Inspection on 16/10/07 for Hamiltons Residential Home

This inspection was carried out on 16th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Hamiltons Residential Home 16/10/08

Hamiltons Residential Home 04/01/07

Hamiltons Residential Home 12/12/05

Hamiltons Residential Home 18/07/05

Hamiltons Residential Home 16/11/04

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

CARE HOMES FOR OLDER PEOPLE Hamiltons Residential Home 26 Island Road Upstreet Canterbury Kent CT3 4DA Lead Inspector Marion Weller Key Unannounced Inspection 09:40 16th October 2007 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 Hamiltons Residential Home DS0000061038.V348891.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. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamiltons Residential Home Address 26 Island Road Upstreet Canterbury Kent CT3 4DA 01227 860128 F/P 01227 860128 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) MGL Healthcare Ltd Mrs Kerry Louise Mullens Care Home 17 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Dementia (DE). The maximum number of service users to be accommodated is 17. Date of last inspection 4th January 2007 Brief Description of the Service: Hamiltons is a large, detached property situated on the main road in the village of Upstreet. The home is registered to provide care for up to seventeen older people, some of whom may have a diagnosis of dementia or other cognitive problems. The three double bedrooms in the home are currently being used for single occupancy. All bedrooms have television, telephone, and a call system facility. Residents accommodation is arranged over two floors. The home has no shaft or stair lift serving the second floor. There is an attractive garden to the rear with a wide flat pathway suitable for wheelchair users. The home has a no smoking policy. Residents who choose to smoke do so outside in a wooden gazebo, which provides shelter from inclement weather but is unheated. There is some parking available to the front of the property. Canterbury and the seaside towns of Whitstable and Herne Bay are within 30 minutes drive. There is public transport available in the village. The home employs carers who work a roster that gives 24-hour cover and other staff for catering, domestic and maintenance duties. Current fees range from £330 -to £390 per week according to assessed personal need. Please contact the manager for further details Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector, who was in Hamiltons on Tuesday 16th October 2007 from 09.40 a.m. until 5:35 pm. During that time the Inspector spoke with the Registered Providers, the acting Manager, the Providers Staff-Training Manager who is usually based in Maidstone, some residents and some staff. Some judgements about the quality of life within the home were taken from observations and conversations. Some records and documents were looked at and the home’s Annual Quality Assurance Assessment (AQAA) was also used as a source of information. In addition, parts of the building and grounds were toured. The Registered Manager for Hamiltons has been on maternity leave since April 2007. The Commission has recently been informed that she will not be returning to the home after her leave of absence and has resigned from her post. The home now has a third acting manager in place overseeing the daily operational running of the service. The Registered Providers are currently recruiting to fill the vacant Registered Manager post. For the purposes of this report the current ‘acting Manager’ will be referred to as the Manager. The Care Home’s Regulations 2001 and the National Minimum Standards for Care Home’s for Older People refer to people who use the service as “service users”. People living at Hamiltons prefer to be referred to as “residents”. Accordingly this shall be done in the text of this report. The Manager and staff gave their full co-operation throughout the inspection. What the service does well: Most residents said the home provided a “homely” atmosphere. Residents liked the staff and said they were hard working and caring. Friends and relatives were welcome to visit and could do so at any reasonable time. There is a choice of meals and some special dietary needs can be catered for. Residents are consulted and are afforded choices on a day to day basis. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are important areas in the home for further improvement and development and the operation of the home does not yet fully safeguard residents. Residents would benefit from information documents that are kept up to date, meet all the requirements of Regulation and are easily accessible after admission. They should also be offered in formats designed to meet all levels of resident capacity. Residents are put at some risk by current inadequacies in the systems for care planning and medication administration in the home. Formal processes need to be further developed and updated so that the home’s complaints procedures are readily available, understood and consistently applied and residents enabled to use them. All staff must be trained to be aware of adult safeguarding issues and procedures so they have the skill, knowledge and ability to fully protect residents from any potential for abuse. