Care Home: Hamilton Nursing Home

What the care home does well The manager confirmed that there have been few substantive changes to this care home since we visited in 2006 and so the findings in this inspection support our earlier assessment that this remains a service that is providing good outcomes for residents. The friendly atmosphere in the home was apparent from the outset and commented upon by visitors, "We are always made welcome and given a cup of tea". The activity coordinator made sure the residents were engaged in a meaningful way at some point in the day with lots of communal activities such as singing and quizzes. All care homes are expected to respect the diversity of the residents and in Hamilton they do this by assessing the residents` individual needs; by speaking to their relatives; by providing services for those with diverse needs including those with diverse beliefs and people with specific disabilities such as sensory impairments. The home employs male and female staff who are from a range of backgrounds so as to reflect the gender, racial and cultural backgrounds of the residents. What has improved since the last inspection? Having been assessed in 2006 and care providing a good service very few requirement were made at that time. The home has addressed these various requirements including for example some improvement in food storage. The registration issue has also been addressed when a resident that was `out of category` and this is no longer the case. The home is now being cleaned to a satisfactory standard. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Hamilton Nursing Home 24 Langley Avenue Surbiton Surrey KT6 6QW Lead Inspector Michael Williams Unannounced Inspection 2nd July 2008 10:10 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 Nursing Home DS0000026247.V366484.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 Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hamilton Nursing Home Address 24 Langley Avenue Surbiton Surrey KT6 6QW 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) 0208 399 9666 0208 390 9394 info@irh-homes.com www.lrh-homes.com London Residential Healthcare Limited Mrs Gnanawathie Jamanetti Care Home 28 Category(ies) of Dementia (0), Dementia - over 65 years of age registration, with number (0), Physical disability (0) of places Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A maximum of three service users in the categories of Dementia and Physical Disability aged between 55 and 65 years. 15th May 2006 Date of last inspection Brief Description of the Service: Hamilton Nursing Home provides personal and nursing care and has accommodation for up to twenty-eight people who have dementia. London Residential Health Care Ltd [LRH] owns and manages this home and the manager advised us that there have been no changes to the ownership of the home or business since the registration certificate issued in 2005. The home is a large detached property, situated in a residential area of Surbiton. Public transport, local shops and leisure facilities are all within a short distance from the home. The home comprises a large communal lounge, a communal dining area, twenty-six single bedrooms and one double bedroom. A passenger lift is available in the home. There is a large garden to the rear of the home and, limited, off-street parking is available at the front of the property. Fees as at July 2008 were from £564 to £891; residents pay for personal requisites but any extra charges for additional care are by negotiation with the commissioning agency. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection commenced on 2nd July 2008 and this included a visit to this Nursing Home in Kingston. In addition to the inspection visit, which lasted about 6 hours, a number of questionnaires were distributed to interested parties including people who use the service (as this is a care ‘home people who use the service’ are referred to as residents). We also gave questionnaires to visitors to the home. Ten replies were received at the point of compiling this report and all were very positive about Hamilton Nursing Home. Two statements convey the general feedback, “Mum is well cared” and “The flexibility of the home and its staff is excellent”. During the course of the visit we tried to meet as many of the residents and visitors as possible, usually in a public setting such as the lounge. Several relatives were visiting and they also contributed to this inspection. A number staff, as well as the manager, were also interviewed. The premises were toured and documentation, including records, were checked. In compiling this inspection report the Commission also noted information received, including details of any complaints, untoward incidents and general correspondence. We also to account of the information provided by the home in their ‘AQAA’, their annual questionnaire and self-audit that is required by the Commission to be completed by all care homes. The contribution of everyone involved is acknowledged. The person in charge when we visited confirmed that there have not been any been changes in the ownership, management or service registration details in the last 12 months and that their current registration certificate is providing the correct details. What the service does well: The manager confirmed that there have been few substantive changes to this care home since we visited in 2006 and so the findings in this inspection support our earlier assessment that this remains a service that is providing good outcomes for residents. The friendly atmosphere in the home was apparent from the outset and commented upon by visitors, “We are always made welcome and given a cup of tea”. The activity coordinator made sure the residents were engaged in a meaningful way at some point in the day with lots of communal activities such as singing and quizzes. All care homes are expected to respect the diversity of the residents and in Hamilton they do this by assessing the residents’ individual needs; by speaking to their relatives; by providing services for those with diverse needs including those with diverse beliefs and people with specific disabilities such as sensory impairments. The Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 6 home employs male and female staff who are from a range of backgrounds so as to reflect the gender, racial and cultural backgrounds of the residents. What has improved since the last inspection? What they could do better: 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 Nursing Home DS0000026247.V366484.