CARE HOME ADULTS 18-65
Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB Lead Inspector
Neal Cranmer Key Unannounced Inspection 20th July 2006 09:30 Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Hamilton Lodge Address Rectory Road Great Bromley Colchester Essex CO7 7JB 01206 230298 01206 231166 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hamilton Lodge Trust Limited Mr E Curtis-Oram Care Home 40 Category(ies) of Learning disability (40), Learning disability over registration, with number 65 years of age (40), Physical disability (40), of places Physical disability over 65 years of age (40) Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may accommodate 40 persons of either sex under the age of 65 with learning disabilities who may also have physical disabilities The home may accommodate 40 persons of either sex aged 65 years and over with learning disabilities who may also have physical disabilities The total number of service users accommodated in the home must not exceed 40 persons 10th February 2006 Date of last inspection Brief Description of the Service: Hamilton Lodge is a care home registered to provide personal care and support to forty people who have a learning disability and/may also have a physical disability. Registered accommodation is provided in three units which cater for varying levels of dependency and need. The main residence is the large country manor house, Selbourne Court is a newer, separate, ground floor unit built on a site adjacent to the main house and the third unit is a small cottage where service users experience small group living on a domestic scale. Each unit is staffed separately and led by a home manager. The home is set in vast well maintained grounds, located in the small rural village of Great Bromley, geographically central to the larger towns of Clacton-on-Sea, Colchester and Harwich. Public transport to the towns, however, is minimal, but the home has four vehicles, which include a mini bus with a tail lift for the use of service users. Service users also have access to a taxi or public transport if they wish. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report follows an unannounced inspection of Hamilton Lodge which took place on the 20th July 2006. It was the first inspection of the home for the year 2006/2007 and was carried out in the company of the assistant home manager. The fieldwork visit to the home was carried out between the hours of 09:30 and 15:30. The inspection included discussions with the manager, staff and service users. In addition to these discussions, a range of documentary evidence was sampled. A total of twenty-two of the forty-three standards were inspected. Of these seventeen were met, four were partially met, with the remaining one being a major shortfall; of the five standards not met, four are requirements that remain unmet from the inspection of the 10th February 2006. What the service does well: What has improved since the last inspection?
The home now has a process for assessing its ability to meet the needs of service users prior to a service being offered. Service users’ plans are based upon the Person Centred Planning philosophy of care, and plans sampled were seen to contain evidence of risk assessment activity having been undertaken Discussion with staff and members of the management team evidenced that staff supervision has improved since the previous inspection. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 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 Lodge DS0000017841.V290123.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users continue to be provided with the necessary information they need to be able to make an informed choice about the home’s ability to meet their needs. The home has in place a pre-admission assessment upon which is based the decision as to whether the home can meet the needs of service users. Although service users have Contracts of Residency, these require development to ensure that they meet the required standard. EVIDENCE: The home’s Statement of Purpose was revised in October 2005 and was sampled at the inspection of the 10th February 2006; it met with regulatory requirements at that time. All files sampled on the day of the inspection were seen to contain evidence of pre-admission assessments which were comprehensively completed and detailed. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 9 Although all the service users’ files sampled contained evidence of Contracts of Residency, these were written as generic documents, and were not individualised. The manager’s attention was drawn to Standard 5 for further guidance. It was, however, noted that significant work had been undertaken to providing the contract in a pictorial format for ease of use by the service users. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home continues to work to the philosophy of Person Centred Planning, and has developed this process significantly since the previous inspection. Service users are supported to make or be involved in decision making on issues that affect their everyday lives, dependent upon their individual needs. Evidence was seen in service users’ files of them being supported to take risks as a part of developing a more independent lifestyle. EVIDENCE: The four plans of care sampled had all been based upon the principles of Person Centred Planning; significant improvement had been made in terms of the recording to support the plans. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 11 Evidence was seen of service users being supported to make decisions about their everyday lives. This was evidenced through the viewing of minutes of transition meetings to which service users were seen to have been invited and contributed. All the plans seen contained evidence of risk assessment activity having been undertaken, with the assessments identifying the rationale for taking the risk, the nature of the risk, and the strategy to be followed to minimise the risk. The assessments all contained a section for recording the signatures of those signing up to the assessment. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users are supported to take part in activities that are age and peer appropriate. Service users are supported to take part in activities within their local communities. Service users continue to be supported to maintain links with their families. The daily routines of the home take account of service users’ rights and responsibilities. Arrangements for food preparation at the home continue to fail to meet the required standard, however this is directly related to the age and condition of the home and is currently being addressed through the programme of reprovision that is well under way. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 13 EVIDENCE: Discussion with the home’s day services manager indicated that all service users accommodated at the home receive some level of support from the team. A summer programme for the period 17-28 July was viewed and evidenced the following activities as being scheduled: • • • • • • • • • • • • Day trips out Making and taking a picnic Visits to a farm 1.1 out and about sessions Music sessions Communication workshops Working in the greenhouse Summer schools Visits to the theatre (one service user spoke of there being a trip to the theatre scheduled for that evening) Rambling Bouncability Swimming Each of the four service users case tracked had a lifestyle review report which was presented in both written and pictorial format, and which identified the following: • • • • • • What activities they had taken part in and enjoyed What they had not enjoyed What they would like to do for the next year What they would need to make this happen Their hopes for the future. What the service could do to facilitate this happening The document also contained a list of activities/services that the service user was currently attending or wished to attend. The manager spoke of service users moving on as part of the re-provision programme continuing to be supported to access activities that they had already signed up to. Service users are supported to maintain links with their families. The home has an open door policy on the receiving of visitors. The daily routines of the home promote service users’ independence. Service users were witnessed choosing when to spend time alone or in the company of others.
Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 14 Staff were heard to interact with service users and not exclusively with each other. Service users were seen to have unrestricted access to the home and its grounds. The kitchen facilities for the home continue to be below standard due to the age and condition of the home. However, this is recognised and is being addressed through the programme of re-provision. Meals continue to be provided by an external catering agency who have made a number of improvements in terms of how meals are provided. Food continues to be delivered to Selbourne Court via heated trolleys. Staff spoke of food now arriving in a much better state. A limited budget has been devolved to enable the home manager to purchase limited stocks, thereby ensuring that snacks are always available. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users’ personal support needs are met sensitively and in a way that preserves dignity and respect. Service users’ physical, emotional and healthcare needs continue to be well catered for. Service users continue to be protected by the home’s policies and procedures on the handling of medicines. EVIDENCE: Evidence would suggest that service users’ personal support needs are sensitively met and that staff work with service users in such a way as to ensure that their privacy and dignity are upheld at all times. All service users are registered with a General Practitioner and records pertaining to service users’ healthcare needs are kept. The records sampled included:
Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 16 • • • • Records of medical appointments attended Accident records Weight records Fluid charts The home’s medication policies and procedures were not inspected at this inspection, but were met in full at the inspection of 10th February 2006. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has in place a complaints policy and procedure that meet with regulatory requirements. The home has in place robust policies and procedures for ensuring the protection of service users from harm and or abuse. EVIDENCE: The home’s Complaints and Adult Protection policies and procedures are robust in terms of protecting service users. Staff have received training in adult protection and discussion with the training needs co-ordinator indicated that further refresher training is planned. Since the previous inspection no complaints or adult protection referrals have been received by either the home or the Commission for Social Care Inspection. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home continues to fail to meet this standard due to the age and condition of the building. The home’s laundry facilities are adequate to meet the needs of the service users. On the day of the inspection the home was generally clean and tidy and free from any offensive odours. EVIDENCE: Environmental issues due to the age and condition of the building continue to impede on the home’s ability to meet this standard. However, this continues to be recognised by the registered provider who is progressing a programme of re-provision with a view to addressing this issue. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 19 The home’s laundry facility is situated away from food preparation areas, separated by two doors, in a position that does not intrude upon service users. The washing/drying facilities are industrial in nature. The laundry room has a sluicing facility. On the day of the inspection the home was generally clean and tidy and free from any foul or unpleasant odours. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 20 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home’s recruitment practice needs to be improved to ensure that all the documentary evidence required to be maintained in respect of staff employed at the home is held. Service users are supported by a team of staff who are appropriately trained and qualified. Service users are supported by a team of staff who are well supported to carry out their roles. EVIDENCE: During the inspection four staff files were sampled in respect of the home’s recruitment practice, all of which had gaps in terms of the documentary evidence required to be held under Schedule 2 of the Care Homes Regulations. The gaps included: • • • Three files - no evidence of Criminal Records check having been carried out. All files - no evidence of induction Three files - no evidence of training and development undertaken
DS0000017841.V290123.R01.S.doc Version 5.2 Page 21 Hamilton Lodge The home continues to employ a training needs co-ordinator who takes the lead on all the training for the home. Discussion with staff indicated that access to training is good. The training needs co-ordinator provided a database report that evidenced a range of training as being provided which included: • • • • • • • • • • • • • • • Fire training Food hygiene First Aid Manual Handling Abuse awareness Infection control Person centred planning Makaton Communication Dementia Epilepsy awareness Administration of rectal diazepam Medication updates Supervision skills Team building Discussion with the manager and staff evidenced that access to formal supervision has improved significantly since the previous inspection. The training needs database evidenced that staff have received training to equip them for this role. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 22 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users are supported and benefit from the management ethos of the home. The home needs to ensure that appropriate action is taken to ensure the health, safety and welfare of service users. EVIDENCE: The registered manager/general manager has significant previous experience of working in the care sector, although they continue not to be qualified at N.V.Q level 4 in management or care. However, they are supported by two home managers, both of whom are qualified, although the overall responsibility remains with the registered manager. The day to day operational responsibility is devolved to the respective home manager. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 23 Discussion with staff indicated that the ethos of the home had improved quite significantly since the previous inspection. The home’s certificate of electrical installation was identified to be out of date at the previous inspection and to date this situation remains. Provision needs to be made urgently to address this matter to ensure that the health, safety and wellbeing of service users is met. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 X 3 X 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 x 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 X 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x X 3 X X X 2 X Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 25 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 YA5 Regulation 5,14 Requirement The registered person must ensure that service users have a contract of residency which meets with regulatory requirements. The previous timescale set of the 31/05/06 was not met. The registered person must address the environmental issues and ensure that the premises are safe and well maintained. The previous timescale set of the 31/05/06 was not met. Timescale for action 31/08/06 2. YA24 16,23 31/08/06 3. YA34 19 (4b) The registered person must 31/08/06 ensure that staff are not employed at the home without first having obtained the information and documents specified under Schedule 2 of the Care Homes Regulations. The registered person must ensure that all reasonable actions are taken to ensure service users health and welfare. This relates to the need to ensure that the home has a
DS0000017841.V290123.R01.S.doc 4. YA42 23 (b) 31/08/06 Hamilton Lodge Version 5.2 Page 26 current certificate for its electrical installation. The previous timescale set of the 31/05/06 was not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations It is recommended that the service continues to look at ways in which this standard maybe further developed whilst the re-provision programme runs its course. Hamilton Lodge DS0000017841.V290123.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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