Inspection on 06/09/05 for Hamilton Lodge

This inspection was carried out on 6th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 11/06/09

Hamilton Lodge 07/05/08

Hamilton Lodge 15/05/07

Hamilton Lodge 20/07/06

Hamilton Lodge 10/02/06

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 08/07/2008.

CARE HOME ADULTS 18-65 Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB Lead Inspector Neal Cranmer Unannounced Inspection 6th September 2005 09:30 Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 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.V250431.R01.S.doc Version 5.0 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.V250431.R01.S.doc Version 5.0 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 54 Category(ies) of Learning disability (54), Physical disability (54) registration, with number of places Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate 54 persons under the age of 65 with Learning Disabilities who may also have Physical Disabilities 25th March 2005 Date of last inspection Brief Description of the Service: Hamilton Lodge is a care home registered to provide personal care and support to fifty-four 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.V250431.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days in September 2005, lasting 10.00 hours. The inspection process included: discussion with service users, home managers, the registered manager and staff. Tour of the premises included observation of communal living areas and gardens. During the course of the inspection a range of documentary evidence was sampled. Hamilton Lodge is in the midst of a major re-provision programme, designed to support service users to move on into accommodation that is more appropriate to continuing to manage their on-going needs. To facilitate this programme a project Team from Essex Social Services has been working at the home, liaising closely with the management team and staff. At the time of writing this report four service users had already moved on as part of the programme. Twenty of the forty-three standards were inspected, of these one was commended, six were met, ten were partially met, with the remainder being major shortfalls. What the service does well: What has improved since the last inspection? Significant improvement has been made in the way meals are provided. Access to food over and above that provided as part of the main menu has been enhanced by the devolvement of a budget to enable home managers to make additional food purchases. In addition, a fridge has been provided at Selbourne Court to enable food to be stored. Since the previous inspection the process of re-provision has taken off, with the first four service users from the main house moving out. A Project Team from Social Services has been working closely with service users, relatives and staff to lead on this project. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 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.V250431.R01.S.doc Version 5.0 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.V250431.R01.S.doc Version 5.0 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 and 5. The home’s Statement of Purpose continues to require amending to fully comply with requirements and provides all relevant information. The home must ensure that service users have contracts of residency which clearly lay out the terms and conditions of their stay at the home. EVIDENCE: The home’s Statement of Purpose was sampled. Reference was still seen to the home accommodating service users with dementia. In this respect the document continues to require clarification as the home is not currently registered to provide care of this nature. In all other respects the Statement of Purpose was deemed to meet with requirements. Three service users’ files were sampled from the main house; there was no evidence seen on file of any contracts of residency. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 8. Care plans require further development to help ensure that personal goals are fully recognised. There was evidence to suggest that service users are being kept informed of proposed changes appropriately. EVIDENCE: Three service users’ plans of care were sampled. There was evidence of identified needs and goals being set, with actions to be followed by staff to facilitate these. However, the structure continues to require further development to ensure that the action plan is specific to the individual’s needs. Discussion with staff from the Social Service Re-provision Team indicated that service users are accessing advocacy services. A number of service users spoke of an awareness of their proposed future moves from Hamilton Lodge. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 10 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): 13,14,15 and 17. Staffing resources at the home are having a negative impact on opportunities for service users to participate in the local community. Service users are well supported to maintain links with family and friends. The diet at the home was healthy and nutritious, although some on-going concerns continue around the food preparation facilities at the home. EVIDENCE: Discussion with staff during the course of the inspection indicated that they continue to feel limited by staff resources in the facilitating of ad hoc activities. The contracts of residency were unavailable in the files sampled so it was not possible to confirm whether the requirement from the last inspection to ensure that the contract price included the option for a seven day holiday outside of the home. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 11 Discussion with service users indicated that the home has an open door policy on the receiving of visitors; they spoke of being able to choose where they receive their visitors. Meals at the home continue to be provided by an external contractor. Four weekly menus were seen, which were seen to be varied and nutritious. The menus evidenced choices being available at dinner and tea times; this was supported by discussion with service users. Kitchen staff spoken with spoke of fresh fruit and salads being made available mid afternoon. The menus seen also evidenced suppers being provided; this was confirmed in discussion with service users. The kitchen facilities are industrial in nature. There was evidence of good hygiene practices being taken, and the latest copy of the Environmental Health Service’s report was seen. Meals continue to be provided to Selbourne Court via a heated trolley. The senior member of staff on duty at Selbourne Court spoke of the situation around access to food having improved significantly. The home now has a devolved budget for the purchasing of food over and above that provided by the home. The senior spoke of now having a fridge where food could be kept for the unit. The lunchtime meal was discreetly observed at Selbourne Court. The meal arrived pre-plated from the main kitchen and was seen to be pleasant and appetising. The lunchtime drink was seen to be dispensed directly from a one galleon plastic container. The meal was taken in a generally quiet, homely and relaxed atmosphere. Staff were observed supporting service users to eat, where assistance was required. The catering arrangements at Hamilton Lodge continue to fall below the National Minimum Standard. This is, however, recognised by the provider and plans are well in hand to redress this issue. It is, however, noticeable that improvements have been made since the previous inspection, although scope for further improvement continues. Service users spoken with spoke of the meals being nice. The issue highlighted at the previous inspection of staff purchasing biscuits and cakes from their own money for service users has ceased with the devolvement of the budget. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 12 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): 19. Records pertaining to service users’ healthcare needs were seen to require further development. EVIDENCE: The three care plans sampled were seen to contain evidence of healthcare appointments being kept, however the evidence of records pertaining to the outcome of these appointments was limited and required further development. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 13 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 The home’s Complaint Procedure is generally sound. The home’s Adult Protection Procedures are quite robust, although practice, in terms of how and when to make referrals, could be improved upon. EVIDENCE: The home’s Complaint Procedure continues to require further development to fully meet with requirements, inasmuch as it needs to contain the contact details of the local Commission for Social Care Inspection office. The home follows the Essex County Councils guidelines on the Protection of Vulnerable Adults. Discussion with the home’s Training Needs Assessor evidenced that all staff have received training in the protection of Vulnerable Adults. During the course of the inspection an allegation was brought to the attention of the inspector, which was then discussed with the registered manager, who subsequently implemented a Protection of Vulnerable Adult referral. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 14 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 The age and condition of the property is not conducive with creating an environment that is homely, comfortable or indeed safe for all of the service users residing at the home. EVIDENCE: Environmental issues due to the age of the building, specifically related to the main house, continue to affect the ability of Hamilton Lodge to provide a suitable environment. The grand staircase provides the only access to service users’ private accommodation. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 15 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): 31,33,34,35 and 36 Evidence suggested that staff were clear about their roles. Although staffing levels would appear adequate to meet basic needs, a review would be advisable. The home’s recruitment practices are generally quite robust in terms of protecting service users. Training provided at the home is comprehensive, and all staff benefit from having individual training plans. The home’s formal supervision practice needs to be reviewed urgently to help ensure that all staff receive formal supervision to enable them to carry out their roles effectively. EVIDENCE: Staff spoken with during the course of the inspection spoke of having job descriptions which were reflective of their roles. Staff spoke of being aware of, and having copies, the general Social Care Council’s Code of Conduct. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 16 Discussion with staff both in the main house and at Selbourne Court indicated that the staffing levels are one senior and three carers in the morning, with one senior and two carers in the afternoon. Further discussion with staff indicated that while they felt this level just about meets service users’ basic needs, it did not allow for any quality time. Four staff files were sampled relating to the home’s recruitment practices. Whilst most of the documentary evidence required under Schedule 2 of the Care Homes Regulations was evident, it was seen to be disseminated across a number of files held in the manager’s office. Discussion with the registered manager evidenced that the organisation has dispatched a performa of documentary evidence to be held in staff files, to be implemented in October 2005, which should address the issue of evidence being kept in more than one place. The home employs its own N.V.Q/ Training needs assessor, who organises all aspects of staff training/induction. The home’s induction process is carried out over six weeks and is facilitated by the Training Needs Assessor. During this period new employees cover units of the Learning Disabilities Award Framework. Also, during the first three weeks of their employment, new