Inspection on 07/05/08 for Hamilton Lodge

This inspection was carried out on 7th May 2008.

CSCI found this care home to be providing an Adequate service.

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 8 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 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 08/07/2008.

CARE HOME ADULTS 18-65 Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB Lead Inspector Deborah Kerr Unannounced Inspection 7th May 2008 09:15 Hamilton Lodge DS0000017841.V364303.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.V364303.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.V364303.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 care@hamiltonlodge.org.uk 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 John Bethall 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.V364303.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 15th May 2007 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/or have a physical disability. Accommodation is provided in three units, which cater for varying levels of dependency. The main residence is the large country manor house, Selbourne Court is a newer, single storey unit built on a site adjacent to the main house and the third unit is a small cottage where one person lives. Both the main house and Selbourne Court are staffed separately and led by a home manager. The home is set in vast well maintained grounds, located in the 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. People using this service also have access to a taxi. Currently fees range from £782.50 to £1734.53 per week. The lower figure is based on 50 care hours a week. People with care needs in excess of 50 hours a week are charged at £15.19 per additional hour. Additional charges are made for chiropodist and towards the cost of the television licence. This was the information provided at the time of key inspection, people considering moving to this home may wish to obtain more up to date information from the care home. CSCI inspection reports are available from the home and our website at www.csci.org.uk Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection, which focused on the core standards relating to adults aged 18-65. The inspection was unannounced and lasted nine and a quarter hours on a weekday. This report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from eight relatives and two staff ‘Have Your Say’ surveys and the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI). This document gives providers the opportunity to inform us about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). Two residents ‘Have Your Say’ surveys were completed and returned to the Commission prior to the inspection, however due to the profound learning disabilities the individuals had been supported by staff to complete the questionnaires, therefore it is not possible to ascertain if these are a true reflection of the individuals thoughts. We (CSCI) also carried out a safeguarding thematic probe. This is how we gather additional information on a particular theme from a key inspection. This thematic inspection focused on issues surrounding ‘safeguarding’. We looked at the National Minimum Standards (NMS) for protection to assess whether people who use services are protected from abuse, and recruitment to assess whether people who use the service are supported and protected by the services recruitment policy and practice. A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home, one relative and five members of staff. The service manager was not present at the home on the day of the inspection, however they were spoken with over the telephone to complete the thematic probe questions around safeguarding and to provide feedback about the inspection. The manager’s from the main house and Selbourne Court were available during the inspection and fully contributed to the inspection process. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? One requirement and one recommendation were made at the previous inspection. Information provided in the AQAA and verified at this inspection confirmed that action has been taken to address the recommendation, to improve arrangements for the preparation of meals. However, the requirement for the home to obtain a current certificate for its electrical installation has not yet been completed. Improvements have been made to the environment, these include refurbishment of the main house to provide accommodation for up to eight people. Two rooms on the ground floor have been made to facilitate wheelchair users. Selbourne Court has had an extension built to incorporate a training kitchen, meeting room and a main kitchen and dining room making the unit self reliant. The gardens at the rear of Selbourne Court have been nicely landscaped with tables and chairs provided for people to use in good weather. The pavilion has been moved and now provides a sensory room and activities centre. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 7 What they could do better: Information needs to be updated in the statement of purpose to reflect the changes made to the service, including where there has been changes of service manager and services director. Each person living in the home must be provided with a copy of terms and conditions of residence (contract), which sets out the amount, and method of payment of fees. This will ensure people living in the home know that services are provided and what they must do. More could be done to ensure people living in the home have care plans, which look at all areas of their life in a person centred way. This includes making sure that support plans are completed and kept up to date following assessments by specialists. This will ensure staff are provided with guidance to support the individual and help them manage their condition and /or behaviour. Where possible, the individual has been involved in the development of their care plan, which is written in a format that the individual would be able to understand. Some parts of the grounds, especially to the front entrance and side of the main house would benefit from some attention to improve the appearance of the home. The services manager needs to ensure that there is an annual quality assurance process, which seeks the views of people living in the home or other people connected with the service. The home’s safe working practices are in need of improvement to ensure that people living and working in the home are protected. This specifically relates to the homes electrical installation certificate. This has been a repeated requirement since 31st May 2006. An electrical installation test was completed in August 2007, however other than a copy of a quote for work required, there was no certificate available to confirm the work has been carried out. Additionally, there was no record that Portable Appliances had been tested within the last year. The manager must take adequate precautions against the risk of fire, including making adequate arrangements for containing fire. Where they have identified that they are having Dor guards fitted to specified doors, the CSCI must be notified to confirm that these have been fitted. A record of the temperature at which food is served must be kept. This will minimise the risk of food poisoning and ensure food is served above the recommended temperature of 65 degrees. The management team must ensure that any event, which adversely affects the well-being or safety of any person living in the home is reported to the Commission (CSCI) in line with regulation 37 of the Care Homes regulations 2001. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 8 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. The summary of this inspection report can be made available in other formats on request. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 9 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.V364303.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, People who use the service experience good quality outcomes in this area. Prospective people to use this service will have their needs assessed and will be supported to try out the home before they, and their representative, make a decision about whether the home will meet their specific needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A copy of the home’s statement of purpose was provided at the inspection, this gives detailed information about the home and its services. However, information needs to be updated to reflect that the Coach House is no longer used as a small group home, also to detail the new specialised service in the main house for up to eight people with autism. Additionally, the names of the service manager and services director should be updated as well as the contact details for the Commission (CSCI) to reflect the Regional Contact Team (RCT). Three peoples care plans examined identified that one person had been issued with a contract. The contract formed part of the service users guide to the service including how to complain, the individual’s fees and arrangements for payment of fees. This information has been provided in an easy read pictorial format with the individuals photograph on the front and room number. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 11 Information provided in the AQAA and verified at the inspection confirmed that potential users of the service are supported to visit the home with their families or carers before moving in. People are encouraged and supported to move in over a period of time including day visits and overnight stays. This is an area the service manages well. Extra staff had been rostered on the day of the inspection to meet an individual moving into the home the following week. These staff escorted the individual back to their current placement to get to know them in familiar surroundings. A care plan has already been completed, which covers all aspects of the person’s health, personal and social care. This has been developed in conjunction with staff at the individuals current assessment centre and provides good guidance for staff to support them to make the transition from education into residential care. Time was spent with a relative who has been impressed with the manager and the staff, they commented, “they have a ‘can do’ attitude and the focus is on the people living in the home”. They were not aware of any information about the home, but commented that the social worker had been very helpful setting up the placement for their relative. They had introduced them to Hamilton Lodge and felt well informed of the services available. They confirmed that a pre admission assessment had been completed for their relative, before a decision was made if Hamilton Lodge would be a suitable placement. Three people from the trust, themselves and the General Practitioner (GP) were involved in process. They confirmed they had been able to visit and look around, and that they had visited more than once. They also described the manager of the main house as approachable and they had been able to discuss the best outcomes for their relative. They stated that they would have no worries about raising concerns with the manager, should the need arise. Their only concern was that the main house is being set up as a new service, with it a relatively new staff team. Two new staff had commenced employment the previous day. Discussions with them and other relatively new staff confirmed that they had received excellent training as part of their induction. Training certificates and records confirmed staff have received relevant training to ensure they have the skills to deliver the care and services, set out in the homes statement of purpose. Discussions with staff confirmed that they have an excellent understanding and knowledge of the people using the service and were able to provide a verbal account of each person’s needs. Examination of care plans confirmed that the organisations consultant clinical psychologist, service manager and home manager had completed pre admission assessments to ensure they could provide appropriate facilities, staffing and specialist services to meet the individuals needs. Additionally, a new assessment had been undertaken where an existing service user’s needs had changed. This was to ensure the service identified where additional support was required to help them maintain their quality of life. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, People who use the service experience adequate quality outcomes in this area. People using this service will have their needs identified, reviewed and set out in a care plan, however the development and review of these is variable, and do not always have up to date information to reflect how their needs are to be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three people’s care plans were examined, two from the main house and one from Selbourne Court. The care plans varied in content, those relating to people living in the main house who have profound learning disabilities had been developed using a more person centred approach, based on information taken from the comprehensive pre admission assessments. The care plan of the individual living in Selbourne Court contained a lot of information covering all areas of their life, but did not reflect that they had been involved in the development of their plan, neither had it been written in a format that the individual would be able to understand. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 13 Information provided in the AQAA and confirmed in discussion with the services manager identified there are plans to revisit the needs and aspirations of all people living in the home. The service employs it own psychologist who is to be involved in the process to support staff to develop more person centred care plans. Care plans in the main house had been divided into two parts, information and working. The information part consisted of twelve sections covering all aspects off the individual’s health, personal and social care needs. These covered the individual’s likes and dislikes, including ‘my personality’, which had been written in the first person, for example ‘things that make me happy’ and ‘people who matter to me’. The working part of the plan contained monitoring records and personal (daily recording) notes. These gave a good account of the personal care provided, mood, activity and interaction of the individual. The care plan of the individual residing in Selbourne Court contained a lot of information and reports about their health and welfare following specialist intervention. However, support plans to reflect the recommendations made following these assessments, and to provide guidance for staff, had not been completed. The information in some cases was not relevant or up to date, making it difficult to establish the person’s current needs. For example, following an assessment by the Speech and Language Therapist in July 2006 a detailed plan had been implemented to support the individuals eating and dietary needs. Although these recommendations remain much the same, the plan needs to be updated to reflect that the individual has been diagnosed as diabetic and where they have eating, drinking and swallowing problems associated with dementia. The personal notes of one individual had a detailed account describing where they were showing signs of non-responsive and agitated behaviours associated with bi polar. These cross referenced with a behaviour plan and behaviour recording sheet, however the plan had not been completed. The recording sheet uses a coded system to reflect patterns of behaviour developing. These provided details of a recent three-day time frame with a good description of the individual’s behaviour, how they were supported and when PRN (as required) medication had been administered to help calm the individual. The other two care plans also contained behavioural support plans. These identified the behaviour causing concern, those agreeing to the plan and background information. They also identified long and short term goals, conditions and environmental factors, (for example noise, crowds) and other triggers likely to result in incidents and plans to avoid and prevent further incidents. They described the actions staff need to take to promote positive behaviours. All staff are SCIP trained, to ensure that problematic behaviours are understood and dealt with appropriately. The training includes instruction on deflection techniques when managing behaviours where people living in the home are likely to be aggressive or cause themselves harm. Time was spent Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 14 talking with staff in the main house and observing their interaction with an individual living there. Staff’s behaviour was appropriate, friendly but providing firm boundaries to support and safeguard the individual. Care plans contained detailed risk assessments covering all aspects of daily living and supporting people out in the community. These identify the nature of the risk and strategies to safeguard the individual, whilst enabling them to take part in their chosen activity. Activity plans identified individuals are involved in some decision making about the home, such as day-to-day living and social activities. People are encouraged to help with domestic chores such as the laundry, tidying their rooms and developing cooking skills. A comment received in a relatives ‘Have Your Say’ survey confirmed this stating, “my relative is not really able to make choices, but they are consulted”. The care plan of the individual from Selbourne Court had basic information informing them of their rights and responsibilities whilst living in the home. These included their right to privacy, dignity and respect, and also stated the consequences to the individual if they harmed others in the home, which may result in their rights being limited (infringed). Where the individual’s rights were being limited, the reasons why and the steps taken by staff to support the individual had been assessed and agreed with the individual and documented in their care plan. Information provided in the AQAA and verified at the inspection confirmed the views of people who use the services are incorporated into what the service does. This includes obtaining information at reviews and assessments, the use of advocates, feedback from families, day services, key workers, formal and informal conversations with people living in the home and observing and responding to individuals gestures and behaviours. Additionally, all staff are trained in inclusive communications techniques (ICE) and use different language formats suited to the individual such as signs, symbols, pictures and text boards. The communication passport seen in one care plan clearly reflected how the individual communicates, using and understanding some Makaton and their own signs, images and written words. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17, People who use the service experience good quality outcomes in this area. People who use this service are supported to make choices about their lifestyle and take part in social and recreational activities, which meet their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirms that people living in the home are supported to take part in community-based activities, that are age appropriate, and to maintain links with those important to them. This was confirmed in many comments received from relatives in ‘Have Your Say’ surveys, these included, “the carers have time for the people who live in the home and often on unexpected visits you find them sitting talking or playing games with them” and “staff help my relative to enjoy the few activities that they can participate in” and “my relative is very happy in Selbourne Court, staff take them out, they love to go and see the farm animals and also to visit me”. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 16 A friendship group has been established to maintain links with people who previously lived at Hamilton Lodge, who now live in the community. They are invited to the home for regular coffee mornings, entertainment evenings and discos. Relatives ‘Have Your say’ surveys confirmed they retain contact with their relative, comments included, “people are always made welcome when they visit” and “my relative has delightful carers who helps them with visits and never forgets times of celebration like mothers day”. The AQAA reflects that staff listen to people using the service and plan achievable goals with regards to educational, leisure, social and independent living activities. This was confirmed in care plans and in discussion with the assistant home manager of day services and activities. Care plans contained personal activity plans, which included how the individual is supported throughout the day to complete daily living tasks. They also contained information about the individuals preferred activities, these included ball games, bike rides, gardening, music and relaxation, tactile photo puzzles and games and walks out. People are supported through the risk management process to access activities in the community including horse riding, swimming and trampoline via the bounceability service. Additionally, trips out are planned according to requests, these have included visits to Tropical Wings, Stoneham Barns, the seaside, local cafés, theatre, eating out, coffee mornings at Clacton voluntary services, journeys on boats and trains and other places of interest. Sixteen people using the service have access to adult education either externally or internally. An onsite Outreach Course is held every Friday afternoon “experiencing my world” which is a course to enable people with more complex needs to access education. Other people attend adult education colleges in Clacton, Harwich and Colchester, which provide a range of courses, including pottery, stimulation courses using sensory techniques, making snacks, arts and crafts, music and about local history. Activities provided on site include gardening, involving a kitchen garden where people are supported to produce vegetables for the home and to sell. Other activities include arts and crafts and life skills, which involves planning, shopping and cooking food in the training kitchen. The home has it’s own sensory facility on site, which is always accessible to people to use when they want to. A carpenter visits the service fortnightly to provide woodwork sessions for three people. The manager of day services is currently looking into establishing their own pottery, as it is difficult to access courses through colleges. They are also looking to re develop day services. They are networking with other organisations exploring ideas for a horticultural work experience project and developing an indoor sports facility on site. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 17 A previous requirement was made regarding the arrangements for preparing meals. These were being cooked in the kitchen in the main house and transported to Selbourne court, which was not conducive with a homely environment. Selbourne Court now has their own kitchen where all meals are prepared. The manager of the main house did state that as there had only been two people living in the main house their meals were being prepared in Selbourne Court, however with the addition of a third person a cook has been allocated to the main house as of the following week. People were observed laying tables and eating their meal in Selbourne Court. It was a happy and relaxed atmosphere, they told the inspector “it is lovely here and we get nice food”. There is a four-week rolling menu in place, with a good variety of meals providing people with a nutritious and balanced diet. A menu chart shows where people have been able to make a choice of what they would like to eat. Food in the home is of a good quality, mostly home cooked, well presented. The cook was aware of the dietary needs of people, including where individuals had been prescribed special diets by the speech and language therapist. Food stores seen reflect a good range of dry and fresh foods available. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, People who use the service experience good quality outcomes in this area. People using this service are supported to have their physical, emotional and health needs assessed, however more could be done to ensure plans are kept up to date to reflect changes in their health to ensure their individual needs will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that people living in the home are supported to have access to health care services. Dates and details of health appointments are clearly recorded in peoples care plans. The care plan of an individual identified that following an Endescpoy examination they were diagnosed with a hiatus hernia and needed to be admitted to hospital for surgery. To support the individual through this process the manager contacted the hospitals physical health facilitator for people with learning disabilities to ensure they were given equal rights to access health care and to support the individual throughout their stay. An easy read and pictorial form called ‘All about me’ was completed providing a person centred plan for hospital staff to understand the needs of the individual whilst in hospital and to ensure that the individual was prepared for what would happen when they arrived at hospital. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 19 Relatives ‘Have Your Say’ surveys confirmed people are receiving the care and support they need. Comments included, “what the home does well is the personal care and love the staff give” and “I always hear of any medical attention regarding eyes, teeth and visits to hospital” and “my relative has severe learning disabilities, the care home responds very well to their every need, the only time I have had any concerns regarding their welfare was when there were changes to my relatives medication, but with the help of the specialist at the local medical centre the matter was resolved”. Additionally, information received in one health professional survey, stated that they felt the staff provide care to all people living in the home to high standard. Care plans contained letters from health professionals setting out plans to support individuals to take control and manage their own health care. However the plans to help manage their conditions, such