Care Home: Hamilton Lodge Nursing Home

What the care home does well What has improved since the last inspection? What the care home could do better: CARE HOMES FOR OLDER PEOPLE Hamilton Lodge Nursing Home Hamilton Lodge 36 Honor Oak Road Forest Hill London SE23 3RZ Lead Inspector Ms Rehema Russell Unannounced Inspection 09:00 29 August, 7 & 13 September 2007 th th th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamilton Lodge Nursing Home Address Hamilton Lodge 36 Honor Oak Road Forest Hill London SE23 3RZ 020 8699 6080 020 8699 2074 hamiltonnursing@aol.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Premiere Care (Southern) Ltd Mrs Patricia Jenkins Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability (40), Terminally ill (0) of places Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 patients, frail elderly persons aged 60 years and above (female) and 65 years and above (male), and chronic sick persons aged 40 years and above 4 people may have a terminal illness Date of last inspection 23rd August 2006 Brief Description of the Service: Hamilton Lodge is a care home providing nursing and residential care for up to 40 older men and women. It occupies a nineteenth century building that has four floors. There are 22 single and 8 double bedrooms. The first three floors are used for resident accommodation and are accessible by lift. The top floor is used for office space. There is a large sloping back garden and a sun terrace. There is off street parking on the forecourt to the front of the building. The home is situated in a residential area. It is on a bus route which is a few stops from a local shopping centre that has library and rail facilities. Prospective residents are given a copy of the Statement of Purpose and given verbal information about the category of residents and the various facilities available at the home. Copies of the most recent CSCI inspection report are available for perusal in the office, and prospective residents are told it is available on the internet. Current fees range between £500 - £726 per week and there is an additional charge for hairdressing. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two half-days on 29th August and 7th September, both unannounced. The inspector spoke with the manager, administrator, two nurses, seven sets of relatives and four residents, looked at records and documentation and toured the premises. A completed Annual Quality Assurance Assessment form filled in by the home was also used to inform this report. A follow up visit was made on 13th September with a Regulation Manager in order to inspect the structural problems with the kitchen more thoroughly. What the service does well: Evidence from the inspection indicated that there are many areas where the service does well: • Potential residents are given a thorough assessment and full consultation takes place with the resident and interested parties prior to admission • Each resident has a thorough and regularly reviewed plan of care • The home ensures that residents benefit from the full range of healthcare facilities and that their privacy and dignity is respected • Residents are supported to satisfy their social, cultural, religious and recreational interests and needs, relatives and friends are encouraged to visit the home and are made welcome. • The food provided is nutritious, varied, tailored for individual tastes and preferences, and attractively presented. • Residents and relatives feel that they are listened to and that any issues concerns raised are taken seriously and acted upon. • There are good staffing levels and a good mix of staff in relation to skills, qualifications, ethnic background and gender. • Staff are well trained, including in the palliative care that is provided by the home • The manager and staff have a good understanding of the needs of the resident group and an empathetic attitude towards them. Residents and relatives made the following comments about the home: • “It is comfortable here” • “I like the food” • “I love it here, it is friendly and welcoming” • “The manager makes you feel wanted” • “Wonderful care” • “Visitors are welcomed” • “All staff are friendly and approachable” • “There’s a very nice atmosphere” Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are some areas of the physical environment that need to be improved: • • • • The areas where residents sit outside in the garden and patio must be kept in a state of good repair There are insufficient disability bathrooms for the numbers of residents. The low sinks in the kitchen must be raised The Commission must be informed of the timetable regarding the repair of the subsidence affecting the kitchen. In addition, the Registered Provider must provide monthly reports arising from Regulation 26 visits to the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5, 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are given a thorough assessment before moving into the home, and are encouraged to visit the home at least once before admission. Residents’ relatives are also encouraged to visit the home and to visit others for comparison. The home does not accept residents solely for intermediate care. EVIDENCE: Three care files were inspected and evidenced that a full needs assessment is undertaken for all new residents prior to admission. This assessment is undertaken by the Registered Manager, who insists on having a copy of the care management assessment from the social worker before undertaking the home’s assessment. The manager also speaks with relatives/carers if the resident is assessed at home or with the nurses on the ward if the resident is assessed in hospital. The home’s pre-admission assessment is detailed and thorough, including the full range of healthcare needs, plus emotional aspects Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 9 such as mood and behaviour, as well as activities preferences and any additional services