Care Home: Hamilton House Nursing Home

What the care home does well Prospective service users are provided with good quality information about the Home. People have the opportunity to visit the home and detailed needs assessments are completed before they move in to Hamilton House. The people living at Hamilton House have their changing needs and personal goals reflected in an individual plan of care, they are able to make decisions about their lives and are supported to take risks appropriately. The people living at Hamilton House are able to take part in activities that suit them, be part of the local community, enjoy leisure activities as they wish and have good relationships with their family and friends. People are offered a healthy diet and appear to enjoy their food. The people living at Hamilton House receive personal support in the way they prefer, their physical and emotional health needs are met and they are protected by the home`s medication policies and procedures. Hamilton House has a clear complaints procedure, both formal and informal. Staff are well trained in areas such as mental health, adult protection and medication. Hamilton House is generally a homely, comfortable and safe environment. Hamilton House has robust recruitment procedures. Hamilton House is a well run home and the people living there benefit from good quality leadership and day-to-day management. The people living at Hamilton House also know their health, safety and welfare is promoted and protected. What has improved since the last inspection? The external and smoking areas were seen to be vastly improved since the last inspection, with considerably less litter and cigarette ends being discarded inappropriately. The previously observed `harsh` notice on the conservatory door has been removed. A good cleaning rota is currently in place, which helps to ensure each bedroom is checked and cleaned with the residents on a regular basis. What the care home could do better: Consideration must be given to the size and layout of the dining area. To ensure people are able to eat their meals in an unhurried fashion, at a time of their choosing. Key inspection report Care homes for adults (18-65 years) Name: Address: Hamilton House Nursing Home The Street Catfield Gt Yarmouth Norfolk NR29 5BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Debby Allen     Date: 2 7 1 1 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 31 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 Homes for Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Hamilton House Nursing Home The Street Catfield Gt Yarmouth Norfolk NR29 5BE 01692583355 PF01692583355 info@prime-life.co.uk info@prime-life.co.ukwww.prime-life.co.uk Prime Life Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Amy Elizabeth Cannell Type of registration: Number of places registered: care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Hamilton House is a registered care home offering nursing care to 39 people who have a mental illness. It stands on the main road in the Norfolk village of Catfield. The large main house has been extended and provides 23 single rooms and 1 double room. The rooms in the extension are particularly good with their own shower facilities and French doors to the outside. The accommodation is bright and attractive and has extensive communal space. In addition, a new building on the grounds provides 8 self-contained flats, 6 Care Homes for Adults (18-65 years) Page 4 of 31 1 9 0 6 2 0 0 9 39 Over 65 0 Brief description of the care home accommodating 2 service users and 2 for 1 person making 14 in all. These service users are assisted to shop, make their own meals and to be more independent. There is also a large garden. The basic fees are currently in the region of #315 per week and increase according to the level of support each individual requires. Care Homes for Adults (18-65 years) Page 5 of 31 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. The fieldwork of this inspection was carried out over a period of six and a half hours and included a tour of the premises, inspection of staff and residents records and the homes records relating to health and safety. Discussions also took place with the manager, staff and a number of residents. Questionnaires were completed and returned to the Commission by one resident and five members of staff, prior to the inspection. Some of the additional comments Care Homes for Adults (18-65 years) Page 6 of 31 included: ...could take you out on more trips - shopping or out for meals... ..two forms of transport should be provided as, on a day when there are doctor/hospital appointments, it is hard for staff to take service users out... ...celebrates diversity and encourages independence... ...the kitchen is disgusting, as are the floors and walls... ...generally the care is good... ...communication between staff could be better, with better team work... ...support workers could listen more to nursing staff... ...there could be a better break system for staff and a change in the shift patterns, as twelve hours is too long... ...we meet the care standards for the service users... ...there is a high level of care but there is room for improvement with the facilities... ...the pay could be improved for the work we do... Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Consideration must be given to the size and layout of the dining area. To ensure people are able to eat their meals in an unhurried fashion, at a time of their choosing. Care Homes for Adults (18-65 years) Page 8 of 31 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. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective service users are provided with good quality information about the Home, so they are able to make an informed choice about living there. People have the opportunity to visit the home and detailed needs assessments are completed before they move in. Evidence: Three care plans were looked at in detail during this inspection and each was seen to contain comprehensive information, which confirmed that a full assessment had been carried out prior to each person moving into the home. The information pack, which is given to all prospective service users, was seen to include: An Introduction to Hamilton House, Statement of Purpose and Terms & Conditions for Self Funding Clients. Meanwhile, a completed questionnaire was returned by one of the people living at Hamilton House and the responses confirmed that they were asked if they wanted to move to Hamilton House and that they had received enough information about the Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Home before deciding to move in. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Hamilton House have their changing needs and personal goals reflected in an individual plan of care, they are able to make decisions about their lives and are supported to take risks as part of an independent lifestyle. Evidence: Three care plans were looked at in detail and an individual discussion was held with one person, which helped to confirm that the contents of the plans were accurate. The contents of the care plans included very comprehensive information, to ensure consistency of care and make sure that each person is genuinely treated as an individual and receives the level of support they require. The contents of the care plans were made up of sections such as: * Admission Details (including information from the pre-admission assessments). Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: * Physical Health (this section included information in respect of doctors appointments, vaccinations and referrals to people such as the chiropodist). * Specialist Care (information regarding people such as advocates, social workers and decision makers where relevant). * Communication (included the initial assessment and a service user plan and copies of regular reviews/evaluations). * Mental Health (included the initial assessment, service user plan, Clinical Psychologists report and copies of regular reviews/evaluations). * Behaviour (included the initial assessment, service user plan and copies of regular reviews/evaluations). * Eating and Drinking (included the initial assessment, service user plan and copies of regular reviews/evaluations). * My Life (included the initial assessment, service user plan and copies of regular reviews/evaluations. Also, contained information regarding personal wishes such as returning to independent living). * Occupation (this section included information regarding financial management, hobbies, interests and a daily timetable, in addition to the initial assessment, service user plan and copies of regular reviews/evaluations). Daily Care notes were seen to be maintained for each person in a separate folder. A number of records also provided good evidence of how the staff and management at Hamilton House have consulted, and are working with, other health/care professionals in order to support people to live their lives as they choose, as safely as possible The risk assessments that were looked at were seen to be very person specific in many areas and were of an empowering nature. Some of the risk assessments seen covered areas such as going out walking alone, going shopping, getting public transport, hitch-hiking, cooking, alcohol consumption, smoking and managing cigarettes within personal budgets. As described in the previous inspection report, Personal Behavioural risk assessments were also seen to be in place for some of the people living at Hamilton House and Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: these contain excellent information explaining how to read and understand each persons behaviour and mood at various times, how to respond to it appropriately and any relevant de-escalating procedures. Meanwhile, observations and discussions with some of the people living at Hamilton House confirmed that the people living there are genuinely supported and encouraged to make decisions for themselves, take risks appropriately and live their lives as independently as possible. All the records and personal information relating to the people living at Hamilton House were seen to be stored securely in the main office, thus ensuring confidentiality is maintained. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. The people living at Hamilton House are able to take part in activities that suit them, be part of the local community, enjoy leisure activities as they wish and have good relationships with their family and friends. They are also offered a healthy diet and appear to enjoy their food, although consideration needs to be given to the size and layout of the dining area. Evidence: Discussions and observations during the inspection confirmed that independence and empowerment continues to be highly promoted at Hamilton House and people are supported and encouraged to live their lives as they choose, at their own pace, as much as possible. It was noted that a previous resident has been supported to move on from Hamilton House and now has their own accommodation and lives independently, although they Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: continue to visit and maintain contact with their friends living at the Home. Additionally, it was confirmed that two people were married from Hamilton House and another couple are supported in their relationship together. Meanwhile, additional comments in the questionnaires that were completed by some of the staff members and one resident included: ...could take you out on more trips - shopping or out for meals... ...two forms of transport should be provided as, on a day when there are doctor/hospital appointments, it is hard for staff to take service users out... ...celebrates diversity and encourages independence... A discussion with the manager confirmed that, although lack of transport can sometimes be an issue, people are still supported to go out by using alternative forms of transport such as the local buses or taxis. One person spoken to also confirmed that they enjoy going shopping in town and regularly get a taxi. During this inspection two other people were observed going out to the nearby towns of Stalham and Great Yarmouth to do some shopping