Inspection on 03/05/05 for Hamilton House Nursing Home

This inspection was carried out on 3rd May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hamilton House Nursing Home 19/06/09

Hamilton House Nursing Home 30/01/08

Hamilton House Nursing Home 14/07/06

Hamilton House Nursing Home 10/10/05

Hamilton House Nursing Home 15/11/04

Hamilton House Nursing Home 01/06/04

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

CARE HOME ADULTS 18-65 Hamilton House Nursing Home The Street Catfield Great Yarmouth NR29 5BE Lead Inspector Dot Binns Unannounced 3 May 2005 9.20pm 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hamilton House Nursing Home Address The Street Catfield Great Yarmouth Norfolk NR29 5BE 01692 583355 01692 583355 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) Prime Life Limited Mrs Stella Evans Care Home 25 Category(ies) of Mental Disorder (25) registration, with number Mental Disorder - over 65 (1) of places Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty-five (25) service users who have a mental disorder, excluding disability or dementia may be accommodated. 2. One (1) person with mental disorder over 65 years, who is named on the Commissions file, can be accommodated. 3. Maximum number not to exceed twenty-five (25). Date of last inspection 15 November 2004 Brief Description of the Service: Hamilton House is a registered care home offering nursing care to 25 people who have a mental illness. It stands on the main road through and on the outskirts of the Norfolk village of Catfield. The main large house has been extended and provides 23 single rooms and one double room. The rooms in the extension are particularly good with their own shower facilities and French doors to the outside. The accommodation is bright and attractive and has extensive communal space. There is a large garden. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out in the late evening by the regular inspector for the home and the pharmacy inspector. It was part of the routine inspection programme, the purpose being to see how the home functioned in the late evening. The inspection took about two hours during which time the nurse on duty was interviewed and assisted the pharmacy inspector with his medication inspection. Two other members of staff were seen in private and a group of service users were seen together in the dining room. Two samples of care records were also examined. What the service does well: What has improved since the last inspection? A third member of staff is provided in the evening on three days a week. This is an improvement and staff themselves feel they have more time with the service users. The building has been renovated and recarpeted and is looking bright and cheerful. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected EVIDENCE: Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,8,9 Service users assessed and changing needs are reflected in their care plans and are regularly updated. There is not enough consultation with the service users about how the home runs. Service users are supported to take risks. EVIDENCE: Two care records were selected for inspection. Both contained a lot of information about the service user in the Home’s assessment document and outlined the assistance needed from staff in a care plan. Individual requirements were broken down into planned actions from staff. Any treatment programmes were outlined and areas of risk were assessed. All areas were covered in the assessment from physical health to behaviour, medication to mental health. Care plans were evaluated regularly and any changes documented. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 10 There was a grumble from a group of service users that they were not consulted about how the Home operated and had to make an effort to speak up in order to make any changes. They gave the inspector the impression that it was difficult to get results. However the fact that the service users were able to be vocal showed some confidence and the staff should be applauded for empowering the service users to express their views. This anecdotal evidence does indicate that their views if sought are not acted upon however and the opportunities for discussion need to be reviewed to provide better communication. Risk assessments were apparent in the care records with steps for staff to take to ensure the risk was responsible. There is also information from hospitals and social workers prior to admission about specific risks for a service user and action is taken to minimise the risk (seen on the care records). In the records seen the risks assessed included, risk with self medication, risk of diabetes and risk of aggression. For one particular service user who does have unexplained absences staff follow a detailed procedure. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14,17 Service users engage in some leisure activities but there is still room for improvement in social care and stimulation. Service users enjoy the main meal of the day but tea and supper need to be improved to ensure service users are having enough. EVIDENCE: There are some activities provided by the Home like games and table tennis and the Home has an adult education class in literacy and cooking on the premises every week. A church group is attended in the village by a small group of service users. A theatre trip is booked for next week and a visit to the Norfolk show is planned. Individual service users enjoy specific hobbies like gardening. The inspector has seen more emphasis placed on this aspect of social care in recent months and staff seen at this inspection felt there was more offered to the service users. Evening staff seen at the inspection had however never taken service users off the premises on their shift but felt when there were three staff on duty, they could sit down and talk to service users in a constructive way. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 12 The Home has a minibus to take service users on outings to the shops, theatre or countryside. The manager says it is now booked one day a week for taking service users out instead of being used by staff for their chores. The inspector thought this availability should be increased. The service users were more critical of the opportunities for activities saying things like “We don’t get off the premises very much” and “We make our own entertainment and we do get very bored”. One said they had only been in the minibus “three or four times” and thought it was for staff use to do their chores. Another person said they did do some cooking to prepare for being more independent and that there were some who gardened and played their music. However there was a lack of things to do. Some people did not want entertainment and seemed “happy to sit around”. One person said he went out by himself so did not need staff to take him out. What is clear to the inspector is that for some service users there is not enough stimulation while for others they are happy to be more left to themselves. Some need to be more motivated to participate. A more individual approach needs to be adopted (a keyworker system?) with staff being more organised in focussing on what their key residents need whether this is individual activity, more group activities or more assistance to leave the premises. In terms of the food, the service users are very satisfied with the main meal and confirmed they had a choice and that it was very good. Breakfast was also satisfactory though they said they never had cooked breakfasts which they would have liked now and again. They reported that the teatime meal was “atrocious” with only one bowl of soup. They could have a sandwich as an alternative but said they could not have both though one said they asked for both and having been refused by staff at first was eventually given both. Another said the food was poor but they did not like to say anything about it to staff. There are no desserts or cake at teatime. When staff were spoken to about this they said more was available but that some service users were watching their diet and were diabetic. The menu in the office says High Tea – choice of sandwiches, soup, salads or dishes on toast to your taste” . The inspector considers that if a group of service users are complaining then something is going wrong and the matter needs to be attended to. Whether it is the quality or quantity of the food or staff restrictions, the teatime meal should be reviewed. