Inspection on 11/06/09 for Hamilton Lodge

This inspection was carried out on 11th June 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hamilton Lodge 15/09/09

Hamilton Lodge 07/05/08

Hamilton Lodge 15/05/07

Hamilton Lodge 20/07/06

Hamilton Lodge 10/02/06

Hamilton Lodge 06/09/05

Hamilton Lodge 25/03/05

Hamilton Lodge 01/11/04

Hamilton Lodge 15/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB The quality rating for this care home is: zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michelle Love Date: 2 3 0 6 2 0 0 9 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 38 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 38 Information about the care home Name of care home: Address: Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB 01206230298 01206231166 care@hamiltonlodge.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hamilton Lodge Trust Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 40 40 40 learning disability physical disability Additional conditions: The home may accommodate 40 persons of either sex aged 65 years and over with learning disabilities who may also have physical disabilities The home may accommodate 40 persons of either sex under the age of 65 with learning disabilities who may also have physical disabilities The total number of service users accommodated in the home must not exceed 40 persons Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 38 A bit about the care home Hamilton Lodge is a residential care home. Accommodation is provided in two units and consists of a large country manor house and Selbourne Court. The home is set in large grounds, located in the rural village of Great Bromley and close to Clacton-on-Sea, Colchester and Harwich. Public transport to the towns is minimal, but the home has four vehicles, which include a mini bus with a tail lift. This means that the people who live at the home can get around easily. Everybody who lives at the home has their own bedroom and nobody has to share a room. Care Homes for Adults (18-65 years) Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 38 How we did our inspection: This is what the inspector did when they were at the care home This was an unannounced key inspection. The visit took place over two days by one inspector and lasted a total of 15.5 hours. We spent time talking to people who live and work at the care home. We also looked at staff files, peoples care plans and records about health and safety. We looked at some policies and procedures. Policies are rules about how to do things. Procedures tell people how to follow the rules. What the care home does well People can visit the care home before moving in so that they can be sure they like it. A lot of training is given to staff to help them meet the needs of people living in the home. Surveys returned to us from people living at the care home, told us that they are happy living there. Complaints are well managed. People are happy with the accomodation provided. The gardens behind Selbourne Court have been nicely landscaped. Table Care Homes for Adults (18-65 years) Page 7 of 38 and chairs are provided. What has got better from the last inspection What the care home could do better Peoples care plans must show what the needs of individual people are and how they need to be supported by staff. Medication practices and procedures within the home need to be improved so as to ensure peoples safety and wellbeing. There must be enough staff on duty at all times, so as to ensure that the needs of people can be met. Staff must be supported by the manager and other senior people within the service. Care Homes for Adults (18-65 years) Page 8 of 38 If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Michelle Love CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 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 set out 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. Care Homes for Adults (18-65 years) Page 9 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be assured that their care needs will be assessed prior to them being admitted to the service or that they will have up to date information about the home. Evidence: A copy of the homes Statement of Purpose was provided at this inspection. This document includes information pertaining to the aims and objectives of the service and details of the specific services and facilities provided. Information recorded was observed to be satisfactory however at the time of the site visit this did not include a Service Users Guide. We were advised that the Service Users Guide is currently being reviewed and rewritten, however the AQAA makes reference to this document being in place. There is a formal pre admission assessment format and procedure in place, so as to ensure that the management and staff team are able to meet the prospective persons needs. The AQAA details that a full assessment is completed by the organisations service manager and clinical psychologist prior to a placement being offered. Out of 10 surveys returned to us from people who live at Hamilton Lodge, all advised that they were assisted to make the choice to move into this home by their family or other representative. Care Homes for Adults (18-65 years) Page 11 of 38 Evidence: As part of this site visit, the care files for 2 people who had been newly admitted to the service were examined. Records showed that a pre admission assessment was available for 1 person only as the assessment could not be located. The pre admission assessment that was available was observed to be comprehensive and detailed and completed prior to the persons admission to the service. There was evidence to show that as part of the admission assessment process, the young persons family and other professionals where appropriate had been involved in all stages of the initial referral, assessment and transition period. Records showed that the young person was given the opportunity to visit the service and the transition period had been thoughtfully planned and was carried out over a significant period of time. We were advised by the assistant manager that the length of the transition period varies, according to the persons needs, information from other agencies, information from the persons family and the progress of subsequent visits to Hamilton Lodge. Comments received from 3 staff surveys intimated that staff are not always given up to date information about the needs of a prospective person being admitted to the service. 