Hamilton House

Hamilton House provides accommodation and personal care for up to 19 adults with mental health needs, including alcohol and substance misuse. There were 17 people using the service at the time of the inspection. The property spans over two converted houses, with all areas being accessible to people using the service.

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

People were protected from abuse and avoidable harm. People said they felt safe living at Hamilton House and knew how to raise any safeguarding concerns.

There were sufficient staff available to effectively meet people’s needs and they had been recruited safely. People said staff were always available when they needed them.

Risks associated with people’s care and support needs had been assessed and planned for. Staff had a positive and supportive approach with how known risks were managed. Health and safety checks of the environment and premises were regularly completed.

People were well supported with their prescribed medicines. Medicines were managed and stored safely.

The home was clean and hygienic. Improvements had been made to the environment, including redecoration and new flooring and this was ongoing. People had a choice of communal rooms and a safe and secure external rear garden with a smoking shelter and seating.

Before people moved to Hamilton House, they had an assessment of their care and support needs completed and were invited to visit the home. The provider had policies and procedures that reflected current legislation and best practice guidance.

People were supported by staff who were trained and supported. People were positive about the care and support they received and were confident staff understood their individual needs.

People received choices of meals and had continuous access to hot and cold drinks. People said they were happy with the meal choices and they received sufficient to eat and drink.

Health care needs were known and understood and monitored by staff. People said how staff supported them to attend health appointments if this was required. Positive feedback was received from a health care professional in how staff supported people with their health and welfare needs.

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.

New and improved systems and processes that assessed, monitored and reviewed safety and quality had been implemented. The provider had a service improvement plan to support further development and improvements.

People, relatives and staff received opportunities to share their experience of the service. People were positive about living at Hamilton House. Staff said they felt the management team were supportive.

There was a positive staff culture. Staff were kind, caring and compassionate. Staff understood and practiced the provider’s values. People were supported to achieve positive outcomes. This included developing their independence to enable them to live a more independent life in the community.

The staff worked well with external health and social care professionals. Positive feedback was received about how well staff supported and advocated for people and how care and support was person centred.

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 Requires Improvement (published 25 May 2022) and there were breaches of regulation. 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.

Why we inspected

We carried out an unannounced focussed inspection of this service on 8 and 9 March 2022. Two breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the support for staff.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We also checked whether the Warning Notice we previously served in relation to Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good, 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 House on our website at www.cqc.org.uk.

Follow up

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

Hamilton House provides accommodation and personal care for up to 19 adults with mental health needs, including alcohol and substance misuse. There were 14 people using the service at the time of the inspection. The property spans over two converted houses, with all areas being accessible to people using the service.

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

Staff training and support remained an area that required further action. Some staff training had been completed and planned for, but we identified further training was required. Improvements with staff supervision and appraisals were also required to ensure staff provided effective care and support. Improvements had been made and were ongoing in relation to staff deployment.

The systems and processes of management oversight and development needed further action to enable continued improvements to be embedded and sustained.

Peoples support plans and risk assessments needed further review to ensure guidance for staff was up to date. However, staff demonstrated a good awareness and understanding of people’s individual needs.

People received their prescribed medicines when they needed them and where possible, independence was promoted, and some people managed their own medicines. People received sufficient to eat and drink and were supported with their individual needs in weight management to lose or gain weight. People were happy with the meal choices. People received support to access health care services.

Risk management procedures had been improved to protect people from the risk of fire. New and improved procedures and staff guidance had been developed to increase monitoring of people’s individual needs and safety.

Action had been taken when required when people’s safety had been identified as a risk and accidents had occurred.

People told us they felt safe living at Hamilton House and were positive about the support they received. Action had been taken when safeguarding concerns had been identified.

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.

Improvements had been made since our last inspection.

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. However, staff required training on the Mental Capacity Act to ensure they fully understood their role and responsibilities.

We undertook this inspection at the same time as CQC inspected a range of urgent and emergency care services in Leicester, Leicestershire and Rutland. To understand the experience of social care providers and people who use social care services, we asked a range of questions in relation to accessing urgent and emergency care. The responses we received have been used to inform and support system wide feedback.

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 Inadequate (published 3 September 2021) and there were breaches of regulation. 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 some improvements had been made and the provider was no longer in breach of one regulations. However, two breaches in regulation remained.

This service has been in Special Measures since 2 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate ton Requires Improvement. This is based on the findings at this inspection.

