Inspection on 02/12/09 for Hamilton House Care Centre

This inspection was carried out on 2nd December 2009.

CQC 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 CQC 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 Care Centre 12/03/09

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Hamilton House Care Centre Drayton Lane Drayton Portsmouth Hampshire PO6 1HG Lead Inspector Anita Tengnah Key Unannounced Inspection 2nd December 2009 09:45 X10015.doc Version 1.40 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamilton House Care Centre Address Drayton Lane Drayton Portsmouth Hampshire PO6 1HG 02392 385448 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) www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Ltd Mrs Alexandra Ogley Care Home 60 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Dementia (DE). The maximum number of service users to be accommodated is 60. Date of last inspection 12 March 2009 Brief Description of the Service: Hamilton Care Centre is a purpose built care home within a residential area of Drayton. The service is registered to provide nursing and care for up to 60 service users in the older person category and dementia. Accommodation is provided over 3 floors within single occupancy en-suite rooms. Décor and signage has been provided in line with current best practice guidelines for dementia care. Each floor provides ample space, with wide corridors and doors and themed pictures creating a different personality to each. Access between floors is via a passenger lift or stairs. Outside garden areas are accessible via a level path around the rear of the property, secured by locked or keypad access. The outside area is limited to a patio area with a raised flowerbed providing additional seating. Some car parking facilities are available to the front of the home. The current fee charged is available from the manager at the service. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is Zero stars. This means that The people who use this service experience Poor quality outcomes An unannounced visit to the service was undertaken as part of the inspection on the 2 December 2009. This visit was carried out by two inspectors over a day and lasted six and a half hours. The process included walking round the service where a number of the bedrooms, communal areas, kitchen, laundry and bathrooms were viewed. As part of case tracking the staff and service users views were sought, practices observed and care records looked at. We sent out our Annual Quality Assurance Assessment (AQAA) previously to the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This is included in this report, as was information gathered by the Commission since the last inspection to contribute in assessing judgements in this report. What the service does well: The service users are provided with warm, homely, clean accommodation and maintained to a very high standard throughout. The pre admission assessment process is followed by staff and looks at the needs of both potential and existing service users. The meals at the service offered the service users variety and choices taking into account individual’s likes and dislikes. There is a range of equipment in place to support and maintain the service users’ independence. What has improved since the last inspection? Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 6 There has been a change of management and the new manager has recently been registered with the Commission. There is no evidence of other improvements and there is evidence that outcomes for people are now poor. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 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 Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This judgement has been made using available evidence including a visit to this service. The pre admission assessment process is good and ensures that service users’ needs are assessed. The home does not provide intermediate care. EVIDENCE: The last inspection showed that people’s needs were assessed prior to moving into the home. The pre admission records of two service users were looked at as part of this visit. We found that the assessments contained good details of Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 9 needs. These included speech, skin integrity and assistance with personal care and continence needs. A list of the service users’ medication was also maintained as part of the assessments. The manager reported that the service users are offered the choice of visiting the home prior to admission. The service users’ family visited, as most of them were unable to do so due to their frailty. Information such as the statement of purpose and the service user’s guide were available in the entrance hall that relatives/visitors can access. However some of the information needed to be updated to ensure that these are current and appropriate. The manager confirmed that the service does not provide intermediate care. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and records of care given were available but not sufficiently detailed to inform care. However risk assessments and care plans in relation to dietary needs were inadequate to safeguard people. The access to external agencies is available to the service users. Medication management is poor and does not ensure that people receive their prescribed medicines safely. The service users are treated with respect; however there is a risk of their choices and privacy being compromised by others. EVIDENCE: Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 11 We looked at the care records of six service users as part of this visit to assess how the service was planning to meet the needs of people accommodated. The care records contained information and assessments such as personal life history, manual handling, fall assessments, dependency, diet needs, and psychological needs. Care plans we looked at contained information such as people’s personal history, their daily routine and detail regarding their personal care needs in respect of washing, bathing and dressing were recorded. One of the service user’s care plans gave details such as support needed with all aspects of care, and risks of burns such as hot food and told the reader that the person is registered blind. Other information included considering talking books but this has not been achieved. People