Inspection on 16/10/08 for Hamiltons Residential Home

This inspection was carried out on 16th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hamiltons Residential Home 16/10/07

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 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Hamiltons Residential Home 26 Island Road Upstreet Canterbury Kent CT3 4DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Lawrence     Date: 1 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 23 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 23 Information about the care home Name of care home: Address: Hamiltons Residential Home 26 Island Road Upstreet Canterbury Kent CT3 4DA 01227860128 F/P01227860128 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) MGL Healthcare Ltd Type of registration: Number of places registered: care home 17 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 17. 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) Dementia (DE). Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 23 Over 65 0 17 17 0 Brief description of the care home 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. 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 £390 to £450 per week according to assessed personal need. Please contact the manager for further details Care Homes for Older People Page 5 of 23 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection visit was unannounced and started at 10:50 and finished at 15:50. We, that is the commission for social care inspection (CSCI) looked at various records in the home and also used information sent to us by the manager through her completion of the Annual Quality Assurance Assessment (AQAA). Information from the previous inspection which took place on the 16 October 2007 was also referred to, as was the improvement plan completed by the home in response to that inspection. A tour of parts of the building was undertaken partly in the company of the manager and partly alone. We observed staff interacting with residents and we noted residents responses to staff. We spoke to staff on duty as well as the manager. We spoke to residents both in communal areas and in their own accommodation. Care Homes for Older People Page 6 of 23 Care Homes for Older People Page 7 of 23 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 23 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 23 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the home judges that it can meet their needs because it assesses their needs before they move in. Evidence: We looked at the records of assessments for residents and noted that they were appropriate and in keeping with the information in Standard 2. The new manager has improved the assessment and care plan formats and they are now more person centred. They also contain information from relatives or previous carers, where appropriate and we saw evidence that information is sought from the placing authority. Care Homes for Older People Page 10 of 23 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having an individual plan of care which identifies how their health and care needs are to be met. They are protected by the homes procedures for dealing with medication and they can be confident that they will be treated with respect. Evidence: We looked at four care plans for this inspection. They contained clearly written information for staff about the particular needs that a resident might have. They cover a range of areas including personal care and any preferences someone might express. The following things are also included, eating and drinking, health and medical, social and family, spiritual, continence and elimination, cognition, communication and psychological well being, safety and supervision, mobility and activities. The care plan identifies any need but also includes any strengths that the individual has and this is followed by guidance to staff about the support or assistance needed. Information is also included about any night time care needs or preferences. An evaluation sheet (daily record) is maintained by staff, as well as records of any special needs such as Care Homes for Older People Page 11 of 23 Evidence: fluid intake or turning routines, and this information is used to review the care plans on a monthly basis. The manager said that she tries to involve residents whenever possible, as well as relatives where appropriate and we did note examples of relatives signing an agreement to the care plans. Healthcare professionals are involved both routinely and if required. We noted examples of specialist input from an osteoporosis and falls nurse as well as GP visits and community nurses providing a service. Weight is monitored on a monthly basis and needs, as well as preferences regarding food and nutrition are covered in the care plans. A chiropodist was visiting at the time of this inspection and the records of residents shows that opticians, dentists and audio specialist are also involved. Risk assessments for part of the care plan and those seen were individual and reflected that staff try always to encourage people to be independent. We looked at the storage of medication, which was appropriate. We looked at the records of administration as well as observing medications being given to residents and these were satisfactory. We were informed that staff who give out medications have received training. The member of staff we observed confirmed that she had undertaken a safe handling of medications course as well as a training session with the pharmacy which provides the monitored dosage system in the home. She further confirmed that the manager had assessed her competency in July. We noted an example of the home asking the general practitioner to review one persons medication. We saw staff being polite and respectful to residents. When they were providing some care or support they spoke to residents, involving them in what was happening. People were asked about what they would like to drink, both at morning coffee and at lunchtime, indicating that there were no assumptions made. There was a choice of three different flavour squashes. One person has an individual pot of tea as this was what had always been part of a preferred routine. When staff, including the cook and the cleaner, walked past residents in the lounge they engaged with people in a friendly, chatty way. Residents preference for how they wish to be addressed is known. Privacy is considered important and staff spoken to said this was clearly an important part of the care provided. One person said sometimes they forget about it so its important that we maintain their dignity. Care Homes for Older People Page 12 of 23 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their preferences will be identified and responded to and that they will be enabled to maintain contact with friends and family. Residents will be enabled and encouraged to make choices and they will benefit from healthy, well-presented food at a time and place to suit them. Evidence: The assessments and care plans contained information about an individuals religion but also refelects whether they are practising or not. We noted examples of residents being able to make choices. This included simple, but important things like which drink or flavour of squash, which choice of meal (we saw the cook asking individuals what they would like for tea), what time people liked to get up or go to bed (when we arrived three people