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 7 Although it is clear that some improvements have already been made to the premises and more are planned, the quality of life and safety of residents currently has the potential to be adversely affected by issues concerning the home’s environment and the lack of facilities designed to secure their welfare. Although recent improvements in access to staff training have been made this matter requires focus and further investment to ensure that all staff can evidence they have the skills and knowledge required to ensure that a consistent high standard of care is being delivered. 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. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 8 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 Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12356 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using this service have most of the information they need to make an informed decision about whether the service is right for them. Residents would benefit further from information that is kept up to date, meets all the requirements of Regulation, is accessible to them after admission and can be offered in other formats which are designed to meet all levels of capacity. The personalised needs assessment means that people’s diverse needs are identified and planned before they move to the home. The provider is taking action to ensure that all staff can evidence they have the skills, knowledge and experience to deliver the services and the care the home offers to provide. EVIDENCE: The home’s Statement of Purpose and Service User Guide are combined into one document. This provides a range of information about the home, its Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 10 principles of care, facilities and services. It was identified at the last key inspection that content did not fully comply with the demands of Regulation. The previous inspector sent a letter to the home in January 2007 detailing the elements that needed to be included to obtain full compliance. The home’s information documents seen on this inspection were dated November 2006. They contained inaccurate and out of date information due to staff changes, revised staffing structures, amended registration details etc. It was unclear if the guidance had been fully complied with. It will be a requirement in this report for the manager to comprehensively revise documents in line with Regulation and good practice to ensure residents and their representatives have accurate up to date information on which to base decisions about the suitability of the home. Information documents are available to residents in standard format. The home should consider providing other formats to suit all resident capacities in line with their category of registration and to make them accessible to residents when they are in residence as an aid memoir. An admission checklist continues to be recommended in resident files to evidence the issue of a Statement of Purpose, Service User Guide, contract and other key public information to individuals admitted, Residents spoken were not able to accurately recall the preadmission process in any detail. However, records confirm that an assessment of needs is carried out before each admission, either by the funding authority (and supplemented by the home’s own) or home (if the placement is self funded). There are opportunities for residents or their representatives to visit the home before admission to assess suitability. There is also a four-week trial stay. Each admission is properly confirmed by a contract. The contract generally complies with most elements of good practice. It now identifies the room number allocated, albeit hand written on the top of the document. It still does not however describe the room’s provisions. This continues to be recommended to ensure people are clear about what they are being offered and what they are paying for. In line with the Local Authorities plans for improvement, the providers could evidence they are taking prompt action to address current shortfalls identified in staff training needs. This home does not provide intermediate care. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are put at some risk by the current inadequacies in the systems for care planning and medication administration in the home. EVIDENCE: Each resident has a plan of care based on their preadmission assessment. Three were looked at in some detail. Care plans largely illustrated the action that needs to be taken by care staff to ensure that all aspects of the health and personal care needs of the residents are met. They also establish the residents’ individual capacity for self-care. Risk assessments are in place. Records confirm that care plans are reviewed regularly and the main plan changed if necessary. Residents or their representatives, as good practice demands, now sign care plan review sheets. It remains unclear how much residents or their representatives are involved in the formulation of the original care plan upon admission. The plan needs to be signed to show the individuals agreement to it and evidence they or their Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 12 representative’s full involvement in the drawing up of the document. Records still need to better evidence this. Individual Care Plan folders were seen to be overly large. They contained some documentation that could easily be maintained separately from the main plan. Care plans would also benefit from some elements being archived to ensure files are kept up to date and current. It is important that care plans provide easily accessible information to identify individuals’ care needs and be directive to ensure staff know how needs are to be met. It is doubtful that staff will spend time going through unnecessary or out of date information