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 13 At the time of the arrival of the inspectors, service users were having a cup of tea as a supper drink. Service users confirmed that they were also offered two biscuits. As they did not find that enough, a service user had bought a pack of biscuits and shared them around. As this same group of service users did not feel that they were offered enough for their tea, then clearly they needed some thing substantial for supper. Staff said that there was cake and apples but the service users did not mention these and they were not in evidence when the inspector arrived though were later pointed out in the kitchen. Also a large pot of tea was made for the service users and they were not offered alternative drinks. Staff thought there was not enough milk for horlicks or ovaltine and accepted that this was not offered though service users could ask. It seems to the inspector that the teatime and supper meals are not being thought through clearly by staff, possibly because the cook is not in charge of those meals and care staff on duty prepare them. The onus is always on the service users to ask. A full review of these meals is recommended. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 Health care needs were being met on the night of the inspection. The pharmacist inspectors overall judgment of medication practice at the home is that service users are not protected by safe medicine administration and record-keeping practice at all times. EVIDENCE: The care records showed evidence of links with hospitals and social workers as well as evidence of staff monitoring physical care such as blood sugars and sleeplessness. Care plans showed how risks regarding diabetes were managed. The staff on duty described her nightly duties in terms of the nursing tasks she had to do and confirmed the extra care given to one service user with special needs. A full inspection of Standard 20 relating to medication was simultaneously carried out by specialist pharmacist inspector Mark Andrews. The detailed findings of his inspection have been provided in a separate Pharmacy Inspection Report sent alongside this report. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected EVIDENCE: Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28 The communal space complements the individual rooms of the service users and gives them various comfortable and bright places to relax. EVIDENCE: The various communal spaces were visited as part of the inspection. The home has a spacious sitting room with large television where a few service users were seen relaxing. There is also a games room with a table for pool or table tennis. This was empty at the time of the inspection. There is also a smaller lounge area and a separate conservatory which is used as a smoking room. Both these were empty though there was evidence that they were used at an earlier hour. Several of the service users were in the dining room for their evening drink at the time of the inspectors’ arrival. This room is quite small for the size of the home and only seats 16/18 service users. Some service users eat in their rooms. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 17 The Home has recently undergone some redecoration which the service users were pleased about and felt “the owners looked after the place”. Overall communal space is varied, comfortable and spacious. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 36 On the night of the inspection, the service users had satisfactory support from competent staff. This staff cover is not available every night compromising the support for the service users. Staff are being formally supervised. EVIDENCE: At the time of the inspection there were three staff on duty till 11pm after which two staff were on waking duty during the night. This gave better support to the service users and is a welcome increase in staff hours. At the last inspection it was a requirement for more staff to be on duty after 8pm and this has been partly met. The remaining days of the week need to be also covered to ensure that staffing is adequate. The rota for the week of the inspection has three staff on duty for only three nights. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 19 The staff member on duty till 11pm confirmed she only worked on three days a week on average but believed it provided a much better service to the service users when there were three staff on duty in the evening. The tasks to be covered in the evening include assisting a few service users to bed, making the supper drinks and for the nurse, giving out the medication. With three staff more time could be given to talking to the service users and providing individual time. The staff confirmed that she had never taken service users off the premises in the evening. This is an area which could be developed. The nurse on duty was aware of the tasks required during the night and could name individual service users who may need assistance and care. She confirmed that some training is given to care staff during the night. Although the nurse on duty was fairly new, both care staff were of long standing and knew the service users well. One staff was a male reflecting the gender composition of the service users. All staff were over 21years. As it was a night inspection, full staff records were not scrutinised. However both care staff confirmed that they receive supervision on a regular basis from a nurse or manager and one had already completed her NVQ3. The care staff on duty during the night confirmed that he would receive some training from the nurse on duty as part of his foundation training. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Safety is promoted by the practice of fire drills. EVIDENCE: Only a small part of standard forty two was inspected and that was with regard to fire drills. Staff confirmed that they have had fire drills and that the service users respond well and move to the meeting point correctly. Only one or two service users have to be looked after by staff. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.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 Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 2 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x 3 x x Standard No 11 12 13 14 15 16 17 x x x 2 x x 2 Standard No 31 32 33 34 35 36 Score x x 2 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hamilton House Nursing Home Score x 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 22 Yes 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 20 Regulation 13(2),14 Requirement The registered person must ensure that for all service users wishing to self-administer medicines a recorded risk assessment is undertaken, completed and reviewed on a regular basis in order to assist in safeguarding the health and welfare of the individual service user The registered person must take steps to ensure service users are protected by arrangements in place for the recording, handling, safekeeping, safe administration and disposal of medicines received into the home. The registered person should provide staffing as required by the staffing notice issued by the Health Authority and provide more staff on duty till 10pm.on all days. Timescale for action 31.5.05 2. 20 13(2) Immediate and ongoing 3. 33 18(1) 31.5.05 4. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 23 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. 2. 3. Refer to Standard 14 17 Good Practice Recommendations It is recommended that service users are consulted and have access to a range of appropriate leisure facilities. It is recommended that a review into the teatime and supper provision and staff practice around those tasks is carried out in consultation with the service users. Hamilton House Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF 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 Nursing Home I55 S15643 Hamilton House V225387 030505 Stage 4.doc Version 1.30 Page 25 - 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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