Care Home: Hamilton House Care Centre

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What the care home does well The home has complied with the requirements made following the key inspection in December 2009. Changes have been made to care provision including care planning practices and the management of medications to improve outcomes for people living at the home. Improvements have been made to infection control practices with the provision of linen trolleys and relevant staff training. New staff have been recruited which means there are more staff on duty at any one time to meet the needs of people living at the home. With these changes and staff training about safeguarding vulnerable adults the home is protecting people living at the home from harm. It is noted these changes have occurred whilst there has been increased input from Social Services who have been monitoring the care provision at the home and the manager has being receiving support from a Quality Service Adviser from Southern Cross Ltd. The home needs to ensure these changes continue to be made and are embedded in care practices at the home so people living at the home continue to receive good quality outcomes when the intense support is no longer being provided and occupancy at the home increases. What the care home could do better: No new requirements have been made as a result of this inspection. However as previously stated the home needs to ensure changes being made in the running of the home must be sustained and embedded into care practice to ensure the wellbeing of people is always protected. Random inspection report Care homes for older people Name: Address: Hamilton House Care Centre Drayton Lane Drayton Portsmouth Hampshire PO6 1HG zero star poor service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gina Pickering Date: 0 5 0 5 2 0 1 0 Information about the care home Name of care home: Address: Hamilton House Care Centre Drayton Lane Drayton Portsmouth Hampshire PO6 1HG 02392385448 Telephone number: Fax number: Email address: Provider web address: www.schealthcare.co.uk Name of registered provider(s): Name of registered manager (if applicable) Alexandra Ogley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Southern Cross Care Homes No 2 Limited care home 60 Number of places (if applicable): Under 65 Over 65 0 0 dementia old age, not falling within any other category Conditions of registration: 0 0 The maximum number of service users to be accommodated is 60. The registered person may provide the following category/ies of service only: Care home with nursing - (N) 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 Care Homes for Older People Page 2 of 11 Brief description of the care home Hamilton Care Centre is a purpose built care home within a residential area of Drayton. The service was registered with the Commission for Social Care inspection in October 2008. The service is registered to provide nursing and care for up to 60 service users in the older person category and dementia. Accommodation is provided over 3 floors within single occupancy en-suite rooms. Decor and signage has been provided in line with current best practice guidelines for dementia care. Each floor provides ample space, with wide corridors and doors and themed pictures creating a different personality to each. Access between floors is via a passenger lift or stairs. Outside garden areas are accessible via a level path around the rear of the property, secured by locked or keypad access. The outside area is limited to a patio area with a raised flowerbed providing additional seating. Some car parking facilities are available to the front of the home.The current fee charged is £800 - £950 per week. Care Homes for Older People Page 3 of 11 What we found: This random inspection was completed to assess the homes compliance with requirements made following the last key inspection on 2 December 2009. Information for this inspection was obtained by a variety of methods. We used information from the improvement plan completed by the registered manager of the home and received by us 5 February 2010. The improvement plan detailed actions the service had taken and were going to take to ensure compliance with the requirements. A visit was made to the home on 5 May 2010 during which we looked at documentation and the environment and spoke with the registered manager, staff members, two relatives of people living at the home and four people living at the home. At the last inspection a requirement was made that detailed assessments and care plans are put in place to inform staff about the actions to take to meet peoples needs. The improvement plan told us that assessments are completed for all people living at the home and care plans were being re-written to make them more person centred. During our visit the manager discussed the process for writing the care plans in a person centred way. Staff told us they are drawn up in consultation with the person living at the home and/or their relative. We spoke with two visiting relatives who confirmed that they had been consulted over plans of care for their relative. We looked at care plans for five people living at the home. For each person there were detailed assessments of their needs. This included assessment of any potential risks such as moving and handling, falling, malnutrition and challenging behaviour. From these assessments a plan of care is developed detailing what the person can do for themselves, what the person wants to achieve and what staff at the home need to do to assist the person achieve their goal. For example for one person assessed as being at high risk of falls the care plan includes it must be ensured the person is wearing correct fitting shoes, trip hazards are removed, support is given while they are mobilising and lights need to be on at night so the person can see where they are walking. There were also clear details about the help and support that the person wanted if they had a fall that took into consideration their mental health needs as well moving and handling needs. Assessments were completed for the likelihood