Hamilton Rest Home

We found the following examples of good practice.

Current government guidance in Infection Prevention and Control had been introduced so the risks to people living and working at the home were minimised. Staff were provided with enough supplies of personal protective equipment (PPE). Staff had completed training in the safe ‘donning and doffing’ of PPE. Residents and staff also took part in the testing and vaccination programme.

People were encouraged and supported to maintain contact with family and friends. Visiting arrangements were kept under review in line with guidance. An area of the home had been identified where safe visiting could be facilitated.

People’s health care needs continue to be met with support from the local GP and district nurse team. Activities and opportunities are provided offering people variety to their day, helping to maintain their mental well-being. Where people accessed the local community, appropriate PPE was worn.

The home was well maintained with adequate ventilation. As the home has a number of shared bedrooms, contingency plans were in place should people need to isolate.

Staff continue to be supported on formal and informal basis, utilising social media to chat as well as share information. Staff travelling to and from work were asked not to wear their uniform, changing before and after their shift. In addition, temperature checks were being taken when starting work so changes in health could be quickly responded to.

Domestic and care staff took responsibility for cleaning the home. Cleaning schedules were in place along with monthly audits. Additional cleaning of touch surfaces and equipment were being carried out to reduce the risk of cross infection to people.

Hamilton Rest Home is a residential care home providing personal care and support for up to 23 people aged 65 and over, some of who were living with dementia. The service does not provide nursing care. At the time of the inspection there were 15 people living in the home.

Hamilton Rest Home is an older style property with accommodation on two floors. A stair lift provides access to the first floor. The home is situated on a main road close to shops and a park.

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

During the inspection, we found the provider had failed to report all incidents occurring in the service to the Care Quality Commission (CQC). However, we had received other notifications from the service and the local authority safeguarding team confirmed all incidents had been reported to them. The registered manager had previously sought advice about notifications and this had been misinterpreted. Appropriate action had been taken following the inspection to resolve this.

People told us they felt safe and were happy with the service they received. They said staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to protect people from abuse. Recruitment processes ensured new staff were suitable. There were enough numbers of staff to meet people's needs and to ensure their safety. People received their medicines when they needed them from staff who had been trained and had their competency checked. Risk assessments were carried out to enable people to retain their independence and receive support with minimum risk to themselves or others. The home was clean and free from odours. The provider had a system to ensure staff documented any accidents or incidents which had taken place. We discussed how this could be improved.

People were given choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s care and support needs were assessed prior to them using the service to ensure their needs could be met. Staff received ongoing training, supervision and support. People’s health and nutritional needs were monitored. People enjoyed the meals and were offered variety and choices. Staff worked in partnership with healthcare professionals, when needed.

Management and staff had developed friendly, caring and respectful relationships with people using the service and their families. People’s care was tailored to their needs and staff knew about their routines and preferences. People, or their family members, had been consulted about their care needs and some had been involved in the care planning review process. People had access to a range of appropriate activities. People did not have any complaints about the service but were confident to raise any issues.

People were happy with the way the service was managed. There were systems to assess and monitor the quality of the service and the practice of staff. Appropriate action was taken when shortfalls were noted. Staff received support from management team and from each other and they felt valued. People’s views and opinions of the service were sought and acted on.

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 (published 15 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hamilton Rest Home on our website at www.cqc.org.uk.

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.

Hamilton Rest Home provides residential care for 23 older people. The home is situated within a residential area of Whitefield in the Bury and is next to a park. Car parking is available at the rear of the home. Accommodation within the home is situated on the ground and first floor. There is a chair stair lift providing access to the first floor. There were 17 people living at the home at the time of our inspection.

At the last comprehensive inspection in January 2016, the service was rated ‘Requires Improvement’, with two requirements and two warning notices issued in relation to regulations. We returned to the service in April 2016 and carried out a focused inspection in relation to the two requirements and two warning notices. We found action had been taken to address the shortfalls found at the comprehensive inspection in January 2016. The service was rerated ‘Good’.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We saw documentation that the registered provider had made every effort to find a suitable registered manager and on two occasions had been let down by applicants after they had agreed to take on the role. However because there is no registered manager in place we have placed a limiter on the ‘well led’ section of this report as requires improvement.

Staff were able to tell us of the action they would take to protect people who used the service from the risk of abuse. They were confident that the registered provider and senior staff would take the right action to protect people.

Recruitment checks were carried out to ensure suitable people were employed to work at the home with vulnerable people. Our observations and discussions with staff and people who lived at the home confirmed sufficient staff were on duty both day and night.

Risk assessments were in place to help minimise any potential risk of harm to people during the delivery of their care and support. These had been reviewed on a regular basis.

People told us that they liked the home. We had a walk around parts of the building and found it had been maintained and was clean and tidy. Plans to make on-going improvements to the home were in place.

Arrangements to check the homes electrical fittings were in place and we were informed by the provider following our visit that a satisfactory electrical report had been received.

We found medication procedures at the home were overall safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Comments from people who lived at the home were all positive about the quality of meals provided. We observed regular snacks and drinks throughout the day were provided between meals to make sure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met.

People who lived at the home spoke positively about the staff who supported them. The atmosphere was homely, relaxed and friendly.

People who lived at the home told us they were encouraged to participate in a range of activities that had been organised. It was respected that not everyone wanted to join in and that was their choice.

People who used the service knew how to raise a concern or to make a complaint. We saw information to support they were dealt with by the service.

People spoke positively about the registered provider who in turn gave us information that supported they highly valued the staff team and the support they gave to people who used the service.

Changes had been made to the senior care arrangements at the home. Staff said this had been an improvement in the day-to-day management of the home.