3 relatives surveys were returned to us and only one stated that they were given sufficient information about their member of family. Comments ranged from Very informative and friendly-every thing is always explained and We are not informed about [name of person] day to day condition unless we enquire. Evidence also showed that following a recent hospital admission, the person was not reassessed prior to their return to the service. This is not good practice and potentially places people at risk of returning to a service that may not be able to meet their care needs. Care Homes for Adults (18-65 years) Page 12 of 38 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home can expect to have a plan of care, however shortfalls identified mean that some people cannot be assured that their needs will always be met or proactively managed. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the care home. As part of this site visit the care files for 3 people were examined (2 in full and 1 partially examined in relation to specific healthcare needs) on the first day of inspection. Further development in care planning/risk assessing is required to ensure the care needs of individual people are clearly recorded and staff have the most up to date information to ensure appropriate levels of care delivery are achieved. Records showed that the care needs of some people had not been recorded, detailing their specific care needs and the staff support required. It was of concern that no plan of care for one young person was available, 18 days after they were admitted and following a significant period of transition to the service over several weeks. When discussed with Care Homes for Adults (18-65 years) Page 13 of 38 Evidence: the assistant manager on duty, we were advised that the rationale for this was as a result of the information for the care plan being stored on their memory stick. One member of agency staff was able to demonstrate a basic understanding of the young persons needs. However we acknowledge from correspondence received from the organisation following the inspection, that steps have now been taken by them to ensure that this does not happen in future. The care file for another person showed that since their admission to the service their nutritional intake has been consistently poor. On inspection of daily care records these showed the person regularly refuses to eat and/or drink fluid. A management plan had been completed in relation to the persons poor dietary needs in March 2009, however there was no evidence to show this had been written at the time of their admission in October 2008. The management plan as detailed within the care file, recorded that food and fluid charts should be completed each day identifying the persons food and fluid intake, however on inspection of these, records were inconsistently completed and it was not always possible to determine whether the person received a satisfactory diet each day. Additional information is recorded within the Personal and Healthcare Section of the report to demonstrate that the healthcare needs of the person were not being proactively managed by the service. Records also showed that no risk assessment had been completed detailing the specific risk and how this was to be proactively managed by the staff team. The care file for the same person recorded them as experiencing recurrent episodes of poor mental health, being resistant to some aspects of care provision and this resulting with the person exhibiting agitated and/or aggressive behaviours on occasions. There was little evidence to show that specific guidelines were devised and in place detailing the persons care needs and the action to be taken by support staff to ensure that the needs of the person are met and other people protected. Accident records showed that several members of staff have sustained injuries as a result of the above persons agitated and/or aggressive behaviours. No risk assessment was devised. Records also showed that where changes to individuals care needs had taken place, the plan of care had not been updated to reflect the changes. For example the care file for one person made reference to them being diagnosed with vascular dementia. A general plan of care was in place, we were advised by staff that the persons dementia had deteriorated over time, however the plan of care did not record specifically how this impacted on their ability to undertake activities of daily living. The evaluation of the care plan recorded all reviewed. Additionally the plan of care made reference to the person on occasions forgetting to eat and requiring prompting and that they could on occasions become agitated. No risk assessments were devised for either areas. On inspection of daily care records these confirmed that the person continues to display physical aggression on occasions and does not always eat their meals. As a result of the above concerns a Serious Concern Letter was forwarded to the Care Homes for Adults (18-65 years) Page 14 of 38 Evidence: organisation detailing our findings. A response was promptly forwarded to us and this sets out the actions to be taken by the organisation to improve care planning and risk assessing processes within the service and to improve outcomes for people using the service. Wherever possible people are supported to make choices throughout the day e.g. what time