Hamilton's Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Inadequate. At this assessment the rating changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 proactive and positive culture of safety, based on openness and honesty. Staff had investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Since our last inspection the provider had improved the way accidents and incidents were recorded, reported and analysed to look for any patterns and trends. Staff had received training and support around record completion, and the quality of records had improved. This had been kept under review and staff had completed additional development, to ensure managers always had all the information they needed to make decisions about people’s care. Risk assessments and care plans had been updated following accidents to reduce the risk of them happening again. People and relatives told us staff responded effectively to incidents. One relative said, “One person was breaking things and damaging their room. The staff calmed them down. It seemed to be dealt with calmly and very quickly”.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s needs were assessed with them and others who knew them well before they moved into the service, to check staff could meet their needs. One person told us, “My relative found this place for me. There was only one vacancy so I’m lucky it was for me. I know there was an assessment, but I didn’t need as much support then. I need more support now and they help me”. Action had been taken since our last inspection to make sure care plans were available for staff to follow when people moved in. When people were transferred to hospital, staff printed off an emergency pack from the electronic care plan system, to send with people. Relatives told us they were informed about any changes in their loved one’s health and treatment, including if they were admitted to hospital or saw their GP.

The provider worked with people and health and social care partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had processes in place to report safeguarding concerns to the local authority. No concerns had been raised since our last inspection. People told us, “It feels like a home here. I feel safe and I trust them (staff)” and “The staff treat me like a human being. They listen to me.’

Staff had completed safeguarding training and could describe the action they would take. They were confident to raise any concerns with the manager or provider and felt they would act to keep people safe.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Four people had DoLS in place and applications had been made for a further eleven people. Systems were in operation to monitor when new applications were needed, and these were submitted within the agreed timeframe before the DoLS ended.

Restrictions on people were minimalised, and we observed people moving freely around the building. One person declined their medicine at times, and a decision had been made in their best interest to administer them without their knowledge, known as covert administration. Staff had developed a positive relationship with the person, and the person trusted them. The medicine was always offered to the person, and it was only administered covertly when the person refused.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At our last two inspections, there were shortfalls in the management of risk. At this inspection we found improvements had been made. People and relatives told us risks had been assessed with them and they were supported to take risks whilst remaining as safe as possible. One person told us they enjoyed walking in the garden and were free to do so when they liked. They also told us staff reminded them to use their walking stick if they forgot. Another person told us, staff respected their decision to use the stairs, instead of the stair lift, as they felt it was good exercise and helped them stay mobile.

Staff had been given permissions to review and update people’s electronic care plans and told us they were pleased to be able to do this again. They made changes as soon as they were needed. Care plans and risk assessments had been reviewed and updated since our last inspection. Care plans for people living with diabetes were now personal to the needs of each person, including their usual blood sugar range, and the action to take if it was too high or low.

Care plans now contained information about the how to use pressure relieving equipment for maximum benefit. Staff checked the equipment was set correctly each day and regular audits were completed.

Care plans had been updated for people were prescribed medicines to thin their blood. Guidance was in place about the risks of excessive bleeding and the action to take if people sustained an injury.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Action had been taken since our last inspection to protect people in the event on an emergency. A new fire alarm system had been installed and fire doors were being replaced. Personal emergency evacuation plans (PEEPs) to guide staff during an emergency were in place for everyone. PEEPs had been reviewed and now contained up to date information. Clear guidance had been put in place around the use of evacuation equipment, including stair lifts which had batteries for emergency use. Fire drills had been completed and reviewed. Action had been taken to address any shortfalls found, for example walkie talkies were now used so staff could communicate from different parts of the building in an emergency. People and relatives told us the garden was safe and accessible and they enjoyed spending time outside. Their comments included, “‘I can use the garden path using my walker. I feel safe” and “(Person’s name) uses their walker in the garden. I’m glad because it means they’re keeping some independence.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. Staff received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Improvements had been made to staff training and supervision. However, further improvements were needed to ensure there were always enough staff deployed to support people’s wellbeing, as well as their care needs. The provider had identified people’s needs had changed and had requested reviews from the funding authority to ensure people’s care was funded at the correct level. They had not deployed additional staff to meet this increase in need, and staff were taken away from engagement with people to provide personal care. People received the care they needed to keep them safe and well. A relative told us, “We’ve seen no problems with them taking people to the toilet or helping residents eat”. However, staff did not have time to spend with people, chatting or engaging them in meaningful occupations, such as household tasks or hobbies. One person told us, “We could do with more of them (staff) sometimes”. This is an area for improvement.

Staff employed since our last inspection had completed a robust induction which included assessments of their skills and knowledge. All staff had been supported to complete refresher training to ensure their skills were up to date. The manager kept training levels under review and had supported staff to get their training up to date. Staff had completed practical fire training and commented they had learnt a lot from practicing using the evacuation chair in different areas of the building.

Staff received regular supervision. All staff had received at least 2 supervision sessions since our last inspection. They had discussed their development needs and career goals. Some staff told us they had been supported to begin recognised qualifications in social care.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Effective processes had been put into operation to monitor infection prevention control (IPC) since our last inspection. Fabric covered chairs had been replaced with vinyl covered chairs. Staff told us these were easy to clean and disinfect. They appeared clean and were odour free.

Regular checks were now completed on equipment, such as mattresses, to ensure they were clean and undamaged. Cleaning schedules showed all areas of the service were cleaned regularly. Staff wore personal protective equipment (PPE), including gloves and aprons, when they supported people with personal care. Stocks of PPE were accessible throughout the building. People and relatives told us, “The staff keep it very clean, and they change my bed regularly” and “I see the staff wearing aprons and tearing them off when they leave someone’s bedroom”.

Effective IPC checks had been completed since our last inspection, and the standard of cleanliness had improved. Action had been taken to address any shortfalls found. The provider had updated their policies to reflect Government guidance in relation to visiting during an infectious outbreak. Processes were now in place to support people to continue to receive visitors in the event of an outbreak.

The provider did not always make sure that medicines were safe and met people’s needs. Staff had involved people in planning how they would take their medicines.

At our last two inspections, we found medicines had not been managed safely. At this inspection we found improvements had been made, however further improvements were needed. Some people were prescribed medicines on a ‘when required’ basis, such as pain relief or to help them remain calm. Guidance had not been given to staff about when to give one medicine prescribed in August 2025. This was put in place during our inspection. Guidance had been provided about other medicines including the action to take if the medicines were not effective.

Guidance was now in place around the risks associated with blood thinners medicines, however this was not always specific to people’s needs. For example, the guidance included the increased risk of bleeding if people sustained a cut whilst shaving. Staff confirmed this was not relevant for two people who used electric razors.

Previously some people declined to take their medicines. Staff had worked with GPs and people were now prescribed easy to swallow medicines and no longer refused to take them. Detailed guidance was in place for staff around how to prepare and administer the medicines.

People told us they received their medicines regularly and were happy with the times they were administered. One person told us they received their medicine every morning at 7AM, and this fitted into their preferred routine. People understood what their medicines were prescribed for. Improvements had been made to processes in operation to order, store, administer and dispose of medicines. Detailed records were now maintained of medicines which had been disposed of and the reason why. Records had been kept of the temperature medicines were stored at, to ensure they remained effective. Temperatures recorded were within the range recommended by manufacturers.