Random inspection report
Care homes for adults (18-65 years)
Name: Address: Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Michelle Love Date: 1 5 0 9 2 0 0 9 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 learning disability physical disability Conditions of registration: 40 40 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 Brief description of the care home Hamilton Lodge is a residential care home. Accommodation is provided in two units and consists of a large country manor house
Care Homes for Adults (18-65 years) Page 2 of 14 Brief description of the care home 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 3 of 14 What we found:
This was an unannounced random inspection. At the previous key inspection to the home in June 2009, we issued an Immediate Requirement Notice pertaining to the temperature of hot water emitting from a random sample of wash hand basins being above 50C. In addition we issued a Serious Concern Letter as a result of poor care planning and risk assessment processes and poor medication practices and procedures. A response to the areas of concern raised by us was received promptly from the registered provider and this detailed the actions taken/to be taken to meet the regulatory requirements. The purpose of this site visit was to focus on whether or not, compliance to meet the Immediate Requirement Notice and Serious Concerns had been achieved. The visit took place over one day by one inspector and lasted a total of 5 hours. Additionally, a pharmacist inspector examined the homes medication practices and procedures. We enquired as to the long-term management arrangements within the service. The acting service manager confirmed that they were still employed by an external agency and their contract had been extended to the end of September 2009, however they were unclear as to the future management arrangements within the service. We discussed this with the service manager and we were advised that following changes to the management team since the last key inspection, the organisation are looking to recruit 2 new managers for both the main house and Selbourne Court. An application to deregister the service as it stands has been submitted to us and it is proposed that each manager will be registered independently for both the main house and Selbourne Court and a service manager will oversee both establishments. The service manager confirmed that the acting service manager had made significant progress to address shortfalls and regulatory requirements from the last inspection. We were also advised that several new members of staff had been newly employed. A tour of the premises was undertaken by us and a random sample of wash hand basins and baths were tested. This was to ensure that the hot water emitting from these outlets provided water that was at a suitable temperature for the health and wellbeing of people living within the service. We were advised by both the service manager and acting service manager that following the last key inspection, steps had been taken to address the issue and all wash hand basins, baths and showers within the main house and Selbourne Court were now fitted with fail safe devices to ensure that hot water meets the appropriate health and safety requirements. In addition a new system for monitoring hot water temperatures in both individual peoples rooms and communal facilities has been introduced. The temperature of hot water sampled within both the main house and Selbourne Court was noted to be appropriate and records confirmed this. We therefore consider that the Immediate Requirement highlighted at the previous key inspection has been met. On a tour of the premises we observed 2 doors (fitted with Dorguards) within the main house being wedged open by furniture. We advised support staff who accompanied us on the tour of the premises of the potential risk of both doors not closing if the fire alarm was raised. Support staff spoken with stated that the rationale for this was as a result of the young people wanting the doors to be kept open. While we recognise this, it is the management team of the homes responsibility to ensure that adequate fire arrangements are in place to safeguard people who live there. In addition 3 fire doors on
Care Homes for Adults (18-65 years) Page 4 of 14 the ground floor of the main house do not close properly posing a potential fire risk. We also observed 2 exit doors (in the main house and Selbourne Court) not being locked and/or secure. This poses a potential risk to people who live within the service leaving the building undetected and others entering the premises unnoticed. Both issues were discussed at feedback with the service manager and acting service manager. As part of this site visit we looked at 2 peoples care files. Records showed that improvements have been made to address some of the shortfalls and deficits identified at the previous key inspection in relation to care planning and risk assessment processes. Records for one person showed that an appropriate healthcare professional had been contacted following the last key inspection in relation to their nutritional care needs and advice provided and recorded. In addition records showed that the persons support plan had been re-written and their weight was now being monitored and recorded on a weekly basis to evidence weight gain and loss. Records showed that the person still continues to refuse meals and/or fluids on occasions. However it was noted at this site visit that no risk assessment had been devised, despite this being highlighted at the previous key inspection to the home. The care file for one person showed they have complex care needs, specifically in relation to their challenging and/or inappropriate behaviours. The support plan clearly recorded the challenges presented by the person, known triggers and actions to be taken by support staff to manage and support the person during incidents of aggression or when they chose not to co-operate. In addition risk assessments were completed for the above. However, we noted that although the above had been reviewed and updated following the last key inspection, neither the support plan or risk assessment had been reviewed and updated to reflect the recent increase of incidents relating to their challenging and inappropriate behaviours. Records also showed that as a result of the latter a set of rules and restrictions have been formally drawn up by the organisation which warn the service user that some of their activities and rights will be restricted and/or reduced as a means of managing their behaviours. This refers specifically to personal items being taken away for up to 1 week and their personal money being witheld for 2 weeks. There was no evidence to show who within the organisation had compiled the set of rules, the date these were devised, evidence that these had been formulated as part of a multidisciplinary team or that the service user had agreed to these being imposed. The service manager advised that the rationale for implementing the rules sheet was, we have to keep people safe. The acting service manager confirmed that support staff found it difficult on occasions to deal effectively with the persons challenging and/or inappropriate behaviours. Records also showed that where incidents of aggression and/or inappropriate behaviours had occured, these were to be recorded within the relevant behaviour monitoring record (ABC record). However we noted that where incidents had occured and been written in the daily care records, not all information was transferred to the above record and records did not always include the date of the incident or specific information relating to the incident on some occasions. Records for the same person also showed that not all of their specific healthcare needs had been recorded within a support plan and a risk assessment had not been devised. While we note there have been no healthcare issues pertaining to this particular