employees work in a supernumerary capacity; for the remaining three weeks of their induction period they work supervised. The home employs approximately forty care staff, of whom the Training Needs Assessor reported fourteen being qualified at N.V.Q level 2 or better. In addition, a further twelve are registered for the award, 50 of whom are scheduled to complete the award by the end of this year. Further discussion with the Training Needs Assessor indicated that all staff have received mandatory training in the last year. Discussion with staff indicated that access to training is excellent, felt largely to be as a result of the input received from the Training Needs Assessor, who all spoke of being extremely helpful and supportive. Significant training has taken place around speech and language and a number of key workers have received training around acquired brain injury. The Training Needs Assessor stressed that all staff have an individual training plan which is reviewed annually. Discussion with staff relating to supervision was variable, depending on whether staff were working in the main house or Selbourne Court. At best staff were receiving supervision every 6-8 weekly, whilst others spoke of not having received any formal supervision for anything up to a year. All staff Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 17 providing formal supervision spoke of having received training to prepare them for the role. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 18 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): 37,38 and 43. Although the registered manager has extensive experience of working in the care sector, they are not N.V.Q qualified. Evidence suggested that the ethos of the home is variable, dependent upon who was spoken to. Lines of accountability within the home were clear. EVIDENCE: The registered manager does not have an N.V.Q level 4 in care or management, although they do have significant experience of working in the care sector. The manager spoke of the Disabilities Trust’s probable intention not to pursue this, given the registered manager being close to retirement age. However, both the home managers do have N.V.Q level 4 in care and both have been put forward for the Registered Managers Award. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 19 Discussion with staff pertaining to the ethos of the home was variable depending on whether you spoke to staff from the main house or Selbourne Court. Some felt that the management team were open and transparent, whilst others did not. Discussion with staff indicated that there appeared to be clear lines of accountability both within the home and to external management. However, discussion with a number of staff during the inspection evidenced the need they felt for communication to be better, particularly given the major reprovision programme that is underway. A number of staff spoke of feeling de-motivated and devalued. Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x 1 Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x 3 x x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 2 14 1 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 3 x 2 3 4 2 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hamilton Lodge Score x 2 x x Standard No 37 38 39 40 41 42 43 Score 2 2 x x x x 3 DS0000017841.V250431.R01.S.doc Version 5.0 Page 21 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 YA1 Regulation 4 Requirement The registered person must review and produce an up to date Statement of Purpose, to include all details as required in Regulation 4 (1) (c) Schedule 1 of the Care Homes Regulations and Standard 1 of the National Minimum Standards, and ensure a revised copy is submitted to the CSCI. The previous timescale of the 31/3/2005 was not meet. The registered person must ensure that service users have a contract of residency. The registered person must ensure that there is an identifiable individual service user’s plan which is based upon assessed need. The previous timescale of the 31/03/2005 was not meet. The registered person must ensure that staffing levels at the home are adequate to facilitate service users participation in the local community. The registered person must ensure that contracts of residency make provision for the DS0000017841.V250431.R01.S.doc Timescale for action 31/12/05 2 3 YA5 YA6 5,14 15 31/12/05 31/12/05 4 YA13 16 (m) 31/12/05 5 YA14 4 31/12/05 Hamilton Lodge Version 5.0 Page 22 6 YA19 12 7 YA22 22 (a) 8 YA24 16,23 9 YA33 18 (a) 10 11 YA36 YA37 18 (2) 9 basic contract price to include the option of a seven-day holiday outside of the home. The registered person must ensure that records pertaining to service users’ healthcare needs are clear and concise. The registered person must ensure that the home’s Complaint Procedure includes the contact details of the CSCI. The registered person must address the environmental issues, and ensure that the premises are safe and well maintained. The registered person must ensure that at all times staff are provided at the care home in appropriate numbers to meet the health and welfare needs of service users. The registered person must ensure that all staff receive formal supervision. The responsible person must make provision for the registered manager to achieve N.V.Q level 4 in care and management. Previous timescales set have not been meet. 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA 38 YA 17 Good Practice Recommendations The registered person should, in relation to the conduct of the home, ensure an open and inclusive atmosphere for staff. The registered person should, in relation to service users being served drinks, ensure they are prepared individually, as opposed to from pre-prepared containers. DS0000017841.V250431.R01.S.doc Version 5.0 Page 23 Hamilton Lodge 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hamilton Lodge DS0000017841.V250431.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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