Archived: Hamilton House Care Home

Hamilton House Care Home is a nursing home providing personal and nursing care for up to 53 people. At the time of the inspection there were 36 people living at the service. The registered manager told us there were 43 rooms available to people not 53 as registered. Some rooms had been double occupancy but had all been changed to single occupancy. This had reduced the number of rooms.

The home was over three floors all accessed by a lift. Some rooms were en-suite and for those that were not, there were communal bathrooms and toilets available. There was a courtyard garden which was easily accessed.

People’s experience of using this service and what we found

People were supported by staff who had been recruited safely and were trained. There were sufficient numbers of staff available. Nursing staff managed the medicines and made sure people had their medicines as prescribed. Medicines administration records were kept which recorded what medicines people had and when. Risks had been assessed and management plans were in place which nurses reviewed regularly. The service was clean and good infection prevention and control practice was followed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s needs were assessed, and care delivered effectively. Food looked and smelt appetising and we observed people had the support they needed to eat. People had timely access to healthcare where needed and records demonstrated action taken. The environment looked dated in some areas. For example, one bathroom needed updating and some carpets needed replacing. Communal areas such as the dining rooms and some bathrooms had been refurbished which made them bright and fresh.

People were supported to maintain important relationships and friends and relatives were able to visit without restrictions. Refreshments were available, so relatives could help themselves. People were involved in their care where they were able, choice was promoted and respected by the staff team. People’s independence was encouraged where possible, but staff were on hand to help if needed. Privacy and dignity was promoted and maintained by a staff team who respected and valued the people they were supporting.

People had their own personalised care plans which were reviewed regularly by the nursing team. Care plans had been written positively and contained guidance needed for staff to provide safe care. Where needed, monitoring was in place for additional needs and this was checked by nurses. End of life care was provided and staff had received many compliments about the compassionate care they had provided. Activities were available, and people were supported to engage with what they chose to do.

Quality monitoring systems were robust and identified improvement needed. The registered manager and provider had oversight of the service and monitored areas such as falls, training and people’s weight. Staff told us there was good team work and the registered manager was supportive. Staff felt able to speak up about any concerns they had. People’s views were sought in ‘resident meetings’ and surveys. Action was taken in response to suggestions raised.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection - The last rating for this service was Good (report published 22 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The home is registered to accommodate up to 53 older people who required accommodation and or nursing care. The home is situated close to the town of Buckingham. The registered manager has been in place since November 2015.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in January 2016 we asked the provider to take action to make a number of improvements. These included their recruitment practices and medicine practices. We also requested improvements in the application of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards DoLS, and the correct use of pressure relieving equipment, these action have been completed.

During the inspection we spent time with staff who worked well together and who understood the needs of the people they were caring for. They were aware of the values of the service, and from what people told us and our observations we could see they were embedded in their practice. There were sufficient numbers of staff to meet people’s needs. Staff knew what people’s individual needs were, including their preferences. People spoke positively about their relationship with staff and described them as “Empathetic” “Kind” “Calm” and “Nice”. We observed positive interactions between people and staff and it was apparent, people enjoyed spending time with staff.

Staff showed respect for people and preserved their dignity and privacy. People acknowledged this was the case and valued this aspect of their care. For example, people told us they felt comfortable when staff provided personal care.

People felt safe and supported in the home, risk assessments related to care and the environment were in place. Care plans were in place that guided staff to provide appropriate care, these were reviewed on a monthly basis. Staff were able to demonstrate their knowledge and received training in how to identify and report concerns related to abuse.

People’s consent had been obtained where possible and people were supported to have maximum choice and control of their lives. Staff understood the MCA and how this applied to their role. Where people required their liberty to be limited, staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Appropriate applications for DoLS had been made to the local authority.

Medicines were safely administered and stored by trained staff. Records associated to the administration of medicines were up to date and accurate.