before they access the guidance they require. This could potentially place residents at risk. There was clear evidence to demonstrate that the healthcare needs of service users are being met. Records are maintained of all healthcare professional input including district nurses, GPs and complimentary healthcare professionals such as Chiropodists and Opticians. Nutritional assessments are completed and weight charts are routinely maintained. The home has ‘sit in’ scales designed to meet all resident capacities. The standard of daily record keeping is generally informative but does not always reflect the demands of the individual’s plan of care. Daily records are maintained separately from care plans for all residents. This is not best practice. They need to be accessible to the person to whom they relate and need to be in a form that enables this. Documentation for each individual should not be unnecessarily fragmented. The manager is aware of current shortfalls and has plans to further develop the care planning system in the home. Medication administration processes and medication administration records were inspected. The manager is currently reviewing the home’s medication policy and procedure documents. There is currently no policy or procedure for residents who may elect to self-administer medicines, neither is there a risk assessment to establish an individuals capacity to do so. Some bedrooms do not evidence a lockable storage facility, as standards require enabling safe storage. The home has access to a lockable medicines trolley, which contains medication currently being administered. They use a monitored dosage system (MDS) provided by a local pharmacy. There is no separate storage area for medicines in the home and medicines are currently kept in locked cupboards in the home’s downstairs office. As they intend to change their MDS system to a much bulkier version they need to reconsider medication storage. Medicines newly delivered, those being administered and those awaiting return to the pharmacy, must be kept locked away from communal access areas. The Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 13 home has a dedicated lockable medicines fridge. Records of storage temperatures for medicines are currently not being maintained. Medication records showed no obvious gaps in records of administration. Hand written transcriptions were not all signed by the individual recording the details, neither were they signed by a second person to confirm accuracy of transcription. Some hand written transcriptions did not contain all the information included on the pharmacists label. Most staff that administers medication has received one day training, some have completed or are in the process of undertaking more comprehensive training. The Providers training manager stated that medication training is ongoing in line with the home’s action plan. It is noted that 5 care staff, some of which are night carers and therefore work unsupervised, have not received medication training. This should be arranged without delay. Staff should also have their ongoing competency regularly tested, with records maintained as evidence. A requirement will be issued in the respect of medication administration in the home. Residents’ privacy and dignity are respected. All bedrooms are used as single occupancy, which means health and personal care can be given in private. Staff were seen to knock on doors before entering and called residents by their preferred name. Interactions between staff and residents were observed as friendly and relaxed but respectful. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In line with increased staffing levels, the home’s activities programme should be further developed to ensure that opportunities for mental stimulation both inside and outside the home are sufficiently regular and that all resident capacities are provided for. Dietary needs of residents are well catered for with food available that meets their tastes and preferences. Residents are enabled to maintain contact with friends and family. EVIDENCE: There is currently no dedicated activities co-ordinator in the home to ensure up to date information about activities (on and off site) is circulated to residents. However, in line with the recent increase to staffing levels the manager is intending to revisit the residents current activities programme to consider if this can be further developed. On this site visit staff spoke of arranging a residents Halloween party to which family and friends were to be invited. Staff Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 15 were also investigating the possibility of some residents attending lunch clubs in the local area and encouraging the regular involvement of local schools at the home. Activities on site were said to include Bingo, card games, Ludo, snakes and ladders, drawing and painting and occasional singing sessions. Residents had the use of a large communal TV in the lounge and individuals were seen reading and another drawing during the visit. The home is on the A28 and the No.8 bus route, linking it to Canterbury, Margate and Broadstairs. Upstreet has a pub a few doors away and a post office / general store. The mobile library stops at Upstreet once a week. A hairdresser comes in fortnightly, and staff will dress residents’ hair in between times. Although staff are aware of the need to plan routines and activities of the home in a way which meets the choices and wishes of residents, it is strongly recommended that following consultation with residents and their representatives