Hamilton Park Nursing Home

Hamilton Park Nursing Home provides accommodation and nursing care for up to 34 people.

Accommodation is arranged over three floors and all bedrooms are single occupancy. The home is staffed 24 hours a day and a registered nurse is always on duty. 15 people were living at the service at the time of the inspection.

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

The provider and registered manager had made improvements in relation to the areas of concern we found at our last inspection. A new manager has been registered with the Care Quality Commission and provided strong leadership and direction for the staff team. People, relatives, staff and healthcare professionals were positive about the new manager and commented on the positive changes they had introduced.

The registered manager and provider monitored the quality and safety of the service. There was an improved programme of checks in place. Many improvements had been made since the last inspection to ensure the safety and quality of the care and support provided.

People using the service and their relatives were satisfied with the care and support they received from staff. People said they felt safe at the service and staff treated them with care and kindness. Staff were attentive, thoughtful and caring. We observed positive interactions between people and the staff team.

People were protected from the risk of abuse as staff received training, so they understood how to keep people safe. Risks associated with people's care were identified and managed safely. Sufficient numbers of safely recruited staff were on duty to meet people's needs. Medicines were managed in a safe way. Staff practiced good infection control to help protect people from possible infections.

People were supported by a group of staff who were trained and competent and who took pride in their work. Staff ensured people were supported with their dietary needs and had enough to eat and drink. People were referred to healthcare professionals when necessary and their recommendations were followed.

People were supported by staff who upheld their dignity and encouraged their independence. Staff supported people to take part activities and we observed staff spending time engaging people in conversations, and speaking to them in a friendly, warm and polite way.

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 knew how to raise concerns and were confident the registered manager would deal with them appropriately and resolved them where possible. There were systems in place to obtain people's views about the service.

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

Rating at last inspection and update - The last rating for this service was requires improvement and there were breaches of regulation (published 3 December 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider follow manufacture's guidance when using medicine patches and that they ensure medical equipment is serviced as per the manufacture's recommendations. At this inspection we found the provider had acted on this recommendation and had made improvements.

Why we inspected - We undertook this unannounced comprehensive follow up inspection to check they had followed their action plan and to confirm they now met legal requirements.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hamilton Park Nursing Home provides accommodation and nursing care for up to 34 people.

Accommodation is arranged over three floors and all bedrooms are single occupancy. The home is staffed 24 hours a day and a registered nurse is always on duty. 19 people were living at the service at the time of the inspection.

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

The service had not been consistently well led in the past few months. This had led to some quality assurance measures not being carried out and some identified shortfalls not being addressed. This meant the systems in place to monitor the quality of people's care and safety had not been fully implemented to drive improvements. At the time of the inspection the provider was taking action to improve the management of the home. The provider had been working with recruitment agencies to find a registered manager for several months.

Improvements were needed to ensure fire safety checks were completed regularly when the maintenance person was on leave. Some equipment needed to be serviced and we have made a recommendation in relation to medical equipment.

People said they felt safe living at the service. Comments included, “I am happy and safe here. Staff are very nice to me”; “Life is not at all bad here. I'm very well looked after” and “I have no concerns about my care.”

Relatives and professionals felt people were safe from harm and they expressed confidence in the staff and the care provided. Comments included, “(Person) is very happy indeed and getting all the care (they) need. We have no complaints at all” and “Yes, (person) is definitely safe. We trust them (staff). They are excellent at their job”.

People told us staff usually responded quickly when they required help. Rotas and feedback from staff showed the provider’s recommended staffing levels were not always maintained due to unplanned staff sickness levels. However, people confirmed they received the care and support they needed. Regular agency care staff and registered nurses were booked in advance to cover vacancies or planned absences such as holiday.

Risks to people’s health and wellbeing were being managed. People's care records identified risks and mitigating actions for staff to follow. Care and nursing staff worked with other health and social care professionals. They sought guidance and advice from health professionals to ensure the safety and wellbeing of people was maintained. Health professionals confirmed they were informed of any concerns. For example, GPs confirmed they were alerted in a timely way to any changes to people’s health.

People received their medicines safely from staff who had received specific training to carry out the task.

The standard of cleanliness throughout the home was good and appropriate infection prevention and control measures were in place including staff using PPE . We have signposted the provider to resources to develop their approach.

Although staff did not have the full management support they needed, they described a team which worked well together to deliver a good standard of daily care. People were supported by a staff team who were committed to providing good care for them. Throughout our two days at the service we saw many kind and compassionate interactions. Staff supported people safely when helping them to move and ensured people’s dignity was maintained.

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.

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 22 October 2020).

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels, the safe management of medicines and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach in relation to regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 good governance and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hamilton Park Nursing Home provides accommodation and nursing care for up to 34 people.