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 Nursing Home DS0000026247.V366484.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): NMS 1 and 3: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the service user or, in most cases, their representative so residents know that their needs have been fully assessed and can be met in this home. EVIDENCE: Several relatives confirmed they, on behalf of residents, had been given a chance to visit the home prior to admission. They told us how staff had explained what the home would provide for the person to be admitted. A sample of case files were checked and they include the assessment provided by either hospital staff or care managers. These assessments include details of diversity and cultural needs such as language and religious preferences. The home also provides a statement of purpose that clearly sets out the aims and objectives of the home and so does the resident’s guide. Both however need to be revised as both documents are dated 2005 with an annual review date advertised in their title pages. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 9 Whilst the admission of residents ‘out of category’ was the subject of a requirement in our previous report the home this was no longer the case and the manager gave an assurance that all residents were now within the home’s registration category. Areas of strength include the documentation supporting the admission including the statement of purpose and user guide; assessments that are in place for each resident and relatives complimented the home for the support and information they received at the time of admission. No requirements are made and just one recommendation is made about updating admission documentation. This section is assessed as good. Hamilton Nursing Home DS0000026247.V366484.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): NMS 7 to 11: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are all satisfactory so as to ensure the social, and health care of service users can be met in all but one case. EVIDENCE: Residents are receiving personal and healthcare support using very detailed care planning documentation to outline their rights of dignity, equality, fairness, autonomy and respect. Personal healthcare needs including specialist health, nursing and dietary requirements are being clearly recorded in their plans and we confirmed this by checking a sample of case notes across a range residents who have lived in the home for several years and some newer resident, and both male and female residents files were checked. We also checked that diversity issues were being addressed such as beliefs, disabilities gender and more generally residents wishes and preferences as described by the resident or more typically their representatives. The documentation, in two forms – a ready use card index and main office file with initial assessments, contracts and correspondence - gives a Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 11 comprehensive overview of their health needs and act as an indicator of change in health requirements. The statement of purpose details the specialist treatments the home can deliver with a commitment to individual personalised care, and that document, the statement of purpose, also refers to the skills and ability of the staff group, many of whom are nurses and even some of the carers are overseas nurses preparing for UK accreditation. Personal support is responsive to the varied and individual needs and preferences. The delivery of personal care is individual and is flexible, consistent, reliable; this was confirmed by the visitors’ comments such as, “The flexibility of the home and its staff is excellent”. Visitors we spoke to endorsed this and said the staff were very thought, kind and caring. Staff respect privacy and dignity and are sensitive to changing needs. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. People are supported and helped to be independent and can take responsibility for their personal care needs. Residents have access to healthcare and remedial services; this is recorded in the various forms used by the home to record every event from bathing, hairdressing, to doctor’s visits and the like. Residents have the aids and equipment they need and these are well maintained to support them and staff and this includes a number of hoists, assisted baths, handrails and similar adaptations to the environment. Staff have access to training in health care matters including safe techniques for ‘moving and handling’ residents and are encouraged and given time to attend seminars on specialist areas of work such as caring for people with dementia and the protection of vulnerable adults from abuse. The home has an efficient medication policy supported by procedures and practice guidance, which staff. Usually nursing staff or care staff under supervision of a nurse, understand and follow good practice. Our brief examination of medication procedures indicates that medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. If residents prefer or where they lack capacity (as is the case in many instances in this home), care staff manage medication on their behalf. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of controlled drugs. Staff have completed and passed an appropriate medication course. Staff work to clear and robust practices when caring for individuals who are terminally, for example in the latter stages of dementia. Care plans have provision for recording last wishes and funeral arrangements and for choices and preferences about end of life care for example any last wishes, any arrangements in respect of religious beliefs. The new care-plan forms reflect changes in the law, in particular the Mental Capacity Act, which allows for advance directives and choices about accepting or refusing treatment when unwell. When residents die family and friends can help with the arrangements if this is what the resident had agreed to and the manager explained in some details how they worked with Jewish family to ensure this was the case. It was Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 12 evident from our discussions with the manager that staff support both the family and the home’s other residents during the bereavement process. Areas of strength include the detailed documentation supporting care and the practice of nurses and carers putting those plans into practice. No requirements arise in this section. This section, about health and personal care, is assessed as good. Hamilton Nursing Home DS0000026247.V366484.