they get up/retire to bed, choosing their meals, choice of clothing, whether or not they wish to participate in activities etc. As a result of some peoples inability to verbally communicate and their formal diagnosis of autism, there is a range of communication systems in place to enable people to make choices and to understand the structure and routine of their day through pictures and symbols. The AQAA details that within the next 12 months it is hoped that further improvements will be made to ensure that support staff use makaton and other communication methodologies when communicating with people who live within the service and that the service will liaise closely with speech and language therapists and clinical psychologists. It was observed on the second day of inspection that the communication board on Selbourne Unit depicting the day, date and staff on duty was inaccurate and related to staff on duty 3 days previous. This could potentially be confusing for people living within the unit. Interactions between staff and people who live within the service were observed to be variable and there were occasions throughout both days of the site visit whereby the main lounge area on Selbourne Court was left unstaffed and people were left unsupervised. On occasions staff were observed to talk exclusively with one another and to not engage with people sitting within the lounge. On a positive note people confirmed that staff treated them well and that they listened and acted on what they were told. One survey recorded, we are all happy with our staff, we have known most of them a long time and we all get on with staff. Out of 3 relative surveys returned to us, only 1 felt the care home met the needs of their member of family. Care Homes for Adults (18-65 years) Page 15 of 38 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the care home can expect the activities programme to generally meet their social care needs. People can expect to receive a varied diet. Evidence: Information recorded within the AQAA and verified on both days of the inspection confirmed that people living within the service are supported and enabled to take part in a range of activities, both in house and within the local community. Within the main house weekly and daily planners in both pictures and symbols were devised for individual people. Each plan was observed to reflect the persons needs, personal preferences and interests. Within Selbourne Court there was an activity planner located in the dining room. Whilst it was up to date on the first day and reflected accurately the activities provided and/or available, on the second day, staff coming on duty for the afternoon shift did not know what was planned and/or arranged and had to ask the senior in charge of the shift. Of those people case tracked as part of the inspection process, a plan of care detailing Care Homes for Adults (18-65 years) Page 16 of 38 Evidence: individuals social care needs was recorded for 2 out of 3 people. Records showed that people can access the local community, listen to music, watch television and films, go swimming, trampolining, participate in arts and crafts, attend sensory sessions, gardening (including a kitchen garden where people are supported to grow vegetables for the home use and to sell), shopping and cooking in the training kitchen. Additionally people are supported and enabled to attend adult education classes and courses and we were advised that one person is a member of the local bowling club and regularly takes themselves off to play a game and to meet up with other club members. The AQAA details under the heading of what we could do better, We need to ensure we are supporting service users both as individuals and as part of a group-some service users have been used to doing activities on a group basis-we need to increase the number of options available for people on an individual basis. People spoken with stated that they do participate in activities. Staff meeting minutes on Selbourne Court recorded that some members of staff were refusing to undertake activities with people who live there. Out of 10 surveys returned to us from people who live at Hamilton Lodge, 8 confirmed that they can do what they want during the day, in the evening and at the weekend. However 2 surveys recorded no to being able to do what they want at these times and comments included, activities are planned for us, we do not have an alternative and things are organised for us, but we do sometimes want to do our own thing. There is an open visiting policy at the care home, whereby visitors can see their member of family and/or friend at any reaonable time. The AQAA details that people are supported to maintain and form friendships and support is given for people to attend social gatherings and external clubs e.g. Gateway Club. There is a rolling 4 week menu in place which provides 2 choices at both lunchtime and teatime. The menu was observed to provide a varied diet to people living within the service. On the first day of inspection the days choices were clearly recorded on Selbourne Unit, however on the second day of inspection the choices available were not recorded. Two people spoken with on the second day were unable to tell us the choices available. The dining experience for people within the unit was observed to be positive and where people require assistance this was provided in an appropriate way, however there was little verbal encouragement and/or verbal interaction provided by individual members of staff. Meals provided are of a good quality and in sufficient quantity. People spoken were positive about the meals and comments included, nice and the food is good. Care Homes for Adults (18-65 years) Page 17 of 38 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the care home cannot expect to have a plan of care which details all of their healthcare needs or that these will be met or proactively managed. Evidence: Records showed that people living within the service have access to a range of healthcare professionals and services. These include GP, attendance at hospital appointments, Optician, Dentist, Consultant Psychiatrist, Speech and Language Therapist, Clinical Psychologist, HATS Team (Home Assessment and Treatment Service), Dietician, etc. The dates and details of healthcare appointments have been recorded for individual people and records showed in some cases that healthcare needs were not always being met and/or proactively managed. For example the care file for one person recorded them as having consistently poor nutritional intake since their admission to the service. Records showed that a meeting to discuss the persons weight loss and referral to an appropriate healthcare professional was not made by the service until 3 months after their admission. No rationale was recorded and/or provided to us by senior members of staff as to why this was not dealt with sooner. Additionally records showed that following a visit by the healthcare professional and compilation of a report, not all recommendations as highlighted within the report were being followed. Care Homes for Adults (18-65 years) Page 18 of 38 Evidence: The assessment by the placing authority for the above person, recorded them as having epilepsy. The assessment recorded that whilst there had been no recorded seizures for many years, it provided information detailing the type of seizures experienced by the person and that if these should occur they should be monitored and recorded. The Medication Administration Record (MAR) confirmed the person was prescribed regular specific medication to control their seizures. No plan of care or risk assessment was completed in relation to the persons medical condition. Records also showed that this person regularly refuses to take their medication. A management plan was in place and recorded If [name of person] refuses their medication for three days, the GP and Community Nurse should be informed. It was unclear from the care file and from discussions with members of the management team that this plan of action had been formally agreed as part of a multi-disciplinary agreement. Following the inspection and from discussions with a pharmacist inspector, some of this persons medication is not life threatening if not taken, however the impact of regularly refusing to take their medication which is prescribed to control their epilepsy could potentially have serious consequences and requires further discussion. No risk assessment was devised for refusal of medication. During both days of inspection the privacy and dignity of people living within the service was observed to be met by staff. We watched medication being given to people on both days of the inspection and this was observed to be undertaken satisfactorily. Appropriate medication policies and procedures were readily available. Medication records and storage facilities were examined within the main house and on Selbourne Court unit. Medication is stored securely however medication that requires cold storage (dedicated fridge/Selbourne Court) was not stored securely and could potentially place people at risk. The fridge was left unlocked and on occasions staff were not present where this is located. On both days of the site visit, several people were observed to be sitting in the lounge area close to the proximity of where the fridge is located. Medication that requires cold storage is stored within the dedicated fridge, but the temperature showed on both days of the inspection that the temperature was warm and outside of the recommended range. This was initially highlighted on the first day of inspection however a fridge thermometer was only purchased on the second day of the inspection and after we had once again brought it to the person in charges attention. The senior in charge of the shift on the afternoon of the first day of inspection was unaware of the range of temperature that medication should be stored at and the importance of keeping medication that requires cold storage, cold. We also advised that the dedicated fridge for medication should only be stored for this purpose. On the second day of inspection the fridge also stored half a cheese sandwich, bottle of water and suntan lotion. The temperatures of where medication is stored are not monitored or recorded. Staff were advised that failure to store medicines under the correct temperature could result in people receiving medication that is ineffective. Care Homes for Adults (18-65 years) Page 19 of 38 Evidence: On inspection of MAR records a number of discrepancies and poor record keeping were noted. These included no record of some medicines having been given to the person when they were due, as the entries on the MAR chart had been left blank and not signed or initialed by staff. On the second day of inspection the senior in charge did not sign the morning medication for one person as having been given and received and when questioned stated, Oh I forgot, I should have signed for it. The MAR record for one person showed that one of their medications was not administered in line with the prescribers instructions. No rationale could be provided as to why this had happened. As part of good practice procedures, handwritten MAR records were not double signed to confirm that the medication received was accurately recorded. Additionally, the date and quantity of medication received was not always recorded. Where the code G (see note overleaf) was recorded on the MAR record, the explanation for this was not always recorded within those records sampled. Also where a variable dose of medication is to be given e.g. 1 or 2, the specific dose administered had not always been recorded. As a result of the above concerns a Serious Concern Letter was forwarded to the organisation detailing our findings. A response was promptly forwarded to us and this sets out