Accommodation is arranged over three floors and all bedrooms are single occupancy. The home is staffed 24 hours a day and a registered nurse is always on duty. 16 people were living at the service at the time of the inspection.

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

At the last inspection the provider had not ensured the governance systems were

sufficiently effective to monitor and improve the quality and safety of the service. At this inspection improvements had been made in several areas. However, further improvements were needed to ensure consistent good practice was embedded over time. We have made a recommendation that the provider continues to develop and oversee quality assurance systems to ensure continuous improvement. Improvements had been made to ensure the management of medicines was safe. However, we have made a recommendation that the provider review procedures for managing medicines prescribed to be given ‘when required’ to ensure best practice guidance is followed.

People felt safe at the service and relatives and professionals expressed their confidence in the staff team. Comments included, “I feel safe, staff pop in regularly and help me” and “We are very happy with the level of care. We never felt that (person) was unsafe at the home. We have no reason to suspect (person) is not well cared for.”

Staff knew how to safeguard people from abuse or neglect and how to minimise identified risks to people’s health and wellbeing. Regular health and safety checks were carried out on the premises and equipment to make sure they were safe. There were enough staff to meet people’s needs and requests in a timely way. We were assured the service was following safe infection prevention and control procedures.

People’s needs were assessed to make sure their care could be provided by this service. Staff were familiar with each person’s preferences and how they wanted to be supported. People and relatives felt staff were well-trained to meet people’s needs. People were supported and encouraged to have a varied diet that gave them enough to eat and drink. The staff team worked well with external professionals to ensure people received the healthcare they needed in a timely

way. The provider had taken steps to improve the environment, and additional plans were in place to continue the refurbishment of the premises.

Improvements had been made to ensure 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.

People were treated with dignity and respect by a kind and caring staff team, who knew them well. People were involved in making decisions about their care and their daily life. Relatives made many positive comments about the friendliness of staff and the support that people received. They felt involved and included in discussions about people's care.

The registered manager had left the service since the last inspection. Interim management arrangements were in place. People; relatives and staff expressed their confidence in the manager and praised the improvements made since the last inspection. Comments included, “(The manager) seems to be doing wonders in there”; “There has been a massive improvement. Better leadership by an experienced manager” and “Things feel a lot better, a lot calmer”.

The manager and provider worked to create an open and transparent culture. Staff felt supported in their work and people felt involved in the service.

Rating at last inspection (and update) - The last rating for this service was requires improvement (published 21 August 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The overall rating for the service is now good.

Why we inspected

This was a focused inspection to check whether improvements had been made since we last visited. We reviewed the Safe, Effective, Caring and Well-led domains only. Our report is based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the Responsive key question was not looked at on this occasion.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. We were assured that the service was managing.

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

Follow up

We will continue to monitor information we receive about the service and we will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Hamilton Park Nursing Home provides accommodation and nursing care for up to 34 people. Accommodation is arranged over three floors and all bedrooms are single occupancy. The home is staffed 24 hours a day and a registered nurse is always on duty. The service provides 14 Home First pathway places, which are commissioned by Somerset County Council and Clinical Commissioning Group (CCG.) There is a full team of NHS therapists based at the home from Monday to Friday. The therapy team consists of a physiotherapist, occupational therapist, social worker and reablement assistants. The Home First pathway provides a period of rehabilitation and reablement with the aim of the individual returning home. 24 people were using the service at the time of the inspection, including seven people who were using the Home First Pathway.

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

The provider’s current systems to monitor the quality and safety of the service people received, had not been effective at identifying issues and driving improvement. Some records requested during the inspection were not available.

The management of medicines did not always adhere to best practice guidelines published by the National Institute for Health and Social Care (NICE). Improvements were required to ensure medicines were safely managed.

Risks to people’s health and wellbeing were not always managed safely, for example risks relating to the prevention of pressure ulcers, weight loss and certain health conditions. Care records lacked specific details to guide staff on how to meet people’s needs.

People’s feedback was mixed in relation to staffing levels. The current arrangements for determining staffing levels did not reflect the need for nursing staff or other factors to ensure staffing consistently met people’s needs. Not all staff had received core training or updated their training to ensure they worked safely.

People had mixed views about the quality and variety of the meals provided.

Parts of the environment required redecoration and refreshment to ensure it was homely.

We received mixed feedback from people about staff’s attitude and approach. Some people found some staff to be abrupt and unfriendly. Observations during the inspection showed some staff had developed positive and friendly relationships with people. Some staff were exceptional in their approach.

People were offered opportunities to take part in regular activities, however relatives and staff felt activities were an area for further improvement.

People felt they were protected from the risk of abuse and told us they felt safe. People had access to various health care professionals, except for a domiciliary dentist. The registered manager was working to find an appropriate service for those people who would not be able to visit a dental practice.

Improved information was being developed for people using the Home First service, to ensure they fully understood the nature of this service.