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): NMS 12 to 15: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Varied activities and wholesome meals are provided, visitors are warmly welcomed and service users are given the opportunity to make choices. So the differing expectations and lifestyles of residents are well catered for. EVIDENCE: This care home provides care for older people with dementia so their aspirations and expectations for the future are necessarily limited. Planning for independence would be unrealistic in a home where residents are very frail and dependent. Nonetheless where possible residents are supported to maintain such skills as they retain for example, in dressing, eating, using toilet and so forth. But in many instances they need the close support and supervision of staff. Residents have the opportunity to maintain important personal and family relationships and this was confirmed by the several visitors we met during our visit in July. The staff promote individual rights and choice, but also consider the protection of residents in supporting them to make what limited choices that are still within their capacity. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 14 The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided as outlined in their statement of purpose and resident guide. Residents are involved in meaningful daytime activities of their own choice and according to their individual interests, diverse needs and capabilities. In Hamilton they are often engaged in activities lead by the ‘activity coordinator’ who provides gentle exercise, songs and quizzes as well as general human contact by way listening and sitting with residents who show no discernable response to discussions and questions. The tranquil atmosphere that prevails in this home indicates that residents are as content as might be expected. Whilst it is unlikely that many residents were fully involved in the planning of their lifestyle and quality of life it is clear from their case files that their relatives met with care managers to plan for residents’ care needs on their behalf. Residents can access and enjoy the opportunities available in their local community, such as the local parks, pubs, and places of interest; the photographs in the lobby testify to this. The service is committed to the principles of inclusion and promotes and fosters good relationships with neighbours and other members of the community including local schools and churches. We inspected the catering arrangements in some detail on this occasion. This included an inspection of the kitchen, which remains very small, the catering records and the meals provided. The freezer temperature record was signed for 2nd July by the cook in charge on the 1st so this was clearly an error. The meal was changed from the planned savoury mince to cottage pie and a change to the pudding but there was no record of these changes. Although fish cakes were available as a second choice this was not listed on the published menu on show in various locations around the home. The record of food is spread over no less than nine different documents including a book, several checklists, care plans, several printed menus and the main cycle of menus. None however was insufficient detail to enable us to check whether the nutritional needs of a particular resident were being met. Whilst there was no indication the resident was not receiving a satisfactory diet this could not be confirmed by checking the records as was intended. A requirements is made to review what records of food are to be maintained and how they might be refined to provide the detail required. We observed the midday meal being served and noted that the care staff are were very sensitive to the needs of those residents who find it difficult to eat. Support provided by staff in feeding were gentle in their manner and helped residents at the pace of the resident, making them feel comfortable and unhurried. Areas of strength include the good work of the activities coordinator; the calm relaxed atmosphere of the home; the entertainment including in-house events and outings. Matters requiring improvement include the needs to improve records for recording food and nutrition. This section, about daily life, is assessed as good. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 15 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): NMS 16, 17 and 18: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are now handled effectively, so service users and their representatives will feel that they will be listened to and their concerns will be acted upon. Residents’ rights are respected and vulnerable adults procedures in the home are in place and serve to ensure that service users are protected from abuse. EVIDENCE: The home has an open culture that allows residents and their families to express their views and concerns in a safe and understanding environment. Residents and others involved with the home say that they are happy with the service provided. All ten of the written feedback forms we received confirmed this point. Relatives the residents are safe and well supported by an organisation that has their protection and safety as a priority. The service has a complaints procedure that is clearly written and easy to understand and information is available in various locations including the resident guide and notices. Again the feedback from relatives indicate that they know how and to whom to complain if they have concerns so residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. A ‘comments’ book is kept in the home’s entrance lobby and this is being used for visitors to make any comments they wish and the manager makes a note of how she has dealt with any concerns. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 16 The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. Staff working at the service know when incidents need external input and who to refer the incident to. We questioned several staff to confirm this and even the newest staff who have worked in the home for less than a month were well informed about safeguarding procedures and how to report suspicions of abuse. There is a clear system for staff to report concerns about colleagues and managers. Staff that ‘blow the whistle’ on bad practice are supported by the service. The home manager understands the procedures for safeguarding adults and attends meetings to external agencies such as the local Social Service Department when requested. There are a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. The outcomes from any referral are managed well and issues resolved to the satisfaction of all involved if at all possible. Training of staff in safeguarding is regularly arranged by the Home. Other training around dealing with physical and verbal aggression is also made available to staff as needed. We confirmed this by speaking to staff, the manager and by checking their training records. The manager understands what restraint is and alternatives to its use in any form are always looked for. Equipment that may be used to restrain individuals such as bed rails, keypads, recliner chairs and wheelchair belts are only used when necessary. People, including relatives and care managers are involved in the decision making process about any limitations to residents choice in this area. Individual assessments are always completed which involve the individual where possible, their representatives and any other professionals such as the care manager or General Practitioner. The issue of restraint and ‘deprivation of liberty’ was discussed at some length with the manager who was advised about two aspects that she might follow up; the first is how frequently residents capacity will need to be checked and in what circumstances since this is not a one-off decision and secondly to check what the new local authority arrangements will be when the ‘Deprivation of Liberty’ Safeguards come in force in 2009. Areas of strength include clear information; well informed staff; a management approach that welcomes the discussion of concerns. No matters require improvement but a recommendation is made in respect of the amended Mental Capacity Act. This section, about complaints and protection, is assessed as good. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 17 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): NMS 19 and 26: People using this service experience adequate quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained, decorated and furnished to a reasonable standard and in general the facilities are clean and safe. This ensures that service users live in a pleasant, homely environment. However, shortfalls in hygiene and maintenance do not ensure the comfort and well being of all service users at all times. EVIDENCE: This home is a large detached property, converted to provide accommodation for up to 28 residents. It has the style of a large family house with well maintained gardens to the front and back. The gardener is complimented for maintaining such a nice setting for the residents, the roses were particularly beautiful. Inside, the premises are agreeable homely and decorated to a reasonably good standard throughout – except for the staff quarters on the top floor which are not used by residents but even in this area the staff training Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 18 room is well appointed. The home was free of malodour and all the areas we checked were clean and tidy. We noted that a bedroom door was wedged open by an armchair and we were advised a member of the cleaning staff had done this; as there were two doors to this room there was no immediate risk of smoke and fire spreading but we recommend magnetic door holders are used if fire doors need to be held open. Another fire door, to the hairdressing room was not closing fully and again there appeared to be no immediate risk but fire doors need to be maintained in good order including the self-closing devices. We checked windows and doors for security and noted that some windows do not afford adequate security for residents. One of the first floor bathrooms was in a poor state with a broken blind and two cracked windows. This bath hoist was also out of action awaiting repair. Another bathroom was being used as storage space for cleaning equipment. The kitchen remains very small with very limited storage space but the owners intend extending the home and improving kitchen facilities in due course. Inevitably the kitchen remains very cluttered because it is too small for the number of people it serves, up to forty people each meal including residents, staff and visitors. We noted that a freezer seemed to running above -18oC and we noted that the temperature recordings show the freezer to be fluctuating between minus 16 and 18oC day by day. It was also noted that the temperature of the freezer was recorded for 2nd July by the cook who was on duty on 1st and not 2nd. There is clearly a need to record readings accurately, not to rely entirely upon the digital read-out on the unit and to adjust cooling equipment that is running too warm. The kitchen staff had no means of recording changes made to the planned menu – although the cook did advise us that he informs the manager when changes are made. The midday meal was cottage pie - which did seem to be an improvement on the advertised ‘savoury mince’. Areas of strength are the well presented accommodation; the homely atmosphere; the good standard of hygiene and the nice gardens but matters requiring improvement include maintenance of bathrooms, the fire doors and window security. The kitchen and storage space remain inadequate. This section, about the environment, is assessed as adequate. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 19 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): NMS 27 to 30: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures offer protection to people living in the home. There is a staff training and development programme that provides staff members with skills necessary for meeting the needs of residents. Residents appear safe in the hands of this staff team. EVIDENCE: To assess that standards are being met staff were interviewed, staff files were checked and the manager and the personal staff were interviewed. Staff recruitment is organised from the company’s head office also in Surbiton, a short distance from Hamilton. The arrangements for recruitment have been checked by the Commission on several occasions and seem sound we tested the arrangements for requesting staff files, as agreed formally with the Commission and the system worked well – staff files were brought from head office to Hamilton during the course of our visit. The