Staff were supported through regular supervision and appraisals. Training for staff was provided and kept up to date. New staff completed an induction and the Care Certificate training. Staff spoke positively about the registered manager and the support they received. Staff meetings also took place to encourage feedback from staff and to drive forward improvements to the service.

People told us the food was good but not great. The registered manager and the new chef were in discussions about how the food could be improved. It was still work in progress as the chef had recently taken over the catering from an external catering company.

Staff were aware of people’s nutritional needs and how to support them. Where required charts were completed showing people’s food and fluid intake, this enabled to staff to monitor if people were at risk of malnutrition.

Staff had recorded and monitored the pressure in the pressure relieving mattresses used to alleviate the risk of skin damage. Other health needs were identified and where required, external professionals worked alongside people and staff to assist people to maintain or improve their health.

People joined in a variety of activities which they reported to us they enjoyed and visitors were made to feel very welcome. The “Wishing Well Project” enabled people to share their wishes and for the staff to attempt to make them a reality. These are things that people really want to do. This had happened for some people.

The home practiced safe recruitment in relation to new staff. Employment checks were carried out and records kept. This minimised the risk of inappropriate staff working with people.

The registered manager had put systems in place to encourage and motivate staff and to recognise their contribution. Checks were made on the safety of the home and the quality of the service provided. The registered manager had an overview of the home and was working towards continuous improvement. Both staff and people in the home spoke positively about the registered manager and the senior staff.

Hamilton House Care Home is a residential nursing home for up to 53 older people. The house provides residential accommodation over three floors. Qualified nursing staff and care staff provide care to people.

At the time of the inspection a registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff knew how to identify indicators of abuse and how to report their concerns. The home appeared clean and tidy. Some improvements had been made to the décor of the home with further refurbishment planned in the future.

Documents related to the employment of staff did not show robust and thorough checks on candidate’s employment history had not taken place. We found gaps in their recorded employment histories, there were no documented reasons given for these. This meant the provider could not demonstrate safe recruitment practices were in place. We have made a recommendation about recruitment practices in the home.

We have made a recommendation about the storage and administration of medicines; this was because we saw poor practice in relation to both these areas.

We found insufficient checks and information related to pressure relieving mattresses were in place. This placed people at risk of harm as the correct setting of the mattress was not always clearly documented or adhered to. Staff were not aware of what the correct setting was for each mattress.

During our previous inspection in February 2015 we had concerns related to the staff’s understanding and application of the Mental Capacity Act 2005. Mental Capacity Assessments were not decision specific. We found the concerns remained the same during this inspection.

Staff training was not up to date, but a matrix and plan were in place to improve this area of the service. Records showed staff were supported to carry out their role through supervision, daily meetings and planned appraisals.

Some people were not happy about the quality of the food in the home. The overall opinion seemed to be that it fluctuated between being good some days and poor on other days. The registered manager told us they were working with the kitchen staff to address this. Where people required specialist support with food and fluids this was provided by staff.

People told us the staff were extremely caring and our observations supported this. People told us they felt listened to and respected by staff. They felt involved in their care planning and encouraged to be as independent as possible.

There appeared to be a lack of activities in the home. People told us there were not a lot of activities on offer. Staff told us when they had time they tried to involve people in activities. To address this a newly recruited activity organiser had been appointed.

Care plans and risk assessments were in place for each person. They were kept up to date and reviewed regularly. They included information on people’s preferences and dislikes as well a personal history. This helped staff focus on people as individuals.

Where complaints had been received these had been responded to in line with the provider’s complaints policy. Where possible; learning from complaints took place which helped to improve the service.

The registered manager was aware of areas of the home that required improvements, and was actively working with staff to achieve this. Staff felt the registered manager was approachable and helpful. There was a clear sense of team work and both staff and the registered manager working together to improve the service to people.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw how risk assessments had been completed to ensure people received safe care.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted we saw documentation in the care plans related to end of life care. We saw how people had been consulted about how they wished to be cared for at the end of their life. Where people did not have the mental capacity to make decisions, we read how their relatives had been consulted and best interest discussions had taken place. We saw how staff had been trained in the area of deprivation of liberty.