the actions to be taken by the organisation to improve medication practices and procedures within the service. On inspection of staff training records, these showed that not all staff who administer medication both within the main house and within Selbourne Court have got up to date medication training. Records also showed that not all staff had received regular assessment as to their continued competence to administer medication. Records showed that several people have received training relating to epilepsy and epilepsy medication but some of this training is coming up to being 3 years old. Care Homes for Adults (18-65 years) Page 20 of 38 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect their concerns to be listened to and dealt with appropriately and that they will be safeguarded by staffs knowledge and supporting policies and procedures. Evidence: There is a complaints policy and procedure in place, which has been newly created in an alternative easy read format for people living at Hamilton Lodge. On inspection of the complaints folder there has only been 1 complaint made in the last 12 months. Records showed this related to there being mouldy bread. Action was taken immediately and people were provided with a takeaway meal. Staff spoken with stated that if they had concerns about the well-being of an individual living in the home they would discuss this with the management team of the home. All surveys returned to us from people living at Hamilton Lodge confirmed that they know who to speak to if they are not happy or have concerns. Comments included, I have a key worker who I would go to if this happens. 2 out of 3 relative surveys returned to us, confirmed that they knew how and who to make a complaint and/or raise issues. We have not received any formal complaints or safeguarding referrals in relation to the service since the last Key inspection (May 2008). Information within the AQAA and verified on the first day of inspection confirms that the service has not had any safeguarding issues. Safeguarding policies and procedures are readily available and staff spoken with were able to demonstrate a good understanding and awareness of safeguarding procedures. Care Homes for Adults (18-65 years) Page 21 of 38 Evidence: The staff training records provided to us showed that all staff have up to date training relating to safeguarding adults. Records also showed that nearly all staff have undertaken SCIPP training. This training is provided so as to ensure that staff have the skills and competence to deal with people within the service who are resistant to care and/or display challenging behaviour. Care Homes for Adults (18-65 years) Page 22 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to live in a comfortable, homely and well maintained environment which meets their needs. Evidence: A partial tour of the main house and Selbourne Court was undertaken on the first day of inspection. Accommodation for people is currently available within 2 units, which cater for varying levels of dependency and need. The main residence is the large country manor house providing specialised care for up to 8 young people with autism and associated disabilities. Selbourne Court is a single story unit adjacent to the main house providing accommodation for up to 18 people who have a learning disability. People who live within the main house were observed to have a large spacious room with en-suite facilities. A random sample of bedrooms were inspected and all were seen to be personalised and individualised. Additional communal areas within the home are available for peoples use and include lounge areas, an activity room and dining area. One health and safety issue was raised at the time and this related to one young persons bedroom window being propped open with 2 pieces of wood. We were advised by the manager on the second day of inspection that this issue had been dealt with. Selbourne Court is divided into 3 zones with a large communal lounge, dining area and kitchen in the centre. Each zone has 6 bedrooms with en-suite facilities. There is also a Care Homes for Adults (18-65 years) Page 23 of 38 Evidence: conservatory, communal bathrooms, toilets, sluice and laundry. To the front of the premises there is a training kitchen on one side and a meeting room and administration offices on the other side. Adjacent to the unit there is a large barn, which has a sensory room and an area for arts and crafts. There is a landscaped garden and patio area to the rear of the unit, with a water feature and tables and chairs for people to use. A maintenance person is employed within the service for 37.5 hours Monday to Friday. On inspection of staff training records, these showed that they have undertaken training relating to moving and handling, fire awareness and safeguarding. Records showed they have not received training relating to health and safety, infection control and COSHH (Control of Substances Hazardous to Health). A random sample of safety and maintenance certificates showed that equipment within the home has been serviced and remains in date until their next examination. Records showed that a fire risk assessment was reviewed and updated in February 2009. It was unclear from inspection of the fire records as to whether or not the emergency lighting and fire alarms are tested regularly (weekly or monthly). Records of fire drills were examined and the last drill was dated July 2008. Care must be taken to ensure that these are undertaken more frequently. Random testing of hot water temperatures were undertaken at Selbourne Court on the second day of inspection. The temperature of hot water emitting from a random sample of wash hand basins were examined. This examination showed that 2 communal toilet wash hand basins and 2 wash hand basins in communal bathrooms were above 50 degrees centigrade, which could pose a health and safety risk to people who live there. As a result