more opportunities for stimulation and meaningful activity are provided in line with individual preferences and current levels of resident capacity. Residents are able to have visitors at any reasonable time. There is no separate visitors room in the home but residents can use their bedrooms to entertain friends and family in private if they wish. There is a communal pay phone in the main lobby but this does not provide a great deal of privacy. Residents can arrange to have phones installed in their rooms at their own expense if they wish. Unless other arrangements have been agreed, the manager stated that residents receive their mail unopened. Nutritional needs are identified as part of the preadmission process and updated or amended thereafter. Records are maintained of dietary intake, and residents weight is regularly monitored. Residents are given a choice of menu. The pace of the meal observed at lunchtime was unhurried and congenial. Staff offered residents sensitive assistance in eating where it was necessary. Hamiltons Residential Home DS0000061038.V348891.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Residents feel safe and listened to. However formal processes need to be further developed and updated so that the home’s procedures are readily available, understood and consistently applied. The home continues to train staff to be aware of adult safeguarding issues and procedures so they have the skill, knowledge and ability to fully protect residents from the potential for abuse. EVIDENCE: The home has a written complaints procedure, which evidenced appropriate timescales for resolution. The complaints procedure is clearly detailed in information documents. As mentioned earlier, these documents are not available in alternative formats to suit all individual capacities resident in the home, neither are they given to residents to retain as aid memoirs following admission. In addition, some amendment needs to be made to the current complaints procedure to clearly state that the Commission can be contacted at any stage of a complaint being received and not just as a last resort. There was a complaint, concerns book seen in reception. Since the last inspection the manager stated that one concern had been recorded. This was not retained in the book for reference purposes. The manager explained that Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 17 the concern dealt with emergency door release equipment that failed because dead batteries had not been replaced. This had since been satisfactorily resolved. The manager said these items of equipment are now monitored regularly. It is regrettable that this simple but important issue had to be raised as a written concern. Such equipment should have been regularly attended to within the home’s normal Health and Safety monitoring procedures and is somewhat indicative of the home’s recent lack of attention to detail and resident safety. These issues are now being addressed under the action plan with the Local Authority. The provider evidenced a firm commitment to address all shortfalls. The home does not routinely record minor concerns and there have been no formal complaints received since the last inspection. With no records to view it is difficult to evidence that residents and their families are enabled to use the home’s concerns and complaints procedure effectively or that concerns raised with the home inform quality assurance systems. It continues to be a challenge for this service to adequatly evidence residents and their representatives have the confidence to use the home’s complaints process, and are supported to do so. Residents spoken with knew whom they would contact in the first instance if they had a concern and all said they felt safe and secure in the home. There is currently two Adult Protection Alerts open which were raised by the Kent County Council in response to concerns raised by Care Managers and the failure of the home to comply with the local authority’s contract specifications. Staff spoken with have a generally good understanding of what constitutes abuse. There is still some staff that have not had training in safeguarding adults. The providers training manager is a ‘Trained Trainer for Adult Protection and spoke of their intention to address the shortfall. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 22 24 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although it is clear that some improvements have already been made and more are planned, the quality of life and safety of residents has the potential to be adversely affected by issues concerning the home’s environment and the lack of facilities designed to secure their welfare. EVIDENCE: Hamiltons is a detached building with residents’ accommodation arranged over two floors. Changes in residential and social care mean that people referred to care home’s have increased frailties and care needs than previously. Whilst Hamiltons is able to offer people a “homely” environment, from observation, it could be very difficult for staff to meet residents’ continuing care needs safely if for instance they become immobile or bedfast and unable to negotiate stairs. The home does not have a passenger or chair lift and relies on people Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 19 maintaining their mobility. Transporting lifting hoists to different parts of the house could be problematic if not impossible and does not safeguard either residents or staff. Due to their recent change in registration the Provider must now make an informed decision as to whether the