Hamilton House Care Home

Hamilton House Care Home is a nursing home providing personal and nursing care for up to 46 people. At the time of the inspection there were 23 people using the service. The service was over 3 floors all accessed by a lift. Some bedrooms were en-suite and for those that were not, there were communal bathrooms and toilets available.

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

People and their relatives were happy with the care provided. They felt people got safe care and told us the registered manager had brought positive changes to the service.

Risks to people were identified and mitigated. Accidents and incidents were managed, and action taken to prevent reoccurrence. Systems were in place to manage infection control risks.

Safe medicine practice was promoted, and people’s health and nutritional needs were identified and met.

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.

Staff were suitably recruited, inducted, trained and supported in their roles. Sufficient staff were provided with less reliance on agency staff, which promoted continuity of care for people.

The service was clean and free from odours. Areas of the service had been refurbished with further improvements planned.

Staff were kind, caring and had a good knowledge of people. Staff were responsive to people’s needs.

Person centred care was provided, with people and their relatives involved in their care. Communication needs were identified, and end of life wishes sought. Access to activities had improved for people with further improvements planned. Systems were in place to manage concerns.

The service was suitably audited and well managed which resulted in improvements across the service. Records were suitably maintained, and organised. Systems were in place to get feedback from people and their relatives. Communication and teamwork had improved which resulted in positive outcomes for people.

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 inadequate (published 27 April 2022) and there were breaches of regulations. 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 best practice in relation to safeguarding people, meeting people's hydration and nutrition needs and to promote people's privacy, dignity, choices and ensure they are treated with respect.

At this inspection we found the provider had acted on the recommendations and improvements had been made.

This service has been in Special Measures since 27 April 2022. 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 carried out an unannounced comprehensive inspection of this service on 28 February, 1 and 15 March 2022. 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 safe care and treatment, staffing, need for consent, person centred care, good governance, premises and equipment and notifications to us.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal 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.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hamilton House Care Home 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 Care Home is a nursing home providing personal and nursing care for up to 46 people. At the time of the inspection there were 30 people living at the service. The home was over three floors all accessed by a lift. Some rooms were en-suite and for those that were not, there were communal bathrooms and toilets available.

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

People and relatives were accepting of the care provided. However, they gave us examples of how the staffing levels impacted them and resulted in delays to their care.

Risks to people were not mitigated and there was no evidence of learning from incidents to prevent reoccurrence and promote safe care. People’s medicines were not given as prescribed and changes in their health needs were not responded to in a timely manner.

Sufficient staff was not provided, and staff were not suitably inducted, trained and supervised in their roles to promote safe and effective care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not suitably maintained, fit for purpose or hygienic. Person centred care was not provided, and people did not have access to a range of activities to meet their needs.

The service was not effectively managed and monitored to ensure safe, effective, caring and responsive care was provided. Records were not accurate, complete and contemporaneous.

Systems were in place to manage complaints. Staff were suitably recruited. People described staff as kind and caring, however some staff practice did not promote people’s privacy, dignity and choices. We have made a recommendation for the provider to address this.

People’s nutritional and hydration needs were identified but not consistently met. We received mixed feedback on the meals provided and have made a recommendation for the provider to seek advice from a reputable source to address this.

Systems were in place to safeguard people, however practices needed to improve to ensure procedures were followed to safeguard people. We have made a recommendation for the provider to work to best practice in relation to safeguarding.

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

Rating at last inspection

This service was registered with us on 13 May 2020 and this is the first inspection. The last rating for the service under the previous provider was good (published on 3 September 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s care, which included concerns that the service was not responsive to changes in people’s health. A decision was made for us to inspect and examine those risks.

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, effective, caring, responsive 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 full report.

Enforcement

We have identified breaches in relation to management of risks, medicine practices, induction and training of staff, staffing levels, record management, person centred care, hygiene and environment, auditing of the service and failing to work to the principles of the Mental Capacity Act 2005.

Full information about CQC’s regulatory response to more serious concerns found during the inspection are outlined at the end of this full 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, including progress with the action plan, which will help inform when we next inspect.

Special Measures:

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 6 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 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.