Care Home: Hamilton Rest Home

What the care home does well Residents at the home were being cared for and supported well by the registered manager and her staff. Residents spoken to said the quality of care provided was very good. Residents said staff spoke to them respectfully and maintained their dignity, particularly when personal care was being given. Comments made included: `the staff are relly very good and caring`, `they look after me really well and make sure they give me the help I need`, `they are kind and I like chatting to the girls when they are helping me`, ` my relative is very happy with the way they are looked after here, and I think the staff are very caring and able at what they do`, `I decide when I get up in the morning and when I go to bed`, ` I choose what activities I take part in`, `You are able to stay in your room if you wish some privacy or go to the lounge`, `I pick what clothes I am going to wear and what meals I want`, ` The staff always ask me what I think or want to do and try to respect my choices`. The home was being managed effectively. What has improved since the last inspection? The home has undergone a programme of redecoration and refurbishment since the last inspection. And this has nearly been completed. The staff training programme has been further developed and the registered manger has developed the ways in which she measures the quality and effectiveness of the services provided at the home. The requirements made at the last key inspection in July 2007 have been addressed. What the care home could do better: Requirements and recommendations have been made as a result of this inspection. These describe (in the relevant sections of this report) the things that need to be done to improve the quality of the service provided to residents at the home. Specifically improvements can be made in the way residents medications are managed, how care plans and risk assessments are developed, how staff training is developed and the staff recruitment process. Key inspection report Care homes for older people Name: Address: Hamilton Rest Home 211 Bury New Road Whitefield Manchester M45 8GW     The quality rating for this care home is:   Three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michael Murphy     Date: 1 2 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Hamilton Rest Home 211 Bury New Road Whitefield Manchester M45 8GW 01617667418 01617662007 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Eric Walters care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category: Code OP The maximum number of service users who can be accommodated is: 22. Date of last inspection Brief description of the care home Hamilton House is a large attractive detached property situated on a main road in Whitefield. The gardens are well maintained and attractive. Hamilton House provides residential care for up to 22 older people. the home is easily accessed by car and public transport. The home informed us that the fees at the time of this inspection were; 388.00 pounds to 420.00 pounds 0 Over 65 22 Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection included an unannounced visit to the home on the 12th of August 2009 between 9am and 5pm and a further visit between 10am and 11am on 19th August 2009. During the visits we talked to residents, relatives, staff, the home owner and the registered home manager. We also looked at documents and records the home have to keep such as residents care records, medicine records, written policies and other records. Before the inspection, we also asked the registered home manager to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home sees the service they provide the same way that we see the service. We felt this form had been completed in sufficient detail and provided useful information. Care Homes for Older People Page 5 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 6 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 7 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Before being admitted to the home prospective residents have their care and support needs assessed to ensure the home is able to meet their needs. Evidence: All prospective service users undergo a pre-admission assessment before a decision is made about them entering the home. This assessment is conducted by the appropriately qualified and experienced registered manager of the home. The purpose of this assessment is to decide if the home will be able to meet the potential residents care and support needs properly. It also helps prospective residents and their relatives in their decision of how appropriate the home would be for them. A record of the preadmission assessment is kept in each residents care records and identifies what care and support they will need. Other pre-admission assessments conducted by social workers and health care workers were also kept in the care records. Discussion with residents indicated that their views were taken into account before admission to the home. Care Homes for Older People Page 8 of 25 Evidence: Prospective residents are given the opportunity (where possible) to visit the home prior to admission. Formal review of new admissions are undertaken about six weeks after admission to determine if the new resident has settled well, is happy at the home and decide if the home is meeting their care and support needs properly. The home does not provide intermediate care. Care Homes for Older People Page 9 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs of residents were being appropriately met. However one aspect of the way residents medicines are manged needs to be improved and residents care plans could be made more personal to reflect the good care and support they receive. Evidence: The care records of three residents were looked at on this occasion. These were generally well organised and contained care plans that set out the action that needed to be taken by the care staff to ensure the health, personal and social care needs of residents are met. However it is recommended that the care plan documentation used be developed to describe in more detail the personalised care that is provided to residents. The care records also contained risk assessments that identified possible threats to a residents health and safety and described things that needed to be done to keep them safe at the same time as maintaining their freedom and independence. For