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Archived: The Hamiltons Care Home Good

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Reports


Inspection carried out on 9 January 2018

During a routine inspection

This comprehensive inspection took place on the 09 and 10 January 2018. The first day was unannounced. This meant the provider did not know we would be visiting the home on this day. The second day was announced.

The Hamiltons is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided; both were looked at during this inspection.

The Hamiltons provides personal care for up to 18 people. The service has bedrooms and communal rooms including bathrooms to the ground floor and to the second floor further bedrooms and bathrooms are situated. It has a passenger lift between the floors and a large stair case at each side of the building for easy access between both floors.

As part of the homes registration conditions it is required to have a registered manager employed to oversee the day to day running of the service. A registered manager has been in post at the service since February 2017.

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 comprehensive inspection on 01 and 02 December 2016 we found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. We recognised that although medicines practice had significantly improved since our previous inspection in April 2016 the service was still required to improve on areas such as missing signatures on medicine records and a lack of omission codes being used for medicines which were prescribed as, ‘when necessary’ (PRN).

At this inspection we found the service was now compliant in this area. Medicines records were now completed appropriately including PRN, as required and staff were now using the correct coding system. Medicines audits were robust and identified any errors. Medicines were kept secure and staff were appropriately trained to administer medicines in a competent way.

Safeguarding policies and procedures were in place to ensure people, staff and visitors were aware how to raise concerns if needed and what constitutes abusive practice. Staff received training in this area and a record of safeguarding referrals was kept securely.

Risk assessments were in place in people’s files to recognise individual risk taking and also environmental risk assessments were completed for both internal and external areas. Appropriate checks were done by registered external tradespersons on areas such as gas appliances, fire equipment, electrical appliances, hoists and lifts.

Business continuity plans were in place to offer information and guidance in the case of adverse weather or any other unforeseen circumstances which could affect the day to day running of the service. People had personal evacuation plans and fire audits were completed by both external agencies and internally by the maintenance person.

The service had recently undergone a decorating schedule, mainly in the communal areas which made the environment brighter. We observed no malodour around the building during the inspection.

During the inspection the service had an outbreak of upper respiratory infection which meant a number of people using the service were required to be cared for in their bedrooms. The service dealt with this well and contacted the relevant authorities to seek advice and guidance.

People had care files which contained person centred information. Each care file was written in a way which reflected the individual and only contained documents relevant to the person. People’s human rights and diverse needs were reflected within each plan and we received positive feedback during the inspection wh

Inspection carried out on 1 December 2016

During a routine inspection

This inspection of The Hamiltons Care Home was carried out on the 1 and 2 December 2016 and the first day was unannounced.

We last visited The Hamiltons Care Home 28 April 2016. At that time eight breaches of legal requirements were found. These related to a failure to send appropriate notifications of abuse to the Commission. We also found further systems and processes had not been operated effectively to prevent the abuse of people using the service. The service did not demonstrate that they had provided care and treatment appropriate to meet people’s needs and reflect their preferences and had failed to assess, monitor and improve the quality and safety of people using the service. The service did not always treat people with respect and had failed to act on feedback from relevant people. The service had failed to ensure the safe management of medicines and had not securely maintained confidential records. The service had failed to establish and operate effective recruitment procedures and had not ensured sufficient numbers of suitably qualified staff were employed. As a result of this the service was rated inadequate.

Following the inspection, the provider wrote to us to identify what actions they would take to meet legal requirements.

During this inspection we found significant improvements had been made to meet legal requirements. However we found the service to be in continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. This was in relation to medicines management. You can see what action we told the provider to take at the back of the full version of this report.

The Hamiltons Care Home provides accommodation and personal care for up to 18 people. The home is situated close to Atherton town centre and other local amenities. All rooms at the home are for one person but there are two adjoining rooms that can be made into a double room if this was required. Six rooms have en suite facilities and all rooms have a hand wash basin. Toilets and bathrooms are in close proximity to bedrooms and communal areas. There is a small car park at the front of the home.