Systems were in place to ensure equipment was safe and in good working order. The premises were clean and free from odours.

The registered manager was motivated to improve partnership working with other health and social care professionals for the benefit of people using the service.

People were supported to have 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.

Rating at last inspection: Good (Report published April 2017)

Why we inspected

The inspection was prompted in part due to concerns received about the safe management and prevention of pressure ulcers; the management of people’s medicines; staff attitude and approach; staffing levels; the quality of food; record keeping; cleanliness and the governance and management of the service. A decision was made for us to inspect and examine those risks.

Due to the number and nature of the concerns raised about the quality and safety of the service, especially those relating to people using the Home first initiative, admissions to the Home First service were reduced and monitored by Somerset County Council. People with complex needs were not being admitted to the service.

Somerset County Council were working through the quality improvement process with the registered manager to support improvements at the service.

We have found evidence the provider needs to make improvements. Please see the safe; effective; caring; responsive and well-led sections of this full report.

We have identified breaches in relation to the safe care and treatment provided and how the quality and safety of the service is monitored, and improvements made.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can see what action we have asked the provider to take at the end of this full report.

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

At the time of the inspection there were 33 people living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin.

People continued to receive effective care. People told us their healthcare needs were met. One person said “My doctor visited me here when I felt poorly.” Another person told us “When I came out of hospital I had a blister on my leg. Since I have been here they have taken good care of it and it has all healed up. I think they do an amazing job.” People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The home continued to provide a caring service to people. One person told us “The staff are great and we have great banter. I am very happy here.” Another person said “I find all the staff very pleasant and caring.” A visitor said “I am very happy with everything and the staff are lovely.” The atmosphere in the home was relaxed and people were supported in an unhurried manner. Staff interactions were kind and respectful.

Improvements had been made to ensure people received care which was responsive to their needs and preferences. People had been involved in planning and reviewing the care they received and we found care plans were reflective of people’s needs and preferences. One person told us “When I first came here I was asked all about the help I needed and the things I liked or didn’t like. They [the staff] wrote it all down so all the staff can see it.”

The service continued to be well led. The registered manager was very visible in the home and knew people very well. People told us the management within the home were open and approachable. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below.

The last inspection of the service was carried out on 12 August 2014. No concerns were identified with the care being provided to people at that inspection.

Hamilton Park Nursing Home provides accommodation with nursing care for up to 34 people. Accommodation is arranged over three floors and all bedrooms are for single occupancy. The home is staffed 24 hours a day and a registered nurse is on duty at all times.

There was a registered manager 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.

Care plans did not evidence that people were involved in planning and reviewing the care and support they received. We found one care plan which had not been updated to reflect the changes in the care they received. This could place people at risk of receiving care which was not in accordance with their assessed needs and preferences.

Staff sought people’s consent before assisting them and people told us they were never made to do something they didn’t want to do. One person told us “There is no pressure to do anything. It’s very relaxed here. I enjoyed a nice lie in this morning. That’s never a problem.” Staff had received training about how to protect people’s human rights and we found the service followed the correct procedures where people were unable to consent to important decisions about the care and treatment they received. The service needed to make sure the principles of the Mental Capacity Act were followed for all decisions where a person was unable to give their consent.

People were cared for by a staff team who were well trained. A registered nurse was on duty during the day and at night. They were supported by a team of senior care staff and care staff. Staff were confident and competent in their interactions with people and people told us they felt safe living at the home. One person told us “I feel safer here than I did at home. There is always somebody about to help you.” Another person said “It’s very peaceful here and I feel very safe.”

People told us staff treated them with kindness and respect. One person said “We are like a family here. The staff are all lovely and very kind.” Throughout the day we heard staff checking whether people were happy where they were and with what they were doing. One person said “I am always treated with respect and it’s a comfort to know that they [staff] know what’s important to me. It makes me feel special.”

There were procedures in place to reduce risks to the people who lived at the home. Staff had received training and they knew how to recognise and report any signs of abuse. All were confident in reporting concerns and felt confident concerns would be taken seriously to make sure people were safe. Checks were made on prospective staff to make sure they were appropriate and safe to work with vulnerable people.

People received their medicines when they needed them and medicines were stored securely. Medicines were managed and administered by registered nurses whose skills and knowledge were regularly monitored.

People saw their GP and other health care professionals when they needed. People told us the home was very good if they were unwell and made sure they were referred to appropriate professionals. One person said “They are very good here. If you feel unwell, the nurses or matron [registered manager] will ring the doctor.”

People were provided with opportunities for social stimulation and they were supported to maintain contact with their friends and family. People told us they could see their visitors whenever they wished and that they were always made to feel welcome. This was also confirmed by a visitor we met with.

People and their visitors knew how to make a complaint. Everyone we spoke with said they felt confident any concerns would be addressed.