required. Local authority care management assessments were seen on file, plus discharge notifications if appropriate. If the new service user is being placed for palliative care then the specialist nurse from St. Christopher’s Hospice, who is allocated to the home, will visit the home and further assess the resident within a few days of admission. The manager tries to ensure that the potential resident, relatives/carers and the social worker always visit the home prior to admission. If the resident is unable to visit the home, the manager will not carry out an assessment until either a relative or advocate has visited and seen the home. The manager also encourages potential residents and their relatives to visit other homes in order to make a comparison and a positive choice. This was confirmed by relatives spoken with. On the trial visit to the home the resident is shown the home and their room, speaks with the manager and meets other staff and residents, and is given hospitality. If there is only a double room vacancy, the potential resident and their relative/social worker meet with the resident already occupying the room. If requested, an agreement is made for the new resident to move to a single room when one becomes available. There is now a waiting list for the home, which is an indication of the improvements that have taken place over the past two years. The home does not admit residents solely for intermediate care and so Standard 6 is not applicable. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ needs are thoroughly set out in an individual plan of care, and their health care needs are fully met. Residents are protected by the home’s policies and procedures for dealing with medicines. Residents feel they are treated with respect and their right to privacy upheld, and relatives are happy with the manner in which care is given at the home. At the time of serous illness and death, staff treat residents and their families with sensitivity and respect. EVIDENCE: Three care plans were examined. Each has a minimum of 6 areas of identified need, and each need has a date, goal/aim, action to be taken, review date and evaluation. All care plan components are reviewed monthly, each review being dated and signed. Apart from physical and nursing needs, care plans also have emotional/social identified needs, such as sexuality/low selfesteem/emotional loss, which is good practice. The care plans of residents who had been at the home for several years have additional newly identified needs where their needs have changed or increased. Each care file also has Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 11 several different types of risk assessments, such as nutrition, manual handling and falls, and these are also reviewed, dated and signed on a monthly basis. There are also profiles for each resident, with a photograph, admission sheets, property lists, personal information sheets including the name by which they wished to be called, their religious interest and their background, and signed and dated permission for cot sides where appropriate. Health and social care assessments, filled in within a day or two of admission, covered the full range of needs such as physical, emotional, spiritual, social, relationships and leisure. Daily comments sheets are filled in for each resident at the end of both the day and night shifts. Verbal evidence and documentation evidenced that residents are supported to access the full range of healthcare professionals and facilities. This includes the general practitioner, optician, chiropodist, psychologist, dietician, nutrition nurse, dentist, physiotherapist, speech and language therapist and therapeutic care from hospitals and community health teams. Continence, tissue viability and falls advice is sought as appropriate and the home has an allocated nurse from St. Christopher’s Hospice who visits, assesses and oversees the care of residents admitted for palliative care. One resident who was wheelchair bound when admitted in autumn 2005 can now not only walk about independently but can also climb stairs. This had been facilitated by the home arranging a period of intense physiotherapy, and by the encouragement and support of staff. Files evidenced several other examples of where specialist health teams had been used by the home to improve the health and mobility of residents. The home has a new General Practitioner, with whom they have established a good relationship and with whose service they are “very pleased”. His visits the home for about one-and-a-half hours each week, brings a phlebotomist with him to take blood, and attends the Community Health Specialist Team meetings. The storage, administration and recording of medication was checked and no problems were found. The home uses the monitored dosage system and each month nurses check each monitored dosage card supplied against the prescription to ensure that there are no errors or omissions. The Medication Administration Records folder has a list of specimen signatures at the front, plus relevant protocols such as peg feeding, and there is a photograph of each resident to ensure correct identification. Controlled drugs are kept in a suitably lockable cabinet and are counted at every shift changeover. The CD records book with the required double signatures was seen and no problems found. CHST pharmacist audits medication at the home on a six monthly basis, and the report arising from the most recent audit had no requirements or recommendations. All medication is held in the treatment room, which has a mini fridge for medication such as insulin, with an external thermometer to ensure that the correct temperature is monitored and maintained. Verbal evidence from residents, relatives and staff indicates that residents are treated with dignity and respect and that their right to privacy is upheld. Staff Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 12 were