Care Home: Hamilton Court

Similar services:

• Hillside
• Applegarth
• 122 Scorer Street
• Jubilee Villa Care Home
• Thornham Grove
• Beech Lodge
• 8 Thorndale Road (Homefield College)
• Hunter`s Lodge

What the care home does well Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Staff have a good understanding of the needs of people living at Hamilton Court. People living at Hamilton Court are treated with dignity and respect by staff that support them. The health and personal care needs of people are well met. People living at Hamilton Court enjoy their food, and have a menu which they like, and is nutritious. People living at Hamilton Court experience a pleasant living environment. The living and dining rooms are nicely decorated, as are their individual bedrooms. People living at Hamilton Court feel able to tell staff what they like and dislike, and know who they can complain to. Staff are provided with good training opportunities. There are good recruitment systems in place to ensure that staff who work in the home are safe. People living at Hamilton Court are involved in the staff recruitment process. What has improved since the last inspection? The home environment has improved. Building work has enabled two people living at the home to have en-suite facilities, and has improved access to shower/bathing facilities for those with a physical disability. What the care home could do better: The service should ensure there are regular opportunities for people living at the home, and their relatives to have their voices heard, through more regular resident meetings and/or through other communication channels.Hamilton CourtDS0000035561.V376077.R01.S.docVersion 5.2The service should ensure there are robust checks on the management of medication. The medication care plan should not only include the medication being prescribed, but also the reasons why it is being prescribed and any adverse effects it might have on the person. The service should look at more effective care planning in relation to day time activities. All people living at Hamilton Court go to day centres, but there is no record to show why people go to the day centres, the activities they are involved in, and how these activities meet their identified social, emotional or educational needs. There are appears to be limited liaison between day centre staff and Hamilton Court staff to find out whether the activities being undertaken are of value to the person. The service should make sure that staff record the outcome of meetings about individual people living at Hamilton Court held with healthcare professionals to ensure there is a clear record of decisions taken, and the involvement the service user has in the decision making process. The service should look at whether the limited number of staff on duty during the day has a detrimental effect on the daily lives of people living at the home. The service should ensure risk assessments are undertaken if behavioural changes mean that staff have to manage challenging behaviour to keep people living and working at the home, safe. Key inspection report CARE HOME ADULTS 18-65 Hamilton Court 50 Smith Crescent Coalville Leicestershire LE67 4JE Lead Inspector Fiona Stephenson Key Unannounced Inspection 16th June 2009 09:30 Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamilton Court Address 50 Smith Crescent Coalville Leicestershire LE67 4JE 01530 831767 01530 835046 awilson@leics.gov.uk www.leicestershire.gov.uk Leicestershire County Council Social Services 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) Mrs Anne Elizabeth Frewin Care Home 7 Category(ies) of Learning disability (7), Sensory impairment (1) registration, with number of places Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. No one falling within category SI may be admitted into the home when there is 1 person of category SI already accommodated within the home No one falling within category SI may be admitted to the home unless that person also falls within category LD i.e. dual disability Named Service User To be able to admit the person aged over 65 years of age who falls within category LD(E) named in correspondence from the Leicestershire County Council dated the 2nd July 2003 19th July 2007 Date of last inspection Brief Description of the Service: Hamilton Court is a care home providing personal care and accommodation for seven adults with learning disabilities. Hamilton Court is on the outskirts of Coalville, where local facilities and amenities can be found. Hamilton Court is made up of two semi-detached houses. The living room/ dining room is on the ground floor, as is a large conservatory which is used as another living area. There are seven single bedrooms, of which two have ensuite facilities. The service has communal shower/bathing facilities, of which is suitable for people with disabilities. There is a large back garden for people living at Hamilton House to use. The maximum weekly fee is £924. This fee does not cover all leisure activities or other services such as hairdressing appointments or chiropody. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Following our visit to Hamilton Court, this service is given a one star – adequate service rating. This means people who live at Hamilton Court receive adequate outcomes. This key inspection included a visit to the service. This is the first key inspection to Hamilton Court since July 2007. We (the CQC) visited on the 16th June 2009 from 9.25 to 2.50pm and 19th June 2009 from 3.30pm to 5.45pm. The Registered Manager and the staff in the home helped us during the visit. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to the people who live in the home, - talking to staff and management, - watching how people are given support, - looking at records. We looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CQC, and it tells us what the provider thinks about the service they deliver to people who live at Hamilton Court. We also looked at the surveys called Have your Say About.. which are sent out to people who live and work at Hamilton Court. We received five surveys back from people who live at Hamilton Court and 13 from staff. All five said they could do what they wanted during the day, and four said they always make the decisions about what they want to do. One person said they ‘sometimes’ make the decisions about what they want to do. All five said they can do what they want at week-ends, but two said this was as long as there was enough staff. All said staff treat them well, and four said carers listen and act upon what they say (one person did not respond to this question). The staff survey showed that nine staff thought they met either regularly or often with management to get support and discuss how they were working, with four saying they only sometimes meet to get support. Eight thought there was usually enough staff to meet the needs of people living at the home, with five thinking there was only sometimes enough staff to meet people’s needs. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 6 Typical responses from staff about what they think the home does well were: ‘it caters quite well for the service users needs i.e. It’s clean, trained staff’. ‘looks after them (people who live at Hamilton Court) really well’ ‘provides a clean environment, healthy diet, care and dignity to residents’ ‘….there is a key worker system in place so residents can out on a one to one basis on occasions’. ‘all the staff are very caring’ ‘there is a good variety of food on offer…service users appear generally happy’ Responses about what the home could do better were: …recent issues regarding staff changes have had huge impact on behaviour of residents…no consultation of residents about how they feel about the changes. ‘service users may need more encouragement to do tasks for themselves more often’ ‘staff could support each other better and communicate on relevant matters better with each other’ ‘I think we could all do better if we all worked more as a team’ ‘the home should have the same staff on a regular basis as the residents get a little anxious with different staff’. ‘organise more community based activities’ ‘more trips out, to get the service users out and about’ ‘more staff so they (people living at Hamilton court) can go out, and you could have more time to spend with certain individuals’ ‘have a mini-bus to take serve users out’. We checked all the standards that the Care Quality Commission has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences What the service does well: Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 7 Staff have a good understanding of the needs of people living at Hamilton Court. People living at Hamilton Court are treated with dignity and respect by staff that support them. The health and personal care needs of people are well met. People living at Hamilton Court enjoy their food, and have a menu which they like, and is nutritious. People living at Hamilton Court experience a pleasant living environment. The living and dining rooms are nicely decorated, as are their individual bedrooms. People living at Hamilton Court feel able to tell staff what they like and dislike, and know who they can complain to. Staff are provided with good training opportunities. There are good recruitment systems in place to ensure that staff who work in the home are safe. People living at Hamilton Court are involved in the staff recruitment process. What has improved since the last inspection? What they could do better: The service should ensure there are regular opportunities for people living at the home, and their relatives to have their voices heard, through more regular resident meetings and/or through other communication channels. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 8 The service should ensure there are robust checks on the management of medication. The medication care plan should not only include the medication being prescribed, but also the reasons why it is being prescribed and any adverse effects it might have on the person. The service should look at more effective care planning in relation to day time activities. All people living at Hamilton Court go to day centres, but there is no record to show why people go to the day centres, the activities they are involved in, and how these activities meet their identified social, emotional or educational needs. There are appears to be limited liaison between day centre staff and Hamilton Court staff to find out whether the activities being undertaken are of value to the person. The service should make sure that staff record the outcome of meetings about individual people living at Hamilton Court held with healthcare professionals to ensure there is a clear record of decisions taken, and the involvement the service user has in the decision making process. The service should look at whether the limited number of staff on duty during the day has a detrimental effect on the daily lives of people living at the home. The service should ensure risk assessments are undertaken if behavioural changes mean that staff have to manage challenging behaviour to keep people living and working at the home, safe. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): There is good information provided to help people in choosing whether Hamilton Court is the right home for them. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: All people who live at Hamilton Court have lived at the home for many years, and all the available rooms are being use. The original assessments of needs are no longer valid, as the needs of people have changed over time, but the staff have ensured that the needs of each person have been reviewed and their care plan has changed accordingly. The service has a ‘service user guide’ written in plain English and uses pictures to help people understand the content. Changes are being made to this because we, as the registering body, have changed our name from the CSCI to the CQC, and have changed our address and telephone number. There have also been changes to the service’s complaints procedure. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People living at Hamilton Court are generally consulted about their individual needs and choices, but there is little information to determine how much choice they have in the activities they take part in during the week-days. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We case tracked three people who live at Hamilton Court. We saw that each person who lives at Hamilton Court has a care plan that has been reviewed and updated. We saw that people living at Hamilton Court keep a copy of a Person Centred Care plan in their own bedrooms. These plans are written in plain English, and support the reader to understand the plan with pictures and photos. All residents who live at Hamilton Court go to a day centre for all, or most of the week. We saw nothing in the care plans which informed of how they made Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 12 the decision to go to the day centre, and how the day centre activities were meeting their needs. We looked at the daily notes and could find no feedback recorded about the day centre activities and the impact these were having on the life of the individual. But we understand that a daily diary is used by some people at Hamilton Court to record their activities. We were told by three members of staff that they felt for some people who live at Hamilton Court, the day centre did not meet their needs. We talked with some people who live at Hamilton Court but were unable to determine from their answers what their views were on going to the day centre. We also saw that one of the people we case tracked had been displaying challenging behaviour. We saw that there had been involvement with healthcare professionals to determine the cause of the behaviour, and we were told that staff had been using S.C.I.P. (Strategies for Crisis Intervention and Prevention) techniques to manage the challenging behaviour. The risk assessment relating to this did not show how staff should deal with the behaviour to reduce the risk to other people living at Hamilton Court whose quality of life was being affected, or to reduce the risk to staff supporting the person. One person living at Hamilton Court has the use of a personal mobility car. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: People living at Hamilton Court generally, have a good lifestyle. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Although it is unclear how much choice people have in going to the day-centre, and how much the day centre meets their needs; it is clear that for other parts of the day and evening people living at Hamilton Court have a good lifestyle. We saw people, on return from the day centre, choosing what to do with their evening. One person got dressed into their nightwear as they didn’t want to do anything in the evening, another showed us the clothes they had recently bought, and other people were eating their dinner and watching television. We saw that people have the opportunity to take part in leisure activities, and engage in the local community. Although we did not see any visitors during our visit, we were told that friends and relatives can visit at any time, but most Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 14 chose to visit at the week-end. We were told that people living at Hamilton Court go on holiday together, and that a trip had been arranged to go to Hunstanton. The AQAA told us that people who live at Hamilton Court are involved in decisions made in the home through resident meetings. We found that although four meetings have been arranged, only two meetings have taken place. We looked at the menu for people who live at the home. They have lived at Hamilton Court for many years, and the cook knows what their likes and dislikes are. The menu is varied and nutritious. We saw people living in the home having their meal when we visited on Friday. The meal was nicely presented. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Staff have a good understanding of people’s health and personal care needs, but healthcare records and medication records are not always clear or accurate. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We observed the interaction between staff and people who live at Hamilton Court. We saw that staff are sensitive to the needs of people who live at Hamilton Court, and treat people with dignity and respect. We saw by looking at the care plans that people get up and go to bed when they want; and can do what they want during the evening and week-ends. We saw that people made choices about how to dress, and what clothes to buy. One person told us about new shoes they had just bought, and another told us they had been into Leicester to buy records. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 16 We saw that the service pays good attention to the health of people who live at Hamilton Court and staff showed that they had a good understanding of people’s health needs. We saw that the home consults well with healthcare professionals, but staff do not always record the discussions or decisions taken, and don’t always record the level of involvement the service user has had in the process. We looked at medication management by checking the MAR sheets (Medication Administration Record) of the people we case tracked, by looking at stock control, pharmacy reports on the service; and medication storage. We saw that medication management was not putting anyone at risk but two of the MAR sheets looked at, were misleading, and in one instance there was no audit trail to show why one person living at Hamilton Court had been given different dose levels of medicines through the day. We saw that the service had more medicines in stock than it needed to have. We found medication being stored in Hamilton Court for people who do not live there, but who live in supported living. There should be no medication stored in the home for anyone who does not live there. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People living at Hamilton Court are listened to, and protected from harm. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There have been no complaints raised in the home or to the CQC regarding any aspect of the service being provided at Hamilton Court. The five people living at Hamilton Court, who completed the survey, said they knew to who to talk to if they weren’t happy. We were told that if a resident is unhappy, staff try to deal with their concerns straight away. The CQC have received no ‘Regulation 37’ notifications. These are notifications that tell us if anything has happened in the home that might affect the care of people living in the home, or to tell us if a person has been hospitalised, or if there has been a ‘safeguarding’ issue. We asked the staff we spoke with if they knew what to do if they had concerns that a person living in the home was unsafe, either because of the actions of another person living there, or because of the actions of a member of staff. All staff spoken with knew to report their concerns to the manager, and knew what the manager should do to address their concerns. They told us that they would go to a higher authority if they felt it wasn’t being properly addressed. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 18 We saw that the service has booked staff onto ‘Safeguarding’ training, during the July to October 2009 period. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People at Hamilton Court live in a pleasant, safe, and clean environment. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Major alterations to the home have impacted on the lives of people living at Hamilton Court, but these have now been completed, and people living at the home are benefiting from the improvements, which include two ground floor bedrooms with en-suite facilities, and improvements to bathing/shower facilities for people with physical disabilities. Communal areas are decorated and furnished to a high standard, and provide a homely and comfortable home for people living at Hamilton Court to live and relax. There is an open plan living and dining room, with the conservatory leading off from the dining area. People use the conservatory as another living room. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 20 The bedrooms have been well-decorated, and people living at the home have been supported in choosing the paint colour, curtains, fabrics and furniture. Hamilton Court has a large back garden, which is mainly lawn but also has trees, plants and shrubs. There is a patio area, with seating. People living at the home enjoy using this, although the garden is not used for other activities such as growing vegetables or fruit. We saw that the home was very clean, and the kitchen and laundry areas were also had systems in place to ensure good hygiene and infection control. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): There is adequate staffing to support the needs of people living at Hamilton Court. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Over the last year there have been changes made to the way staff support people who live at Hamilton Court. Instead of working solely for people that live at Hamilton Court, the Assistant Support Officers now work across the three service located in Smith Crescent, with Support Officers working mostly in one or the other service. We were told that these changes have been made to provide a greater flexibility of staffing cover, whilst maintaining continuity of care. The staff we spoke with, and who replied to the ‘Have your Say’ surveys had different opinions as to the impact this had on people who live at Hamilton Court. Some felt that people living at Hamilton Court benefited from having a wider pool of staff that support them in the home, as they had different people to talk to, and to share their interests with. Others felt the changes had a Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 22 negative impact on people living in the home, as there was less continuity of staff. We were told that sometimes staff might not be rota’d to be at Hamilton Court for over a week, and they feel that they then have to catch up on events or issues that have happened for people living there. We were also told that ‘residents can feel a little anxious with different staff’. We looked at the rota, and saw that staffing is based around people who live at Hamilton Court not being around for the morning and early afternoon. When asked how the service would manage if someone requested staying home from day centre, we were told it could be difficult because of staffing. Some staff told us they felt people went to the day centre because there were not enough staff on duty to enable them to stay at home. The rota shows that during the week there are usually three staff on duty in the morning between approx 7.00am -9.30/10.00am, one member of staff on duty from 9.30/10.00am – 2.00/3.00pm and three from approx 3.00pm to 9.30pm. But each evening one of the rota’d members of staff also covers the people living in the Supported Living home for between two to three hours, and is therefore not available to meet the needs of people living at Hamilton Court. At the week-end there is three support staff on duty during the day and evening until 9.30pm to meet people’s needs. All five people who responded to the survey said they can do what they want at week-end but two added comments saying ‘I like to go out sometimes if there are enough staff’. We looked at the training and qualifications of staff that support people living at Hamilton Court. We saw that staff have received good training to help them deliver the care and support required. The AQAA told us that of the 26 permanent care staff, 13 have a National Vocational Qualification in Care to level 2 or above, and eight are working towards this certificate. We also saw that some staff have undertaken the LDAF (Learning Disability Award Framework), which is a detailed induction specifically designed for those caring and supporting adults with a Learning Disability. We checked the induction training for new staff, and were satisfied that the service fully supports new staff in ensuring they are aware of the needs of people who live at Hamilton Court, and provides training to ensure they do the job safely. We looked at staff supervision and saw that staff were not being provided with the one-to-one supervision within the timescale set out by the local authority. We looked at recruitment procedures. We saw that people who live at Hamilton Court are involved in the recruitment of staff, with a specially devised format to support people living at the home asking questions of candidates, and recording their views about the answers given. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 23 We looked also checked that the recruitment procedures included making checks on candidates to ensure they are safe to work with people in a care environment, and we were satisfied these were carried out well. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Management have supported change over three services, and this has had an impact on the time available to check systems and procedures at Hamilton Court. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Anne Frewin is the registered manager for Hamilton Court and has been the registered manager since September 2008. She has worked in the caring sector for many years, and has the Registered Manager’s Award and a National Vocational Qualification (level 4) in care. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 25 Ms Frewin is the registered manager of three services based in Smith Crescent. She manages Hamilton Court, a supported living service, and a respite service. The local authority which own the services have made changes to the services and the way they are staffed. The manager has worked hard to deliver the changes in service provision, and to support staff in the changes they have had to make in their working lives. This has been a challenging period for the manager and her team, and although the service is continuing to operate safely, some management processes have not taken place in the way they normally would. The manager acknowledged in the AQAA that they could improve on getting the views of people who live at the home, and their relatives. We saw questionnaires that had been sent out to people who live at the home and their relatives but the questionnaires for relatives are not comprehensive and there is little space available for people to make further comments. The questionnaire is not dated, and so although some competed ones were seen, we couldn’t determine when they were sent back. The questionnaires for residents were brief, and not in formats designed to allow further comments. The service currently does not have a development plan. The last development plan was completed in 2008. There is health and safety monitoring at Hamilton Court and this is generally keeping people living at the home, safe. The manager has delegated some monitoring (e.g. medication) to other senior members of staff. This delegation has not been properly overseen to ensure that high standards of recording and stock control are maintained. Hamilton Court DS0000035561.V376077.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 2 x x 2 x Version 5.2 Page 27 Hamilton Court DS0000035561.V376077.R01.S.doc 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 YA7 Regulation 12 Requirement The provider must assess whether the day care provision meets the social, and educational needs and wishes of individuals living at Hamilton House, and act accordingly. These assessments should be part of the care planning process and reviewed regularly. The provider must ensure that Hamilton Court does not hold medication for people who are in supported living. The provider must ensure that the recording, handling, storage and disposal of medication is monitored effectively to ensure the safety of people living at Hamilton Court. Timescale for action 16/08/09 2 YA20 13 16/07/09 2 YA20 13(2) 16/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 28 1. 2. YA39 YA39 3. YA33 4. 5. YA36 YA20 6. YA8 The provider should consider having an annual development plan for the home, which reflects the aims and outcomes for people living at Hamilton Court. The provider should look at improving the quality assurance questionnaires sent out to residents and relatives so that the focus is more on how the service is supporting the needs of the individual person living at Hamilton Court. The provider should review staffing provision alongside the review of day time activities to ensure that there are enough staff on duty to support people living at Hamilton House being at home during the day during the week, or who may wish to participate in more one to one activities during the week, through the day or evening. The provider should ensure that staff have regular, recorded supervision meetings, in line with the supervision contract set out by the local authority. The provider should ensure care plans accurately record the medication being prescribed, the times medication should be taken, and the reasons why medication has been prescribed to the individual. Any changes to medication should also be recorded and the reasons why. The provider should ensure that people living at Hamilton Court have regular opportunities to contribute to the running of the home, and to give their own feedback about changes that have taken place in the home. The provider should ensure that the care plan is amended to reflect any decisions taken by consultants or other healthcare professionals, to provide a clearer record of changes being made to the treatment and support of people living at Hamilton House. The provider should consider having risk assessments in place for people living in the home whose behaviour requires managing to support and protect people who are living and working in the home. 7. YA6 8. YA6 Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 29 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastmidlands@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Hamilton Court DS0000035561.V376077.R01.S.doc Version 5.2 Page 30 - 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!