of people exhibiting challenging behaviours due to their mental health conditions. Clear instructions were detailed in the plans about the action staff must take to support the person. One example was a care plan clearly detailing what a person wanted staff to do for him/her when he/she is angry or distressed. We observed staff interacting with people living at the home in a sensitive and effective way to diffuse the beginning of any challenging behaviours exhibited by people. Discussion with staff members evidenced they knew the support needed by individual people with regard to their mental health needs. Nutritional assessments were completed and relevant plans put in place for people assessed as at risk of malnutrition. Staff members were able to explain how the nutrition monitoring form worked and relevant notes showed that GPs are contacted about the possibility of dietitian referrals when the scoring system indicated this should happen. Care Homes for Older People Page 4 of 11 Dietary likes and dislikes were noted in the nutritional assessment. For one person who received nutrition through a feeding tube, instructions in the care plan and on the fluid chart detailed when and how much feed through the tube was to be given and at what speed it needed to be administered. Relevant details from health care specialists such as dietitians and speech and language therapists were kept in the care plans. These records evidenced that the feeding regime being delivered was the same as that instructed by relevant health professionals. All plans that we looked at had evidence of reviews of the plans completed with the person living at the home, their relative or representative and staff at the home. We were told by relatives that as far as I am concerned my husband/wife could not be looked after better. I am quite happy and there is nothing wrong here and that relatives are involved in choosing the key worker for the person living at the home. There was clear evidence from the plans and conversations with staff and relatives that the home involves relatives in discussions over the best care for people living at the home. We have concluded the home has complied with the requirement about assessments and care planning. A requirement had been made after the last inspection that peoples health and personal care needs are met at all times. There had been concerns that information in some care plans did not correlate with information detailed in health care professional correspondence. This meant people were at risk of not receiving care as prescribed by relevant health care professionals. It had also been observed that care staff were not providing the care as directed in care plans and some care staff were not informed of the care needs of people living at the home. The previous inspection identified inconsistencies with the monitoring of nutritional intake. Information already provided in this report indicates that these shortfalls have been addressed, with information in care plans corresponding to information provided by health care professionals. We were told new charts recording dietary and fluid intake have been introduced. Discussion with staff indicated these are simple to use and a continual assessment can be made of peoples dietary intake. The charts we saw detailed both dietary and fluid intake and gave a clear indication of the amount of fluid and food had by people living at the home We were able to track changes prescribed by health care professionals such as medication changes being acted on promptly. Carers told us the processes that are in place to ensure they have the correct information to provide care and support to people living at the home. This includes them having instant access to care plans, verbal hand over from shift to shift of the care needs and changes in care needs of people living at the home. We have concluded the home has complied with the requirement about peoples health and personal care needing to met at all times. A requirement had been made about the management of medications. We had a look at the medication administration charts (MAR) for the people whose care plans we had looked at. These were accurately completed detailing the name of the medication, the time and amount administered to the person. We observed administration of medications being carried out in a manner that ensured people are witnessed as having taken their medications. We observed one person refusing to take their medication which the nurse managed with sensitivity. The nurse described the process that is completed if a person Care Homes for Older People Page 5 of 11 refuses medication. The MAR sheet for that person confirmed the correct process had been completed with a record documented as to why that medication had been not been administered. Some people are prescribed medications to be taken as required for example pain killers and inhalers. Individual care plans had details about how to recognise when the person needs the medication and what the medication is for. In the case of inhalers the care plan detailed that person should be helped to take their inhaler. It was discussed with the nursing staff and the manager that to ensure the person receives consistent manner of support to take this medication the way the person inhales the medication should be detailed. However conversation with staff members indicated consistency in the delivery of this medication. At the last inspection it was detailed that for medications prescribed out of the medication ordering cycle such as antibiotics and pain relief, there was sometimes a delay in these medications being received for up to 48 hours. This meant people were not always having their health and welfare promoted. At this inspection we were able to track the receipt of antibiotics prescribed, evidencing that they were received and administered to the person on the day of prescription. There were no details on the MAR charts we looked at of medication not being administered because they were out of stock. Staff confirmed to us that processes are in place to ensure people receive medications on the