Inspection on 23/08/06 for Hamilton Lodge Nursing Home

This inspection was carried out on 23rd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 but made no statutory requirements on the home.

Other inspections for this house

Hamilton Lodge Nursing Home 13/03/06

Hamilton Lodge Nursing Home 20/09/05

Hamilton Lodge Nursing Home 01/11/04

Hamilton Lodge Nursing Home 11/06/04

Hamilton Lodge Nursing Home 02/04/04

Hamilton Lodge Nursing Home 16/01/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Hamilton Lodge Nursing Home Hamilton Lodge 36 Honor Oak Road Forest Hill London SE23 3RZ Lead Inspector Rehema Russell Unannounced Inspection 23 & 25th August 10:00 rd X10015.doc Version 1.40 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 Nursing Home DS0000007023.V295919.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 Older People. 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 Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamilton Lodge Nursing Home Address Hamilton Lodge 36 Honor Oak Road Forest Hill London SE23 3RZ 020 8699 6080 020 8699 2074 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) Premiere Care (Southern) Ltd Mrs Patricia Jenkins Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40), Terminally ill (0) of places Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 patients, frail elderly persons aged 60 years and above (female) and 65 years and above (male), and chronic sick persons aged 40 years and above 4 people may have a terminal illness Date of last inspection 13th March 2006 Brief Description of the Service: Hamilton Lodge is a care home providing nursing and residential care for up to 40 older men and women. It occupies a nineteenth century building that has four floors. There are 22 single and 8 double bedrooms. The first three floors are used for resident accommodation and are accessible by lift. The top floor is used for office space. There is a large sloping back garden and a large sun terrace. There is off street parking on the forecourt to the front of the building. The home is situated in a residential area. It is on a bus route which is a few stops from a local shopping centre that has library and rail facilities. Prospective residents are given a copy of the Statement of Purpose and given verbal information about the category of residents and the various facilities available at the home. Copies of the most recent CSCI inspection report are available for perusal in the office and at the nurses stations, and prospective residents are told it is available on the internet. Current fees range between £500 - £726 per week and there is an additional charge for hairdressing. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the two days of 23rd and 25th August 2006. The inspector spoke with seven residents, four sets of visiting relatives, the Registered Manager, several staff including interviewing 3 night healthcare assistants, 1 nurse and 2 (daytime) healthcare assistants, the cook, the administrator, the home’s General Practitioner, and briefly with the activities co-ordinator and the specialist nurse from St. Christopher’s Hospice. The inspector also toured the premises and looked at records and documentation. What the service does well: What has improved since the last inspection? Improvements since the last inspection include: • More recent care plans now incorporate goals for residents’ social and emotional needs. • The use of two previously double rooms as single bedrooms. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 6 • • • Good working relationships have been established with visiting healthcare professionals such as the General Practitioner and the palliative care nurse. A full time activities organiser has been employed for five days per week to provide a comprehensive timetable of activities and stimulation New good quality carpet has been laid on the central stairway and reception hallway. 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 Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice about where to live. No resident moves into the home without having their needs fully assessed and without an opportunity to visit the home. The home does not accept residents solely for intermediate care. EVIDENCE: There is a Statement of Purpose which covers all of the areas required by regulation and gives prospective residents the information they need to make an informed choice about the home. The home does not have a separate Service User Guide but uses the Statement of Purpose as a combined document. However National Minimum Standard 1 recommends that resident’s views of the home are included in the Service User Guide and so this should be added to the Statement of Purpose. See Recommendation 1. Four care files were inspected and evidenced that a full needs assessment is undertaken for all new residents prior to admission. This assessment is undertaken by the Registered Manager, who insists on having a copy of the Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 9 care management assessment from the social worker before undertaking the home’s assessment. Care management assessments were seen on file. Whilst undertaking the assessment, the manager speaks with relatives/carers if the resident is assessed at home or with the nurses on the ward if the resident is assessed in hospital. The home’s assessment includes the full range of healthcare needs, plus emotional aspects such as mood and behaviour, as well as activities preferences and any additional services required. If the new service user is being placed for palliative care then the specialist nurse from St. Christopher’s Hospice, who is allocated to the home, will