Care Home: Hamilton Lodge

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What the care home does well People can visit the home before moving in so as to make sure they like it. Staff are givenots of training. Surveys tell us people are happy living at Hamilton Lodge. People like their rooms. People are provided with activities they enjoy. People like the meals provided. What has improved since the last inspection? Medication practices have improved. Care plans are much improved. Staff receive supervision. What the care home could do better: Staff need to know the care needs of people who live at Hamilton Lodge. There should be enough staff on duty at all times. Carry on making the paperwork better. Key inspection report Care homes for adults (18-65 years) Name: Address: Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB The quality rating for this care home is: one star adequate 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: Michelle Love Date: 1 2 0 1 2 0 1 0 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. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 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. They reflect the things that people have said are important to them: 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial 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. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Hamilton Lodge Rectory Road Great Bromley Colchester Essex CO7 7JB 01206230298 01206231166 care@hamiltonlodge.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hamilton Lodge Trust Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 40 40 40 40 learning disability physical disability Additional conditions: The home may accommodate 40 persons of either sex aged 65 years and over with learning disabilities who may also have physical disabilities The home may accommodate 40 persons of either sex under the age of 65 with learning disabilities who may also have physical disabilities The total number of service users accommodated in the home must not exceed 40 persons Date of last inspection 2 3 0 6 2 0 0 9 Care Homes for Adults (18-65 years) Page 4 of 32 A bit about the care home Hamilton Lodge is a residential care home. Accommodation is provided in two units and consists of a large country manor house and Selbourne Court. The home is set in large grounds, located in the rural village of Great Bromley and close to Clacton-on-Sea, Colchester and Harwich. Public transport to the towns is minimal, but the home has four vehicles, which include a mini bus with a tail lift. This means that the people who live at the home can get around easily. Everybody who lives at the home has their own bedroom and nobody has to share a room. Care Homes for Adults (18-65 years) Page 5 of 32 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: one star adequate 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 Care Homes for Adults (18-65 years) Page 6 of 32 How we did our inspection: This is what the inspector did when they were at the care home We looked at lots of different evidence for this report. We looked at paperwork like care plans, staff files and menus. We looked around the home. We talked to people living in the home and staff. We looked to see if people were happy with what goes on in the home. We got some surveys from people telling us what they think about Hamilton Lodge. What the care home does well People can visit the home before moving in so as to make sure they like it. Staff are givenots of training. Surveys tell us people are happy living at Hamilton Lodge. People like their rooms. People are provided with activities they enjoy. People like the meals provided. Care Homes for Adults (18-65 years) Page 7 of 32 What has got better from the last inspection What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Care Homes for Adults (18-65 years) Page 8 of 32 Michelle Love CPC1 Capital Park Fulbourn Cambridge Cambridgeshire CB21 5XE 01223771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 32 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 32 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. People are assessed prior to admission however the homes poor record keeping does not provide sufficient evidence of the admission process. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Out of 14 surveys returned to us from people who live at Hamilton Lodge, all confirmed they were assisted to make the choice to move into this home by their family or other representatives and 12 surveys confirmed they were given sufficient information about the service prior to moving into the home. The care files for the two newest people admitted to Hamilton Lodge were requested. Initially records showed there was no pre admission assessment available for either person, however the assessment for one person was located after a search by the acting manager and after consultation with the homes psychology team. The pre admission assessment was seen to be detailed and informative and there was evidence to show that Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: the prospective persons family visited Hamilton Lodge and representatives of the organisation visited the persons previous placement, prior to them being formally admitted to Hamilton Lodge. Records showed the transition visits by Hamilton Lodge to the persons previous placement had gone well. In addition records showed that a decision was made for the prospective person not to visit the service as this could prove confusing and upsetting. Instead photographs of Hamilton Lodge were provided including pictures of their intended bedroom, other internal views of the home and the homes gardens and grounds. The pre admission assessment for the other person could not be found initially, however after an extensive search by the acting manager this was located. The assessment was not as detailed as the previous persons pre admission assessment and there was no evidence to show that the prospective person had visited the home prior to admission, that they experienced a period of transition to the home or that a member of their family and/or representative had visited the home on their behalf. The rationale for the move to Hamilton Lodge was recorded. During the site visit we spoke with staff and they confirmed the new resident experienced a transition to the home and staff from the organisation visited their previous placement as part of the assessment process. No records were available to confirm this or to demonstrate how the visits had gone. Care Homes for Adults (18-65 years) Page 12 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general terms the care needs of people are recorded so as to ensure positive outcomes for people. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. As part of the inspection process we looked at 4 peoples care files (2 in full and 2 in relation to specific healthcare needs). Of those people case tracked, 3 out of 4 people were observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and from other associated information provided by other stakeholders. Records showed that since the last key inspection to the service in June 2009 and random inspection in September 2009, steps have been taken by the acting manager and other members of the senior management team to address previous identified shortfalls relating to care planning, risk assessing and delivery of care by support staff. Where the care needs of individual people are recorded these were noted now to provide a Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: reasonable level of detail of the actions and interventions required by care staff to ensure that aspects of their health, personal, emotional and social care needs are met. Each care plan was seen to be written in plain language and was easy to understand. There was evidence to show that care plans are more person centred however care must be taken to ensure there is more evidence of residents and/or their representatives involvement in the process. The care plan for one person newly admitted to Hamilton Lodge since our last visit was seen to be detailed, informative and person centred. Information included a Client Information Sheet and Essential Information detailing their personal details, medical history, contact details of people important to them, a recent photograph of the person, list of current medication and information relating to their formal diagnosis. The support plan was well organised and included a range of subject headings relating to People that Matter to Me, My Environment, My Activities, My Morning, Activities of Daily Living, Other Activities, My Money, Night Time Routine and Accessing the Community. A comprehensive Risk Assessment and Management Plan were in place detailing the persons identified risks and how these are to be proactively managed. In addition there were Clinical Management Guidelines in place, however these were compiled by the persons previous placement some 6 months earlier and it was unclear that these had been reviewed and/or updated to reflect their current routines and needs. When discussed with the acting manager we were advised that a reassessment of these areas was being conducted by the homes psychologist. Records showed for this person that they could exhibit inappropriate and aggressive behaviours towards others. Although a detailed risk assessment was in place, as stated previously it was unclear that the Clinical Management Guidelines which provide guidance and direction to support staff as to how to deal effectively with this, remained appropriate and/or effective. At the time of the site visit we requested to see the persons behavioural/incident records and when cross referenced with their daily care records found these did not coincide and records muddled. For example the daily care records made brief reference to incidents that had occured and recorded see separate incident sheet however these were not always evident. Where these were in place these recorded the specific details of the incident but did not always include details of the outcome and any follow-up actions to be taken. We looked at another care plan for someone newly admitted to the home. Records showed that a Client Information Sheet and Essential Information record had been completed. In addition a Risk Identification checklist and a detailed Risk Assessment and Management Plan had been completed by the homes psychologist, identifying risk areas and steps to be taken to minimise the risks. It was of concern that not all areas of their support plan had been completed and support staff were reliant on information provided by the persons previous placement. We spoke with staff and they advised some aspects of their eating and drinking support plan provided by the other home are not accurate and are not working. When asked as to what actions were being taken to address this we were advised that staff had spoken with the residents family. Staff spoken with stated they were concerned that information provided was inaccurate in some places and Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: this had led to doubt as to whether other information provided was factual. Their care file also made reference to them having a number of specific allergies which could lead to adverse reactions to their health and welfare. There was no evidence to show that specific information relating to the persons potential adverse reactions was documented or identified as a risk. We spoke with 3 members of staff about this persons care needs and it was of concern that only 1 member of staff had read the persons care file and was aware of their background history and care needs as detailed within information supplied by the previous placement. The same persons care file made reference to them being funded by their placing authority on a one-to-one basis for 16 hours per week. On inspection of the one-to-one recording sheet, the number of hours provided on a one-to-one basis did not total 16 hours and indicates they may not be receiving their allocated number of hours. We received 8 completed surveys from relatives of people who live at Hamilton Lodge. Out of these, 3 confirmed they were given sufficient information about their member of family , 4 recorded usually and 1 recorded sometimes. Additional comments recorded included communication could be better and a chance for involvement in some decision making. We received 8 completed surveys from staff who work at the home. Of these 3 confirmed they are always given sufficient information about the needs of people they support, 3 stated usually and 2 recorded sometimes. Additional comments recorded included