of concerns we left an Immediate Requirement Notice. A response was promptly forwarded to us and this sets out the actions taken by the organisation to ensure that people who live on Selbourne Court are protected and safeguarded. The response details that the problem with the hot water temperatures were identified on 27th May 2009 and the organisation were in the process of having a programme of works agreed when we visited. Care Homes for Adults (18-65 years) Page 24 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this 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 level of staffing and staff deployment on occasions restricts the ability of the service to deliver person centred care and to ensure peoples needs can be met. However people are assured that staff have up to date relevant training. Evidence: At the time of the first day of inspection, we were advised that 5 people were living within the main house and 16 people were living at Selbourne Court. The main house and Selbourne Court have independent staff teams. We were advised that staffing levels for Selbourne Court are 1 senior and 4 support staff between 07.00 a.m. and 14.15 p.m. and 1 senior and 3 support staff between 14.00 p.m. and 22.15 p.m. and 2 waking night staff between 22.00 p.m. and 07.15 a.m. 7 days a week. Additionally there is a manager on call each day. The manager on site is supernumerary to the above figures and additional ancillary staff are employed and these include chef and housekeepers. The service also employs 2 administrators Monday to Friday. On inspection of 4 weeks staff rosters for Selbourne Court these evidence that staffing levels as detailed above have not always been maintained. We have not received Regulation 37 notifications, advising us of the staffing shortfall and measures undertaken to deploy staff to the unit. Staff spoken with during the inspection confirmed that staffing Care Homes for Adults (18-65 years) Page 25 of 38 Evidence: levels as detailed above have not always been maintained. We observed on the first day of inspection on Selbourne Court that the morning shift was short of one member of staff, as a result of one staff member not turning up for their shift. We were advised by the senior in charge that a member of staff from the main house had provided cover between 07.30 a.m. and 10.00 a.m. and then returned to the main house, leaving the shift short of one person. There was no evidence to show that alternative arrangements were made to get cover for the rest of the shift. The AQAA details that staff retention within the service has improved. The staff files for 3 people who had been newly employed since the last key inspection were examined on the first day of inspection. Records showed the majority of records as required by regulation had been sought, however some shortfalls were identified. These relate to no recent photographs on any of the files sampled, the CRB on file for one person related to their previous employer and not Hamilton Lodge and one person commenced employment prior to a satisfactory POVA 1st and CRB being issued. In addition we requested to see the employment file and/or pro-forma of the acting manager. No records were available to confirm if this person has been recruited in line with regulatory requirements or if the agency has confirmed in writing that all checks have been undertaken by them and are satisfactory. Records showed that all 3 people were provided with a comprehensive induction LDQ (Learning Disabilities Qualification Induction Award). This is then followed by an NVQ of the appropriate level for the job role and the staffs experience/qualifications. The LDQ Induction Award provides some of the underpinning knowledge evidence for their NVQ award. We were advised that new employees are supernumerary for the first 3 weeks and work within both the main house and Selbourne Court. The AQAA details that a new induction programme is being developed by the clinical team and speech and language team within the organisation. Discussion took place with the services NVQ/training co-ordinator and a copy of the training plan for all staff was provided to us. Evidence showed that the service ensures that all staff within the organisation receive relevant training that is targeted and focused on making sure there is an effective staff team to meet the needs of people living within the service. It was apparent that the service places a high level of importance on training and this was confirmed by staff. We saw evidence of training currently booked and training planned for 2009. We were advised by the training co-ordinator that there are 7 qualified NVQ assessors, 2 trainee A1 assessors and 1 Internal Verifier. Additionally 18 staff have NVQ Level 2 and 10 people are currently working towards achieving NVQ Level 2, 8 staff have NVQ Level 3 and 7 people are currently working towards achieving NVQ Level 3, 2 staff have NVQ Level 4 with one person currently working towards achieving NVQ Level 4, both assistant managers have attained NVQ Level 4 and the Registered Managers Award and in total 25 out of 42 direct care staff hold one or more NVQs with a further 7 staff members working Care Homes for Adults (18-65 years) Page 26 of 38 Evidence: towards one. We requested to see evidence of staff supervision records on the first day of inspection, however we were advised that these could not be accessed as one of the assistant managers had lost the key to the filing cabinet where these are held for safekeeping. We requested access to these on the second day of inspection and were only able to see a limited number of records. Evidence showed that regular supervisions are not being undertaken in line with National Minimum Standards recommendations. We were advised that a new format for recording information was implemented approximately 2 months previous and topics covered include, general performance, working relationships, role