come and further assess the resident within a few days of admission. The manager tries to ensure that the potential resident, relatives/carers and the social worker always visit the home prior to admission. If the resident is unable to visit the home, the manager will not carry out an assessment until either a relative or the social worker has visited and seen the home. The manager also encourages potential residents and their relatives to visit other homes in order to make a comparison and a positive choice. On the trial visit to the home the resident is shown the home and their room, speaks with the manager and meets other staff, meets other residents and is given hospitality. If there is only a double room vacancy, the potential resident and their relative/social worker meet with the resident already occupying the room. If requested, an agreement is made for the new resident to move to a single room when one becomes available. The home does not admit residents solely for intermediate care and so Standard 6 is not applicable. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are set out in an individual plan of care, and their health care needs are fully met. Residents are protected by the home’s policies and procedures for dealing with medicines. Residents feel they are treated with respect and their right to privacy upheld. At the time of their death, staff treat residents and their families with care, sensitivity and respect. EVIDENCE: Four care plans were examined in detail. Each had a minimum of 6 areas of identified need, with each need being dated, having an goal/aim, action to be taken, review date and evaluation. All care plan components had been reviewed monthly, each review being dated and signed. Two of the care plans of recently admitted residents had emotional/social identified needs, such as sexuality/low self-esteem and emotional loss, which is good practice. The care plans of residents who had been at the home for several years had additional new identified needs where their needs had changed or increased. Each care file also had several different types of risk assessments, such as nutrition and manual handling, and these were also reviewed and signed on a monthly basis. There were also profiles for each resident, with a photograph, admission Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 11 sheets, property lists, personal information sheets including the name by which they wished to be called, their religious interest and their background, and signed and dated permission for cot sides where appropriate. Health and social care assessments, filled in within a day or two of admission, covered the full range of needs such as physical, emotional, spiritual, social, relationships and leisure. Daily comments sheets are filled in for each resident at the end of both the day and night shifts. Documentation in care files, plus verbal evidence from residents and relatives, shows that residents are supported to access the full range of healthcare professionals and facilities. This includes the general practitioner, optician, chiropodist, psychologist, dietician, nutrition nurse, dentist, physiotherapist, speech and language therapist and therapeutic care from hospitals and community health teams. Continence, tissue viability and falls advice is sought as appropriate and the home has an allocated nurse from St. Christopher’s Hospice who visits, assesses and oversees the care of residents admitted for palliative care. One resident who was a new admission and wheelchair bound at the time of the 21st September 2005 inspection was observed at this inspection to be up and walking about the home, with no assistance needed from staff, and very happy with her independent mobility. Staff explained that earlier in the year they had arranged for a period of intense physiotherapy for the resident and that this progress in mobility was the result. There were several other examples of where specialist health teams had been used by the home to improve the health and mobility of residents. The General Practitioner for the home was met and spoken with. He visits the home for about one-anda-half hours each week to see any residents specifically referred, but also ensures that he sees every resident over a three month period. The manager confirmed that there is a good relationship with the GP, citing an instance when he was requested to return to the home within half an hour of finishing his weekly visit in order to speak with relatives, which he was happy to do. The storage, administration and recording of medication was checked and no problems were found. The home uses the monitored dosage system and each month nurses check each monitored dosage card supplied against the prescription to ensure that there are no errors or omissions. They also write any allergies of individual residents onto the card. The folder with the MAR charts has a list of specimen signatures at the front, plus relevant protocols such as peg feeding, and there is a photograph of each resident to ensure correct identification. Controlled drugs are kept in a suitably lockable cabinet and are counted at every shift changeover. For increased accuracy, liquid controlled drugs are measured out using a syringe, and records with the required double signatures were seen. The pharmacist currently used by the home is licensed to collect and dispose of waste medication and a copy of the licence is kept at the home. All medication is held in the treatment room, which has a mini fridge for medication such as insulin, with an external thermometer to ensure that the correct temperature is monitored and maintained. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 12 Observation of practice and verbal evidence from residents, relatives and staff indicates that residents are treated with dignity and respect and that their right to privacy is upheld. Staff described care practices that safeguards residents’ dignity, privacy and rights and their attitudes demonstrated empathy and understanding for residents’ needs. Residents told the inspector that they were happy with the staff, that staff treat them well and ensure their privacy, and bedbound residents said that staff always come to the room when the call button is pressed. Relatives said that staff are very attentive and that they are happy with the care being given. Funeral preparation plans were present on care files and had been filled in, signed and dated in all cases where the resident or their relatives were willing to do so. The home is registered to care for people needing palliative care and the manager described how this can lead the home to provide holistic care, which very often involves supporting the family emotionally and psychologically. On the second day of the inspection there was a death at the home and the inspector observed the sensitive and caring way in which the death was handled and the considerable effort made by the manager to contact and support the relatives. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to satisfy their social, cultural, religious and recreational interests and needs. Residents are encouraged and supported to maintain contact with family and friends, and to exercise choice and control over their lives. Residents are given a nutritious, balanced and appealing diet in pleasant surroundings. EVIDENCE: Verbal and documentary evidence throughout the inspection demonstrated that routines at the home are flexible to accommodate the individual needs of residents. One resident spoken with, who is mobile, told the inspector that she enjoys watching television and entertaining visitors in her room and that she chooses to eat her evening meal there too. Night staff described the behaviour of one resident who always wakes during the night and asks for food and drink. The cook leaves a ready prepared tray of sandwiches in the fridge each evening so that this resident, and any others who wake and wish it, can be given a snack during the night. Several residents were observed to move about the home and access their own rooms at will during the day, and two residents, who are fully mobile, go out into the community as they wish. The home arranges for ministers of religion to visit residents who want this, and the home ensures that residents from minority ethnic backgrounds have Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 14 access to culturally appropriate food, music, hairdressing and any other items of choice. To formalise this provision the home has devised an Equalities Provision form which will be filled in for each resident. The home has recently employed a full time activities co-ordinator for five days per week, who has devised a programme of varied activities. These include quizzes, making toast racks/objects, exercise, reminiscence and games, arts and crafts, and talks on wildlife/subjects of interest. The programme is flexible and is varied according to the weather, the moods and interests of residents on the day and any other events. For example, on the first day of the inspection the home had received a large amount of flowers and so the activities co-ordinator held a spontaneous flower arranging session, which all residents in downstairs dining/day room were enjoying. During the summer the activities co-ordinator had organised a fund-raising fete, for which residents grew plants for sale, and during which crazy golf and football games were held. The activities organiser also runs a trolley shop, whereby residents can buy confectionary, toiletries and other articles. There is a hairdresser who visits the home regularly and staff were pleased that they had recently been able to persuade one resident, who is bedbound and always very reluctant to be assisted out of the bed, to have their hair done. There were several sets of visiting relatives at the home during the days of the inspection. Relatives said that they were always made welcome and offered hospitality and that they found the manager and staff at the home friendly and welcoming. They said that staff always kept them informed about their relatives and one visitor said that she particularly appreciated that staff always passed on messages given. Residents can be visited in privacy in their bedrooms or in the unused lounge on the third floor. Whilst discussing other aspects of care at the home, the manager mentioned two separate cases where she had protected residents from relatives/visitors they had told her that they did not want to see. There is a noticeboard at the entrance of the home which gives relatives and visitors information about the programme of activities, events such as the summer fete, the library service, the equal opportunities policy and the complaints procedure. The manager intends to add a daily notice of which staff are on duty, which is good practice. Although the majority of residents have their money managed by their relatives, there is one resident who manages his own money entirely and another who is given cash when she wishes to go out. Residents and their relatives are informed of how to contact external advocates in the Statement of Purpose, and there was evidence in the majority of bedrooms that residents are encouraged to bring personal possessions with them into the home. Meals were sampled on both inspection days and were found to be nutritious, appealing and tasty. The ethnic minority meal sampled on the second day was particularly appetising. Menus were seen and demonstrated that residents are given a nutritious, balanced and varied diet, with alternative choices available at each meal, and with medical and specialist meals prepared as appropriate. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 15 The cook is very flexible and will vary the menu on any particular day to suit the weather or the mood/taste of residents. For example, the cook gives a different group of residents each week a complete free choice for supper, giving them whatever they choose. Residents spoken with said that they liked the food at the home and confirmed that they can always have an alternative choice, one resident stressing that the home has a “very, very good cook”. Homemade cakes/biscuits are provided in the afternoon, each resident’s birthday is noted and celebrated, and sandwich snacks are available during the late evening and at night. The inspector observed some residents being fed at lunchtime and this was done with patience and dignity. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure which meets the requirements of regulation. The procedure is available at the back of the Statement of Purpose, a copy of which is given to every service user, and a copy is displayed on the noticeboard at the entrance of the home for relatives and visitors. The home has received no formal complaints since the inspection of 20th September 2005. Residents and relatives spoken with told the inspector that if they had any problems they would tell a nurse or the manager, who was “always around to speak with”. There are suitable policies on adult protection, restraint and whistleblowing and these are reviewed and signed annually by the Registered Manager. The manager is going to add information about the current local authority adult protection procedures when she next reviews the adult protection policy shortly. All staff have had training in the prevention of abuse except for the four newest members of staff who will be undertaking the training in due course. Verbal evidence from staff indicated that they are empathetic and understanding towards residents’ difficult behaviours and handle them appropriately. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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, 20, 21, 22, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and generally well-maintained home. There are sufficient indoor and outdoor communal areas but improvements could be made to provide a homely lounge and more accessible garden facilities. Residents live in safe, comfortable bedrooms with their own possessions around them according to their choice. There are problems with the physical standards in regard to the number of bathrooms that are suitable for people with physical disabilities, with low sinks and the effects of subsidence in the kitchen and with no carpeted lounge (although there are two day rooms). EVIDENCE: The home is located in a pleasant residential area, on a bus route that gives access to a local shopping area with railway. It is built on a hill in a hilly area so there are nice views from most of the bedroom windows. The home is generally safe and well maintained and two safety problems noted on the first day of the inspection were fixed by the second day. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 18 The very large back garden slopes steeply so although it is a very pleasant area to view, its use for people with mobility and physical restrictions is limited. However there is a large flat terrace that is accessible from the second floor and which can be used for sitting out or for outdoor activities. One resident, who is wheelchair bound, said that it was a shame that the main part of the garden was inaccessible. See Recommendation 2. Inside the home there are three main communal areas. The first is on the ground floor and located next to the kitchen and the passenger lift. It doubles as a dining room and day room. It is bright, pleasant in shape and décor and has music facilities but is not carpeted. Residents sit at the various dining tables in the room, which are convenient for the many activities carried out there. On both of the inspection days residents were observed to be enjoying using this room. The second communal room is a large L-shaped room on the second floor, which also doubles as a dining/day room. This room has television and music facilities and several armchairs and recliners but also is not carpeted. The inspection report of 13th March 2006 required that the registered person ensure that dining rooms have a floor covering which is homely in character. The manager said that she is currently obtaining estimates for laminating the floor for the two dining/day rooms. The timescale for the requirement had not expired at the time of this inspection. See Requirement 1. The third communal area is a large room on the third floor but this room has not been used for some time and is neglected. It has the potential to be a very attractive lounge, and as it would not have to double as a dining room, could be carpeted and made into a very homely lounge for residents’ use. See Recommendation 3. All resident bedrooms were seen. Although many of the rooms were pleasantly laid out, decorated and personalised, some seemed a little bare. Whilst respecting the wishes of residents who do not wish to have personalised articles or ornamentation in their rooms, the Registered Person should consider offering to provide some framed pictures/ornamentation to any residents who may not have these possessions themselves