We found the service to be in breach of one 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.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We found the service to be safe because care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns. The people we spoke with told us they felt safe at the home and they commented on the kindness of the staff. Comments included 'I feel very safe here. They wouldn't let any harm come to you' and 'the staff are all very nice indeed.'

We observed that staff were competent and professional in their interactions with people who lived at the home. During our inspection we observed people were relaxed and appeared very content with the care and support provided.

We looked at the personnel files for three members of staff. These showed the home had followed robust recruitment procedures which meant that risks to people who used the service were minimised.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Staff carried out regular health and safety checks to make sure that the building was maintained to a safe standard. These checks included testing the fire detection system and hot water temperatures.

Is the service effective?

We found the service effective. The care plans we looked at had been regularly reviewed. This meant that people received care and support which met their up to date needs and preferences. Records showed that the home liaised with people's relatives and representatives as appropriate and that the individual was involved in the review of their care plan where appropriate.

Staff told us they were provided with up to date information about the people who lived at the home. They said 'we have a handover at the start of our shift and this keeps you up to date with how people are.'

The two visitors we met were complementary about the care their relative received and the staff who supported them. They made the following comments 'I am very happy with everything' and 'I don't have any complaints. If I did I would go straight to the matron as I know she would sort things out straight away.'

The people we spoke with did not raise any concerns about the care and support they received. Comments included "they wait on you hand and foot' and 'the staff are good. They help me to have a shower every morning. I've seen the doctor since I've been here and I have special cream which the staff help me with.'

We saw that where people had been assessed as being at high risk of pressure damage to their skin, they had been provided with appropriate pressure relieving equipment. We also saw people were supported to change position at assessed frequencies.

Is the service caring?

Staff interacted with people in a gentle and kind manner. People who lived at the home and visiting relatives were complimentary about the staff who worked at the home. They said 'we have always found the staff to be kind and caring. I am very happy with everything' and 'they couldn't be kinder. They really will do anything they can to help you."

One person told us 'the staff help me to be as independent as I can be. I like that. When I moved here they spent time asking me about what I wanted and what I liked. Everyone is helpful and kind.'

Is the service responsive?

We saw that staff were responsive to any changes in people's well-being. For example we read a person's care records which showed they had recently been losing weight. We saw staff had monitored the person's weight at two weekly intervals and had monitored their diet and fluid intake. We saw staff had recently forwarded the records to the GP and requested a visit as there had been no improvements.

Two people told us they had recently been seen by a dentist and were due to receive new dentures this week. The care records showed people had access to a range of health care professionals. These included chiropodist, doctor, dentist, optician and specialist health care professionals such as diabetes clinicians and mental health practitioners.

The staff we spoke with were knowledgeable about the needs and preferences of the people they supported. They knew about the things which were important to people.

Is the service well led?

We found the service was well led. There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We observed staff were competent and professional in their interactions with people who lived at the home. The manager and staff spoken with told us that the home benefited from a stable staff team with little staff turnover. This meant that people were supported by staff who knew them well.

We saw that there was a clear staffing structure in place which meant that senior staff were always available to support less experienced staff.

A record of formal supervision sessions for staff had been maintained and we saw staff supervisions had either taken place or were planned to take place. We looked at the personnel files for three members of staff. Supervision records showed their skills and competencies had been reviewed and they had been able to discuss any training needs. This meant that systems were in place to monitor the skills, competencies and performance of the staff who worked at the home.

The manager sought the views of people who lived at the home. We saw a number of 'feedback' surveys where people had been able to express a view on outside entertainers and in-house events such as Easter and Christmas parties. Surveys were due to be sent to people to seek their views on the quality and choice of meals at the home.

Annual surveys were sent to people who lived at the home and their representatives to seek their views on the quality of the service provided. We read the results of the last survey. These showed a high level of satisfaction with the standard of care provided and of the staff team. We saw 90% of people were satisfied with the overall care provided by the home. The survey did not identify any areas of concern. We read the findings of a staff survey. This showed staff were positive about the training and support they received.

Each person had a plan of care which was personalised to their needs and preferences. The people we spoke with were positive about the care and support they received. Comments included 'It's lovely here and I feel very well cared for. The staff are kind and attentive' and 'I have no complaints at all. I think the care is very good.' A visitor said 'I am very happy with everything and the staff seem very nice.'

The home's safeguarding procedures minimised risks to the people who lived at the home. People told us that they felt safe and they commented on the kindness of the staff. They told us that they would feel confident in raising concerns if they had any.

Systems were in place which meant that staff received appropriate levels of support and training to enable them to meet the needs of the people who lived at the home.

All records relating to the people who used the service had been securely stored to ensure confidentiality. Care records were up to date and they reflected the current needs and preferences of the people who lived at the home. This meant that the risks of people receiving unsafe or inappropriate care were reduced.