as autistic spectrum disorder, dementia and varicous veins, had not been completed. Similarly, the care plan in place to manage their dietary needs, requires updating to reflect foods that are a risk to them following diagnosis of diabetes and the introduction of a soft food diet and the use of thickening agents to help manage eating, swallowing and drinking problems. Information provided in the AQAA and verified during the inspection confirmed that personal care is tailored to the individual needs of people using the service, allowing them to choose their clothing and to maintain their privacy and dignity. All people living in the home were appropriately dressed and well presented on the day of inspection. Medication procedures were looked at in Selbourne Court. The practice of administering medication is generally safe and well managed. The Medication Administration Records (MAR) charts have a front page with a photograph of the individual to avoid mistakes with the person’s identity and a description of how the individual prefers to take their medication. MAR charts inspected were completed correctly, with no gaps. Staff had made good use of the reverse of MAR to reflect when proprietary medications such as paracetomol had been given, the amount and reason for administering the medication. A list of staff authorised to administer medication and their sample signatures, as they would appear on the MAR charts are held at the front of the MAR folder. This is so it can be easily determined, who has administered medication at any one time. The MAR folder and care plans contained protocols in respect of PRN medication prescribed to manage incidents of agitation and challenging behaviour. These provided guidance for staff when and how they should use PRN medication. It was noted that these protocols appropriately highlighted alternatives to drug intervention and that the line manager’s approval is needed prior to administering the prescribed drug. Medication is locked in a storage cupboard in the office, to which only seniors hold the key. Limited stock is held. No person living in Selbourne Court is Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 20 currently prescribed controlled drugs, however staff keep diazepam and lorazepam separately, in a locked tin, within the medication cupboard. Should controlled drugs be prescribed for one or more persons it is a legal requirement that the home has a separate metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall, with either rawl or rag bolts. A locked tin within the medication cupboard does not meet legal requirements. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23, People who use the service experience good quality outcomes in this area. People who use this service are supported to express their concerns and have access to a robust and effective complaints and safeguarding procedures, which protect them from abuse, neglect and self harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear and effective complaints procedure and an appropriate adult safeguarding policy in place, which includes clear guidance of the procedures staff must take to report allegations of abuse. These will need to be amended to reflect the change in the contact details of the Commission for Social Care Inspection (CSCI). Due to the complex and specialist needs of the people using this service and their level of understanding, the ability of individuals to make a complaint is varied. The complaints procedure is in an easy read format, telling people how to complain and what will happen. The procedure provides examples of ‘things that you may not be happy about’ for example, ‘if people are not kind to you’ and ‘things you would like to do but are not able to because’. For people with limited means of communication it is reliant on staff and relatives observing and responding to individual’s gestures and behaviours to identify if the individual was unhappy or upset. Staff had an excellent understanding of the needs and different personalities and behaviours of each person in their care and were confident they would be able to identify by their behaviour if something was wrong. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 22 Staff spoken with are aware of peoples rights and how to refer a complainant to a senior member of staff. They were clear about their duty of care and what they would do if they had concerns about the welfare of an individual living in the home. The complaints procedure should be displayed in a number of areas around the home, for people using the service and visitors so that they are clear of how to make a complaint. Consideration should be given to how and where these can be displayed, so that they are accessible but do not pose a risk to people whom eat inappropriate objects. Comments, complaints and suggestions forms seen confirmed that neither the Commission (CSCI) or the home have received any formal complaints or adult safeguarding referrals in relation to this service, since the last inspection. This was confirmed in comments received in relatives ‘Have Yours Say’ surveys comments included, “ I dont think I ever will need to complain as the service and the care my relative gets is excellent” and “there has rarely been a need to complain”. As part of this inspection we undertook a thematic probe, which focused on issues surrounding ‘safeguarding’. We looked at the National Minimum Standards (NMS) for protection to assess whether people who use services are protected from abuse, and recruitment to assess whether people who use the service are supported and protected by the services recruitment policy and practice. Our findings were that staff are made aware of Protection Of Vulnerable Adults (POVA) issues. Training of staff in the area of protection is regularly arranged by the home, it is also an integral part of the induction process. Training is provided to staff, which specifically relates to adults with learning disabilities and challenging behaviour, which focuses on constructive ways of diffusing and guiding people away from dangerous situations without the use of restraint. The emphasis is on identifying patterns of behaviour and deescalating behaviour, which could lead to episodes of challenging behaviour. The service has robust recruitment procedures are in place. Staff files seen confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check. Additionally, the service has one individual living in the home under the age of 18, therefore some staff have begun the process of Child Protection (POCA) training. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29, 30, People who use the service experience good quality outcomes in this area. The physical design and layout of the home enables people who use this service to live in a safe, well maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback obtained through discussion with people visiting the home and relatives, ‘Have Your Say’ surveys was complimentary about the facilities and accommodation. Comments included, “I am impressed with the size of the home and available space, room sizes and the grounds” and “I can find no fault with the home, it is in a beautiful spot in the country and plans are constantly being made to improve the accommodation”. The home is set in eighteen acres of grounds and woodland. Some parts of the grounds, especially to the front entrance and side of the main house would benefit from some attention to improve the appearance of the home. Accommodation is provided in three 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 people with autism and associated disabilities. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 24 Selbourne Court is a newer, single storey unit built on a site adjacent to the main house providing accommodation for up to 18 people with learning disabilities and the third unit is a small cottage where one person chooses to live independently. A tour of the environment confirmed both units have aids and equipment to encourage maximum independence and comfort for the people living in the home. These include grab rails, hoists and hydro tilt baths. Information provided in the AQAA and verified at the inspection confirmed that there has been a programme of refurbishment and maintenance to both the main house and Selbourne Court. The main house has been refurbished creating 8 single occupancy rooms with en-suite shower and toilet facilities. Two of these on the ground floor are accessible for people with a physical disability. There is a selection of communal areas, consisting of wide and spacious corridors, a lounge, dining room and a quite room. The dining room has recently been redecorated, and although it looks clean and fresh, there are no pictures on the walls, giving it a clinical feel rather than being homely and inviting. The lounge is in the process of redecoration. There are further plans to turn the quite room into a sensory room. There is one communal bathroom in the main house. There are plans to expand the bathroom to install a freestanding adapted bath to provide easier access for people with disabilities and make it easier for staff to support individuals with their personal care. All doors throughout the main house and doors to the outside are operated on door codes for security and to safeguard people living there. There are pads for people living in the home to release doors internally where access to areas is safe. All radiators thought the main house have been covered to protect people living there from the risk burns. One bedroom on the first floor in the main house had the door propped open with a chair. The manager explained that the person likes their door open and had already identified this is an issue. To protect people living and working in the home they have arranged to have a dor-guard fitted to the bedroom and lounge doors so that they will close automatically in the event of a fire. The laundry facilities in the main house were clean and tidy with appropriate equipment to launder clothing and bedding, including a commercial washing machine with a sluice programme for dealing with soiled linen. People who use the service are encouraged to help with their personal laundry, however access is restricted for their safety unless a member of staff accompanies them. There is a main kitchen with an additional training kitchen on the first floor for people to learn and develop basics cooking skills. Selbourne Court is divided into three zones with a large communal lounge, dining area and kitchen in the centre. Communal rooms are well furnished with domestic style furniture, carpets and curtains. All areas of the unit are accessible for people, who are wheelchair users. Each zone has 6 bedrooms, with a conservatory at the end, a communal bathroom, toilet, sluice and Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 25 laundry. One conservatory to the front of the building has been rebuilt to provide a training kitchen and a meeting room. Plans are in place for the remaining two conservatories to be redeveloped so that each zone has their own training kitchen. Behind Selbourne Court a pavilion has been erected, which has a sensory room and area for arts and crafts. The gardens have been landscaped providing a water feature and tables and chairs for people to use in good weather. All bedrooms in both units are suitable for the needs of their occupants with suitable lighting, safe radiators, en suite facilities, individual bedding and colour schemes. Personal effects reflect people’s hobbies and interests. Appropriate hand-washing facilities of liquid soap and towels are situated in all en suite facilities where staff may be required to provide assistance with personal care. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when washing their hands, taking a bath or shower. Currently there are two people living in the main house and seventeen in Selbourne Court. People were observed moving freely around both houses and the grounds spending their time as they chose. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36, People who use the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support the people who use this service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Relatives ‘Have Your Say’ surveys provided mixed views about staffing levels. Comments included, “there are always plenty of carers about when I visit and my relative and other residents are often taken on trips” and “the carers have time for the people who live in the home and often on unexpected visits you find them sitting talking or playing games with them” however, other comments suggested “more personal attention to detail would be desirable, but the staff always appear to be busy and sometimes reliant upon agency staff who are not tuned in to the personal needs of each person” and “most things are to a fairly good standard, but more personal attention is needed, this may be due to a shortage of time and sometimes of staff”. The main house and Selbourne court have separate staff teams. Examination of the duty roster confirmed there is adequate staffing numbers throughout the day to meet the needs of people using both services. Information in the AQAA shows the home have reduced the