and visit friends. Some of the activities that were seen to be recorded in the care plans included snooker, pool, darts, cookery, literacy, laundry/domestic tasks, boat trips, woodland walks, beach walks, bowling, theatre trips, pub visits and parties. It was confirmed that there are usually six main parties at Hamilton House each year to celebrate events such as Easter, Valentines Day, Summer Ball, and Christmas. Barbecues and small parties/get-togethers also happen at regular intervals throughout the year. Photographs were seen of the last Halloween party, which showed people having a very enjoyable time. A discussion with the manager confirmed that a drama therapist now visits the home every Wednesday and a number of residents regularly take part in the sessions and seem to particularly enjoy the mask making. In respect of mealtimes, although the meals themselves were of a good quality and it was observed and confirmed that people are able to make genuine choices and any special dietary needs are catered for, the atmosphere, layout and decor of the dining Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: room was not found to be particularly pleasant or inviting. It was observed that, as there are insufficient seats and tables in the dining room for all the residents to eat at the same time, meals are served on a first come first served rotational basis. However, some people were observed becoming a little agitated while they were waiting for a space, as they clearly wanted their meal at the same time as the others. Additionally, for the people eating first, there was a sense of needing to just eat and go to free up a space for the next person. Care Homes for Adults (18-65 years) Page 18 of 31 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The people living at Hamilton House receive personal support in the way they prefer, their physical and emotional health needs are met and they are protected by the homes medication policies and procedures. Evidence: The care plans that were looked at during this inspection confirmed that the people living at Hamilton House are totally recognised as individuals and each care plan was seen to have very comprehensive information regarding the level of support each person requires and their preferences with regard to how that support is provided. Two people, for whom care plans were looked at in detail, have had quite complex support needs during the last twelve months and for both people, it was very clear to see how each person was being supported and how they were progressing. Evidence of involvement with various healthcare professionals was also plentiful, particularly in respect of psychologists, psychiatrists, general practitioners, district nurses, community psychiatric nurses and care managers/social workers. Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: On occasions it was noted that, where peoples needs have increased significantly, alternative options have been to move to a hospital environment. However, it was clearly evident that the staff, management and external healthcare professionals work very hard with the people living at Hamilton House to enable them to continue having a good quality of life and retain their independence for as long as possible, with the hospital option being an absolute last resort. Two people were noted to be currently self medicating and good risk assessments were seen to be in place to support them. Another person was noted to be preparing for independent living and information was available to show how they were being supported, step by step, to be able to manage and administer their own medication for the future. Observations and discussions during the inspection confirmed that the management and administration of medication by the Home continues to be robust and, of the records seen, no errors or omissions were noted. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. Hamilton House has a clear complaints procedure, both formal and informal, which helps ensure that people feel their views are listened to and acted upon. Staff are well trained in areas such as mental health, adult protection and medication, to help ensure people are protected from abuse, neglect and self-harm as much as is possible. Evidence: A random inspection was carried out on 19th June 2009, following some concerns that were reported to the Commission from an external source. The outcome of this inspection was that all the issues raised had already been acknowledged and dealt with appropriately by the staff and management team at the Home. Good records were seen to have been kept in respect of any complaints or concerns that have been raised formally or informally and the management team regularly keep the Commission informed of any incidents or issues. A discussion with the manager, together with the training records seen, confirmed that staff are kept up to date with training in areas such as adult protection and Deprivation of Liberty (DoL) training is also currently being accessed. Meanwhile, the responses in the questionnaire, completed by a person living at Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: Hamilton House, confirmed that they know who to speak to if they are not happy and that they know how to make a complaint. Care Homes for Adults (18-65 years) Page 22 of 31 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. A general tour of the premises was carried out and observations confirmed a generally homely and comfortable environment, although consideration needs to be given to the size and layout of the dining area, as there is inadequate space and seating for everyone to eat together at the same time if they wish. Evidence: A considerable amount of time was spent during this inspection meeting and chatting with some of the people living at Hamilton House, in various areas of the home. Of the areas seen, the environment was found to be clean, hygienic and pleasantly decorated throughout most areas, with no unpleasant odours noted. People were observed using a number of the communal areas and appeared to be very relaxed and settled. The only