specific issues, training and development, personal issues and any other business. The AQAA details that there has been an expectation that supervisions will be conducted every 6 weeks, however it is recognised that these need to be undertaken more frequently and these are now being planned for each month so as to achieve a minimum of 10 per year. This did not concur with our findings. Care Homes for Adults (18-65 years) Page 27 of 38 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot expect the service to be run in their best interests and shortfalls and deficits identified could potentially mean poor outcomes for some people. Evidence: Prior to the inspection we were advised in writing in April 2009 that the previous manager had left the employment of Hamilton Lodge and in the interim period, Mr Dick ODonovan (Service Manager) would assume the role of manager at the site. At the time of our inspection an acting manager from an external agency had been recruited to manage Hamilton Lodge and had been in post since 18th May 2009. We were made aware that it is the organisations intention for the acting manager to become the permanent manager of the service in due course. Additionally, both Selbourne Court and the main house has an assistant manager to oversee each establishment. Both people have worked at Hamilton Lodge for some considerable time and have attained NVQ Level 4 and the Registered Managers Award. The AQAA details that within the next 12 months the organisation are seeking to develop a more robust management structure across the service, this includes registering the main house and Selbourne Court as separate services. The rationale for this is to give each service a more unique profile and an improved level of service. It is also envisaged that the organisation will build an Care Homes for Adults (18-65 years) Page 28 of 38 Evidence: additional 4 x 4 bedroom bungalows on site. We were advised that planning permission has been agreed, funds are in place and building works will commence in October 2009. The acting manager has vast experience in supporting and managing young people who have a learning disability and who present with challenging behaviour. The acting manager has attained the Certificate in Social Services (CSS), is a qualified Social Worker and has completed the Combined Certificate in Counselling and Certificate in Theory/Counselling Skills. We were advised that their training in core subject areas e.g. manual handling, health and safety, fire awareness etc are up to date. From discussions with the acting manager we were advised that the ethos of the service is to enable people within the home to be as independent as possible and for the prinicples of person centred care to be promoted. Feedback of the inspection findings were provided to the acting manager on both days of inspection. They are aware of the need to improve the current quality of service provided, however they recognise that any significant progress will only be achieved over a sustained period of time and not in the short term. The acting manager concurred with our findings in relation to poor communication processes within the service, in particular between support staff and members of the management team. This was also confirmed by some members of staff spoken with. From discussions with the Service Manager on the second day of inspection he confirmed that he too had recognised shortfalls within the service, and had felt that this was partly due to staff not being managed effectively and the difficulties posed by trying to manage a service from a distance. There are some areas of good practice. The Service Manager, acting manager and members of the staff team understand the main principles of person centred planning and care, but evidence on both days of the inspection showed that some people have difficulty in putting this into practice, so as to ensure positive outcomes for people. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was generally informative, however some sections do not give an accurate account of the current situation within the service. Some elements of the document as detailed within the main text of the report provide little or no evidence to support the claims made within it. Records showed that a quality review of the service was undertaken in January 2009. This recorded, despite a clear committment to the values and ethos of person centred care and support, the quality review found that there were several essential underpinning elements to the service that were in urgent need of review, development and implementation. Actions to be taken included the Service User Guide being reviewed to reflect service provision, care plans sampled required reviewing and all care plans to accurately reflect the level of care and support required for each person and risk assessments and management plans to be clear and reflective of the individual person. Care Homes for Adults (18-65 years) Page 29 of 38 Evidence: On inspection of Essex County Council Quality and Development Service Monitoring Report (October 2008) this highlighted a number of requirements pertaining to recruitment procedures, staff supervision, staff training and risk management. The acting manager and administrator were unclear as to the frequency of a quality assurance review being undertaken at Hamilton Lodge. Records also showed that regular unit, staff, team and senior meetings are undertaken within the service. Minutes of meetings held also demonstrated evidence that concerns raised by us, have also been discussed and emphasised prior to our inspection and over several months. Regular monthly visits are conducted by a representative of the organisation and a report compiled. Records showed that some issues as already highlighted have been picked up. For example comments included, communication between managers must be improved. Some staff have had supervision recently, others state they have not had it for several months-this must be addressed and It is important to ensure that all risk assessments are current, dated and signed with their last review date. Risk assessment review documentation to be updated in all care plans. Care Homes for Adults (18-65 years) Page 30 of 38 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 38 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action 1 24 13 Appropriate measures are undertaken to reduce the risk and to ensure that hot water emitted from wash hand basins and baths/showers does not exceed 43 degrees centigrade. 