observed to speak to residents in a friendly and respectful manner and to demonstrate empathy and understanding of residents’ needs, moods and behaviours. Residents told the inspector that they were happy with the staff, that staff treat them well and ensure their privacy. Relatives said that “all staff are friendly and approachable”, that they “create a very nice atmosphere” in the home and provide “wonderful care”, and that “they treat residents with respect and are willing to help with anything they need”. Funeral preparation plans were present on care files and had been filled in, signed and dated in all cases where the resident or their relatives were willing to do so. The home is registered to care for people needing palliative care and the manager and staff often find themselves supporting family and relatives emotionally an psychologically. The inspector spoke with a relative who did not want his parent to be placed in a hospice but was very happy with the care, facilities and support that both he and his mother were getting at the home. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are supported to satisfy their social, cultural, religious and recreational interests and needs. Residents are encouraged and supported to maintain contact with family and friends, and to exercise choice and control over their lives. Residents are given a nutritious, balanced and appealing diet in pleasant surroundings. EVIDENCE: Throughout the inspection verbal and documentary evidence demonstrated that routines at the home are flexible to accommodate the individual needs of residents. Although residents are supported and encouraged to eat communally, if they wish to take their evening meal in their rooms/with their visitors, they are assisted to. The cook leaves a ready prepared tray of sandwiches in the fridge each evening so that this resident, and any others who wake and wish it, can be given a snack during the night. Several residents were observed to move about the home and access their own rooms at will during the day, and fully mobile residents are able to go out into the community as they wish. The home arranges for ministers of religion to visit residents who want this, and the home ensures that residents from minority ethnic backgrounds have access to culturally appropriate food, music, Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 14 hairdressing and any other items of choice. To formalise this provision the home has devised an Equalities Provision form for each resident. The home employs an activities co-ordinator for four days per week, with a senior carer organising activities on the fifth day. There is a programme of varied activities, including quizzes, exercise, reminiscence and games, arts and crafts, coffee mornings and painting. The programme is flexible and is varied according to the weather, the moods and interests of residents on the day and any other events. For example if a donation of flowers is made one day, then a spontaneous flower arranging session will be held. A fund-raising event is being held at the end of the month, for which residents may prepare plants for sale or arts and crafts. The activities organiser also runs a trolley shop, whereby residents can buy confectionary, toiletries and other articles. There is a hairdresser who visits the home regularly. The inspector spoke with seven different sets of relatives during the inspection. Every one said that they were “very happy” with the care given at the home. Other comments included “we have no complaints”, everyone is “friendly and welcoming”, “residents get everything they need”, “staff will help with anything needed”, “staff are very attentive” and “we are always kept informed”. Residents can be visited in privacy in their bedrooms or in the lounge on the third floor, which residents tend not to use at the moment. The manager is also clear that she will protect residents from relatives whom they do not wish to see. There is a notice board at the entrance of the home which gives relatives and visitors information about the programme of activities, the two nurses in charge that day, events such as the summer fete, the library service, the equal opportunities policy and the complaints procedure. Residents are encouraged exercise as much choice and control over their lives as they can. Residents and their relatives are informed of how to contact external advocates in the Statement of Purpose and in leaflets from relevant organisations that the manager obtains and makes available. The home does not manage money on behalf of any residents: the majority have their monies managed by relatives unless they can manage their own money themselves. There was evidence in all bedrooms seen of residents being encouraged and supported to bring in personal possessions, including a small item of furniture if they wish. Menus evidenced that residents are given a nutritious, balanced and varied diet, with alternative choices available at each meal, and with medical and specialist meals prepared as appropriate. The two cooks are flexible and obliging and will vary the menu on any particular day to suit the weather or the mood/taste of residents. Cultural preferences are catered for on a daily basis. For example, there is one resident who required an Asian vegetarian diet, which is provided for, and the cook prepares stir fries, curries and foods such as falafels, on a regular basis for residents who desire them. Often one cook will shop for cultural foods for individual residents in their own time, which demonstrates her commitment to providing residents with their Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 15 individual choices and needs. On the day of the inspection the main lunch choice was roast beef, cauliflower, broccoli, roast potatoes and carrots but residents could also choose sweet potatoes or pumpkin. Residents spoken with said that they liked the food at the home and confirmed that they can always have an alternative choice. The alternative was a healthy salad made with egg, salmon, cold mixed vegetables, lettuce, peppers, tomatoes and quiche. There was also homemade soup, which was tasty. Homemade cakes/biscuits are provided in the afternoon, each resident’s birthday is noted and celebrated, and sandwich snacks are available during the late evening and at night. Other suppers provided are light meals such as sausage rolls and baked beans or lasagne and salad. The inspector observed some residents being fed at lunchtime. Healthcare assistants were observed to be patient and to be speaking with the person they were feeding, thereby preserving their dignity. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are confident that their complaints and concerns will be listened to, taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure which meets the requirements of regulation. The procedure is available at the back of the Statement of Purpose, a copy of which is given to every service user, and a copy is displayed on the noticeboard at the entrance of the home for relatives and visitors. The home has received only one formal complaint since the 23rd August 2006 and this complaint was fully investigated and responded to within 28 days. There was verbal and documentary evidence however that the home treats any informal comments/queries/complaints with importance and seriousness, and responds immediately and thoroughly. For example, a comment was made at a placement review that there was no choice at mealtimes. The manager immediately investigated this and found that some staff were, as a cultural misunderstanding, mistakenly giving resident a portion of all of the choices on offer, rather than reading out the different choices to them and letting them choose. This was rectified immediately. All residents and relatives spoken with said that they would not hesitate to speak with the manager, or staff, if they had a query or complaint and that the manager was always “available and willing to listen”. They said that any difficulty was “always responded to and put right as soon as possible”. Four sets of relatives said that there were “no Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 17 problems” at the home and if there were they “would immediately tell Pat”, the manager. There are suitable policies on adult protection, restraint and whistleblowing and these are reviewed and signed annually by the Registered Manager. All staff have had training in the prevention of abuse, which is undertaken during induction and includes training on Adult Protection & Abuse, POVA, the Department of Health’s “No Secrets” and Responding to Abuse. Observation during the both days of the inspection indicated that staff are sympathetic and understanding towards residents’ difficult behaviours and handle them appropriately. There have been no adult protection issues at the home for over two years. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and well-maintained home, which has been further improved physically in the last year. There are sufficient indoor and outdoor communal areas but some improvements need to be made to the garden area to make it more accessible and useable. Residents live in safe, comfortable bedrooms with their own possessions around them according to their choice. There are problems with the physical standards in regard to the number of bathrooms that are suitable for people with physical disabilities, the low sinks in the kitchen and the serious problem of subsidence affecting the whole kitchen. The home is clean and hygienic. EVIDENCE: The home is located in a pleasant residential area, on a bus route that gives access to a local shopping area with railway. It is built on a hill in a hilly area so there are nice views from most of the bedroom windows. The home is safe Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 19 and well maintained with the exception of the subsidence affecting the kitchen, and the seating area in the back garden. The very large back garden slopes steeply so although it is a very pleasant area to view, its use for people with mobility and physical restrictions is limited. However there is a large flat terrace that is accessible from the second floor and which can be used for sitting out or for outdoor activities. The external paintwork in this area needs to be renewed, as does the walkway for access and the garden furniture on the patio area. In addition, the flat concrete area/2nd patio in the garden where residents may sit has become uneven. A relative who wheels his mother out onto this area in the summer pointed out that unless this area is repaired, residents are obliged to sit in full sun on the first patio rather than benefit from the shade provided by trees overhanging the second patio area. See Requirement 1. Inside the home there are three main communal areas. The first is on the ground floor and located next to the kitchen and the passenger lift. It doubles as a dining room and day room. It is bright, pleasant in shape and décor and has music facilities but is not carpeted. Residents sit at the various dining tables in the room, which are convenient for the many activities carried out there. On both of the inspection days residents were observed to be enjoying using this room. The second communal room is a large L-shaped room on the second floor, which also doubles as a dining/day room. This room has television and music facilities and several armchairs and recliners but also is not carpeted. The inspection report of 13th March 2006 required that the registered person ensure that dining rooms have a floor covering which is homely in character. The home has provided floor covering for the third communal lounge which looks like laminated wood but which is soft vinyl that is homely and practical without being carpet. The Registered Provider should consider extending this covering