staff files are clearly indexed so making easy to monitor all necessary checks are completed including references, police checks, identity checks and so forth. The manager was unable to confirm that the Commission has agreed the arrangements for holding staff files off-site at the company’s headquarters and will be required to do so. The manager states that present staffing levels are meeting current service users needs. For the 27 resident on the day of our visit there were two Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 20 qualified Nurses plus the manager who is herself a Nurse. There were also 5 carers on duty for each shift. In respect of staff training and skills it was apparent the company has in place a well organised training programme and staff confirmed that suitable induction is in place for each new member of staff and that on-going training is available to all staff. The nurse interviewed during the site visit was well informed about her clinical duties including wound care and the proper administration of medicines. The home uses a standardised format for residents’ care files and those checked are being maintained in good order by the staff in particular the nursing staff who are responsible for the clinical care of residents. Care staff (non-nursing staff) were also interviewed. Residents and relatives described care staff as kind and helpful and during the course of the site visit they were seen to be acting in a caring and professional manner. There was a sense of a well motivated and positive team of workers in this home. Areas of strength; it can be concluded that residents are safe in the hands in the hands of the staff team worker in this care home and so this section is assessed as good because the arrangements for staffing are acceptable including staff training and staff recruitment. Staff moral seems very positive. This section about staffing is assessed as good. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 21 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): NMS 31, 33, 35, 37 and 38: People using this service experience good quality outcome in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is registered with the CSCI as a person competent to run this home in accordance with its stated aims and objectives and so in the best interests of the service users. The home is well managed, including finances, and is largely safe for service users; some exceptions to this are listed below. EVIDENCE: The manager is registered with the Commission and has been assessed as competent to manager Hamilton Nursing Home. She is supported by a management team that includes administrators and personnel staff as well as a full time trainer. The home is therefore managed by a team and appears to be competently run. With this team to back her up the home it is clear to us that this care home is being run in the best interests of the residents. As a large organisation the company keeps a number of records off-site at their headquarters, including some staff records and some records of service Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 22 users’ money – the home has therefore confirmed that the Commission has agreed the arrangements for doing so and during this site visit we confirmed those arrangements work in practice; staff files and records were brought to the care home promptly and efficiently for us to examine during our inspection. The procedures for managing residents’ money were checked. Some money is held centrally at the headquarters and a small amount is held within Hamilton. Both arrangements appeared safe; accounting was clear and residents’ access to their money is well managed. In respect of the management of safety in the home a small number of matters requiring attention were identified; these include fire safety, doors wedged open or not closing fully. Window and door security again needs to be reviewed restrictors on windows to ensure residents are safe from unlawful entry or risk of residents leaving the premises without suitable support of staff. This section is assessed as good because the overall management of the home appears sound, there are shortcomings as listed in the findings table; these are matters that are the responsibility of the manager for example in respect of hygiene and fire safety. The Commission is however confident that theses matters will be addressed. Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 23 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: Good Standard No Score 1 2 3 4 5 6 ENVIRONMENT: Adequate Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Good 2 X X X X X X 3 Standard No 7 8 9 10 11 Score 3 3 3 3 3 STAFFING: Good Standard No Score 27 3 28 3 29 3 30 3 DAILY LIFE AND SOCIAL ACTIVITIES: Good Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION: Good MANAGEMENT AND ADMINISTRATION: Good Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Standard No 16 17 18 Score 3 3 3 Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23(2)b Requirement Maintenance: the home must ensure all parts of the building are kept in good repair including bathrooms, the hoist, blinds and windows. Timescale for action 30/08/08 Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 25 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 Refer to Standard OP1 Good Practice Recommendations Statement of Purpose: It is recommended that the statement of purpose is checked to ensure it is update date since it is dated 2005; this is so that residents will know they are receiving the correct information. Food Records: it is recommended that the various documents being used to record food provided is reviewed and improved so as to be able to check that an adequate diet is being provided. Residents’ rights: It is recommended that senior staff, including the manager, revise their knowledge of the Mental Capacity Act, in particular the new ‘Deprivation of Liberty’ safeguard procedures so as to ensure the rights of residents are upheld. Security: It is recommended that the home again check external security such as doors and windows that may be unsupervised and so allow unauthorised entry in to the building. We note that since that last inspection some windows and doors were checked but not all. 2 OP15 3 OP17 4 OP19 Hamilton Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Nursing Home DS0000026247.V366484.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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