Hamilton House Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service. We found systems in place were not always effective to monitor the service quality and records relating to people’s care were not always accurate and up to date.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider had clear policies and procedures. Staff were provided with an induction to their role. Without exception all the staff who provided feedback were aware of the provider’s visions and values. Staff told us they had confidence in the management. Nursing staff were deemed competent and held registration with the Nursing and Midwifery Council (NMC) and were subject to regular revalidation of their membership.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. However, leaders did not always have the skills and experience to lead effectively.

We found a complaint had not been handled to the satisfaction of the person who raised the complaint. The complaint response had been escalated to the regional manager.

The manager had not identified some of the concerns we found at the inspection.

People and staff were supported by a manager who was described as approachable, responsive, and trustworthy. Comments from people included "I like manager, [manager’s name] is nice and approachable", "Good person to talk to if any problems” and “I know both managers… they do come and say hello. I did ask them [managers] some small things a couple times, I forgot what it was, but I know they did sort them for me quickly.”

Staff told us they felt supported by the manager and had confidence in them. Comments included, “Our manager has got an open door approach whereby staff can call or text for advice any time of the day”, “Leaders encourage open dialogue, and when I have spoken up, my concerns have been listened to and acted upon” and “Leaders at the service have good communication, decision making, and supportive skills. Yes, they have the knowledge and experience to lead effectively and guide the team well.”

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

People, their relatives and staff all confirmed the manager was approachable. Staff told us they felt heard and valued when concerns were raised. Staff were aware of the term freedom to speak up and told us they had confidence to speak out when needed. One member of staff told us “We have good communication, if we see something wrong, we do whistleblow”. Another member of staff told us “I can raise concerns safely, my manager encourages this by listening and acting.”

People had opportunities to meet with staff and express their views; it was clear from the meeting minutes people’s voices were heard.

Staff had opportunities to meet with the management team. We noted team meetings were focused and discussed topics which affected the home and drove improvement. In addition, staff, external professionals and relatives were given an opportunity to provide feedback in a survey. Action plans were developed to drive improvement following the feedback.

It was clear from the feedback the provider shared with us people, relatives, external healthcare professionals all felt they could share their views with the management. We noted some positive feedback from recent health care assessments, and visits by other professionals.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The home celebrating staff cultures, staff told us it helped aid their understanding of their colleagues’ cultures and was “informative” and “educational”.

Some staff held a “champion role” within the home, for instance, health and safety, falls, safeguarding, and manual handling champions existed. Staff told us they found these useful. One member of staff told us their role had “supported my colleagues, by providing guidance, sharing and providing best practice.” Another staff member who was not a champion told us their colleagues “They always tell us about residents health and help to improve.”

The provider did not always have effective systems of accountability or good governance to drive improvement. People were not supported in a service which ensured their records were accurate and up to date. We found contradictions in people’s records, which could have led to inappropriate care.

The provider’s auditing systems did not always identify the issues we found, for instance, we found records relating to each person were not routinely and consistently complete and contemporaneous. We found people’s care plans were not always clear what support they needed, or records reflected they had received care as detailed in care plans, this had the potential to put people at risk of harm.

The manager and provider had a range of audits and checks in place to monitor the service and drive improvement. However, we found these were not routinely successful in identifying gaps. Where audits did identify improvements, we found there were delays in action being taken.

We found the provider's policies and procedures were not routinely and consistently followed. For instance, not all accidents and incidents had been recorded. The manager confirmed they had added this to a list of improvements which were required.

The manager and provider had not identified all potential risks to people. We made them aware of a number of improvements required. We acknowledge how swiftly the manager and provider responded to our concerns.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

The people living at Hamilton House Care Home benefited from a knowledgeable activities co-ordinator, who had forged links with the local community. We heard from people and their relatives how they were supported to go to garden centres, coffee shops, local town visits. One event which was talked about a lot was a recent car boot sale, with both people and relatives enjoying the event.

The home had engaged with local schools and nursery. People were awaiting a visit by nursery children on one day of our assessment. We received positive feedback from people who visited Hamilton House Care Home about how they had benefited from speaking with people. People told us how much they had enjoyed going to the local town, they told us “I went to listen to the local brass band this summer, it was in the town”, it was clear from photos taken people had enjoyed this event.

The manager and staff worked closely with external healthcare professionals to ensure people received timely and appropriate care. We received positive feedback from external professionals, comments included, “We have a good working relationship, they are well organised in preparation… carry out our requests promptly and efficiently”.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system. They did not always act swiftly when areas of improvement were identified. For instance, although a service improvement action plan was in place, some actions were still not complete which had been identified last year. For example, in respect of some of the issues we found about contradictions in care plans, remedial action to an office door and amendments needed to fire plans to improve responses to fire.

However, the home did work with external professionals to ensure staff were upskilled in certain training for instance, the use of syringe drivers.