Communication is sometimes slow and it would be in everyones interest if this was improved, Inform staff before, during and after any changes are about to be made to allow staff to have an input if possible and communication between staff and families could be better. Interactions between staff and people who live at Hamilton Lodge was observed to be more positive. Within the lounge area on Selbourne Court this was staffed and people not left unsupervised. Within the main house people were observed to have one-to-one support. People spoken with confirmed they were happy and liked living at Selbourne Court and where people were unable to provide a verbal response to our questions as a result of their limited verbal communication, we noted their non verbal cues and these indicated that people were relaxed and happy to be there. Wherever possible people are supported to make choices as part of their everyday routine e.g. what time they get up in the morning, what time they retire to bed, choosing their meals, choice of clothing, whether or not they participate in activities or where they choose to sit during the day (bedroom or lounge). There is limited evidence that people are provided with opportunities for participation in the running of the service. As stated previously as a result of some peoples inability to verbally communicate and their formal diagnosis of autism, there is a range of communication systems in place to enable people to make choices and to understand the structure and routine of their day through pictures and symbols. Out of 14 surveys returned to us from people who live at Hamilton Lodge, the majority confirmed they are supported to make decisions. Care Homes for Adults (18-65 years) Page 15 of 32 Care Homes for Adults (18-65 years) Page 16 of 32 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. People who live at the home can expect to have their social care needs met and to receive a varied diet. Evidence: Of those people case tracked (2 care plans examined in full) as part of the inspection process, a plan of care detailing individuals social care needs was recorded for only one person. Within the main house, weekly and daily planners in both pictures and symbols were completed for individual people. Each plan was observed to reflect the persons needs, personal preferences and specific interests. Within Selbourne Court an activity planner is located in the main dining room. Consideration should be given to devise the activity planner on Selbourne Court in pictorial and/or symbol format as several people are unable to read it. Records showed that people can listen to music, watch television and Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: films, go swimming, trampolining, participate in arts and crafts, attend sensory sessions, gardening (including a kitchen garden where people are supported to grow vegetables for the homes use and to sell), shopping, going for walks, cooking and pottery. Additionally people are supported and enabled to attend adult education classes and courses. On inspection of one staff members recent supervision record, this detailed that the activities planners were not always being followed by other members of staff. Staff confirmed there are occasions whereby the level of staffing and vehicle allocation affects peoples opportunity to access the community. This was confirmed from reading the organisations Regulation 26 report for November 2009, whereby the above issue was highlighted. However this also recorded an additional impact whereby there are drivers on duty but who will not drive the homes vehicles. Out of 14 surveys returned to us from people who live at Hamilton Lodge, 8 people confirmed they can make decisions about what they do each day while 6 people recorded usually. All but one person confirmed they can do what they want during the day, in the evening and at the weekend. One relatives survey recorded The residents are involved in the local community and there are always things for them to do and be entertained. One staff surevy recorded There is an abundance of things for the residents to do during the day and in the evenings. Every effort is made to bring in special events which the residents love e.g. fete and coffee morning. Another staff survey recorded The home would do better with up to date puzzles and games, sensory equipment and an upgrade in computer technology would benefit the clients greatly. There is an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. There is a rolling 4 week menu in place which provides 2 choices of main meal at both lunchtime and teatime. The menu was observed to provide a varied diet to people living within the service. The menu is devised on Selbourne Court in both a written and pictorial format so as to enable people to make an informed choice. On the day of the site visit the two choices available at lunchtime included a hot meal or salad. Consideration should be given to making the menu more flexible and according to the weather conditions. On the day of the site visit it was bitterly cold and there had been a recent snowfall. The dining experience for people was seen to be positive and where people require assistance to eat their meal this was provided in a sensitive and dignified manner by support staff. Meals provided were seen to be presented nicely and looked appetising and in sufficient quantity. People spoken with were positive about the meals provided and comments included that was nice and I liked that. Other people were noted to give the thumbs up sign when asked if the food was good. Care Homes for Adults (18-65 years) Page 18 of 32 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. People can be sure their healthcare needs will be met and the homes medication practices and procedures are safe and provide positive outcomes. Evidence: Records continue to show that people have access to a range of healthcare professionals and services e.g. Chiropodist, GP, Dentist, Optician, District Nurse Services, Consultant Psychiatry, Dietician, Clinical Psychology, HATS Team (Home Assessment and Treatment Service) Speech and Language Therapist as and when required. At both the key inspection in June 2009 and the random inspection of September 2009 we identified one person as having a diagnosis of Epilepsy and refusing to eat and drink on a regular