example risk assessments had been done with regard to residents mobility and nutrition needs. However it is recommended that to improve the quality of the assessment of residents moving and handling needs a specific moving and handling Care Homes for Older People Page 10 of 25 Evidence: risk assessment should be conducted for each resident on a regular basis. Care records had been kept up to date. Arrangements had been made to register all residents with a local GP. Information in the care records and discussion with residents, their relatives and staff indicated residents were able to access health care services appropriately. A record of all such access was kept. The way residents medicines are looked after in the home was secure and generally well organised. However whilst medication is checked in no written record of this was maintained. It is required that this be addressed to maximise the safety of medicines within the home. The senior staff at the home look after the medicines and have had recent training in respect of this. Residents and relatives spoken to said staff spoke to them respectfully and maintained their dignity, particularly when personal care was being given. Comments made included the staff are relly very good and caring, they look after me really well and make sure they give me the help I need, they are kind and I like chatting to the girls when they are helping me, my relative is very happy with the way they are looked after here, and I think the staff are very caring and able at what they do. Care Homes for Older People Page 11 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were supported to enjoy a stimulating lifestyle and access a wide range of social and leisure activities. Residents were encouraged to make as many personal choices in their daily lives as possible, and the general view of food provision was positive. Evidence: The routines of daily living and the social activities available were flexible and varied and meet residents expectations, preferences and capacities. Residents were supported to access a range of social and leisure activities and entertainments. Forthcoming events, activities and entertainments are prominently displayed. Residents said they enjoyed the programme of activities available. Residents were able to follow their own religious practices and as in other areas of life in the home were are able to exercise their own personal choices in respect of this. Residents and relatives spoken to said there were no unreasonable restrictions on visiting at the home. Residents may receive their visitors in the privacy of their own room or quieter area of the home if preferred. Residents also said they were able to exercise choice and independence in their daily lives. Comments made included: I decide when I get up in the morning and when I go to bed, I choose what activities I take part in, You are able to stay in your room if you wish some privacy or go to the Care Homes for Older People Page 12 of 25 Evidence: lounge, I pick what clothes I am going to wear and what meals I want, The staff always ask me what I think or want to do and try to respect my choices. Menus were prominently displayed in the home and were varied, balanced and provided choice. Residents said they can always request an alternative from the menu if they wish. Comments regarding the food included: good homely cooking every day, the food is really quite good and you can always have an alternative if you want something different, the food is dead good and there is always plenty to eat. Lunch was observed on the day of inspection. This was a hot and substantial meal. Staff served and assisted residents appropriately and sensitively. The dining area was comfortable, suitably furnished and appropriate for residents to take their meals in. Care Homes for Older People Page 13 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an accessible and clear procedure in place to deal with complaints. Staff have been provided with safeguarding training and there are procedures in place that describe how to protect residents and keep them safe. Evidence: Information on how to make a complaint was prominently displayed in the home. This information detailed who to contact and how the complaint would be dealt with. A complaints record is kept by the home. Complaints appeared to have been dealt with properly. Discussion with residents and relatives indicated that owner, manager or senior staff are always available and that any issues raised are dealt with promptly and rarely need to become formal complaints. The home operates safeguarding and whistle-blowing policies (including those developed locally and operated by Bury social services) that seek to keep residents safe. Staff spoken to were aware of the importance of safeguarding and protecting residents and described their role in doing so. They confirmed they have been provided with safeguarding training. Inspection of training records revealed that safeguarding training has been provided to all staff at the home. In relation to the Mental Capacity Act the registered manager informed us that no people living at the home were subject to a deprivation of liberty authorisation and that no one living at the home was having their liberty deprived without authorisation. It is recommended that (following recent changes in the law) to maximise residents safety that staff are provided with training in respect of deprivation of liberty Care Homes for Older People Page 14 of 25 Evidence: safeguards (DOLS). Care Homes for Older People Page 15 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, pleasant, comfortable and suitably adapted environment for residents. Evidence: The building appeared to be in a good state of repair and decoration. The lounge and dining area were clean, appropriately and adequately heated, comfortably and appropriately furnished and provided a suitable and safe environment for residents to be cared for and supported properly. Televisions, music centres and other leisure equipment were available throughout the home. Suitably adapted bathing (including a new shower room) and toilet areas were provided. The home has generally been suitably adapted and equipped to meet the needs of residents. For example there is an adequate provision of hoists, grab rails, stair-lift and other equipment. Individual residents specialist needs are met after referral to the appropriate health care worker for assessment. Residents bedrooms that were inspected were clean, suitably furnished and equipped and personalized. The majority of residents bedrooms have been refurbished since the last inspection. At the time of this inspection two still required to be done. We were informed that these would be completed in the next couple of months. Residents spoke positively about the environment of the home saying it was clean, warm and comfortable. The home was very clean and odours were managed well. Suitable arrangements were Care Homes for Older People Page 16 of 25 Evidence: in place to manage residents laundry needs. And appropriate measures were being taken to minimize the potential spread of infection within the home such as adequate hand washing facilities and the provision of protective clothing for staff as well as appropriate cleaning practices within the home. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing arrangements, staff recruitment process and the training arrangements at the home seek to ensure residents are cared for and supported safely and appropriately. Evidence: Staffing arrangements at the home were supporting residents ensuring their needs were met. Discussion with residents and relatives revealed they were of the view sufficient staff were available to make sure residents were being properly looked after. There were appropriate arrangements in place to ensure there were sufficient staff in respect of the management, catering, laundry and housekeeping functions of the home. There was in the main a proper process in place in respect of recruiting staff. This is important to ensure residents are being cared for and supported by suitable people. The recruitment process included making police checks and another check regarding the suitability of the applicant working with vulnerable people. However it is required that an up to date photograph is kept of all people working at the home. This is to ensure the homes recruitment process protects residents as much as possible. The arrangements for training staff ensure that residents care and support needs are being met by competent staff. Discussion with the registered manager, staff and inspection of training records revealed that a well organized and suitable training programme is in place in respect of all staff employed at the home. Training is Care Homes for Older People Page 18 of 25 Evidence: provided at the home and through the local authority training partnership. Training records were detailed and up to date. 95 of the care staff have obtained a level 2 national qualification in care. The remaining carers were undergoing this type of training or are expected to do so in the near future. However it is recommended that staff be provided with training to enable them to more fully support those residents with memory impairement. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was being effectively managed by the registered manager. This ensures that residents are confident that they are safe and being looked after properly. Evidence: The home was being managed effectively. The registered manager holds an appropriate qualification in management and care and is very experienced in managing care services for older people. We were also informed that the registerd manager is to commence a degree course in dementia awareness in September 2009. Senior care staff, a team of carers and other staff assist the registered manager in her role. The registered owner of the home also visits regularly to provide managerial support. Residents, relatives and staff (spoken to on the day of inspection or in responses contained in our surveys of the home) indicated that the manager is approachable and listens to and responds to issues raised with her. Relevant management policies and procedures were in place. The manager seeks to ensure the quality of the service provided to residents is good. Regular checks (audits) Care Homes for Older People Page 20 of 25 Evidence: are carried out to see this is the case. For example checks are made on how effectively residents medicines are being looked after, how residents care records are being maintained and the quality of the environment. Also questionnaires seek the views of residents and their relatives. The manager holds regular meetings for residents, relatives and staff here their views and suggestions can be aired. Residents financial interests continue to be safeguarded. Where residents monies are managed by the home these were secure, appropriately documented and periodically audited. Suitable arrangements were in place to promote and protect the health, safety and welfare of residents and others at the home. In particular staff had been provided with training in respect of safe moving and handling techniques, fire safety, first aid, food hygiene and infection control. Electrical, gas, fire safety, hoists and other equipment at the home had been regularly serviced/certificated. The premises were secure at the time of inspection. Staff monitor all callers to the home. The home operates policies in respect of safe working practices. All staff receive induction training when they start to work at the home. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 That a written record is kept 30/09/2009 of all medicines received in the home for individual residents To ensure residents medicines are safely handled in the home 2 29 19 That an up to date 30/09/2009 photograph is kept of all people working at the home. To ensure the homes recruitment process protects residents as much as possible Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 7 That the care plans currently used be developed to reflect the personalised care that is provided to residents. That to improve the quality of the assessment of residents moving and handling risks a specific moving and handling Page 23 of 25 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations risk assessment should be conducted for each resident on a regular basis. 3 18 It is recommended that (following recent changes in the law) to maximise residents safety that staff are provided with training in respect of deprivation of liberty safeguards. That staff be provided with training to enable them to more fully support those residents with memory impairement. 4 30 Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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