but would like to make their rooms more homely. See Recommendation 4. Similarly, several bedrooms did not have carpeting. Whilst there might be health and safety justifications for this in many cases, the choice to have carpeting in their bedrooms should be given to current and new residents if there are no health and safety reasons why they should not have it. See Recommendation 5. All shared bedrooms have screening for privacy and are arranged to give residents as much separate personal space as possible. The home has sufficient toilet and bathroom facilities but although there are 6 bathrooms in the home, only 3 were useable at the time of the inspection, which is insufficient for the current number of service users. The reason for this was that the new medic bath on the third floor had been installed but the flooring had not yet been laid. Secondly, although there are 4 bathrooms on the second floor, only one is a Parker bath and therefore suitable for people with physical disabilities. The other three bathrooms have conventional baths Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 19 only. One of these has a useable chair hoist to enable access for physically infirm residents, but in the second the chair hoist is not sufficiently robust and the third has no disability aids at all. See Requirement 2. The latter bathroom is used by the visiting hairdresser but the inspector was concerned that it only has a normal sink, which might not be at the required height or angle for washing hair, especially for elderly physically infirm persons. As the home would have sufficient bathroom facilities if all of the other five bathrooms were fully useable, it is suggested that the Registered Person considers converting the sixth bathroom a permanent, suitably equipped, hairdressing room. See Recommendation 6. In regard to aids and adaptations, two different specially adapted wheelchairs had been obtained to meet individual residents’ needs, there are grab rails throughout the home and there are a variety of profile beds and air mattresses to suit the individual needs of residents. However although the home has three hoists, one is very old and the other is mechanical, and the Registered Person should update these to ensure that the home has the best equipment to safeguard residents and staff. See Requirement 3. The inspection reports of 13th March 2006 and 20th September 2005 both required that the recommendations arising from the occupational therapy report of June 2004 be implemented. It was not possible to verify the requirement at this inspection as the current Registered Manager was not at the home in June 2004 and cannot locate a copy of the report at the home. It is therefore assumed that the report is at head office. See Requirement 4. The home has cleaners working two 6-hour shifts daily and on the days of inspection the home was found to be clean and hygienic throughout, with no offensive odours. The kitchen was also meticulously clean and well ordered, but there are two major problems: • The kitchen sinks are very low and cause a health hazard for the kitchen assistants, several of whom are having problems with their backs. The low level of the sinks also prevents the use of rubber mats which would otherwise mitigate the problem of standing still for long periods on a concrete floor. This should be remedied as a matter of urgency See Requirement 5. There has been building slippage/subsidence and there are several areas where slabs of tiles are protruding out away from the wall/steps. The inspector was told that insurance companies are currently investigating the subsidence and the Registered Person must keep CSCI informed of the position. See Requirement 6. • Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by the numbers and skill mix of staff and residents are in safe hands at all times. Residents are supported and protected by the home’s recruitment policy and practices and staff are trained and competent to do their jobs. EVIDENCE: Rotas were seen and evidenced that staffing numbers and the skills mix of staff are appropriate to the assessed needs of residents and to the size, layout and purpose of the home. There are two first level nurses on duty every day from 8am to 8pm and there is one first level nurse on duty each night. There are 7 healthcare assistants on duty every morning and 6 each afternoon, which means that there is extra assistance available at the peak morning time. There are 3 night healthcare assistants on duty with the nurse each night, and all night staff are waking. The home does not use agency staff but has several bank staff who regularly cover absences and so are familiar with the home and residents and can provide continuity of care. As noted in Standard 12 above, the home employs a full time activities co-ordinator five days per week to provide for residents’ recreational and leisure needs. Observation of practice and verbal evidence from speaking with nurses, healthcare assistants and the cook indicated that staff have a good understanding of the problems associated with old age and the general and individual needs of residents of the home. Staff interviewed demonstrated sensitivity and empathy towards residents and a commitment to safeguarding their dignity, independence and rights. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 21 Domestic staff are also employed in sufficient numbers at the home. There are 2 full time cleaners and one full time laundry assistant each weekday, with one cleaner and one laundry assistant at weekends. There are two cooks working full shifts, one of whom works 5 days per week and the other 2 days per week. There are also two kitchen assistants each day at the home, one covering breakfast to lunch and another covering late afternoon and evening. All nurses employed by the home are qualified to 1st Level, including bank staff nurses, which means they are suitably qualified to be in charge of all medication and healthcare needs. In addition, 4 nurses have specialist palliative care training, one nurse is an NVQ Assessor and another is a Mental Health Trainer. Fourteen of the twenty-six healthcare assistants employed by the home have NVQ Level 2, with 3 of them currently taking NVQ Level 3, and so the home has exceeded the 50 training target. The administrator, who works at the home for 4 days per week, organises and administers the staff files. These were found to be very well ordered and kept. The files of six staff who have been employed since the previous inspection of 13th March 2006 were examined. These comprised one nurse, 3 healthcare assistants, 1 domestic and the activities co-ordinator. The documentation seen evidenced that a through recruitment procedure is carried out, which ensures the protection of residents. All files had the required documentation, including application forms, references, POVA First and CRB checks, proof of identity and Visa permissions, medical declarations and training certificates and pin numbers as appropriate. There is a full range of races, nationalities and gender at all levels in the home, evidencing that the home recruits according to equal opportunity practice. Staff confirmed that they had undertaken an induction period when they started work at the home. This is undertaken by a nurse and over a 3 day period covers areas such as fire, care planning, medication, complaints, infection and food hygiene. The new healthcare assistant will then shadow an experienced worker for a fortnight, and after four weeks will have their first supervision. Within their first 3 months of work they will be trained in fire procedures, manual handling, infection control, food hygiene and health and safety. However the manager shortly intends to introduce an externally produced and verifiable induction programme that meets Skills for Care standards. This system requires regular written assessments, which are submitted and marked externally, and provides a Certificate of achievement once the course is successfully completed. In regard to training, nurses currently undertake their 5 days of training each 3 years to keep their qualification renewed and the home is going to participate in the Care Home Support Team training programme for nurses which covers areas such as dementia, care planning and infection control. Healthcare assistants have undertaken various internal and external training courses covering basic Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 22 training needs and also areas such as palliative care, medication and nutrition. Attendees’ names are currently listed under the course title rather than in an individual training log. The home is in the process of developing individual staff development files, which will list areas such as training, supervision and appraisal, and this should be done as soon as possible. See Requirement 7. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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, 32, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is fit to be in charge of the home, is of good character and is able to discharge her duties fully. Residents and staff benefit from the ethos, leadership and management approach of the manager. There is no established quality assurance system but formal feedback from residents and relatives has been sought. Residents’ financial interests are safeguarded. Staff are appropriately supervised. The health, safety and welfare of service users is promoted but some certificates and records need to be submitted to CSCI for inspection. EVIDENCE: The manager is a first level Registered General Nurse and has several years experience as both a deputy and a manager of nursing homes. In addition she is a NVQ Assessor, has a Certificate in Palliative Care and has Wound Care Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 24 Management and tissue viability training. She is just finishing an NVQ Level 4 in Management and Care to fully comply with NMS guidance. The manager demonstrated a comprehensive knowledge of the conditions and illnesses associated with old age, a sensitive and caring attitude and a strong commitment to meeting the needs of residents of the home. Observation and verbal evidence from residents, relatives and staff indicated that the management approach at the home is open, positive and inclusive. Comments included: “the manager is very supportive and approachable”, ”she listens to issues and tries to solve them”, “she is always around”, ”I would tell her if there were any problems” and “all the nurses are approachable and so is the manager, anyone can talk to her”. There is a management structure at the home and clear lines of accountability. The inspector was told that a questionnaire was given to residents and relatives in August 2005 but there was no summary of the comments received. A questionnaire has been printed and is ready to go out for this year and the Registered Person should ensure that an annual summary of residents’ comments is published and made available with the Statement of Purpose/Service User Guide. This was referred to under Standard 1 above and a recommendation made. There were no Regulation 26 reports (monthly visits by the Registered Person) available at the home report and therefore no evidence that there is a quality assurance system in place. See