basis. Records showed that since our last inspection, the persons care plan relating to both areas has been reviewed, updated and/or re-written. The information recorded was seen to be more detailed and there was evidence to show that appropriate healthcare professionals have been contacted for advice and/or to provide continuing interventions. In addition there is now clear guidance for staff as to at what stage the persons GP or other healthcare professional should be contacted if their condition deteriorates. The persons weight chart was examined and this showed that their weight Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: remains stable however this is not completed each week as instructed in their support plan. We looked at practice and procedures for the safe storage, use and recording of medicines. Medicines are stored securely for the protection of residents. The temperatures of storage areas are monitored and recorded regularly and were acceptable but at the higher end of the recommended range. The requirement made about this on the last inspection has been met. It is important that this monitoring continues and if found to be consistently at or above the recommended maximum steps must be taken to reduce the temperature effectively as to store medicines above the maximum could result in people receiving medication that is ineffective. There is no storage provided for controlled drugs but none were in use at the time. If the home were to admit a person prescribed such medicines, these could not be stored in accordance with legal requirements so a recommendation has been made about this. On a tour of the buildings we found some creams in peoples rooms which are now labeled with the persons name. We looked at medication and medication records for people resident in the home. Records are made when medicines are received into the home, when they are given to people and when they are disposed of.These were in good order, account for all medicines in use and demonstrate that people receive their medication as prescribed.The home undertakes regular audits of medication but this is not on a formal basis and not all records of such audits are kept. Where people are prescribed medication on a when required basis e.g to control behaviour or for pain relief, we found detailed guidance on the use of such medicines to prevent them being used inappropriately. We also saw that there was an instruction for care staff on how people like to take their medication e.g. put the medicine in his hand with a drink of water and he will take them. Medicines are only given to people by staff who have been trained and we saw evidence of recent further training provided. The majority of staff have been assessed as competent to handle medication but a few were outstanding but, taking a reasonable view, we consider the requirement made about this on our last inspection to have been met. Care Homes for Adults (18-65 years) Page 20 of 32 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. People can expect their concerns to be listened to and dealt with appropriately and to be safeguarded from harm so as to ensure their safety and wellbeing. Evidence: Information relating to how people can make a complaint or raise concerns was observed to be readily available at Hamilton Lodge. On inspection of the homes complaints log, records showed there have been no complaints raised at the service since the random inspection of September 2009. Out of 14 surveys returned to us by people who live at the home, all but one confirmed they knew who to speak to if they were not happy or had concerns. Relatives surveys recorded confirmation that they were confident about raising concerns and knew who to contact should the need arise. There are corporate safeguarding policies and procedures in place. There have been no safeguarding referrals since the random inspection to the service. Staff spoken with demonstrated an understanding and awareness of safeguarding procedures and stated that should an issue arise, information would be passed to the person in charge and/or acting manager. Staff training records showed that staff have received up to date SOVA (Safeguarding of Vulnerable Adults) training. Care Homes for Adults (18-65 years) Page 21 of 32 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. People can expect to live in a homely and well maintained environment which meets their needs. Evidence: There have been no changes to the homes environment since the last inspection to the service in September 2009. A partial tour of the main house and Selbourne Court was undertaken. Accommodation for people is currently available within 2 units, which cater for varying levels of dependency and need. The main residence is the large country manor house providing specialised care for up to 8 young people with autism and associated disabilities. Selbourne Court is a single storey unit adjacent to the main house providing accommodation for up to 18 people who have a learning disability. On the day of the site visit the premises were seen to be clean, tidy and odour free except for one bathroom facility on Selbourne Court. We noted that there were dried faeces in the toilet and this appeared to have been like this for some considerable time. This was pointed out to a member of staff at the time. People who live within the main house were observed to have a large spacious room with en-suite facilities. A random sample of bedrooms were inspected and all were seen to be personalised and individualised. Additional communal areas within the home are available for peoples use and include lounge areas, an activity room and dining area. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: At the random inspection to the service in September 2009 we noted that 2 doors (fitted with Dorguards) within the main house were being wedged open by furniture. In addition we observed 3 fire doors on the ground floor did not close properly and 2 exit doors in the main house and Selbourne Court were not locked and/or secure for peoples safety. At this inspection all but one issue was addressed as the exit door on Selbourne Court was observed to be unclocked and not secure. As stated previously this poses a potential risk to people who live within the service leaving the buidling undetected and others entering the premises unnoticed. Selbourne Court is divided into 3 zones with a large communal lounge, dining area and kitchen in the centre. Each zone has 6 bedrooms with en-suite facilities. There is also a conservatory, communal bathrooms, toilets, sluice and laundry. To the front of the premises there is a training kitchen on one side and a meeting room and administration offices on the other side. Adjacent to the unit there is a large barn, which has a sensory room and an area for arts and crafts. There is a landscaped garden and patio area to the rear of the unit, with a water feature and tables and chairs for people to use. As a result of the poor weather conditions at the time, people had built a snowman. One minor health and safety issue was highlighted at the time of the inspection and this refers specifically to the cleaners cupboard being unlocked and a number of items e.g. disinfectant, floor cleaner and other items being easily accessible to residents. Random testing of hot water temperatures were undertaken at both the main house and Selbourne Court. The temperature of hot water emitting from a random sample of wash hand basins in residents en-suite facilities and communal baths were seen to be satisfactory and safe for people. Care Homes for Adults (18-65 years) Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The level of staffing on occasions potentially restricts the ability of the service to deliver person centred care. People are assured that staff are recruited robustly and that staff have up to date training. Evidence: At the time of the inspection there were 6 people living within the main house and 15 people at Selbourne Court. The acting manager confirmed that staffing levels for Selbourne Court remain at 1 senior and 4 support staff between 07.00 a.m. and 14.30 p.m., 1 senior and 3 support staff between 14.15/14.30 p.m. and 21.30 p.m. and 2 waking night staff between 21.15 p.m. and 07.15 a.m. each day. Within the main house we were advised that staffing levels are 1 senior and 7 support staff between 07.00 a.m. and 21.30 p.m. (including one-to-one staff for individual residents) and 2 waking night staff and a sleeping-in person between 21.15 p.m. and 07.15 a.m. each day. The acting managers hours remain supernumerary to the above figures Monday to Friday and the Service Manager supports the manager on site 2-3 times a week. In addition to the above there is a personal assistant, administrators, cleaners and cook. On inspection of 4 weeks staff rosters for both the main house and Selbourne Court, Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: these evidence that staffing levels as detailed above have not always been maintained. We have not received Regulation 37 notifications, advising us of the staffing shortfall and measures undertaken to deploy staff to the service. Staff spoken with confirmed that staffing levels as detailed above have not always been maintained and there was no evidence to show that alternative arrangements had been made to get cover. The acting manager confirmed that several members of staff have left the homes employment since the random inspection to the home and although some new staff have been employed, initially there was a shortfall on some occasions. In addition both staff surveys and surveys from relatives intimated there are occasions when there have been insufficient staff on duty. Comments included Recently there have been a number of staff vacancies which has made managing care difficult, Have more carers for the service users needs, Resolve current staffing issues (need more). Resource difficulties within the home and could have less agency staff. The deployment of staff on Selbourne Court during the inspection was observed to be much improved on the day of the site visit and people who live within the main house are supported on a one-to-one basis. We were also made aware by staff that there are difficulties as not all staff employed within the service are prepared or feel able to work across both sites. The Regulation 26 report of November 2009 confirms this and records there have been significant staff shortages within the main house. This has resulted in regular usage of agency staff and this has impacted on providing person centred care. Staff spoken with confirmed the atmosphere within the service is much better, staff are now working cohesively as a team and staff morale has improved. Out of 14 completed surveys returned to us by people who live in the home, 12 people stated that staff listen and act on what they say and 2 people stated sometimes. Three staff files were reviewed at random to check the recruitment process in the home. The files were seen to be in good order with all the required checks and documentation in place. No records were available to confirm if staff had commenced the LDQ (Learning Disabilities Qualification Induction Award). However the 2010 training schedule for the home made reference to staff at Hamilton Lodge receiving LDQ support. We looked at the staff training records for 5 people. Records showed that since the last key inspection to the service in June 2009, a number of staff have received training relating to Autism Awareness, CALM (Crisis and Aggression Limitation and Management), Fire Awareness, SCIPP ( ), Safeguarding, Manual Handling, COSHH (Control of Substances Hazardous to Health), Food Hygiene and Person Centred Planning. As stated previously the service continues to place a high level of importance on training and this was confirmed by staff. Staff surveys recorded Training given is all relevant to the job role. If any member of staff wishes to do something else then the training co-ordinator will try and source it and They give us good training. The 2010 training schedule listed evidence of future training opportunities for staff. We requested to see evidence of a random sample of staff supervision records. The Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: records for 3 people were examined and these showed that since the last inspection to the service, the homes supervision format has been reviewed and amended. There are two records in place, one relates to a record of observation and one record relates to formal supervision. Supervision is now much more detailed and comprehensive and covers feedback on previous actions, current workload, the key worker