to the other two lounges. See Requirement 2. The third communal lounge has been much improved since the inspection of 23rd August 2007. It now has good flooring, good quality furniture and fittings and large framed and attractive portraits of residents when they wore fancy hats for an event held at the home. The majority of resident bedrooms were seen and were found to be well laid out and decorated with high quality fittings and fixtures. All were personalised according to the wishes and means of the occupant, and several had many personal possessions which the resident had brought into the home, making them attractive and homely. Several bedrooms did not have carpeting. This was due to health & safety reasons for the individual resident, and the inspector was assured that should the residency change, then new residents would be offered carpet if this was not contrary to their health & safety needs. All shared bedrooms have screening for privacy and are arranged to give residents as much separate personal space as possible. Residents spoken with said they were very happy with their rooms, particularly the residents on the Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 20 ground floor whose windows are of a height which gives them lovely views, visible from their armchairs and beds. The home has 6 bathrooms, which are more than sufficient in number for the registered number of residents. However only 3 bathrooms are suitable for people with physical disabilities. These are the newly developed 2nd floor bathroom that has a Medic bath, one of the 4 bathrooms on the 1st floor that has a Parker bath and a second bathroom on the 1st floor which has a chair hoist. The other two bathrooms on the 1st floor, and the only bathroom on the ground floor, have ordinary baths and therefore are not used by the majority of residents. The two ordinary bathrooms on the 2nd floor are not used for bathing at all. One is used by the hairdresser, but this is inadequate for this purpose as it has only an ordinary washbasin in it, which is not suitable for washing residents’ hair. Although the Registered Provider has had the 3rd floor bathroom refurbished during the past year to a high, disability-accessible, standard, at least one more bathroom needs to be converted for disability use in order for the home to have sufficient bathrooms that are suitable for residents’ needs. See Requirement 3. If this is achieved, the home would still have 2 ordinary bathrooms, only one of which is necessary. Therefore, it is recommended that the Registered Provider give serious consideration to converting the large bathroom opposite the first floor lounge into a hairdressing room. This would be suitable for purpose, having sufficient space for hairdressing equipment and storage and being close to the communal area so that the social and camaraderie aspects of visiting the hairdresser can be better enjoyed. There are two separate toilets near this bathroom and the lounge, so that conversion to a hairdressing room will not affect residents’ access to toilet facilities. See Recommendation 1. The home has cleaners working two 6-hour shifts daily and on the days of inspection the home was found to be clean and hygienic. The kitchen was also clean and well ordered, but there are two major problems, both of which affect health and safety: • The kitchen sinks are very low and cause a health hazard for the kitchen assistants, several of whom are having problems with their backs. The low level of the sinks also prevents the use of rubber mats which would otherwise mitigate the problem of standing still for long periods on a concrete floor. Following the inspection of 23rd August 2006 a requirement was made for this to be rectified by 1st December 2006 but this timescale was not met. See Requirement 4. There has been building slippage/subsidence that has affected the kitchen and food storage areas. There are large cracks in the ceiling and several areas where slabs of tiles are protruding out away from the wall/steps or have actually fallen out. On the side of the stairs that lead up to a cupboard, the wall covering is coming away from the wall and the lino on the floor is raised up, making both areas difficult to keep clean DS0000007023.V342433.R01.S.doc Version 5.2 Page 21 • Hamilton Lodge Nursing Home and hygienic. The whole wall of the extension to the kitchen where food is stored is coming away from the main building. At a meeting on 13th September 2007 the owners said that they would take steps to ensure that the insurance company fully renovate the kitchen rather than carry out the minor repairs they had been effecting. The inspector was told that insurance companies are currently investigating the subsidence and the Registered Person must keep CSCI informed of the position. See Requirement 5. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by the numbers and skill mix of staff and residents are in safe hands at all times. Residents are supported and protected by the home’s recruitment policy and practices and staff are trained and competent to do their jobs and are friendly and empathetic towards residents and their relatives. EVIDENCE: Rotas were seen and evidenced that staffing numbers and the skills mix of staff are appropriate to the assessed needs of residents and to the size, layout and purpose of the home. There are two first level nurses on duty every day from 8am to 8pm and there is one first level nurse on duty each night, with one on-call. There are 7 healthcare assistants on duty every morning and 6 each afternoon, which means that there is extra assistance available at the peak morning time. There are 4 night healthcare assistants on duty with the nurse each night, and all night staff are waking. The home does not use agency staff but has 2 bank staff who regularly cover absences and so are familiar with the home and residents and can provide continuity of care. As noted in