01/08/2009 So as to ensure the wellbeing and safety of people living within the service. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 2 14 All prospective people are assessed as to whether or not their needs can be met, prior to admission to the service. 24/07/2009 To ensure that the person being admitted to the service is assured that their needs can be met and that they will receive appropriate care and support. Care Homes for Adults (18-65 years) Page 32 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 2 6 14 The plan of care is kept under review and regularly updated to reflect the most up to date information. 01/08/2009 This will ensure that staff have the most up to date information and that information recorded is at all times, reflective of their actual care needs. 3 6 15 There is a plan of care, 01/08/2009 clearly identifying all aspects of the persons care needs and how these are to be met by staff. This will ensure that staff have the information they need so as to provide appropriate care to meet the individuals care needs. 4 9 13 Risk assessments must be 01/08/2009 devised for all areas of assessed risk so that risks to people can be minimised. Records must be explicit, detailing the specific risk, how this impacts on the person and steps taken to reduce the risk. This will ensure that risk areas are identified and staff are aware of the associated risks to peoples health and Care Homes for Adults (18-65 years) Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action wellbeing. 5 19 17 31/07/2009 Where people are at risk of losing weight, maintain appropriate nutritional records, including weight gain or loss and demonstrate appropriate action taken. So as to ensure peoples safety and wellbeing. 6 19 12 31/07/2009 Ensure suitable arrangements are in place so as to ensure that peoples health and welfare are promoted and any issues are promptly addressed and proactively managed. This refers specifically to ensuring that where people require support, records are updated, staff have the skills to recognise when to contact healthcare professionals and to provide appropriate interventions. This will ensure that the healthcare needs of people are met. 7 20 13 Ensure that when medication 31/07/2009 is not administered to people, records clearly record this, the rationale why they are not and any action taken to address the above. Page 34 of 38 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action This is to ensure a clear audit trail and to ensure peoples health and welfare. 8 20 13 People must be protected 31/07/2009 from harm by having their medication administered safely and in accordance with the prescribers instructions. So as to ensure peoples safety and wellbeing. 9 20 13 The temperature of where 31/07/2009 medication is stored must be monitored daily and be within recommended guidelines. This refers to the medication cupboard on both units and the dedicated fridge for medication that requires cold storage. So as to ensure that medication is stored within recommended guidelines and that it does not deteriorate. 10 20 13 Where a variable dose of medication is to be administered, ensure the specific dose given is recorded. 31/07/2009 This will ensure that people Care Homes for Adults (18-65 years) Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action receive the correct amount of medication. 11 20 18 Ensure that staff who administer medication receive up to date medication training and regular assessment as to their continued competence to undertake this task. So as to ensure peoples safety and wellbeing. 31/07/2009 12 33 18 Ensure there are sufficient staff on duty at all times. 31/07/2009 So as to ensure the needs of people who live at the home are met according to their specific care needs and dependency levels. 13 36 18 Ensure that staff receive regular supervision. 31/07/2009 So that staff feel supported and people know that staff are appropriaetly managed and supported. 14 37 10 The service is managed appropriately with skill and competence. To ensure that the service is run in the best interests of Care Homes for Adults (18-65 years) Page 36 of 38 31/07/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action the people who live at Hamilton Lodge. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 Prospective people must have the information they need to make an informed choice about where to live. This refers specifically to the Service Users Guide being reviewed and readily available. Ensure that information relating to activities is clearly recorded, in appropriate formats and people are advised as to what is available during the day, in the evening and at weekends. Ensure that information relating to the meals on offer each day are accurate. Hand written MAR records should be double signed, so as to ensure that the information recorded is accurate. The quantity of medication received, amount of medication carried forward and the date when received should be recorded on the MAR record. Ensure that the homes fire alarms and emergency lighting are tested regularly and that a record is maintained. 2 14 3 17 4 5 20 20 6 24 Care Homes for Adults (18-65 years) Page 37 of 38 Helpline: Telephone: 03000 616161 or Email: enquiries@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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