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 will continue to monitor the service and will take further action if needed.

We have identified a continued breach in relation to staff training and support and management oversight at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The property spans over two converted houses, with all areas being accessible to people using the service.

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

The systems in place to assess, monitor and manage risks to people's health, safety and welfare were ineffective. High risk areas of concern identified in the last fire risk assessment still continued to be in place. People were at risk of harm because risk assessments were not always in place for identified issues. Some

risk assessments were out of date and not regularly reviewed.

Care plans did not always contain adequate information for staff to know how to support people safely. They did not record people's goals or celebrate their achievements.

Government and best practice guidance to protect people living in care homes during COVID-19 were not always adhered to.

Robust recruitment checks had not been completed to ensure only suitable people were employed to work at the service. Insufficient staffing levels and the deployment of staff placed people at risk of harm.

Staff training was not always undertaken in line with current best practice guidance.

We have made a recommendation about the frequency of staff training.

There were no lessons learned protocols in place so the provider could learn and prevent incidents and accidents, safeguarding concerns and complaints and improve the quality of the service.

There were inadequate quality assurance processes in place to monitor the quality and safety of the service. There was a lack of managerial oversight to ensure the provider's policies to keep people safe were adhered to.

Feedback from people was not sought on a regular basis. Staff meetings and supervisions had not been held and there was no evidence that meetings for people using the service were taking place.

People and their relatives felt that Hamilton House was a safe place to live. Staff were aware of the whistleblowing procedures and said they would report any concerns they had.

People's medicines were safely managed, and people received their medication as prescribed.

People and relatives told us the registered manager and the owner were approachable and the atmosphere was open and friendly.

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 12 December 2018)

Why we inspected: We received concerns in relation to poor care planning, the smoking and drinking policy not being followed and a lack of safety and welfare checks for people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 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.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

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

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hamilton House 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 breaches in relation to staffing, risk management and good governance.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our previous inspection on 4 May 2017 we found that people’s risk assessments and the provider’s quality assurance system needed improvement. These were breaches of Regulation 12 Safe care and treatment and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

Following this inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘Is the service safe?’ and ‘Is the service well-led’ to at least ‘Good’. At this inspection we found the provider had followed their action plan and was now compliant in these areas.

Hamilton House provides accommodation and personal care for up to 19 adults with mental health needs. There were 15 people living in the home at the time of the inspection.

Hamilton House 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, and both were looked at during this inspection.

Hamilton House has a registered manager. This 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.

People felt safe at Hamilton House. Staff were trained in safeguarding and understood their responsibilities to protect people from harm. Records showed that If concerns arose about a person’s safety staff worked with the local authority and other agencies, where appropriate, to protect the person from harm.

The home had enough staff to support people to stay safe and meet their needs. Staff were available in the home during the day and at night times. If people needed extra support, for example to attend appointments or if they were unwell, extra staff were put on duty.

The provider had acted to reduce the risk of scalding and accidents at the home. Some individual risk assessments still needed to be put in place.

Medicines were well-managed and staff were aware of people’s healthcare needs and knew what to do in an emergency.

People received personalised care that was responsive to their needs. People who were moving towards independent living were supported to acquire the skills they needed to do this. Care plans were regularly reviewed and records showed people making progress towards their goals.

People said the staff was well-trained and knowledgeable. Staff told us they received thorough and varied training. We observed staff supporting people in a skilful and effective manner, providing personal care, company and reassurance where necessary.

People said they were happy with the food served. They said staff encouraged them to eat and drink enough, maintain a healthy diet, and cook for themselves. The home catered for a range of diets. Staff supported people to make healthy food choices where possible.

People could take part in individual and/or group activities if they wanted to. Some of the people using the service had created an attractive garden feature with fish and plants. Other group activities included charity fundraising, exercise on the park, and film nights. Individual activities included health promotion courses, accessing community facilities, and taking part in cultural events.

The premises were spacious and had a choice of lounges and other communal areas. The home was clean and free of clutter. People with reduced mobility had bedrooms on the ground floor to make access easier for them. There was an outside covered smoking area which was popular with people who liked to smoke.

The staff team was established and people and staff had the opportunity to get to know each other and build up relationships of trust. The home had a calm and relaxed atmosphere and people appeared settled and happy. Staff supported people to be independent and, where appropriate, to move towards living independently.