current environment fully safeguards residents long-term welfare and is fit for purpose. The home will be required to provide a full assessment of the premises and the facilities provided which has been undertaken by someone qualified to do so and who has specialist knowledge of the client group accommodated. Some environmental problems still need to be addressed that adversely affect service users safety and welfare. There is currently a failure of the home to comply with the Local Authority’s contract specifications and some issues identified as shortfalls are of an environmental nature. The Registered Providers have assured the Commission that they are working hard to address these. Timescales for full compliance have recently been extended. It was acknowledged on this visit that some improvements had been made, but more work still needs to be done. A full tour of the building was undertaken. The environment of the home is disappointing and there are some areas that require more thorough cleaning, particularly in hard to reach areas. Soft furnishings, such as bedcovers and curtains also require replacement in resident’s rooms and the general décor in some areas requires upgrading. Bedrooms do not provide lockable storage space for residents use. The reason for not doing so is not explained in care plans. There is an attractive rear garden which provides a choice of discrete areas to wander or sit in and there are attractive focal features. It was noted that the brick walkways are slippery and need moss to be removed to ensure they do not present a hazard to those accessing the garden. The home has a “No Smoking” policy, which means residents who smoke are required to access an external wooden gazebo on the patio area just outside the lounge. While this structure shelters people from inclement weather, it is nevertheless still very exposed to the elements. Residents were observed shivering as they took their cigarette break and upon returning to the lounge were seen being offered hot drinks. This is not ideal and the arrangement for smokers should be reconsidered to secure their welfare. It was noted that some external doorframes, windowsills and window frames are in a poor state of repair. The manager stated that there are plans to further extend this area of the home to provide more communal day space for residents. It is planned to replace them at that time. These should be included on the home’s refurbishment programme. Communal bathrooms and residents’ bedrooms had liquid soap and paper towels for people’s use. Staff also uses disinfectant hand gel. The current Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 20 arrangements and overly large signs concerning the use of hand gel in residents rooms does nothing to promote a homely environment and is over clinical in approach. This should be reconsidered. The home has no sluice for staff use and commode pots are emptied into toilets and washed out nearby. One over bath hoist has the protective finish peeling off the base which compromises the home’s infection control measures and makes it difficult to clean properly. Some tiles were missing from the wall finish in another bathroom and two baths evidenced broken bath panels. It will be a requirement that the Health Protection Unit at Preston Hall are contacted by the manager and asked to undertake a full audit of the home to provide them with infection control guidance and a subsequent written report of their findings. The report will be shared with the Commission. Over the toilet support frames were seen to not be fixed to the floor and present a hazard for an older client group. It will be a requirement that these are permanently fixed. One communal toilet accessible from the lounge is not covered by the staff call system and has the potential to compromise a resident’s ability to summon help when it is required. Laundry facilities are properly sited away from dining and food storage / preparation areas. The floor in this room requires recovering to make it easily cleanable. The home’s washing machine has the specified programming ability to meet disinfection standards and uses alginate sacks as a further precaution. The home has appropriate measures in place for the safe handling and disposal of waste (clinical and domestic / business). Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from recently increased staffing levels and from being cared for by a dedicated staff team who have a good understanding of their needs and clearly defined roles in the home. Although recent improvements in access to staff training have been made this matter requires focus and further investment to ensure that all staff can evidence they have the skills and knowledge required to ensure that a consistent high standard of care is being delivered. EVIDENCE: At the last inspection it was noted that changes had been made to staff deployment in the home. There were no longer to be any dedicated domestic staff. Domestic staff tasks and hours had been absorbed into the careworker role and establishment allocation. The manager at the time said this was designed to better meet residents needs. This system of work however proved unsuccesful and was possibly responsible for a number of the shortfalls in service standards recently identiifed. The current staff team is of mixed gender, which reports working harmoniously and flexibly to meet the day-to-day needs of residents. All had been made Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 22 aware of the improvements the home needs to make in line with KCC contracts