At time of inspection the service had been without a registered manager for 371 days. However there was a manager in post who had submitted an application to the Care Quality Commission to be registered as the manager for the service. 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.

Medicines were stored in a secure place and there were systems in place to monitor aspects of medicine management practices on an on-going basis. Staff had received training in safe administration of medicines and daily audits were completed. However, we noted a number of medicines administration records (MARs) were still missing signatures. In addition to this in some instances we saw the lack of omission codes being used for medicines which had been refused or not required

People told us they considered themselves safe whilst living at The Hamiltons Care Home. They also indicated that the care they received was delivered in a professional and caring way and that staff had the correct skills to undertake their role effectively.

People were now provided with personalised care and support based on their individual needs and requirements. Care files contained person centred assessments and support plans to enable the development of the care planning process and support the delivery of care. Effective systems were implemented to maintain independence, by providing a detailed plan covering essential information staff needed to follow. This ensured clear information about people's needs wishes, feelings and health conditi

Inspection carried out on 28 April 2016

During a routine inspection

This comprehensive inspection took place on 28 April 2016 and was unannounced.

The Hamiltons Care Home is registered to provide personal care and support for a maximum of 18 people. At the time of the inspection, there were 17 people living at the home and one person was in hospital. The home is situated close to Atherton town centre and other local amenities. All rooms at the home were for one person but there were two adjoining rooms that could be made into a double room if this was required. Six rooms had en-suite facilities and all rooms had a hand wash basin. Toilets and bathrooms were in close proximity to bedrooms and communal areas. There is a small car park at the front of the home.

At the last inspection on 12 January 2016 the service was given an overall rating of requires improvement. At that time we found the provider had not made the required improvements in relation to three of the regulations that were outstanding breaches which were identified at the previous inspection on 23 February 2015 relating to pre-employment checks for staff; care planning; training and supervision. At the inspection on 12 January 2016, we also found additional breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to systems and process in place to ensure the service was not inappropriately restricting people of their liberty; display of performance ratings; having adequate systems in place to monitor and assess the quality of service provision.

At this inspection on 28 April 2016 we found the provider had not made the required improvements in relation to the breaches identified at the inspection on 12 January 2016 regarding safeguarding, training and mitigating risk. We found 11 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of dignity and respect, safe care and treatment, safeguarding, staffing, person-centred care, good governance and fit and proper persons employed. You can see what action we have asked the provider to take at the back of the full version of this report. We also found one breach of the Care Quality Commission (Registration) Regulations 2009 in relation to the notification of other incidents. You can see what action we told the provider to make at the back of the full version of this report.

People we spoke with who lived at the Hamiltons told us they felt safe living at the home, but one relative said that they felt there were insufficient numbers of staff on duty and they were looking for an alternative home for [their relative].

Appropriate safeguarding procedures were not in place to safeguard people from abuse and the home had failed report five safeguarding incidents to both CQC and the local authority.

There was no formal dependency tool to establish how many staff were needed to support people safely and staff told us they felt that staffing levels were too low. We also observed there were insufficient staff to care for people safely.

People who lived at the Hamiltons sat unstimulated in the lounge area throughout the inspection and with the last recorded activities taking place on 19 April.

During the inspection we observed these people weren’t closely monitored by staff, in accordance with their needs, which could place these people at risk.

Medicines were not managed in a safe way, including four separate instances where medication had been signed as being administered, when they hadn’t; an unlocked medicines room door; gaps in the recording of medicines fridge temperatures; two controlled drugs which could not be accounted for in the controlled book; some ‘over-stock’ controlled drugs were being stored in an unsuitable cabinet.

Bathing and showering records had not been completed since early April 2016. This had also been raised as a concern in the whistleblowing information we received prior to the date of the inspection.

Whilst looking at the accident and incident records, we noted four

Inspection carried out on 12 January 2016

During a routine inspection

This inspection took place on 12 January 2016 and was unannounced.