we spoke to confirmed that for one of them they did not like ‘bits’ in their food and a pureed diet was available to them. One service user told us that they could not walk and this was not right. They have been trying to get referred for physiotherapy, which they believe has now happened. We checked with the manager who confirmed that that a referral has been made. One of the care plan showed that the service user propelled themselves in their wheelchair with their feet, hence footplates had been removed. We observed this person propelling himself backwards in their wheelchair in a high state of anxiety and closely missed running over two other service users. The risks to others had not been looked into as part of this assessment. Records for a service user showed to ‘weigh monthly. If weight loss is continuous refer to GP for referral to community dietician’. The records showed that they had lost weight and there was no evidence of referral to the GP or dietician. The record for another service user dated 17 November showed that they had a dressing to their sacral area. There was no further record regarding this problem. The staff in charge and the carer could not confirm whether this has been resolved and if they continued/ required a dressing. At the last visit in March 2009, there was a lack of information regarding a service user who was receiving their feed through a tube in their stomach (PEG). The nurse in charge contacted the dietician who sent a PEG feed regime for the service user that included details of the type of feed, volume, and flushes required following administration of medication. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 12 We looked at the care records of a service user currently receiving a (PEG) feed. The speech and language therapist (SALT) assessment could not be found at the time of the visit. This key assessment needs to be made available. The information received in March 2009 from the community dietician contained details of the feed regime for this person and included 80mls fluid to flush the PEG tube prior and after feed/ medication administration. The record also included additional fluids that should be flushed via the PEG. The care plan as formulated at the home did not correlate with this and gave conflicting information. The fluid balance records for this person showed that the staff were administering a small amount of fluid as a flush through the PEG. The fluid balance records did not accurately record the amount of feed that was administered. There was no evidence that this care plan has been reviewed and updated as required. This was brought to the attention of the manager and needed to be looked into to ensure that people receive their prescribed care and are not put at risk of harm. We identified that there was another service user who was at risk of choking/ aspiration and they were receiving thickened fluids. This person had been assessed as an emergency referral in November 2009 as requiring more thickening agent in for fatty drinks such as tea, coffee and milk. We observed that during the lunchtime meal this person was administered fluid without any thickening agent added. One of the inspectors brought this to the attention of the staff in order that they receive their fluids safely. Care plans and assessments need to be developed for all these service users to ensure that they are not put at unnecessary risks and care is provided safely. The care plans should contain details of consistency of the fluids according to their assessments such as amount to be added to food and fluids as appropriate. This information should be made available to the staff at the point of providing care. This was an area of concern at the last visit in March 2009 that has not been addressed. Our concerns are that information in care plans and the care delivered by the staff do not always follow the plan of care. The carers we spoke to and the nurse in charge all stated that the carers deliver the care and the registered nurses wrote the daily records. The carers completed a ‘tick list’ that gives little details of the individual care. The staff we spoke to did not know who required thickening agents in their fluids for the people they were looking after at the time. All the service users are registered with the local surgery. The manager reported that the home had good relationships with the local primary care trust Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 13 and the service users were supported to access health care services as required. The GP did not undertake regular visits to the home but was available on request. The community psychiatric nurse also attended the home regularly and reviewed the service users on request. We looked at the medication management at the service. All medication was stored safely and securely. A sample of the Medication Administration Record (MAR) seen at the time of the visit showed that a record of medication prescribed and administered was maintained. Staff used the coding for when medication was not given but this was not always recorded. At the last visit we reported that the random check of some medication showed that these did not correlate with the stock, these included Temazepam and painkillers, so it was not possible to verify that people had received their medication as prescribed. During this visit from the sample of medicines we looked at, we found that medications were recorded as administered on the MAR charts but were still left in the blister pack. Other medicines had large discrepancies and did not correlate with the amount administered and the stock balance. It was not possible to tell if people were receiving the medication prescribed for them. There were no procedures and care plans in place for ‘as required’ medicines. These included pain killers, bowel medicines, eye drops and inhalers. This put the service users at risk of receiving medicines when they do not require them and not receiving them when they need them. A service user was prescribed a thickening agent that had not been available for five days at the time of the visit since this was prescribed. The nurse in charge told us that ‘it usually takes a couple of days before they receive their medicines’ once prescribed. We were later informed that this was sent out as their monthly order and would have taken even longer and has now been changed. The MAR record showed that they had run out of their pain killers as none has been has been ordered. The nurse in charge told me she had now re ordered, but this means there will be no pain killers for this person for up to 48 hours because of the timescales for ordering and receiving medicines in the service. At the last visit in March 2009 we identified that a record of the drug fridge’s temperature was maintained, staff should ensure that both minimum and maximum temperatures are recorded. This was not available during this visit and staff stated that action will be taken. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 14 Some prescribed items such as creams and thickening agents did not contain the names of people that these have been prescribed for as required. This also included fortified drinks that were prescribed and not discarded when the service users were no longer living at the service. The disposal of controlled medicines was not appropriately managed at the time when a filled syringe driver was still kept following the death of a service user 2-3 weeks ago according to the nurse in charge. We were told this was due to the container for the disposal of controlled medicines not being available. Interaction observed showed that the staff supported them in a respectful manner. Comments included: ‘The staff are very good and they do their best.’ ‘They know her well enough now we have been here a year’ Two people we spoke to at the time said that the staff provide the care and that they can call for assistance by using the buzzer. Comments were ‘they usually arrive quickly but sometimes have to call a second time.’ ‘It takes no longer than ten minutes for someone to answer, they are busy at times.’ We observed that two of the service users’ bedrooms were locked and this denied them access as they did not have a key. A carer said that this was locked to stop the service user touching things in their bedroom. The nurse in charge said that the family of one of the service users has asked for their room to be locked to stop other people entering their rooms and they may take their things away. Another carer later said that the bedrooms were locked as the floor is slippery when washed, however these rooms were still locked hours later and were unlocked by the nurse in charge. We witnessed an incident where one of the female service user’s safety, privacy and dignity was compromised by another resident. This person was visibly distressed and there have been similar recorded incidents in the records seen that put them at considerable risks of harm. There was inadequate supervision from the staff and action plan to ensure that this person is safeguarded from harm. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social and recreational facilities for the service users are supported by the home. However some people say that there are not sufficient activities and there is a lack of opportunities to meet people’s specific needs. The service users are supported to maintain links with the community and their family and friends. The meals are good, offering choices, variety and meeting with the satisfaction of the service users. EVIDENCE: The home has a planned and varied programme of activities for the service users. The home employs an activity coordinator and we observed the activity Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 16 coordinator supporting one of the service users to have their nails done. Another person was sketching flowers from a care card and told us that they enjoyed doing this. Time was spent in one to one support with drinks and meals as required. Since the last visit the home has now opened the first floor where service users with varying degree of dementia are accommodated. People we spoke to on the ground floor said that ‘not much happened during the day and were not aware of activities.’ Another person stated that they had ‘occasionally went to lounge to take part in dominoes and small activities.’ We observed that during the afternoon of the visit, five people were found ‘wandering’ in the corridors and went into other people’s bedrooms. One person in particular was shouting and distressed at first looking for the door as they wanted to get out. This went on for a while with no intervention from the staff. This escalated to an incident where three service users were put at risk of harm and one person was being pursued and visibly shaken. We brought this to the attention of the staff in charge and action was needed to protect some of the service users. Further consideration in the way that activities are managed in particular for people with dementia should be given in particular as they are now accommodated on different floors. The home has an open visiting policy and it was evident from the record of visitors as kept by the home that there was no restriction on visiting. Comments received and a service user confirmed that they have autonomy to receive their visitors in private. A relative said that they visited daily and spent most of their time at the home and assisted their relative with their meals and felt involved in their care. A menu plan for this week and next week was displayed in the entrance hall along with a larger handwritten menu for the day in the entrance hall. The staff from the kitchen told us she speaks to all residents during the day to ask what they would like for the next day’s meals. Meals are delivered from the kitchen on a heated trolley and served from the kitchenette on each floor. We observed the meal provision on the first floor. Some people had plate guards to help them be independent at meal time. For people who needed assistance the meal was only served when the member of staff was ready to assist therefore people were not sitting looking at meals going cold that they cannot eat. Some people had special nutritional needs and pureed diets were provided. For people with special nutritional needs, the home has developed a procedure of placing a red rubber spotted plate mat where they are sitting to highlight this to the staff. However staff need to also look at the care plans as this procedure did not work well on the day of the visit for one person. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 17 During the visit we observed that one of the service user’s was having a cooked breakfast. The staff reported that the chef was aware of their choice. There is a small kitchen area attached to the dining room on each floor where staff had the facility of preparing hot and cold drinks at all times. We noted that this was used throughout the day. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints management process is in place; however information and staff guidance need further development. The service has information on abuse prevention and training for the staff. However some practices put people at risk of harm. EVIDENCE: We looked at the complaint procedure and found that this was available in the service users’ guide. The manager reported that this is made available to all the service users on admission. The complaint procedure should be reviewed to ensure that it contains current and up to date information. This should include the one displayed in the entrance hall. The manager maintained a log of complaint received and this showed that they have no complaint recorded. Training in safeguarding is available to the staff and discussion with the staff indicated that they were aware of what constituted abuse and stated that they would report to the manager. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 19 We received recent information of concerns raised regarding the standard of care that has been investigated as per the safeguarding procedures. The manager reported that they attended the safeguarding meeting and had produced an action plan for the safeguarding team. However they were unsure what the concerns were as they had not been informed. We have concerns following our visit in particular regarding the care and management of three service users. We have made a referral to the safeguarding team and shared our concerns for them to look into as part of the safeguarding protocol with them so that people can be safeguarded. We also left an immediate requirement form and followed this up in writing as care practices we observed put people at risk of harm. The provider was required to respond and let us know within a set timescale of the action that they have taken. As indicated in the previous section of the report we have concerns regarding certain aspects of the health and management of the service users’ safety living at the home. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides the service users with a homely and well-maintained accommodation that meets their needs. The infection control procedures at the home are in place and satisfactory. However staff practices do not ensure that the service users are protected. EVIDENCE: We walked around the service as part of the visit where a number of bedrooms, communal lounges, bathrooms, kitchen and the laundry were Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 21 viewed. This is a purpose built service that offers a good standard of accommodation. All areas at the home were in a very good decorative order, clean, bright and homely. The service has chosen wall pictures that depicted local scenes and articles of interests that were displayed in the corridors. Furnishing was of a high standard and appropriate to the needs of the service users. The bedrooms were personalised and equipment such as hoists, assisted baths were available. All the bedrooms were en suite and one of the service users said was ’very good and like a hotel.’ A service user showed us the reclining chair that was provided for their relative and said it was ‘very good and I can wheel her out.’ The service had put in place ‘memory boxes’ outside all bedroom doors, but not all of these were complete. It was evident that people are supported to bring in items of personal belongings and make it as homely as possible. One of the service users was replacing the pot plants in their relative’s rooms and said these brightened up the room and this was not a problem. We looked at the laundry that was fitted with appropriate washing machines and driers. The linen bags were colour coded to ensure that soiled/infected laundry is maintained separately. Equipment such as gloves and aprons were available to support staff practices. We observed that the linen trolley contained a box of pads that were used as communal. The clean linen was placed on top of a red bag where soiled linen is kept. One of the staff was seen carrying soiled linen in their hands instead of using the appropriate bag available as part of infection control. They failed to follow hand washing procedures to minimise the risk of cross infection. This was brought to the attention of the manager at the time of the visit. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing numbers are inadequate to meet the present needs of the service users safely. The recruitment process is good and checks are undertaken as required. There is an ongoing training programme in place that should ensure the staff have the skills to deliver care safely. EVIDENCE: The home has a duty roster for nurses and carers and a separate roster for ancillary workers. The manager confirmed that there were thirty four service users accommodated at the time of the visit. The number of the service users has considerably increased since the last visit in March 2009. Care is now provided on two floors. The manager told us on the morning shift there were two registered nurses, a senior carer and six carers on duty, in the afternoon Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 23 they had 2 registered nurses, 1 senior carer, 5 carers and one carer on from 58pm. At night there was 1 registered nurse, 2 carers and one senior carer. The manager and the deputy were supernumerary on the day shifts. We looked at a sample of the staff roster for the last four weeks and this showed that there have mainly been 2 registered on the day shifts with 6 days in November where there was only 1 registered nurse on the morning/ afternoon shifts. The night staff included 1 trained staff and 3 carers. Evidence from the rosters show that there were several nights where there has been 1 registered nurse and 2 carers on duty. The staff comments were that there is a lack of continuity and they find it difficult to catch up with the constant movement of staff between the two floors. Comments included ‘too much mixing of days and nights, limited rest time between nights and days. ‘Not enough notice of what shifts you are working.’ Another comment was ‘There is too much swapping of areas of work, lack of consistency. They work across both floors, therefore having to play ‘catch up’ all the time as to what is happening with the service users. Another person said that they thought that there are 2 trained staff on night duty and ‘if only one nurse There is currently inadequate staff in particular on nigh duty where there is one registered nurse responsible for two floors and service users with high care needs. The staff said that most of the service users need two people to assist them in order for this to be carried out safely. The home has a recruitment procedure and the manager interviewed all the applicants. A sample of four newly recruited staff seen indicated that checks were undertaken and references are sought prior to employment. The records showed recruitment checks were completed including 2 written references, criminal bureau checks (CRB) POVA and checks to confirm that registered nurses were on the nursing and midwifery council (NMC) before commencing employment. Copies of relevant course/qualification certificates including nurse registration details were maintained. The records of Criminal Record Bureau (CRB) checks available at the service were also inadequate. The manager reported that the records are kept at their head office. We asked for clarification for a CRB for one of the staff as this was not available and the manager received an email to say that this had been completed. This was a requirement from the last visit that has been met. The home has an ongoing training programme in place. Information we have shows that four care staff have national vocational qualification (NVQ) at level Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 24 3. Two have NVQ 2 and a further four are in the process of doing NVQ 2 or 3. The home has developed a training matrix that records the training that staff have undertaken. This shows that 16 staff have completed dementia awareness and challenging behaviour training in September and October 2009. According to the information provided, the service states that 86 of the staff have completed moving and handling training. Although care planning training is available this indicated that only trained staff have completed this and it is marked as not applicable for the carers. Although staff have completed training in dementia care and challenging behaviour evidence in this report shows that this training is not embedded in care practice Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a newly registered manager with day –to-day responsibility for the service. An internal auditioning process has been put in place and is satisfactory. There is a satisfactory procedure in place to ensure the health and safety of the service users is promoted. However some of the care practices and staffing are inadequate to safeguard people from harm. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 26 EVIDENCE: The home has a registered manager who has recently completed her registration with the Commission. The staff said that the manager was approachable and that they would report to her any concerns that they may have. The home has policies and procedures in place to inform practice, the manager reported that she has been working on these and is in the process of reviewing them. This is to ensure that they are current and meet regulations and good practice guidance. The manager reported that she was not an appointee for any of the service users Invoices are raised for items such as chiropody, hairdressing, toiletries. No money was held on behalf of the service users at the home. We did not look at the service users’ accounts during this visit. There is an internal audit where the nominated person from the company undertakes monthly unannounced visits to the service and reports of these were shared with the manager and copies were made available at the service. Records show that the service user’s guide and statement of purpose had been identified as requiring some of the information updating in September and November 2009. These had not been completed when we looked at these documents during our visit. Information we have received indicated that there is an ongoing programme for the servicing of fire equipment, hoists, wheelchairs, lift and emergency lighting. All these had been in place for the last six months as this is a new service. All substances that are hazardous to health (COSHH) were kept and maintained safely and were kept locked. Risk assessments and appropriate measures was not available to ensure that one of the service users was safe to manage their wheelchair and does not put others at risk of harm. There are inadequate processes in place for the safe management of people’s fluids and medicines. Clear action plans and staffing need to be reviewed to ensure that people are not put at risk of inadequate care/ supervision and poor practices. Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4) 15 (1) Requirement The registered person must ensure that detailed assessments care plans are put in place to inform the meeting of people’s needs The registered person must ensure that the service users’ health and personal care needs are fully met at all times including detailed dietary assessments and care plans to meet those needs. These must include accurate records of diets and fluids. The registered person must ensure that arrangements are in place for the recording, safe keeping, handling, safe administration and disposal of medicines received in the care home. The registered person must ensure by training staff or by other measures, that people are protected from harm The registered person must DS0000072741.V378726.R01.S.doc Timescale for action 15/01/10 2. OP8 14(1) (a) Schedule 3 (o) 15/01/10 3 OP9 13(2). 15/01/10 4 OP18 13(6) 15/01/10 5 OP26 13(4) ( c) 15/01/10 Version 5.2 Page 29 Hamilton House Care Centre 6 OP27 18(1) ensure that staff follow good infection control procedures and practices to prevent the spread of infection in the home. The registered person must ensure that there are adequately trained staff and in sufficient numbers to meet the needs of the service users at all times. 15/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hamilton House Care Centre DS0000072741.V378726.R01.S.doc Version 5.2 Page 30 Care Quality Commission South East Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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