection was carried out on 9th November 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 18/05/07

Hamilton House 02/06/06

Hamilton House 26/04/05

Hamilton House 22/02/05

Hamilton House 03/11/04

Hamilton House 16/04/04

Hamilton House 11/11/03

Hamilton House 23/07/02

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

CARE HOMES FOR OLDER PEOPLE Hamilton House Residential Home 23 Houndiscombe Road Mutley Plymouth Devon PL4 6HG Lead Inspector Helen Tworkowski Unannounced Inspection 9th November 2005 1:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hamilton House Residential Home DS0000003480.V253550.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 Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hamilton House Residential Home Address 23 Houndiscombe Road Mutley Plymouth Devon PL4 6HG 01752 265691 NO FAX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Penton Homes Limited Mrs Elizabeth L Glover Care Home 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 Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered as a care home only (PC), providing care for older people not falling within any other category (OP) over 60 years of age, and also for service users with Dementia over 65 years of age 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 26th and 27th April 05 2. 3. 4. Date of last inspection Brief Description of the Service: Hamilton House is a large care home owned by Penton Homes Ltd. and situated within walking distance of Mutley Plain shopping precinct. The home can accommodate31 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 Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 1pm and 6pm on Wednesday 9th November 05. The inspection included a tour of the building, checks on records, relating to staff and service users. Time was spent in discussion with the managers and staff. Some time was spent talking with a visitor and service users. Feedback was also received from Social Services Review Team. What the service does well: What has improved since the last inspection? What they could do better: Service Users were found to be being inappropriately restrained at this unannounced inspection- both by a barrier across the door and by being seated on low furniture. This is not acceptable, and immediate requirements were made to ensure the well being of Service Users. The layout and the facilities provided are inadequate, particularly in relation to bathing. Some of the bathroom and toilet doors cannot be shut or cannot be locked. Bedding was found to be both inadequate and dirty. Information about service user needs had not been recorded prior to a Service User moving to the home. Service User Plans are documents that describe in detail how individual needs will be met by staff and they failed to do this. On checking the arrangements for Service Users to clean their teeth, it appeared Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 6 from the lack of toothbrushes, steradent and toothpaste, that this most basic of needs was not being carried out. Records relating to the recruitment of staff could not be found, sound recruitment is one way of ensuring that Service Users are protected from abuse. Given the number of issues raised in this inspection there are concerns about the management of the home. 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 Residential Home DS0000003480.V253550.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 Residential Home DS0000003480.V253550.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 and 4 Information about Service User needs is not recorded in a systematic way as part of the assessment process. A thorough assessment is the basis of good care planning and provision. EVIDENCE: Two Service Users have recently moved to the home One of the Service Users had a Social Worker/Care Manager, and there was information on file about the needs of the person. The other individual had no social services involvement; Mrs Glover said she had carried out an assessment. This assessment was recorded in approximately 4 lines of information. On discussion with Mrs Glover it seemed she had visited, had found out a great deal about the individual however this information was not recorded. Mrs Glover confirmed that no letter had been written to Service Users to confirm, before a move to the home, that needs could be met. This is important reassurance for Service Users before they move. Hamilton House Residential Home DS0000003480.V253550.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 and 10. Service User Plans provide inadequate information about how care needs are to be met. The arrangements for maintaining oral and personal hygiene are inadequate. Service Users were found to be inappropriately restrained, breaching their rights and against all the tenants of good practice. The home has a new system and more robust systems for the management of medication. EVIDENCE: A new system of “Service User Plans” is being used at Hamilton House; the document contains minimal information about Service User needs. For example in relation to continence: one of 4 or 5 options can be circled to indicate the level of need- such as “occasionally incontinent”. However this is not a Service User Plan. A Service User Plan is a document that, based on an assessment of need, explains in detail the actions staff need to take to meet need. These documents are important as they inform staff and should help ensure that all care needs are met in a consistent and appropriate manner by staff, particularly in relation to dementia. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 10 As part of this Inspection the inspector asked to see the toothbrushes, toothpaste or “steradent”, that was used by Service Users, as none appeared to be kept by the wash hand basins in the rooms. Many of the Service Users would need assistance to maintain their oral hygiene, and so staff would know where these are. In a number of rooms it was not possible to see how oral hygiene was maintained, as there was nothing to maintain it with. In one room, occupied by two ladies (one who had false teeth and one who had her own teeth), the only equipment that could be found was one toothbrush. The deputy manager said that as mornings were busy teeth were sometimes cleaned in the afternoon. The home provides soap for Service Users to use, where Service Users share rooms two soaps could be found near the sink- however it was not possible to identify whose was whose. Service Users should each have their own soap to use. It was also noted that in some rooms the soap was damp, indicating it had been recently used, however in other rooms the soap was dry. Work to provide Service Users with door locks on their bedrooms has been completed, however one toilet did not have an appropriate door lock, one of the bathrooms had a door that did not shut, whilst another had a door that was very difficult to open once shut. At the start of this unannounced visit it was noted that five of the Service Users with dementia were seated in a lower ground-floor room (which has no outlook and very limited natural light). There were no staff in the room and the five people were contained within the room by a “baby gate”. The Inspector was told that this gate had been in use for five weeks. Three of the service users were seated on a low sofa. The service user in the middle was trying to stand up but was unable to do so as the sofa was too low, and the service user next to her was pulling at her arms, causing distress if not harm. The only activity or occupation in the room appeared to be a child’s musical toy. The Inspector was told that this set up was because one of the individuals kept on running down the corridor and falling or knocking over other service users. Mrs Glover said that this concern had been discussed with other professionals however there was no record of this on file. Staff were told to immediately remove the gate and that sufficient staff were to be provided to ensure the well-being and safety of the service users and to provide occupation and activity. Low seating is not to be used as it not only totally inappropriate for the needs of the Service Users and in effect is another form of restraint. At the previous inspection a requirement was made that all accidents, including falls must be recorded. Only falls where injury was sustained were recorded, other than a note in the daily record. However it is not always obvious at the time if an injury has been sustained. All accidents, including falls must be fully recorded. Recording the details of all falls means that the reason for falls can Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 11 be analysed, the risk assessments reviewed and measures taken to avoid or prevent further falls or injury in future. Feedback from the Social Services Review Team was that the home offered a good standard of care and was able to manage a range of people with very different needs. A new system for the management of medication has been introduced in the home. Mrs Glover said that the local pharmacist had visited to check how the new system was working and was very satisfied that it was working well. Mrs Glover said that 3 care staff were to attend training in relation to management of medication in the next week. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, and 14 For some of the individuals with dementia their experience of life at Hamilton House is likely to be unnecessarily restrictive. EVIDENCE: Please see evidence under previous section. During this inspection no activities appeared to be being offered to Service Users. Some of the more able individuals were able to occupy themselves, and appeared happy to do so. There were a number of visitors to the home at the time of this inspection. Though standard 13 was not fully inspected. Hamilton House Residential Home DS0000003480.V253550.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): Service Users are not comprehensively protected from abuse. EVIDENCE: There are copies of the Plymouth Alerters Guide at Hamilton House, and Mrs Glover said that there had been training in relation to abuse. However given the inappropriate use of restraint found in the home at the time of inspection, further training is required. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 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 the following standard(s): 19,20, 21,22, 23, 24, 25, and 26 The building is poorly suited to the needs of the people with dementia, both in terms of layout and décor. This adds to confusion and disorientation. The bathing facilities are totally inadequate for the number and needs of the service users in the home. Some beds and bedding were of a poor standard and dirty. The new conservatory has provided a light sunny area to sit, however there is nowhere out doors for Service Users to sit in safety. 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 find your way around the home, even if you don’t have dementia. The home is again 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 Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 15 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; such carpets are not appropriate for people who have problems with their visual perception. Mrs Glover said that new carpets purchased in recent months were not highly patterned. Many of the corridors have no natural light; the lighting in these areas appeared somewhat dim. On one corridor the lights had been switched off, and it was only possible to find the switch by opening bedroom doors to give some light. The lighting in corridors must be reviewed. New furniture has been purchased for some areas of the home. However some of the furniture was old and totally unsuited to the needs of most people. The Inspector was unable to get off the sofa without considerable effort, as it was too low and had sagged. At the last Inspection the inspector was told that a number of the dining chairs were being replaced and that some plastic garden chairs were being used whilst waiting for new chairs. Almost six months later these plastic chairs are still in use. 