use of agency staff, in the last 3 Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 27 months the home have used agency on just two occasions. The roster for the main house reflects there are 4 staff on duty between the hours of 7am to 10pm with 2 waking night staff. The night staff ratio is to increase to 3 on the following Monday when a new client moves in. The duty roster for Selbourne Court reflects there is a senior plus 4 care staff on the early shift and a senior plus 3 care staff on the afternoon shift with 2 waking night staff. Staff confirmed staffing levels are good compared to other places they have worked and they felt there is sufficient staff to meet the personal and social care needs of people using the service. Staff spoken with felt that their recruitment was done well and fairly, and that they received good induction training. The Disabilities Trust have produced their own induction pack which provides guidance to staff to complete their induction in line with Skills for Care and the Learning Disabilities Qualification (LDQ) induction standards. The requirement is for staff to complete the induction within 12 weeks of commencing employment with the aim of ensuring they have the skills and knowledge to understand the role of job and how to put these into practice. Time was spent talking with three most recent employees about their induction training and safeguarding. In their first week they had completed moving and handling and fire safety, their second week included POVA training, epilepsy and makaton training. As part of their indication they had watched a video, which provided a persons perspective of life with autism. Comments about staff provided in Relative’s ‘Have Your Say’ surveys were mostly positive. These included, “the staff are wonderful people, they keep my relative well dressed and clean. I think they are doing a great job looking after them” and “I have met my relatives carers, they are lovely, well informed people and very loving”. However, other comments included, “overall we are happy with the level of care and attention but the attitude and skills of staff appears to vary quite considerably, although overall the standards are satisfactory” and “as we are not there all the time one has to put trust for the staff’s ability to deal with situations as they arise. I know that they do take exams to gain these skills, however, the range of experience, skills and attitudes of staff varies quite considerably. Information provided in the AQAA stated staff are well trained. This was confirmed in discussion with staff, who confirmed they had received excellent training since joining the organisation. All staff have their own training plan, which monitors training completed and where additional training is required. Most recent training has included, fire safety, manual handling, first aid, food hygiene, abuse awareness, health and safety including Control of Substances Hazardous to Health (COSHH) and ICE project (communications), Person centred planning, confidentiality, and SCIP (positive behaviour training). Additional training to meet specific needs has included, epilepsy, dementia awareness, autism and brain injury training. Forthcoming training seen Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 28 advertised covered dysphasia (swallowing) training by the speech and language therapist and stroke awareness sessions. Staff authorised to administer medication have completed medication training provided by the Trust and have also completed training provided by the pharmacist for using the Monitored Dosage System (MDS). The AQAA identified that full staff checks are carried out prior to appointment to safeguard the people living in the home. Staff files examined confirmed all the relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker are obtained prior to commencing employment. These included Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks, 2 references, photographic identification, and a completed application form, which reflected the individual’s career history. Additionally, the service manager and training advisor have both completed ‘train the trainer’ training to cascade POVA and POCA (child protection) training to staff. All care staff are required to complete National Vocational Qualification (NVQ) at level 3. This is compulsory on completion of their 6 months probationary period. The home currently employs 38 care staff the other 16 staff are ancillary posts. 21 staff have obtained NVQ, with 8 people working towards completion. Additionally, the home has 2 bank staff, 1 is working towards completion of their NVQ. These figures reflect the service has achieved the National Minimum Standard (NMS) recommended ratio of 50 of care staff to hold a recognised qualification. Staff spoken with confirmed that they felt the manager was very supportive and was always available, if issues or problems arise and that they received regular supervision. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42, People who use the service experience adequate quality outcomes in this area. The management team are competent and qualified to run the home, however more needs to done to seek the views of the people using the service and to ensure safe working practices are robust to protect the health and welfare of people living and working in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Hamilton Lodge has a new service manager in post who is currently applying to us (CSCI) to become the registered manager for the service. The AQAA reflects they have the required qualifications and experience to manage the home. They are a qualified social worker and have completed the advanced management for care and certificate in management. Additionally, each unit has a separate home’s manager. Both managers have worked at Hamilton Lodge for seventeen years and have completed their National Vocational Qualification (NVQ) level 4 and the Registered Managers Award (RMA). Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 30 Discussion with staff and a relative indicated that the management ethos of the home is good, being open and transparent. All of the staff spoken with confirmed the management team are approachable and provide a good sense of leadership and direction. The service manager completed the AQAA when we asked for it, which provides clear and relevant information. The AQAA informed us about changes that have been made to improve the service and identifies where improvements need to be made and how these are to be implemented. The service manager demonstrated a clear understanding of the work required to improve and develop the service. The AQAA identifies where the Trust are planning to make changes to further develop the service and reflects that they have received positive comments from the families of people who use the service, about what they are trying to do. However, there has been no quality assurance to seek the views of people living in the home or other people connected with the service, since 2005. Each person using the service has a ‘my money plan, which states the level of support they require to manage their own money. Where the individual has no understanding of value of money, staff support them to access their money through the office, all receipts and records are kept. The home’s safe working practices are in need of improvement to ensure that people living and working in the home are protected. This specifically relates to the homes electrical installation certificate. Having checked our records, this has been a repeated requirement since 31st May 2006. An electrical installation test was completed in August 2007, however other than a copy of a quote for work required, there was no certificate available to confirm the work has been carried out. Additionally, there was no record that Portable Appliances had been tested within the last year. The service manager identified they had contacted a contractor to carry out PAT testing through the Trust, however they had failed to turn up. Maintenance and service checks had been carried out on hoists, oil tanks and vehicle tail lifts. The fire logbook confirmed that fire-fighting equipment and fire alarm had been serviced. Records showed that the fire alarm is also tested weekly using different zones and regular fire training and drills take place. Inspection of the kitchen in Selbourne court identified all records in accordance with food safety standards were being maintained with the exception of a record of the temperatures at which food is served to ensure food is cooked and served above 65 degrees. The service has good records to reflect where incidents and accidents have occurred. People’s care plans contained detailed information about incidents of self-injury and how these had been managed. However, information in an individuals care plan identified where a medication error had occurred, which had not been reported to us in line with regulation 37 of the Care Homes regulations 2001 to report any event which adversely affects the well being or safety of any service user. Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 31 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 4 3 3 4 4 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 2 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 2 X Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? YES 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 Requirement Each person living in the home must be provided with a copy of terms and conditions of residence (contract), which sets out the amount, and method of payment of fees. This will ensure people living in the home know that services are provided and what they must do. All people using the service must have an up to date, detailed care plan. This includes making sure that support plans are completed following assessments and recommendations by specialists Where possible people have been involved in the development of their care plan, which is written in a format that the individual would be able to understand. This will ensure that they receive person centred support that meets their needs. The manager must make adequate arrangements for containing fire. Where they have identified that Dor-guards are to DS0000017841.V364303.R01.S.doc Timescale for action 30/06/08 2. YA6 15 30/06/08 3. YA24 23 (4) (c) 30/06/08 Hamilton Lodge Version 5.2 Page 33 be fitted to specified doors, the CSCI must be notified that this work has been completed. 4. YA39 24 The services manager needs to ensure that there is an annual quality assurance process, which seeks the views of people living in the home or other people connected with the service. This will confirm how well the service is meeting the aims and objectives set out in the statement of purpose. The management team must ensure that any event, which adversely affects the well-being or safety of any person living in the home is reported to the Commission (CSCI) in line with regulation 37 of the Care Homes regulations 2001. All reasonable actions must be taken to ensure service users health and welfare. This relates to the need to ensure that the home has a current certificate for its electrical installation. This is necessary to ensure the health and safety of people living and working in the home. This has been a repeated requirement from 31/05/06, 20/07/06 and 15/05/07. 7. YA42 13 (4) (c) 16 (2) (i) A record of the temperature at which food is served must be kept. This will minimise the risk of food poisoning and ensure food is served above the recommended temperature of 65 degrees. 30/06/08 30/06/08 5. YA42 37 30/06/08 6. YA42 23 (b) 30/06/08 Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 34 8. YA42 13 (4) (a) (b) (c) Portable Appliances must be tested at least annually to comply with Electricity at Work Regulations 1989. This will ensure the health and safety of people living and working in the home. 30/06/08 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 YA1 Good Practice Recommendations The statement of purpose needs to be updated to reflect that the Coach House is no longer used as a small group home, also to detail the new specialised service in the main house for up to eight people with autism. Additionally, the names of the service manager and services director should be updated as well as the contact details for the Commission (CSCI) to reflect the Regional Contact Team (RCT). Should controlled drugs be prescribed for one or more persons it is a legal requirement that the home has a metal cupboard of specified gauge with a double locking mechanism, which is fixed to a solid wall, with either rawl or rag bolts. A locked tin within the medication cupboard does not meet legal requirements. Consideration should be given to how the complaints procedure can be displayed in the main house, so that they are accessible but do not pose a risk to people whom eat inappropriate objects. Some parts of the grounds, especially to the front entrance and side of the main house would benefit from some attention to improve the appearance of the home. 2. YA20 3. YA22 4. YA24 Hamilton Lodge DS0000017841.V364303.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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