People and staff said the home provided a good standard of care and they would recommend it. They were involved in how the home was run and regularly asked for their views. The provider and registered manager were improving the way they monitored and assessed the quality of the service. They were in the home nearly every day so people could talk with them whenever they wanted.

Hamilton House provides accommodation and personal care for up to 19 adults with mental health needs. There were 15 people living in the home at the time of the inspection.

Hamilton House had 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.

Quality assurance checks undertaken to ensure the quality and safety of service provision were not robust. This meant a number of shortfalls not being identified or addressed. Checks did not cover the assessment and monitoring of the quality of care to ensure care plans and risk assessments were up to date.

There were enough support staff on duty throughout the day to provide people with the support they needed. Support staff knew how to respond to documented concerns so that people were kept safe from harm; however some care plans did not have all the information support staff required to keep people safe. Medicines were managed safely however the storage temperatures were not monitored to ensure they remained potent. Hot water temperatures were not monitored effectively to ensure people were protected from the risk of hot water scalding them.

The provider did not prove they had recruitment procedures in place to ensure staff were of a suitable character to work with people at the home, as we had no access to the staff files. Some staff had received most of the training in the areas considered essential for meeting the needs of people safely and effectively, and some staff had not received this training.

New staff received an induction which included working alongside more experienced staff. This helped them get to know people’s needs and establish a relationship before working with them on a one to one basis. Staff felt there were enough staff to keep people safe and ensure people could attend activities and have planned trips out.

Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. Staff worked as a team to ensure people received the appropriate level of observation to keep them and others safe during the day and evening.

Most staff worked within the principles of the Mental Capacity Act 2005 and had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes. Staff knew people's individual communication skills and abilities and showed concern for people's wellbeing in a caring and meaningful way. Staff were observant of people and responded to their support needs quickly.

Care records were personalised and each file contained information about the person's likes, dislikes, preferences and the people who were important to them. Care plans also included information that enabled the staff to monitor the well-being of people. There were systems in place for staff to share information through having daily records for each person.

Some follow up documentation we requested following the inspection was not received by us in a timely manner, so could not be considered when we wrote our report.

Hamilton House had 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.

The registered manager had reviewed the management of medicines within the service and had made changes to the way in which medicine was brought into Hamilton House, administered and recorded and was supported by a written policy and procedure.

Risk assessments had been carried out where people using the service administered their own medicine. These were regularly reviewed with the person and a member of staff to ensure people safety was promoted. People were encouraged by the service to achieve greater independence in the administration of their medicine as part of their care plan.

People’s medicine administration records had been accurately completed and were consistent with the provider’s policy and procedure. The stock of medicines on the premises which we checked were consistent with the records held by the service, showing people’s medicine was being managed well.

Staff had undertaken training and had had their competency assessed for the management of medicine.

Systems were in place to audit all aspects of the management of medicine which had identified that the policy and procedure was being implemented well.

The Care Quality Commission (CQC) at the next comprehensive inspection will review medicine management to ensure good practice has been sustained.

People we spoke with were positive about the home and the staff team. Our observations showed that people were comfortable and confident in approaching staff and that staff treated people with dignity and respect.

We looked at the records of four people who used the service and found care had been planned and delivered appropriately with regard to people's health and safety and in accordance with their wishes.

There were appropriate arrangements in place for the obtaining and administration of medication. However, the service did not have appropriate facilities for the safe keeping of medication and in particular for controlled drugs.

Staff demonstrated a good understanding of the needs of people who used the service but had not always been appropriately supported to carry out their roles.

There was an appropriate complaints handling process in place.

We carried out this inspection to check that the service had made improvements to the way it assessed and monitored the quality of service provision. We found that the home had implemented a new system for checks and audits so that risks to people's health and safety were now being effectively managed. The service had made significant improvements and now had a robust and effective system.

We did not speak with people who used the service at this visit. Please see our previous report for details of what people told us about Hamilton House.

We looked at the support plans and records of five people who used the service. We found people's needs were assessed and care was planned and delivered in line with their individual plan. We found that support plans were detailed and thorough and provided clear guidance to staff about how people's care and support should be delivered.

We saw that staff had received training about how to protect vulnerable people from abuse and people using the service could be confident that staff had been screened as to their suitability to work with vulnerable adults.

People who used the service and their representatives were asked for their views about their care and they were acted on. However, we found the quality assurance system the service had in place was chaotic and not always effective.