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 is use a Zimmer frame or who needs assistance because of dementia. There is a small bathroom on the lower ground floor, into which a very short bath has been fitted. There is a hoist that can be lowered into the bath. However because the bath is so small, anyone much above 5 foot tall would have to keep their legs bent up whilst seated in the bath. The radiator is uncovered, posing risks of burns. The door does not fit properly and is difficult to shut, and if shut very difficult to open. There is a further bathroom directly above this with a full size bath, however there is no hoist, rails or handgrips to provide any assistance when getting into the bath. There is a wash hand basin adjacent to the bath, and this could provide support when getting into the bath, however it is not stable and therefore could result in a person slipping. The enamel on the side of the bath is damaged. This bath could only be used by a fit person with a good sense of balance. It is totally inappropriate for the needs of the client group accommodated in the home. The door to the room has swollen and does not close at all, and so any one using the room has no privacy. The bathroom on the mezzanine floor at the rear of the house is currently being refurbished and there are rolls of new walling in the bathroom. This bath has a hoist. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 16 There is a further bathroom on the top floor; this room is being converted into a shower room. The room has a toilet, which the inspector was told is still being used by Service Users. However where the old bath had been removed and the new shower was to be fitted, there is a hole in the floor covered by a piece of wood. This area is not safe to be used by service users. 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. . A new call bell system has been fitted and this according to staff is working well. At the last inspection the Inspector was told that the new system will allow for the front door to be fitted with an appropriate alarm, rather than the three locks currently in place. No new locks have been fitted to the front door. 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. All of the bedrooms were seen, and these were for the most part clean and tidy. One room, an empty bedroom, that a Service User had left some days before smelt of urine and the dirty linen was still on the bed. On checking the bedding in some of the rooms it was found that some Service Users had no under-blankets on their beds. They had plastic mattress covers, covered by a thin sheet. This is not comfortable and provides no warmth. When one double room was checked one bed was found to have a worn out mattress, whilst the other bed, which was made up, on checking had sheets smeared with faeces. In another room the blanket on the bed was old and torn and too short to have been pulled up over the shoulders. There was no smell of urine throughout most of the home. However there was a strong smell in one bedroom. The manager said that the carpet was cleaned once per month. However on discussion the carpet is of a domestic hessian backed type, and not suited to a care home where there may be incontinence. Rooms and furnishings must be of a good standard so that they can be regularly cleaned- if necessary on a daily basis. No room should ever smell of urine. New furniture has been purchased for the large conservatory that was recently completed. This room is bright and airy and provides a pleasant place to sit. There is nowhere outside for Service Users to sit in good weather. The opportunity to sit or walk outside is not only a basic right and is important in maintaining good health. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29, and 30 The Registered Manager and staff feel that there are sufficient staff to meet the needs of the Service Users. There are gaps in the recruitment process, or at least the record keeping of this process. Failing to make proper checks on staff could place Service Users at risk. EVIDENCE: The Registered Manager outlined the staffing level in the home as: During the week7.30am till 2pm six care staff 2pm till 9pm five care staff 11am till 7 pm one care staff. 9pm till 9am two care staff And at weekends 7.30am till 2pm five care staff 2pm till 9pm five care staff 11am till 7pm once care staff 9pm till 9am two care staff Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 18 This staffing includes the Registered Manager, who “works the floor” at weekends but is carrying out other aspects of her managerial role during the week. The Registered Manager, Mrs Glover, said that she now had time to carryout her role as a manager, something that was not the case at the last inspection. Staff on duty and Mrs Glover felt that this was sufficient staff. In addition there is a cook and domestic staff. A new kitchen assistant has been recruited so that care staff no longer have to be involved in washing up after meals but are available to care for Service Users. Three staff files were checked for people who had started in the home in recent months. All three had Criminal Records Bureau checks, however it was not possible to find references or application forms for all the individuals, though Mrs Glover said that they had been completed. One new member of staff showed the inspector her induction book that indicated that she was learning about the work in a structured manner. She was clearly enjoying her new role. Mrs Glover said that there had been and were plans to train staff further, though there were difficulties in relation to finding appropriate training in relation to working with people with dementia. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33, and 38 The standard of management in the home is of concern, and indicates that the home is not being run in the best interests of the Service Users. EVIDENCE: Mrs Elizabeth Glover, the registered manager, has now come off the care rota for much of the week, and so has more time to devote to the management of the home. A new office has been created on the ground floor. This means that the office on the lower ground is used for storing medication and Service user records. It provides a private room where staff can contact GP etc in confidence. These changes are a great improvement on previous arrangements. Concerns raised elsewhere in this report- including the inappropriate use of restraint and the poor standards of care in relation to personal hygiene and in relation to beds, indicates that there are concerns regarding the management and leadership in the home. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 20 Mrs Glover said that the home recently received confirmation that the Fire Department was happy with the arrangements in relation to fire. However on a tour of the building three fire doors were found to be wedged open, this practice places Service User at risk. A requirement was made at the last inspection that a Legionella risk assessment is carried out. A check of the water has been made to see if a single sample had bacteria, however this is not a risk assessment. As noted elsewhere in the report not all accidents are being recorded in the accident book. The Registered Manager must ensure that a record of all accidents is 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. The Commission has received no reports of the monthly-unannounced visits to the home made on behalf of or by the Registered Provider. These reports help ensure that the Registered Providers are aware of what is going on in the home. Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 1 1 1 1 1 1 1 1 1 STAFFING Standard No Score 27 3 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 1 1 X X X X 1 Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 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 2 3 Standard OP38 OP38OP10 OP7 OP20OP10 Regulation 13 12 & 13 12, 13 & 23 Requirement Immediate Requirement: No fire door is to be wedged open. Immediate Requirement: The “baby-gate” must not be used on the dayroom. Immediate Requirement: Low furniture must not be used for seating Service Users. This furniture prevented service users from getting out of the chair/sofa unassisted. A similar requirement was made at the last inspection. No Service User may be admitted to the home, unless in an emergency, unless a full and comprehensive assessment has been completed as described in the National Minimum Standards. Prior to admission the Registered Provider must confirm in writing to the Service User, or their representative, that having regard to the assessment the needs of the individual can be met. (This was a requirement at the last inspection to be met by 1/7/05 and has not been met). Timescale for action 09/11/05 09/11/05 09/11/05 4 OP3 14 01/12/05 5 OP4 14 01/12/05 Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 23 6 OP8OP7 15 7 8 OP10OP8O P7 OP9 12, 15 13 9 10 OP12 OP22OP19 16 12,23 11 OP22OP19 12,23 All service users must have comprehensive Service User Plans which are based on an ssessment of need, and detail the actions staff are to take. All Service Users must have risk assessments and moving & handling plans must be comprehensive.(This requirement was made at the last inspection to be met by 1/9/05, and has not been met.) All Service Users must be supported to maintain good oral hygiene. The Registered Provider must ensure that all staff administering medication are appropriately trained. (Similar requirement made at the last two inspections). Service Users must be offered a range of activities, suited to their interests and reflecting needs. 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 February 06. This requirement was made at the last inspection. 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 February 06. This requirement was made at the last inspection. 01/02/06 01/12/05 14/11/05 01/02/06 01/02/06 01/02/06 Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 24 12 OP22OP19 12,23 13 OP25OP22 23 14 OP21OP19 23 15 OP21 23 16 17 18 OP21 OP21 OP23 23 23 23 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 February 06 Lighting in corridor areas, must be reviewed. A copy of this review and actions to be taken must be provided to Commission by 1 February 06 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 February 06. 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 February 06. The bathroom on the top floor must be made safe for Service Users to use. All toilet and bathroom doors must be capable of locking. The cleaning arrangements and the furniture and carpets used should ensure that no room smells of urine. 01/02/06 01/02/06 01/02/06 01/02/06 01/12/05 01/02/06 01/12/05 Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 25 19 OP38OP19 23 20 21 OP26OP24 OP20 12,23 12,23 22 OP20 12, 23 23 OP30 OP18 18 24 OP38 23,13 25 OP38 13 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 since November 2003 and still has not been met. All Service Users must be provided with adequate and clean bedding. A safe outdoor area must be provided for Service Users, so that they can sit or walk, and enjoy their surroundings. Plastic garden chairs must not be used as dining chairs. Appropriate chairs should be provided for all Service Users. A training plan for the home must be developed so that all staff are appropriately trained, this must include training in relation to the protection of vulberale adults. 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 these. 01/12/05 01/12/05 01/04/06 01/12/05 01/02/06 01/02/06 01/12/05 Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 26 26 OP32 12 The Registered Manager must ensure that proper management processes are in place to ensure that safety and well-being of Service Users. 01/12/05 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 This recommendation was not inspected at this inspection. 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 two inspections) This recommendation was not inspected at this inspection.The home should develop a management of service users personal money policy and procedure. (This was recommended at the last two inspection) This recommendation was not inspected at this inspection. 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 two inspection) This recommendation was not inspected at this inspection. 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 two inspections). This recommendation was not inspected at this inspection. 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 two inspections) This recommendation was not inspected at this inspection. A quality assurance system and annual development plan should be implemented. (This was recommended at the last two inspections) 2 OP14 3 OP24 4 OP25 5 OP26 6 OP33 Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 27 7 OP36 8 OP38 This recommendation was not inspected at this inspection. A formal staff supervision system should be developed and implemented. (This was recommended at the last inspection at the last two inspections) This recommendation was not inspected at this inspection. 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 two inspections) Hamilton House Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton 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 Residential Home DS0000003480.V253550.R01.S.doc Version 5.0 Page 29 - 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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