Inspection on 04/05/05 for Hamilton Nursing Home

This inspection was carried out on 4th May 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hamilton Nursing Home 15/05/06

Hamilton Nursing Home 22/09/05

Hamilton Nursing Home 03/11/04

Hamilton Nursing Home 02/06/04

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

CARE HOMES FOR OLDER PEOPLE Hamilton Nursing Home 24 Langley Avenue Surbiton Surrey Kt6 6QW Lead Inspector Diane Thackrah Unannounced 4th May 2005 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 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 G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hamilton Address 24 langley Avenue, Surbiton, Surrey, KT6 6QW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8399 9666 020 8390 9394 jag@lrh-homes.com London Residential Healthcare Limited Mrs Gnanawathie Jamanetti Care Home 28 Category(ies) of Dementia (28) registration, with number of places Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3 November 2004 Brief Description of the Service: Hamilton Nursing Home provides personal care and accomodation for up to twenty eight people who have dementia. London Residentail Health Care Ltd owns the home. The home is a large detached property situsted in a residential area of Surbiton. Public transport, local shops and leisure facilities are all within a short distance from the home. The home is comprised of a large communal lounge, a communal dining area, twenty six single bedrooms, and one double bedroom. Passenger lifts are available in the home. There is a large garden to the rear of the home and parking is available. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place between 09.00 and 13.00. A partial tour of the premises took place. Care records were inspected. The Registered Provider, nurse in charge and three staff members were spoken to. Many of the service users are very frail and do not have the mental capacity to give an accurate picture of life in the home. Nevertheless the inspector spent time sitting and chatting with them and observing how they were cared for and concluded that they appear well care for and were content with life in the home. What the service does well: What has improved since the last inspection? Health and safety issues regarding two windows in the home have been rectified. There has been an ongoing programme of training and development for staff members, including the provision of a training room and training materials. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 6 The home’s Statement of Purpose and Service User Guide have been revised. 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 G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 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 standard(s) 1, 2, and 3. There have been improvements to the Service User Guide, allowing prospective service users and their family members to have the information they need to make an informed choice about the home. Contacts are made available, allowing service users to know what services they are paying for. Service users know that their needs will be met as full assessments of need are carried out. EVIDENCE: The home has a statement of purpose that sets out the aims, objectives and philosophy of care of the home. A Service User Guide has been developed. This document provides information about what service users can expect from the home. These documents are in written format, but can be made available in large print, audiotape and a variety of languages. The home has a statement of terms and conditions that includes all information required by Regulation. There were signed copies of these documents available for the most recent admissions. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 9 There were written needs assessments in place for the most recent admissions. The Registered Manager obtains information through discussions with family members, service users and health and social care professionals. Were appropriate, a representative from the home visits prospective service users in their home, or in hospital, prior to them moving into the home. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 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 standard(s) 7, 8 and 10. There continues to be good systems in place to ensure that staff are able to meet the health and personal care needs and to promote and maintain service users health. In general, service users have their dignity upheld. However, shortfalls in this area mean that some service users are not always fully respected. EVIDENCE: Individual plans of care were in place for each service user. These provided detailed information about how the needs of service users will be met. Risk assessments were in place and plans of care reflected individual risk assessments. Service users and their advocates have opportunities for being involved in the drawing up of the care plan. Reviews of care plans occur monthly. One staff member said that they had undergone training in how to complete care plans. There was documentation detailing this training. Multidisciplinary records are maintained. These detailed that action is taken by the home to ensure that service users have access to other health care professionals. Weight is monitored. Specialist equipment has been provided to those service users at risk of developing a pressure sore. Service users have opportunities for exercise and physical activities. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 11 Service users were noted to be well dressed and had clearly been supported with personal care. Arrangements have been made for ensuring privacy for service users including access to a private telephone line. All new staff members undergo induction training that covers dignity and respect. Staff members, in general were observed to share respectful relation ships with service users at the time of this inspection. However, three incidents were observed during this inspection, were staff members did not consult with service users, or wait to obtain their opinions about whether they wished to partake in an activity session which was occurring. This included one staff member disturbing a service user by placing an object in their hands whilst they were asleep. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 12 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 standard(s) 12 and15. Social activates and meals are both creative and provide daily variation and interest to service users. EVIDENCE: Service users are consulted about the type of activities that they enjoy during the admission process. There were records detailing that structured activities occur in the home on a daily basis. A dedicated activities worker provides these. (A Requirement has been made in relation to activities, Refer to the previous section of this report). Photographs were available of a recent trip to a vineyard arranged by the home. Outings occur each weekend. There was a hairdresser in the home at the time of this inspection. One service user said that they looked forward to visits by the hairdresser. Some service users were observed to be enjoying the activity session occurring during this inspection. There is a six weekly rotational menu. This was examined and found to be balanced and interesting. Food storage areas were noted to be clean and to provide a good selection of food, including fresh fruit and vegetables. There was a choice of meals for the day displayed on the notice board. This included a roast chicken meal, or ocean pie. A meal was sampled and found to be of good quality and presented well. Specialist diets are catered for. Staff members were observed to provide good, sensitive support to those service users who required help with eating. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 13 Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 14 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 standard(s) 16 and 17. In general, service users have their legal rights protected. Complaints are handled in line with the home’s policies and procedures ensuring that concerns are taken seriously. EVIDENCE: There is a policy on confidentiality and staff members spoken with demonstrated a good knowledge of their responsibilities in relation to this. Consent forms were available for service users use bedrails. However, this form had not been signed by family members regarding the use of bedrails for one service user. Policies and procedures in relation to making a complaint are in place and information about how to make a complaint is clearly provided in the Statement of Purpose and Service User Guide. There has been one complaint made to the home since the last inspection. This complaint has been referred to the Commission for Social Care Inspection and is currently under investigation. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 15 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 standard(s) 19, 24 and 26. Outstanding maintenance issues have been addressed. The home, in general, provides safe, clean and comfortable surroundings for service users. EVIDENCE: Most areas of the home viewed were noted to be maintained to a high standard. Requirements made at the last inspection of the home regarding health and safety issues with two windows have been addressed. There was one bedroom with a badly fitted headboard, which had potential for causing discomfort to the person sleeping in the bed. This problem was rectified by the on site maintenance person at the time of this inspection. The grounds were noted to be tidy and attractive. Fire safety procedures were being followed, including fire doors and exits being free from obstructions and fire fighting equipment being available. Bedrooms viewed were decorated to a high standard and provided all furnishings and fixtures as detailed in the National Minimum Standards. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 16 Adjustable beds are provided. Each service user is provided with a lockable storage space. Bedroom keys can be provided. However, risk assessments, detailing why service users are not provided with a bedroom door key are not in place. There were cleaning schedules, with records maintained. Policies and procedures are in place in relation to the control of infection. All areas of the home that were viewed were clean, pleasant and free from offensive odours. Hand washing facilities are prominently sited. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30. There are sufficient numbers of staff to address the assessed and changing needs of service users. The procedures for staff training are robust and provide staff members with the skills necessary for doing their jobs well. EVIDENCE: A number of nurses from overseas are completing their ‘supervised placement’ in the home. These nurses work in the home for an average of nine months, before leaving, at which time a new group of nurses from overseas commences work in the home. In addition to this there is a permanent staff team made up of staff members who have worked in the home for many years. There is a full staffing complement. Agency staff members are not employed in the home, as the current staff team are reported to cover annual leave and staff sickness. There were two Registered General Nurses; three care staff members and three nurses carrying out supervised placements on shift at the time of this inspection. In addition to this there was a chef, an activities worker, a laundry worker, a maintenance worker and cleaners The home’s rota detailed that additional staff members are employed during peak times. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 18 Staff members spoken with said that there were enough staff members to ensure that service users needs were met. Staff members have access to a training manager and there is a dedicated training room. Staff training records detail that training undertaken is in line with The National Training Organisation for Social Care specifications. One staff member said that lots of training was available to them. This staff members training profile backed this up. In addition to mandatory training, nurses carrying out supervised practise training follow a programme of structured training which is supervised by the home Registered Manager. Staff members were observed to follow safe working practices and, in general, be empathetic with the service user group. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 34. Staff members receive good leadership and guidance to ensure that service users receive consistent quality care. Service users are safeguarded by the accounting and financial procedures of the home. The quality assurance systems ensure that the views and wishes of service users and stakeholders are valued. EVIDENCE: Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 20 Staff members spoken with were clear about their roles. They confirmed that they received good support from a Registered Manager who was both fair, and available. Quality assurance and monitoring systems have been established. Feedback has been sought from service users and published in the home. Relatives views are sought via a mail shot and through regular meetings held in the home. A newsletter is produced for the home on a regular basis. A statement of purpose is available which includes details of the home’s business planning. Policies and procedures are reviewed on a regular basis. There is a financial plan. Details regarding accounting and financial procedures have been made available to the Commission for Social Care Inspection. Insurance cover is in place. Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x 3 3 3 x x x x Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 10 Regulation 12 (1)(a)12 (2) & (4)(a) Requirement The Registered Provider must ensure that all service users are consulted with, and their views adhered to prior to them being involved in, or excluded from any organised activity held in the home. All staff members who have contact with service users must undergo training in dignity and respect. Timescale for action 01.06.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 17 Good Practice Recommendations The Registered Provider should review the arrangemnts and procedures for seeking the consent from families were service users use bedrails to ensure that there is limited delay in consent forms being siged. The Registered Provider should ensure that a risk assessment is in place when a service user in not provided with a bedroom door key. The Registered Provider should review the arrangements and procedures for and quality assurance. 2. 3. 24 19 Hamilton G53-G53 S26247 hamilton V211359 050505 stage 0.doc Version 1.30 Page 23 Commission for Social Care Inspection CSCI 8th Floor, Grosvenor House 125 High Street, Croydon CR0 9XP 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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