The Hamiltons Care Home provides accommodation and personal care for up to 18 people. At the time of our visit 18 people were living at the home. The Hamiltons is situated close to Atherton town centre and other local amenities. Six rooms have en-suite facilities and all rooms have a hand wash basin. There is a small car park at the front of the home.

We last inspected The Hamiltons on 23 February 2015. At that time we rated the home as ‘requires improvement’ and identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found the provider had not made the required improvements in relation to three of the regulations and there were on-going breaches relating to pre-employment checks of staff; care planning and training and supervision. We found additional breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to: Systems and processes in place to ensure the service was not inappropriately restricting people’s liberty; display of performance ratings; and having adequate systems in place to monitor and assess the quality and safety of the service. You can see what action we told the provider to take at the end of this report. We are considering our options in relation to enforcement for some of the breaches of legislation and will report further once any action has been completed.

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 time of our inspection there was not a registered manager in post. However, the acting manager was in the process of registering with CQC.

The acting manager discussed plans they had to improve the service with us, and staff told us they felt positive changes had been made by the acting manager. The acting manager had been in post for approximately three months at the time of the inspection. We raised concerns that the provider had not ensured areas we had identified for improvement such as keeping accurate records of training had not been improved since our last visit.

We saw some evidence that staff had undertaken training, but this was inconsistent and there was no clear overview of what training staff had completed. Staff had not received recent supervision, which meant the provider could not ensure they were competent and receiving the support they required.

The completion of care plans was carried out to a variable standard. We found two care plans did not have up to date risk assessments in relation to areas such as malnutrition and mobility. Two care files also did not contain full care plans despite the people these related to having lived at the home for some time. We also found some pre-admission assessments were lacking in detail or missing from the care files. This meant the provider could not demonstrate they had carried out adequate assessment of people’s needs and preferences. It also meant there was a risk that people would not be receiving care in accordance with their needs.

People said they liked the food provided and told us they were able to request an alternative should they not like the choices on the menu. People and their relatives we spoke with told us staff at the home were caring and approachable. We saw that people were treated with respect and given the time they required without being rushed. Staff demonstrated a good awareness about steps to take to help ensure people’s privacy and dignity.

Staff had a reasonable understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). However, none of the staff at the home were aware of who, if anyone had an authorised DoLS in place and the

Inspection carried out on 23 February 2015

During a routine inspection

We carried out an unannounced inspection of The Hamiltons on 23 February 2015. We last inspected the service on 25 August 2013 when it was found to be meeting all standards inspected.

The Hamiltons Care Home provides accommodation and personal care for up to 18 people. At the time of our visit 14 people that lived at The Hamiltons were present. The home is situated close to Atherton town centre and other local amenities. Six rooms have en-suite facilities and all rooms have a hand wash basin. Toilets and bathrooms are in close proximity to bedrooms and communal areas. There is a small car park at the front of the home.

There was a registered manager at the time of our visit. They had been in post for around three years. 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.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponded to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to requirements relating to fit and proper persons employed, staffing, need for consent and person-centred care. You can see what action we told the provider to take at the back of the full version of the report.

We saw there were enough staff to provide people with the support they required on the day of our inspection. People told us they felt safe and thought the staff were kind and caring. We saw staff took time to speak to people and took time in helping people make decisions, such as what they wanted to eat. We observed staff working in person centred ways to meet the needs and preferences of the people they were supporting.

Staff and relatives we spoke to told us the service was homely. They said as it was a small service their family members got to know the staff well. Relatives told us they had been involved in reviews of care for their family member. We saw people who were able to sign to agree their care plan had done so.

Some people felt there were not enough activities at the home, including trips out. The staff told us they would support activities including trips out of the home and one to one activities in the community whenever possible. However recent staff sickness had made this more difficult to do regularly.

We found that the service was not always following proper procedures to ensure only staff suitable to work with vulnerable adults were employed. Where staff had previously been employed in health or social care settings, services should seek evidence from their former employers to determine why their employment came to an end. We saw two staff files where the staff member had previously been employed in health or social care roles, but there was no evidence that references had been sought from their former employers.