specifications and had been given a copy of the agreed action plan. Staff spoken with were motivated and keen to be part of the action for improvement. This is commendable. The provider had taken recent action to ensure there were now 3 members of care staff on duty and the manager during day time shifts Monday to Friday. There are 2 waking night staff. There is also an identified member of the senior staff contactable by telephone who will come into the home if necessary during unsocial hours to support night care staff. There are dedicated cleaning and catering staff. There is a vacancy for a gardner/ handyman. A significant improvement in staffing levels is acknowledged. The current manager has the help and support of the MGL dedicated training manager and more staff training has been booked in line with the KCC action plan for improvement. A full staff training matrix was provided to the Commission following the inspection. This provides a clear overview of staff training needs. It is vital that the home continues to invest and focus their energies in ensuring that all staff have the skills and knowledge required to offer the specialist care the home is registered to provide and that a consistent high standard of care is being delivered. There is a staff induction programme that is compliant with The Skills for Care standards. Induction records seen were compehensive and evidenced both signatures of trainee and trainer. In line with a requirement made at the last inspection, the home could evidence that 50 of their care staff are qualified at NVQ level 2 or 3 in Care and more staff are being supported to prove competence. The manager said she was keen to compile an employees handbook. This is recommended. It was also recommended at the last inspection that staff employed by the home were given copies of the code of conduct and practice set by the GSCC. The training manager stated this had been done. Unfortunately this was not evidenced. It is recommended that a note be made in each staff file to prove compliance and in future staff are asked to sign for their copy during induction. Three staff files were checked. It was acknowledged by the manager that some required elements were missing. She spoke of her firm intention to review all files and ensure that they fully met the requirments of regulation. A Requirement will be issued in this respect. CRB/ POVA checks for staff are arranged by the Provider centrally in Maidstone using the NCHA. The three staff files checked evidenced that a completed CRB/ POVA check had been applied for before the person started work at the home. There are currently some staff files missing. This matter has recently been reported to the Police and is being investigated. This matter will continue to be monitored by the Commission. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 23 The manager stated that she has now recommenced offering formal supervision sessions to staff. This had lapsed. The home is reminded that staff must receive supervision, which is to include identification of training, needs six times a year Residents spoke highly of staff and it was clear that some good supportive relationships between staff and residents exists. The home operates a keyworker system. Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 36 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there have been very recent improvements, the operation of the home does not yet fully safeguard residents. EVIDENCE: The Registered Manager for Hamiltons has been on maternity leave since April 2007. The Commission has recently been informed that she will not be returning to the home after her leave of absence and has resigned from her post. The home now has a third acting manager in place overseeing the daily operational running of the Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 25 service. The Registered Providers are currently recruiting to fill the vacant Registered Manager post. The current temporary manager has a background in care, is motivated, keen and personable, but still has to gain a relevant management qualification. She has recently started work to gain her Registered Managers Award and is employed permanently in an MGL Healthcare Ltd sister home in Maidstone. The Providers are at the home frequently to support the temporary manager, as is the dedicated training manager for MGL Healthcare. There was evidence on this visit of the providers own inspection visits, which are now happening at least monthly. In conversation with the providers they now see the importance of the organization offering clear lines of accountability for the quality and standard of the service being offered and lessons have been learnt from recent experiences. As mentioned throughout the report, there is currently a failure of the home to comply with the Local Authority’s contract specifications. Consequently the contract the home has with them for supported resident referrals has been suspended. An action plan for improvement in significant identified key areas has been agreed between both parties. The Registered Providers have assured the Commission that they are working hard to address all service shortfalls. Timescales for full compliance with the agreed action plan has recently been extended. Consequently much work remains in progress. Further requirements will also be issued as a result of this inspection and the Commission will require an Improvement plan. The temporary manager has been proactive in encouraging and bringing about improvements. Staff spoke highly of her and residents knew who she was and clearly felt safe and secure in her presence. There are two current Adult Protection alerts open in regards to residents finances, and as previously mentioned there are missing staff files. These matters have been referred by the Providers to the Police. The Inspector thefore did not look specifically at these issues. It is entirely possible these matters will be referred to in subsequent reports when they have been fully investigated by other agencies that have lead responsibility. The home’s Annual Quality Assurance Assessment sent to the Commission prior to the inspection was poorly completed. It has therefore not been possible to incorporate evidence from the document in this report. Hamiltons Residential Home DS0000061038.V348891.