role, organisational issues, updates on policies and procedures, training needs, personal issues and any other business. From evidence of staff supervision records and from discussion with staff, staff working at the home are receiving regular supervision in line with the recommendations as detailed within the National Minimum Standards. Care Homes for Adults (18-65 years) Page 26 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In general terms the home is well run however there are shortfalls which potentially place people at risk of poor outcomes. Evidence: The home is currently being managed by an acting manager. They have been recruited from an external agency and have been employed at Hamilton Lodge since 18th May 2009. The acting manager is supported by a Service Manager 2-3 times a week and we were advised that a new Area Manager has been appointed. We enquired as to the longer term management arrangements at Hamilton Lodge and were advised that the acting managers position remains temporary and within the next 3 months it is envisaged that two managers will be recruited to manage the main house and Selbourne Court. The acting manager has vast experience in supporting and managing young people who have a learning disability and who exhibit challenging behaviour. The acting manager has attained the Certificate in Social Services (CSS), is a qualified Social Worker and has completed the Combined Certificate in Counselling and Certificate in Theory and Counselling Skills. Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: Evidence showed that on a day-to-day basis the home is generally well run and provides some positive outcomes for the people who live at Hamilton Lodge. Relatives surveys confirmed they had confidence in the organisation to ensure good care practices were adopted at the home and that there were positive outcomes for people who live in the home. Staff spoken with stated that the acting manager has made a number of positive improvements and changes. These relate specifically to regular formal supervision for staff, recruitment of new staff, ensuring care plans and risk assessments are detailed and updated regularly, that the healthcare needs of people are now being met and improvements to medication practices and procedures. Relatives surveys returned to us recorded We have always been happy with the care [name of resident] receives at Hamilton Lodge. We could not have wished for a better care home for our relative, I think the service that is provided is very good and Hamilton Lodge is just what my relative needed. At the time of the site visit we requested evidence of the homes quality assurance record. This was not available at the time but forwarded to us by the acting manager. There was no evidence to show that the views of people who live at the home, their relatives, support staff or other stakeholders have been consulted or taken into account, to inform the success in achieving the organisations aims and objectives and the Statement of Purpose. However there was evidence of a Quality Review Action Plan dated 2nd November 2009. This identified out of 15 actions to be taken, 3 had been met, 1 was still outstanding, 3 were unmet and for 8 areas there was no evidence as to their progress. In addition to the above monthly Regulation 26 visits and reports are completed by a representative of the organisation. Corporate health and safety policies and procedures were observed to be in place within the home and staff training records showed that staff have received health and safety training. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes  No  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 1 33 18 Ensure there are sufficient staff on duty at all times. Previous timescale of 31/7/09 and 15/9/09 not met. 08/03/2010 So as to ensure the needs of people who live at the home are met according to their specific care needs and dependency levels. Care Homes for Adults (18-65 years) Page 29 of 32 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 Description 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 Description Timescale for action 1 39 24 Ensure the views of people who live at the home, their relatives and other stakeholders are sought about the quality of the service and facilities. 01/05/2010 To evidence the organisation consults with people about the quality of the service. 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 1 2 Ensure there is clear evidence to demonstrate the homes pre admission assessment process and that it is in line with regulatory requirements. Ensure support staff have the opportunity to read peoples care records and to familiarise themselves with an individuals care needs and identified areas of risk. Ensure that where a person is contracted to receive specific Page 30 of 32 2 6 3 6 Care Homes for Adults (18-65 years) 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 one-to-one input from staff, there is evidence to demonstrate this is happening as contracted. 4 6 Where specific guidelines are in place for individual people ensure these are reviewed and updated to reflect peoples current support needs. Ensure behavioural records/incident records and daily care records tally and there is clear evidence of outcomes and actions of any interventions provided to support an individual. Ensure there are appropriate numbers of staff on duty and appropriate transport arrangements in place to guarantee people who live at the home are able to access the community. Ensure that systems are put in place so that people who live at the home do not miss out on the opportunity to particiapte in leisure activities as a result of staffs reluctance to drive the homes vehicles. Suitable cupboards should be provided for the storage of controlled drugs and these should meet legal requirements. Ensure that the cleaners cupboard is locked at all times so as to ensure peoples safety. Ensure security measures are put in place on Selbourne Court so as to ensure peoples safety and wellbeing. 5 6 6 14 7 14 8 9 20 24 10 24 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or 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 non-commercial 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 Adults (18-65 years) Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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