The service used a variety of methods to assess and monitor health and safety at Hamilton Rest Home and sought feedback from people about the quality of the service. Management records would benefit from being improved to give the registered provider clear oversight of the service.

Following the inspection the provider sent us a plan of the actions they intended to take to meet the relevant regulations. This inspection was carried out to check that the provider had met the warning notices and the requirement notices. We found the necessary improvements had been made. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Hamilton Rest Home’ on our website at www.cqc.org.uk.

Mrs Janet Walters is registered to provide accommodation at Hamilton Rest Home for up to 23 older people who require personal care. Hamilton Rest Home is a large detached property situated on a main road in Whitefield. It is within easy reach of local shops, public transport and the motorway network. Accommodation is provided in mainly shared rooms. At the time of this inspection there were 16 people using the service.

When we undertook the inspection the service did not have a registered manager in place. The manager had been in post since January 2016 and had submitted an application to register with CQC as manager at Hamilton Rest Home. We were advised that the manager was interviewed regarding their application to register with CQC later on the day of the inspection and their application was subsequently approved on 15 April 2016. Therefore from the date of 15 April 2016 the service had a registered manager in place.

Improvements had been made to the premises to protect people from the risk of burns from hot pipes and radiators. All pipework and radiators had been covered and individual risk assessments were in place to inform staff of the action they should take to protect people when moving around the building. The manager and provider were undertaking weekly health and safety checks to help ensure the safety of everyone who lived and worked in the home.

Medicines were stored safely and staff responsible for administering medicines had completed refresher training. All staff had been assessed to ensure they were competent to administer medicines safely.

Care records showed that risks to people's health and well-being had been identified and regularly reviewed. We saw that plans were in place to help reduce or eliminate the identified risks.

The manager had introduced arrangements to ensure that staff received the training and supervision they required to carry out their roles effectively. Staff we spoke with told us they considered the training was of good quality. Staff also told us that they were supported to develop their skills and knowledge by undertaking additional responsibilities within the home, with support from more experienced staff.

The manager had introduced a system of robust quality monitoring procedures to help ensure that people received safe and effective care. The manager and provider demonstrated their commitment to continuing to drive forward improvements in the service.

Mrs Janet Walters is registered to provide accommodation at Hamilton Rest Home for up to 23 older people who require personal care. Hamilton Rest Home is a large detached property situated on a main road in Whitefield. It is within easy reach of local shops, public transport and the motorway network. Accommodation is provided in mainly shared rooms. At the time of this inspection there were 20 people using the service.

The service did not have a registered manager in place. A registered manager is a person who has registered with CQC 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. We were told that the previous registered manager had left the service in November 2015. A new manager had commenced employment at the service on the day before this inspection. They were experienced in managing residential care services and told us they intended to apply to register as manager for Hamilton Rest Home.

During this inspection we found four breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because improvements needed to be made to the premises in order to ensure the safety of people who used the service. Staff had not received recent training to ensure they were able to deliver effective care. Arrangements to ensure the safe management of medicines and to identify and manage risks to people who used the service needed to be improved. The provider also did not have robust quality monitoring systems in place. You can see what action we have told the provider to take at the back of the full version of the report.

People who used the service told us they felt safe in Hamilton Rest Home. Visitors we spoke with said they were happy with the care their relative received and had no concerns about their safety.

Staff had been safely recruited and there were sufficient number of staff available to meet people’s needs in a timely manner. Staff had received training in safeguarding adults. They were aware of the correct action to take should they suspect or witness abuse. They told us they would also be confident to report poor practice should they observe this taking place.

Staff told us they received an induction when they started work at the service. Systems were in place to record the training staff had completed and any supervision or appraisal sessions. However, records we reviewed showed some staff had not completed training in areas such as infection control and moving and handling since 2014. Staff had also not received supervision since the registered manager left the service in November 2015.

People we spoke with told us that the staff at Hamilton Rest Home were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service. We saw that people who used the service were encouraged to discuss the care they wanted at the end of their life with their relatives and staff.

Staff showed they had a good understanding of the needs of people who used the service. However, care plans did not always contain accurate information about people’s current needs. Advice received from a speech and language therapist (SALT) had also not been fully included in the care plan for one person who used the service. This meant there was a risk people might not always receive safe care.

Although we found evidence that people received their medicines as prescribed, systems relating to the stock control and storage of medicines needed to be improved.

We saw that all areas of the home were clean. Staff wore personal protective equipment (PPE) in order to protect people from the risk of cross infection.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. However, staff we spoke with did not have a clear understanding of the impact of these legal safeguards on their practice. This meant there was a risk people’s rights might not always be upheld.

People told us they enjoyed the food provided in Hamilton Rest Home. There were systems in place to monitor the nutritional needs of people who used the service.

A programme of activities was in place to help stimulate people and maintain their contacts within the local community. People told us they enjoyed either participating in or watching the activities which took place, particularly those involving local school children.

A local GP held a weekly clinic at Hamilton Rest Home. This meant people who used the service had regular reviews of their health needs.

Records we reviewed showed people had opportunities to comment on the care provided in Hamilton Rest Home. All the people we spoke with told us they would feel confident to raise any concerns with the staff and the newly appointed manager.

Staff told us they enjoyed working in the service. They told us they were optimistic that the appointment of new staff and manager would lead to improvements in the service. The new manager told us they intended to re-introduce staff meetings and supervision sessions as soon as possible. This would provide opportunities for staff to provide feedback on the service.

A system of audits and quality assurance monitoring was in place. However the environmental audits completed had not been sufficiently robust to identify the risks we found during the inspection. The new manager told us they would ensure all audits were brought up to date as soon as possible.