healthcare condition for some considerable time, changes to their medication regime have taken place and further changes are planned which could potentially alter the period of stability. Care Homes for Adults (18-65 years) Page 5 of 14 Records also showed for another service user that as a result of them smoking in their room, their cigarettes and lighter had been removed. While we recognise this poses a potential fire risk, there was no evidence within their care file to show who within the organisation had made this decision or that this had been agreed by the service user. There was no evidence to show that the above action was to be reviewed. We looked at the storage for medication and in general these were secure. We noted that the temperature of some of the medication storage areas are not monitored and recorded but had been recorded outside the recommended range. Although staff knew what the maximum temperature should be, no action had been taken to investigate the quality of the medicines stored there. A cupboard in the office area of the lounge in Selbourne Court is also used to store medication but the temperature of this room is not monitored or recorded and at the time of the inspection was very close to the recommended maximum. On a tour of Holme Oak we found some creams in peoples rooms that did not carry a label with their name on it. We looked at the medication and medication records for several people in the home. We found no unexplained omissions and where medication had not been given, the reasons why were recorded. We noted that for two people who were prescribed medication on a when required basis e.g. to control behaviour, there was detailed guidance for care staff on the circumstances these are used. But for two other people there was no such guidance, either with the medication records or in the care plans. We saw that there were notes about how people liked to take thier medication which is good practice but for one person it said that liquids are taken in his drink. This was not reflected in his care plan and staff said that this was incorrect. It is important that such guidance is up to date so that peoples wishes and choices are respected and they are not put at risk of being given medication in an inappropriate way. One person regularly refuses his medication and an instruction with his medication record stated that this should be reported to his GP if he refused more than 3 days medication. However, his care plan stated that the refusals should be reported to the community nurse if the medication had not been taken for two days. This inconsistent instruction may result in the person not being treated appropriately. We made a requirement on the last inspection for staff to receive up to date medication training and assessment of their competence to administer medication by 31/07/2009. Inspection of the training records and discussions with the training co-ordinator, acting manager and staff themselves, show this requirement has not been met. We were told that further training is planned but that a date has not yet been arranged for this. We have therefore taken a reasonable view and carried forward this requirement with a new timescale for action. Any further failure to meet the requirement may result in enforcement action. What the care home does well:
We recognise that some improvements have been made to the care planning and risk assessing processes within the service and that efforts are being made to review and update each support plan.
Care Homes for Adults (18-65 years) Page 6 of 14 Appropriate steps have now been taken to ensure that the temperature of hot water emitting from wash hand basins, baths and showers meet recommended guidelines and requirements, so as to ensure peoples safety and wellbeing. Appropriate action has been taken to ensure the accuracy of records made when medicines are given to people and to record the reason why any are omitted. Records of the receipt and administration of medicines provide an audit trail of medicines in use and demonstrate that people receive their medicines as prescribed. On the last inspection we recommended that where medication records are hand-written they should be double-signed to ensure they are accurate. We found only one instance were this had not been done and so consider this recommendation to have been implemented. We also recommended that the quantity of medication received and the amount carried forward to a new medication record; and found that this recommendation has also been considered. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 14 Are there any outstanding requirements from the last inspection? Yes R 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement 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. Not inspected on this occasion. Previous timescale 24/7/09. 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. 15/09/2009 2 6 14 The plan of care is kept under review and regularly updated to reflect the most up to date information. Previous timescale of 1/8/2009 not met. 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. 01/10/2009 3 6 15 There is a plan of care, 01/10/2009 clearly identifying all aspects of the persons care needs and how these are to be met
Page 8 of 14 Care Homes for Adults (18-65 years) 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action by staff. Previous timescale of 1/8/09 not met. 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 01/10/2009 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. Previous timescale of 1/8/09 not met. This will ensure that risk areas are identified and staff are aware of the associated risks to peoples health and wellbeing. 5 20 13 The temperature of where 30/09/2009 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
Care Homes for Adults (18-65 years) Page 9 of 14 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action that it does not deteriorate. This requirement has not been fully met by the given timescale of 31/07/2009. 6 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. This requirement has not been fully met by the given timescale of 31/07/2009 7 33 18 Ensure there are sufficient staff on duty at all times. Not inspected on this occasion. Previous timescale 31/7/09. So as to ensure the needs of people who live at the home are met according to their specific care needs and dependency levels. 8 36 18 Ensure that staff receive regular supervision. Not inspected on this occasion. Previous timescale 31/7/09. So that staff feel supported and people know that staff are appropriaetly managed
Care Homes for Adults (18-65 years) Page 10 of 14 31/10/2009 15/09/2009 15/09/2009 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action and supported. 9 37 10 The service is managed appropriately with skill and competence. Not inspected on this occasion. Previous timescale of 31/7/09. To ensure that the service is run in the best interests of the people who live at Hamilton Lodge. 15/09/2009 Care Homes for Adults (18-65 years) Page 11 of 14 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 6 17 There must be evidence to show that where there are restrictions and limitations imposed on individual people, the service user has agreed to this and there is a clear audit trail evidencing that this way of managing the persons behaviours has been fully explored. So as to ensure the persons rights and freedom. 12/10/2009 2 24 23 Adequate precautions must be undertaken against the risk of fire after consultation with the fire authority. This refers to fire doors not closing properly. So as to ensure peoples safety and wellbeing. 19/10/2009 Care Homes for Adults (18-65 years) Page 12 of 14 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 Care Homes for Adults (18-65 years) Page 13 of 14 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 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. Care Homes for Adults (18-65 years) Page 14 of 14 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