day they are prescribed. The storage of medications was in a clean and orderly fashion. Records of medication fridge temperatures were being recorded. The correct procedure for disposing of unwanted medications is now being followed. We have concluded the home has complied with the requirement about management of medications. A requirement was made following the last inspection that people living at the home must be protected from harm. Because of shortfalls in care provision, poor medicine management and a lack of staff numbers at that time it was concluded the welfare of people living at the home was not being protected. Consequently Social Services have been monitoring the care provision at Hamilton House Care Centre as part of their safeguarding procedures. The improvement plan told us that following the inspection all staff completed training about safeguarding vulnerable adults. This was evidenced in the homes training records. Staff demonstrated in conversations a good understanding about safeguarding procedures. Changes in the provision of personal and health care as detailed previously in this report means that the welfare of people living at the home is now being protected. We have concluded the home has complied with the requirement about ensuring people are protected from harm. Shortfalls in infection control practices were identified at the previous inspection with a requirement being made that staff follow good infection control procedures and practices to prevent the spread of infection in the home. The home responded in the improvement plan that staff were to receive update training in infection control and good practice, new trolleys were being purchased to stop linen trolleys being used inappropriately and pictorial prompts were being implemented in all key areas to demonstrate correct techniques for actions such as hand washing. Care Homes for Older People Page 6 of 11 The home was clean and tidy at all time during our visit to the home on 5 May 2010. Instructions and pictorial guides for good hand washing procedures were in bathrooms. There were hand gels available in the corridors of the home to enhance skin cleansing. A visitor confirmed that staff always wear gloves whilst delivering personal to their relative and also that cleaners wear protective clothing. Staff confirmed that the provision of new trolleys had resulted in improvements in the management of soiled linen. We have concluded the home has complied with the requirement about the management of cross infection. Evidence gathered at the previous inspection indicated there was insufficient staff on duty to meet the needs of people living at the home. A requirement was made that there must be adequately trained staff in sufficient numbers to meet the needs of the service users at all times. The improvement plan told us staff were being recruited to increase the number of staff on duty at any one time and staffing levels were being monitored to ensure there are adequate numbers of staff on duty. The home is registered to accommodate 60 people living on three floors. But at the time of this inspection only the ground and first floors were open and staffed with a total of 29 people living at the home. The manager told us there are two nurses on duty with three carers on duty during the day on the first floor where there are sixteen people living with one nurse and two carers on duty at night. On the ground floor where there are thirteen people living there is one nurse and three carers on duty during the day and one nurse with one carer on duty at night. We were provided with copies of the duty rota for the month of April and the week we visited the home, this evidenced these numbers are adhered to. We spoke to staff members who confirmed that staffing levels have increased with more staff being employed. At the inspection in December 2009 we were told by staff that people living at the home did not have continuity of care because staff had to move between the two floors frequently because of lack of numbers. At this inspection the duty rota indicated that staff movement between floors was less frequent which means there is improved continuity of care for people living at the home. It was observed that there was always a member of the care staff in the communal areas during our visit. Relatives confirmed in conversation there is always a member of the care staff in the lounge areas. However it must be noted that the home has voluntarily ceased admitting people to the home to allow time for changes to put in place to ensure people living there have their welfare protected. The home will need to demonstrate when the numbers of people living at the home increase that sufficient staffing numbers are maintained to meet the needs of the increased numbers of people living there. We have concluded the home has complied with the requirement about having sufficient staff with relevant skills on duty at all times. The improvement plan told us about auditing tools that have been put in place to ensure changes are made and sustained at the home. Daily audits are completed by the manager, deputy manager or the senior nurse in charge of the shift. These include a review of three care plans and MAR charts and an assessment of the environment. A Quality Service Adviser for Southern Cross Limited is completing detailed audits of the service four to six weekly. We saw a copy of one of these. The audit identifies areas of good practice and areas for improvement. From this a plan of action is developed and followed to ensure these changes are made. Care Homes for Older People Page 7 of 11 What the care home does well: 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 2. Care Homes for Older People Page 8 of 11 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 11 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, 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 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 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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. 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