were still relaxing over their breakfast) as well as more complex things such as refusing care or medication. In these case there are clear guidelines to staff about how to manage this and what steps to take. Several of the residents smoke and we also noted that if someone chooses they can stay in their room. There are various activities and entertainments provided in Hamiltons and the manager explained that she plans to build on this. There is an activities person who does one to one sessions as well as group activities. There are no restrictions on visitors and we Care Homes for Older People Page 13 of 23 Evidence: observed people being made welcome when arriving at the home. The manager has undertaken training regarding the Mental Capacity Act and she has begun to cascade this to other staff. We observed lunch time and the food looked and smelt appetizing. We asked some of the residents what they thought and they were all positive. One person said they have lovely grub here. The tables were set with napkins and tablecloths. We observed a member of staff assisting a resident to eat and this was done sensitively, allowing the resident to do what she could or wanted to do for herself. The meal was not hurried and residents were given time to sit afterwards. The cook is aware of special needs such as diabetes. Care Homes for Older People Page 14 of 23 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints would be handled objectively and in keeping with the homes appropriate procedures and residents and their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place which create an atmosphere for protecting residents from abuse. Evidence: The home has an appropriate complaints procedure and also seeks positive comments and compliments. We noted an example of a complaint being dealt with appropriately. Information is easily available within the home. Staff have received training regarding the protection of vulnerable people and what constitutes abuse. The manager is a trained trainer for this and she is ensuring that this aspect of training is kept up to date. Staff confirmed they had this training and their individual records did also. There are policies and procedures in place including disclosure of abuse and bad practice. Care Homes for Older People Page 15 of 23 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, well-maintained home which is homely, clean, comfortable, pleasant and hygienic. Evidence: We walked around most of the home in the company of the manager and also partly alone. Some redecoration has been carried out and we were informed that more is planned. The outside of the building has been painted and new lighting is in place. The house is attractively furnished and the rooms seen were personalised. The atmosphere is homelike. The grounds have been improved and a gardener is due to do more work in the near future. The laundry is satisfactory and a new sluice has been fitted since the last inspection. The home was clean and fresh at the time of the inspection. Most of the staff have received training regarding infection control. Care Homes for Older People Page 16 of 23 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by sufficient staff who are competent and trained. Residents are supported and protected by the homes recruitment procedures. Evidence: There is a rota which is used to show who is on duty for each of the shifts and this includes staff roles such as senior. The rota indicates that there are sufficient staff on duty. The manager informed us that she monitors staffing levels carefully to ensure that residents needs can be met. We looked at the records for two members of staff who were on duty at the time of the inspection. They showed that recruitment procedures are satisfactory with application forms, interviews, references (confirmed by telephone), criminal record bureau checks and terms and conditions of employment. Two staff have a national vocational qualification at level 2 and three more people are currently undertaking this. The manager informed us that she is looking to provide more opportunities in the future. Staff are given copies of the general social care councils code of practice. The manager is using an induction training format which is in keeping with the skills for care common induction standards. She has provided staff with opportunities for training such as a distance course on dementia with Bromley College. We saw evidence that there is a programme of training in place which will ensure that any new staff receive what they need. The manager is a trained trainer for adult protection and the Mental Capacity Act and she Care Homes for Older People Page 17 of 23 Evidence: provides this in house. The staff members we spoke to confirmed that they were both doing the distance learning course on dementia and they were also given other opportunities for training both relating to health and safety and to more specific courses such as challenging behaviour in the elderly. Care Homes for Older People Page 18 of 23 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the home being managed by someone who is competent, experienced and knowledgeable. Residents financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. Evidence: The manager is qualified and experienced. She is not yet registered but intends to do this. She is only responsible for one establishment. She keeps up to date with training and as previously noted she is a trained trainer for adult protection and the Mental Capacity Act. Her background is with people with dementia and she brings her knowledge and enthusiasm to her current situation. Staff expressed their confidence in her. Those residents who were able to were also positive in their comments, saying shes lovely; she really helped me sort things out, and other residents enjoyed some banter with her. There are clear lines of accountability both within and external to the home. Regulation 26 visits are undertaken by a representative of the owning Care Homes for Older People Page 19 of 23 Evidence: company and questionnaires have been sent out to relatives and completed with residents. Examples were noted of improvements based on the feedback such as changes to the menu, improved lighting outside the home, more automatic door stops, and improvements to the garden. The home also operates a key worker system which allows for staff to spend time with residents, allowing for views to be expressed. The home generally has no responsibility for residents finances; this is mostly done by relatives or representatives. Where the home has any involvement at all there are systems in place to protect the residents money. We checked some of the maintenance and service contracts and these were seen to be appropriate and in keeping with the information in the AQAA. As noted previously staff have received training with regard to health and safety such as first aid, manual handling, infection control, food safety and health and safety for care staff. There are appropriate and relevant policies and procedures. Care Homes for Older People Page 20 of 23 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 23 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 8 The manager needs to apply 31/03/2009 for registration To comply with legislation Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 22 of 23 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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