We read documentation related to how the provider recruited staff. This showed that checks were carried out on new staff to ensure they were safe to work in the home.

We received information prior to the inspection that people were concerned about the number of nursing staff available in the home. People felt there wasn't enough to safely meet the needs of the people living in the home. We found the provider had not completed the necessary risk assessment nor needs analysis to determine how many staff were required throughout a twenty four hour period. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

We read records that demonstrated staff had been trained to support and care for people safely and effectively.

One person told us 'Whenever I want any help I get it.' A relative of a person who lived in the home told us 'The carers are wonderful, they are first class.'

We were told by staff they knew the needs of the people they cared for. We observed how staff interacted and supported people in a professional and positive manner, in line with their care plans.

Is the service caring?

We observed interactions between the staff and the people who lived in the home. Staff were respectful and positive in their dealings with people.

One person told us 'You get looked after very nicely.' A relative told us 'I think they (staff) are very caring, there is always a nice atmosphere here when you come in, people always speak to you.'

Is the service responsive?

People's needs had been assessed before they moved into the home. The care provided was in line with their identified needs and wishes. One person and their relative told us how since they had moved into the home they had maintained a social outing to a local club once a week. The home staff ensured this happened as this was important to the person.

Records confirmed people's wishes, opinions, needs and preferences were recorded and acted upon. We saw how people were clear about how they wished to be cared for at the end of their life, and how this was respected by the staff in the service.

Is the service well-led?

We spoke with staff and people who used the service and their relatives. Each told us they believed the service had effective management in place.

We saw how audits had been undertaken to ensure the manager was aware of what the strengths and weaknesses of the service were, and had taken appropriate action to improve the service.

One relative told us they were concerned that the manager was working both as a nurse and a manager and they did not feel they could do both jobs well, although they had confidence in their abilities as a manager.

The home was clean, warm and welcoming. We saw people sitting in a conservatory, and in two different sitting rooms with a variety of activities on offer. Their rooms were heavily personalised and comfortable. One person told us "I like my bed; it is much nicer than the one I had at home." Relatives told us the manager was friendly and approachable, and "She really keeps an eye on what is happening."

We heard that the food was delicious, and usually well-presented. We saw breakfast being prepared very early in the morning. Some items were stored in a hot trolley for a long time before breakfast was served. We also noted that some food stored in the refrigerator, and in the dry food store, was not labelled. The kitchen staff told us they had just run out of labels and had requested more be delivered that day. We observed lunch being home-made, and heard appreciative comments about the cheese and tomato quiche.

The manager recorded a wide range of quality assurance checks on a regular basis. These included staff, relative and resident meetings.

The few complaints we saw had been dealt with quickly and appropriately.

People said they were happy with the care and support they were receiving. One person said, 'I am well looked after.' A second person said, 'I am able to make choices'. 'I choose what clothes I wish to wear and what to eat.'

Relatives said they were very happy with the care and support their family member was receiving. One relative said, 'Staff are excellent. They keep me informed of my relative's care.' A second relative said, 'I can't fault the care that staff provide. It is very good.'

People described the way staff spoke to them as 'respectful and polite.' One person said, 'I love living here. I feel safe.'

People said there were sufficient staff employed. People described staff as 'excellent, very good, approachable and kind.'

People told us they were aware of how to make a complaint. People said when concerns had been raised to the manager they were addressed appropriately.

We found people's needs were assessed and their care was provided in line with their individual care plan. People were protected against the risk of abuse. People's medicines were safely administered. There were sufficient staff employed to meet people's needs. There was an effective system in place to regularly assess and monitor the quality of the care people were receiving. Complaints were responded to appropriately.