Medicines were administered safely, however, not all medicines were being stored correctly. We saw two medicines that should have been kept in the fridge being kept in the medication trolley.

The service was not meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). One person told us they would like to be able to go out alone, but didn’t think they would be allowed to. Staff confirmed they would not allow this person to go out alone due to their vulnerability. The service had not made a DoLS application for this person or carried out an assessment of this person’s capacity to take this decision.

People’s weights records were not always completed consistently. We found this was due to keyworkers being responsible for recording weights, and there not being systems in place to ensure other staff picked up this duty when keyworkers were off work. This had also resulted in one individual who had lost weight not being referred to a health professional.

We saw there were gaps in training provision. Some staff had not completed training or it was out of date for a number of courses including safeguarding, infection control, health and safety and the Mental Capacity Act. None of the care staff had completed training in how to complete care plans. In one case this had resulted in a person’s care plan not having been completed.

Staff, relatives and people living at the Hamiltons felt the registered manager and deputy manager were approachable. All the people we spoke to said they would feel comfortable raising a complaint if needed. We saw evidence that complaints and feedback gathered at residents meetings had been acted upon. Staff told us they were happy working for the service and felt supported in their roles. They told us the staff team worked well together.

Inspection carried out on 27 August 2013

During a routine inspection

During our inspection we spoke with five people living at The Hamiltons and four visitors. All of the people who we asked told us that they were happy with their care and support and they thought they were well looked after. One person told us �I get on well with the staff. They make me laugh. All the shifts are the same, there are no problems here.� Another person told us "I find this home good. I have no concerns about the staff or the care here.� We observed care and we saw that people were cared for in a calm, respectful and supportive manner.

We looked at the systems in place to ensure that people were protected from the risks of abuse. We found that there were appropriate procedures in place and that staff were aware of their responsibilities to protect vulnerable adults.

We found that there was an effective recruitment procedure in place to ensure that appropriate people were recruited to work in the home. We also found that there sufficient numbers of suitably qualified staff on duty to ensure that people were safe.

We checked the systems in place for monitoring the quality of care provided at the home and found that an effective system was in place. The people we spoke with could not think of anything that needed to be changed or improved.

Inspection carried out on 1 August 2012

During an inspection looking at part of the service

People told us that they were happy living at The Hamiltons. We spoke with four people and asked them if they wanted to change anything. No-one was able to think of anything that they wanted to change about the home.

The people who we spoke with had not looked through their care records. One person told us "I have only looked at things that I have signed. Another person told us "I like it here and I am looked after well. I don't need to look at my records."

Inspection carried out on 27 April 2012

During an inspection in response to concerns

We spoke with three people who lived at The Hamiltons and one visitor. We heard a range a comments about the home and these included, �Staff are very kind�, �Everything is OK here� and �I prefer it here rather than the last care home where I used to live.�

One visitor said "The staff are friendly, but some are more chatty that others."

Inspection carried out on 9 September 2011

During an inspection in response to concerns

We did not speak to people who used the service at The hamiltons care home about the Management of medication.

Inspection carried out on 13, 20 July 2011

During a routine inspection

People told us that they enjoyed living at The Hamiltons care home. They said that the staff were pleasant and helpful. They felt that the routines in the home were flexible.

Comments included:

�I�ve been here about 12 months and I find it alright.�

�I�m happy here, they�re all very good.�

�There�s everything that�s required I find that nothing�s too much trouble for them.�

And

�It feels safe in a way.�

People said that they enjoyed the food provided and that they were content with the activities.

Comments included:

�Staff are fantastic they serve home made cakes and the meals are good.�

�It�s calm here� we play bingo, passing the balloon, dominoes- everything goes on fine.�

People who lived at the Hamiltons felt that staff listened to them and felt that concerns would be dealt with properly.

They said:

�Staff are very understanding.�

People using the service at The Hamiltons did not raise any issues of concern with the Care Quality Commission during our visit to the home.