Standard 12 above, the home employs a full time activities coordinator four days per week to provide for residents’ recreational and leisure needs. Observation of practice and verbal evidence from speaking with nurses, healthcare assistants and the cook indicated that staff have a good Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 23 understanding of the problems associated with old age and the general and individual needs of residents of the home. Staff interviewed demonstrated sensitivity and empathy towards residents and a commitment to safeguarding their dignity, independence and rights. Residents’ relatives spoken with said that “all staff are friendly and approachable” and that staff provide “wonderful care” and “welcome visitors”. One relative said that there were sometimes “some language difficulties” but did not explain any further. The atmosphere amongst the staff group at the home was positive, friendly and co-operative. Domestic staff are also employed in sufficient numbers at the home. There are 2 full time cleaners and one full time laundry assistant every day. There are two cooks working full shifts, one of whom works 5 days per week and the other 2 days per week. There are also two kitchen assistants each day at the home, one covering breakfast to lunch and another covering late afternoon and evening. All nurses employed by the home are qualified to 1st Level, including bank staff nurses, which means they are suitably qualified to be in charge of all medication and healthcare needs. In addition, 6 nurses have specialist palliative care training and all nurses are doing an external dementia care course. Thirteen of the twenty-two healthcare assistants employed by the home have NVQ Level 2, with 2 of them currently taking NVQ Level 3, and so the home has exceeded the 50 training target. The administrator/secretary, who works at the home for 4 days per week, organises and administers the staff files. These were found to be very well ordered and kept. The files of three staff who have been employed since the previous inspection of 23rd August 2006 were examined. These comprised one nurse, one healthcare assistant and one bank nurse. The documentation seen evidenced that a through recruitment procedure is carried out, which ensures the protection of residents. All files were in good order and had all of the required documentation, including application forms, references, POVA First and CRB checks, proof of identity and Visa permissions, medical declarations and training certificates and pin numbers as appropriate. There is a full range of races, nationalities and gender at all levels in the home, evidencing that the home recruits according to equal opportunity practice. The manager confirmed that there is a full induction period for healthcare assistants which is undertaken by a nurse over a three day period. It covers areas such as fire, care planning, medication, complaints, infection and food hygiene. The new healthcare assistant will then shadow an experienced worker for a fortnight, and after four weeks will have their first supervision. Within their first 3 months of work they will be trained in fire procedures, manual handling, infection control, food hygiene and health and safety. Since the inspection of 23rd August 2007 the manager has introduced an externally produced and verifiable induction programme that meets Skills for Care standards. This system requires regular written assessments, which are Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 24 submitted and marked externally, and provides a Certificate of achievement once the course is successfully completed. In regard to training, nurses currently undertake their 5 days of training each 3 years to keep their qualification renewed. Healthcare assistants have undertaken various internal and external training courses covering basic training needs and also areas such as palliative care, medication and nutrition. The senior healthcare assistants, the administrator and some healthcare assistants have attended an external course on first line management, covering a period of 3 days a week for 3 weeks, which is good practice for staff development. Individual staff’s training records can be evidence from a spreadsheet devised by the administrator. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Manager is sufficiently qualified and experience to run the home, is of good character and is able to discharge her duties fully. Residents and staff benefit from the ethos, leadership and management approach of the manager. Both formal and informal feedback from residents and relative is sought regularly but the Registered Proprietor is not providing reports of monthly monitoring visits as required by regulation. Residents’ financial interests are safeguarded. The health, safety and welfare of service users is promoted and protected. EVIDENCE: The registered manager is a first level Registered General Nurse, has NVQ Level 4 in Management and Care and The Registered Manager’s Award, and has several years experience as both a deputy and a manager of nursing Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 26 homes. In addition she is a NVQ Assessor, has a Certificate in Palliative Care, has Wound Care Management and tissue viability training. The manager demonstrated a comprehensive knowledge of the conditions and illnesses associated with old age, a sensitive and caring attitude and a strong commitment to meeting the needs of residents of the home. During conversation the manager evidenced sensitive management of family dynamics, co-operation with other care homes, placing authorities and professionals, and a subtle understanding of vested interests that could affect residents and the home. There is a management structure at the home and clear lines of accountability. Observation and verbal evidence from residents, relatives and staff indicated that the management approach at the home