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 2 2 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 x 1 x 2 x 1 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X 2 2 1 Hamiltons Residential Home DS0000061038.V348891.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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 & Schedule 1 Requirement The home’s Statement of Purpose / Service User Guide document needs to be fully compliant with all the elements of this standard and be up to date. Previous timescale of 28/02/07 not met. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. In relation to Care Plans: 1. Residents care plans must be further developed and be in a format that easily provides clear detail, direction and guidance for staff. 2. Care Plan content must be regularly archived to ensure care plans remain up to date and current at all times. 3. Care Plans must be signed by the resident to evidence DS0000061038.V348891.R01.S.doc Version 5.2 Page 28 Timescale for action 31/12/07 2. OP7 15 Schedule 3 31/12/07 Hamiltons Residential Home their involvement in its compilation and their agreement to the plan of care. 4. Daily records must clearly evidence that the demands of the care plan are being met. 5. Daily records need to be accessible to the person to whom they relate and need to be in a form that enables this. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. In relation to the home’s arrangements for the recording, handling, safekeeping, safe administration and safe disposal of medicines” 1. The home’s medication policy and procedures document must be reviewed by the manager to ensure that medicines are handled according to the requirements of The Medicines Act 1968 and Guidelines from the Royal Pharmaceutical Society, ‘The Handling of Medicines in Social Care. This review must include the home’s policy and arrangements for residents that elect to self medicate and include a risk assessment to establish their capacity to do so. 2. Hand written transcriptions on MAR’s must be signed by a second person to confirm accuracy of Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 29 3. OP9 13(2) 18 (1) (c) 31/12/07 4. OP16 OP37 22 (2) (5) 17 (2) transcription. 3. Training in the safe handling of medication if staff administer or may be needed to administer medicines must be given. (There is good evidence this is being addressed through the current training matrix but there are still gaps, especially for night staff.) 4. Staff must be regularly assessed for competency with regard to the administration of medication. 5. Written temperature records for the correct storage of medicines in the home must be maintained. 6. Storage of medicines must be reviewed in the home in light of the new MDS system adopted. The home must ensure they store medicines received into the home and awaiting return to the pharmacy in secure areas. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. In relation to the complaints 31/12/07 procedure: • The text of the home’s complaints procedure should clearly indicate that the Commission could be involved at any stage of a complaint being received and not just as a last resort. • It must be more freely accessible to residents and Version 5.2 Page 30 Hamiltons Residential Home DS0000061038.V348891.R01.S.doc their representatives and made available in formats that meet all residents’ capacities and those with specific impairments. • The home needs to better evidence residents and their representatives are aware of and have the confidence to use the home’s complaints process, and are supported/ enabled to do so. Complaint records maintained should clearly show date of receipt of complaints/ concerns and the action(s) the home has taken in relation to them being raised. Be available for inspection purposes. • • An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 5. OP18 13(6) All staff must be trained in Safeguarding Adults and fully conversant with the demands of the Kent and Medway multi agencies protocol, to ensure a timely and co-ordinated approach to adult protection in the home. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. The external grounds must be suitable, safe and adequatly DS0000061038.V348891.R01.S.doc 31/12/07 6. OP19 23 (2) (o) 31/12/07 Hamiltons Residential Home Version 5.2 Page 31 7. OP20 23 maintained. Moss must be removed from walkways in the garden to eliminate slip trip hazards. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. Smoking arrangements for service users are to be reviewed to ensure the facilities provided secure their health and welfare. The arrangements for residents who smoke should appear in the service users guide. 