issue, as mentioned in the previous Lifestyle section, is the lack of seating available and the blandness of the dining room. One of the staff members who completed and returned a questionnaire also stated: ...the kitchen is disgusting, as are the floors and walls... The external and smoking areas were seen to be vastly improved since the last Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: inspection, with considerably less litter and cigarette ends being discarded inappropriately. It was also noted that the previously observed harsh notice on the conservatory door has been removed. Meanwhile, it was noted that a good cleaning rota is currently in place, which helps to ensure each bedroom is checked and cleaned with the residents on a regular basis. Care Homes for Adults (18-65 years) Page 24 of 31 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Hamilton House has robust recruitment procedures and staff are well trained. Evidence: Two staff files were looked at in detail during this inspection and both were seen to contain all the relevant records such as employment checklist, written references, application form, starter form, proof of identification and clear, enhanced, disclosures from the Criminal Records Bureau (CRB), all of which helped to confirm that Home/organisation continues to have robust recruitment procedures. The training records that were looked at confirmed that all new staff receive an induction, which includes Early Days Mentoring covering areas such as understanding policies and procedures, equality and diversity, safety awareness, introduction to care plan systems and the principles of protecting vulnerable adults. Other training that staff were seen to have undertaken included fire safety, food safety, moving & handling (& hoists), COSHH, first aid and health and safety. Additional learning opportunities were also seen to be available in areas such as protection of vulnerable adults, safe handling of medication, infection control awareness, mental health awareness, Mental Capacity Act and Deprivation of Liberty. Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: Staff team meetings were noted to take place on a regular basis and the minutes of the most recent meeting were seen and some of the topics that were covered included the use of personal mobile phones, shift start times, support and supervision, leaving the premises, respecting one another, keyworking, minibus, medication cards, available training, information sharing, cleaning, room checks, one-to-one with residents and activities. Some of the additional comments that were received from the staff members in the questionnaires included: ...generally the care is good... ...communication between staff could be better, with better team work... ...support workers could listen more to nursing staff... ...there could be a better break system for staff and a change in the shift patterns, as twelve hours is too long... ...we meet the care standards for the service users... ...there is a high level of care but there is room for improvement with the facilities... ...the pay could be improved for the work we do... Meanwhile, four out of five staff members responded yes to the questions: Are you being given training that is relevant to your role and helps you understand and meet the individual needs of people? However, two people responded no to the questions: Are you being given training that keeps you up to date with new ways of working and gives you enough knowledge about health care and medication? Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. Hamilton House is a well run home and the people living there benefit from good quality leadership and day-to-day management. The people living at Hamilton House also know their health, safety and welfare is promoted and protected. Evidence: There has been a change in manager since the last key inspection, although the new manager originally started working at Hamilton House in 1999, achieved her nursing qualification in 2003 and has been the deputy since 2005. The new manager completed the Registered Managers Award in July 2009. A number of residents who were spoken with during this inspection said they liked the manager and they were glad shed got the job. Observations throughout the day showed the management team to be friendly and approachable for staff and residents alike. As stated in the previous inspection report, Hamilton House has a good system in place with regard to policies and procedures and the information provided in the Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Annual Quality Assurance Assessment (AQAA) confirmed that all the policies and procedures were last reviewed fully in February 2008, although it was stated that service specific policies and procedures are reviewed and updated, as necessary, on a more frequent basis. An internal Quality Assurance Review continues to be carried out on an annual basis and residents meetings are held on a regular basis, in order to ensure Hamilton House continues to be run in their best interests and that their views are listened to and taken into account. Meanwhile, the records seen during the inspection were found to be satisfactory in respect of the regulated checks for environmental health, fire, water and electrics. Cleaning materials and hazardous chemicals were seen to be stored appropriately and no obvious safety hazards were noted at the time of the inspection. Care Homes for Adults (18-65 years) Page 28 of 31 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 Adults (18-65 years) Page 29 of 31 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 17 23 Consideration must be given 31/05/2010 to the size and layout of the dining area. To ensure people are able to eat their meals in an unhurried fashion, at a time of their choosing. 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 Adults (18-65 years) Page 30 of 31 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. 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. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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