is open, positive and inclusive. Comments included: “there are no problems, if there were we would immediately tell Pat”, “Pat puts you at ease”, “Pat is a star, she is always improving the home” “she knows everyone’s name and is interested in everyone’s well being”, “all staff are friendly and approachable”, “there’s a very nice atmosphere at the home”. The home sends out annual quality assurance questionnaires and also, as observed on both days of the inspection, speaks with residents and relatives on a daily basis to obtain feedback. Examples were given of the home making changes arising from feedback and comments, such as altering the menu and making certain choices more regularly available. The home should ensure that an annual summary of residents’ comments is printed and made available with the Statement of Purpose/Service User Guide, as is recommended in the National Minimum Standards. See Recommendation 2. The Commission received responses to all 10 questionnaires that were sent out to residents’ relatives, and all but one of the questionnaires were effusive in their praise of the home. For example, a relative who visits his mother daily said “ (They) provide a caring environment and maintain the dignity of the residents. I have always witnessed respect to all.” Other relatives commented “Mother is always treated well and appropriately”, “On the odd occasion when consultation was needed, I was phoned at once”, “There are constant learning sessions & talks for all staff”, “Residents can lead their own lifestyle unless it endangers themselves or others”, “I can talk to Mrs. Jenkins at any time”, “(the home) promotes good links with relatives. Tries constantly to entertain residents”, “I was extremely impressed by the way Mrs. Jenkins and all staff pulled together while the lift was out of action”, “I really can’t see how things could improve – he is quite happy with everything and feels like part of a family”. The inspector discussed in detail the issues raised by the one questionnaire returned to the Commission that had some negative comments and was satisfied by the explanations given. However, there were no Regulation 26 reports (monthly visits by the Registered Provider) available at the home. A requirement was made for these to be written following the inspection of 13th March 2006. Continued failure to Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 27 meet this requirement will result in enforcement action being considered. See Requirement 7. The home does not administer or manage any service user monies. Residents’ personal monies are handled exclusively by themselves or their relatives, or by solicitors and social workers where there are no relatives. Relatives/solicitors pay a lump sum to the Registered Person’s head office and anything a resident purchases, such as hairdressing or items from the mobile shop, is financed from petty cash, notified to head office and entered on invoices which relatives receive monthly. Receipts are kept for items purchased. Neither the home nor head office have any interest in residents’ savings, which are managed exclusively by relatives or legal stakeholders. The inspector checked the following health and safety areas and no problems were found: • • • • • • • • • • Storage of substances hazardous to health (COSHH) Servicing of boilers and central heating Regular checks of fire alarms Lift maintenance Collection of hazardous waste Servicing of hoist Servicing of bath hoists Weekly checks of water temperatures Regular checks of call points Fire Risk Assessment report There was a problem with the recording of fire drills. One drill was recorded for January 2007, including as good practice signatures of all those who attended, but no other fire drills were recorded although the inspector was told a second one had been carried out. The home should ensure that all fire drills are recorded. See Recommendation 3. Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 2 2 2 X X 3 X 2 STAFFING Standard No Score 27 4 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 1 X 3 X X 2 Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP20 Regulation 23 (2) (b) & (o) Requirement The Registered Person must ensure that the woodwork and external areas where residents may sit outside, and the garden furniture, are in a good state of repair. The Registered Person must ensure that lounges and dining rooms have floor covering which is homely in character. Previous timescale of 01/01/07 not fully met. The Registered Person must ensure that there are sufficient disability bathrooms for the numbers and needs of residents. The Registered Person must ensure that the low kitchen sinks are raised to a suitable height. Previous timescale of 01/12/06 not met. The Registered Person must keep the Commission regularly informed of the progress regarding the renovation of the kitchen. The registered person must ensure that a structured quality assurance system is put in place. DS0000007023.V342433.R01.S.doc Timescale for action 01/03/08 2 OP20 23 (2) (h) 01/03/08 3 OP21 23 (2) (n) 01/04/08 4 OP38 16(2)(g) 01/12/07 6. OP19 23(2)(b) 01/10/07 7. OP33 24(1)(a) & (b) 01/11/07 Hamilton Lodge Nursing Home Version 5.2 Page 30 Previous timescale of 31/12/06 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP21 OP33 Good Practice Recommendations The Registered Provider should consider converting the currently unused bathroom opposite the 1st floor lounge into a suitable hairdressing room. The Registered Manager should ensure that a summary of residents’ comments from the annual quality assurance survey is printed up and made available to all interested parties. The Registered Manager should ensure that all fire drills are recorded. 3 OP38 Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hamilton Lodge Nursing Home DS0000007023.V342433.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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