Requirement 8. The home does not administer or manage any service user monies. Residents’ personal monies are handled exclusively by themselves or their relatives, or by solicitors and social workers where there are no relatives. Relatives/solicitors pay a lump sum to the Registered Person’s head office and anything a resident purchases, such as hairdressing or items from the mobile shop, is financed from petty cash, notified to head office and entered on invoices which relatives receive monthly. Receipts are kept for items purchased. There is currently one resident who manages his own finances entirely and another who manages their own personal allowance. Neither the home nor head office have any interest in residents’ savings, which are managed exclusively by relatives or legal stakeholders. The inspection report of 13th March 2006 required that that care staff receive formal supervision at least six times yearly. The timescale for the requirement had not passed at the time of this inspection and there was evidence that progress was being made, with each member of staff having had 2 formal supervisions since March 2006. See Requirement 9. The Registered Manager supervises the nurses, some healthcare assistants and the domestic staff and the nurses supervise the remaining healthcare assistants. A nurse interviewed said that she found the supervision given very useful. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 25 The inspector checked service and maintenance reports after 6 pm on the second day of the inspection and the maintenance worker had finished his shift and many records could not be located. Evidence of the following records and services were seen and found to be in order: fire extinguishers, annual gas safety check, lift maintenance, small electrical appliance tests (PAT), hoist services, gas boiler maintenance, hazardous waste collection, weekly water temperature check, and the safe storage of COSHH materials. The following certificates/records could not be located and copies must be submitted to CSCI: fire drills, call point tests, five year electricity test, waste licence, sluice/washer/disinfection certificate, emergency lighting and the most recent Environmental Health and LFEPA (fire) inspection reports. See Requirement 10. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 1 2 X 3 X 2 STAFFING Standard No Score 27 4 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 1 X 3 2 X 2 Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 27 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 OP20 Regulation 23(2)(h) Requirement The registered person must ensure that lounges and dining rooms have a floor covering which is homely in character. The previous timescale of 30/09/06 has not yet expired. The Registered Person must ensure that there are sufficient disability bathrooms and suitable adaptations for the needs of residents. The Registered Person must update the two hoists to ensure the home has the best equipment to safeguard residents. The registered person must ensure that any recommendations arising from the occupational therapy report of June 2004 have been implemented. Timescales of 30/11/05 and 31/07/06 not met. The Registered Person must provide a copy of the occupational report to CSCI. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 28 Timescale for action 01/01/07 2 OP21 23(2)(n) 01/04/07 3 OP22 13(5) 01/02/07 4. OP38 23(2)(c) 01/12/06 5 6 7. OP38 OP19 OP30 16(2)(g) 23(2)(b) 18(c)(i) & Sch.2 (4) 24(1)(a) & (b) 8. OP33 9. OP36 18(2) 10. OP38 12 (1) (a) & 12 (4) The Registered Person must ensure that the low kitchen sinks are raised to a suitable height. The Registered Person must inform CSCI of the position regarding kitchen subsidence. The Registered Person must ensure that an individual training record is drawn up for each member of staff. The registered person must ensure that a structured quality assurance system and annual development plan are put in place. The previous timescale of 31/12/06 has not yet expired. The Registered Person must ensure that care staff receive formal supervison at least six times yearly. The previous timescale of 30.09.06 has not yet expired. The Registered Person must submit copies of the health and safety certificates and records under Standard 38 of this report to CSCI and ensure that copies of these are maintained at the home from now on. 01/12/06 01/11/06 01/12/06 01/01/07 01/04/07 01/11/06 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 OP1 Good Practice Recommendations The Registered Person should ensure that residents’ views are attached to the Statement of Purpose whilst it continues to be used as a combined Service User Guide document. DS0000007023.V295919.R01.S.doc Version 5.2 Page 29 Hamilton Lodge Nursing Home 2. 3. 4. 5. 6. OP20 OP20 OP24 OP24 OP21 The Registered Person should consider making parts of the back garden more accessible to residents. The Registered Person should consider developing the third floor communal room into a carpeted and homely lounge. The Registered Person should offer ornamentation to any residents who may wish to have a homely bedroom but does not have personal ornamentation available. The Registered Person should offer to carpet any bedrooms where new or existing residents wish this and there are no contrary health and safety reasons. The Registered Person should consider converting the unused bathroom on the first floor to a permanent, suitably equipped, hairdressing room. Hamilton Lodge Nursing Home DS0000007023.V295919.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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. 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