31/12/07 8. OP22 23 (2) (n) 9. OP22 13(4) 23 (1) An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 31/12/07 A full assessment of the premises and the facilities must be made by a suitably qualified persons, including an occupational therapist, with specialist knowledge of the client groups catered for and a subsequent written report obtained that evidences that all the recommended disability equipment, including passenger lifts, have been secured or provided and environmental adaptations made, to meet the needs of service users accommodated. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. All parts of the home to which 31/12/07 service users have access are so far as reasonably practicable free from hazards to their safety DS0000061038.V348891.R01.S.doc Version 5.2 Page 32 Hamiltons Residential Home In that: 1. Support frames used around toilets must be secured to the floor. 2. The call system is to be extended and provided to all rooms used communally by residents. 3. A new floor finish is required in the laundry. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 10 OP24 23 (2) (m) Bedrooms - The furniture and fittings should be checked for compliance with all the provisions of the National Minimum Standards. Of particular concern is the lack of lockable storage facilities for residents. Non-provision needs to be supported by fully documented consultation and/or risk assessment in the individuals care plan. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. The manager must arrange for a full infection control audit of the premises by The Kent Health Protection Unit. The subsequent report of the audit will be shared with the Commission. Work found to be necessary must be included in the home’s Improvement Plan and details of actions to be taken/proposed with completion dates included. An improvement plan detailing how the service will address this Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 33 31/12/07 11. OP26 OP38 12(1), 13(3)(4) (c) 16(2)(j) 31/12/07 must be forwarded to the Commission within the timescale indicated. 12 OP29 OP37 19 (1) No person shall be employed at the home unless a minimum of two satisfactory written references are obtained, their employment history including their reason for leaving the last employer, gaps in employment are adequately explored and answers recorded. Previous training is validated. • Staff files must be reviewed to ensure they contain all the requirements of regulation and to evidence the home exercises robust recruitment practices to secure the welfare and safety of residents. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated There must be evidence that all staff have the necessary training to carry out the work they are to perform. Staff are to undertake training in safe practices and care topics covering: Infection Control, Moving and Handling, Risk Assessment, First Aid, Care Panning, Food Hygiene, Health and Safety, Moving and Handling, Fire Safety, COSHH. Medication Administration, Dementia and Dealing with Challenging Behaviour. There is evidence that this is being addressed through the Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 34 31/12/07 13. OP30OP37 18 (1) (c) 31/12/07 current training matrix but there are still some gaps for core training. Training Certificates must be available as evidence of compliance on staff files. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. There needs to be compliance with the National Minimum Standard in respect of formal staff supervision sessions. An improvement plan detailing how the service will address this must be forwarded to the Commission within the timescale indicated. 14. OP36 18(2) 31/12/07 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 An admission checklist is recommended to evidence the issue of a Statement of Purpose, Service User Guide, contract and other key public information to residents. It is recommended that the Service User Guide be produced in formats that meet all resident capacity. It should be more accessible and be further developed to provide a visual memory tool, using more pictorial referencing, for those with cognitive difficulties and who may not get the opportunity to visit the home before moving in. The home’s contract should identify the facilities and provisions of allocated rooms. Records need to better evidence the active involvement of residents and their representatives in the care planning DS0000061038.V348891.R01.S.doc Version 5.2 Page 35 2. OP1 3. 4. OP2 OP7 Hamiltons Residential Home and review processes. 5. OP12 It is recommended that the manager fulfil the stated intention to further develop the home’s activities programme inside and outside the home. Special consideration should be given to meeting the needs of all capacities of residents and those with specific impairments. Consideration should be given to allocating dedicated staff time to ensure the provision is consistently offered to residents. Staff need to better familiarise themselves with the Kent and Medway multi agencies protocol, to ensure a timely and co-ordinated approach to adult protection, should it occur. It is strongly recommended that a programme of renewal of the fabric and redecoration of the premises is produced and provided to the Commission with relevant timescales. It is recommended that recruitment / induction records / staff files should evidence that staff employed by the home are given copies of the code of conduct and practice set by the GSCC. 6. OP18 7. 8. OP19 OP29 Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. Extracts may not be used or reproduced without the express permission of CSCI Hamiltons Residential Home DS0000061038.V348891.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!