CQC report explained · a nursing home
What the CQC found at Hamilton House Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, March 2023
Rated Good; inspectors found major improvements after an earlier Inadequate rating, and the home left Special Measures.
This was an unannounced comprehensive inspection on 22 and 23 February 2023. Inspectors spoke with people, relatives and staff. They observed care, checked the building and reviewed care plans, medicines, staff records and management records.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found better risk management, staffing, training, medicines practice, care planning, activities, records and leadership. People and relatives were generally happy with the care.
The previous inspection had rated the home Inadequate, with breaches of regulations, and the home had been in Special Measures since April 2022. This inspection found enough improvement for the breaches to end, the overall rating to become Good and Special Measures to stop.
Risk management
Inspectors found that risks such as falls, choking, poor nutrition, dehydration and skin damage were identified and acted on. Staff followed people's risk plans during the inspection.
“Risks associated with medical conditions, moving and handling, falls, smoking, tissue viability, choking, nutrition and hydration needs were identified.” from the report
Staffing and continuity
Staffing levels matched the occupancy at the time of inspection. The home was relying less on agency staff, which gave people more continuity.
“Sufficient staff were provided, based on the current occupancy levels.” from the report
Kind and respectful care
Staff were observed engaging warmly with people and supporting them respectfully during meals and other care. Bedrooms were personalised and staff knocked before entering.
“We observed positive engagements between people and staff.” from the report
Improved activities
The home had employed activity staff and provided both individual and group activities. Relatives said activities had improved and more variety was being planned.
“Access to activities had improved for people with further improvements planned.” from the report
Leadership and oversight
Management audits covered care plans, medicines, infection control, staffing and the environment. Inspectors found records were more organised and issues were followed up.
“Good governance was established and effective in identifying shortfalls in the service.” from the report
Missing medicine records at first
minorRecords for some medicated skin patches were not in place when inspectors first checked. This was corrected by the second day, but the family should ask how this is now checked.
“Transdermal patch records were not in place. However, this was immediately acted on and we saw these were in place on day 2 of the inspection.” from the report
Front door delays
minorRelatives said they could visit at any time, but there had sometimes been a delay before the front door was answered. They said this had improved.
“They told us they were made to feel welcome and whilst there was sometimes delay with the front door being answered to them, this had improved.” from the report
Unexplained professional concerns
minorOne community professional shared concerns about some aspects of care. The report does not explain what these were or what action followed, so this is worth asking about.
“A third professional shared some concerns about aspects of care.” from the report
- 01What checks are now in place to make sure transdermal patch records are completed every time?
- 02How many agency staff are currently being used, and will the same staff usually care for my relative?
- 03What further improvements are planned for the windows, storage, furniture, en-suite showers and communal bathrooms?
- 04How will you make sure people who prefer to stay in their rooms receive regular individual activities?
- 05What were the concerns raised by the community professional, and what action was taken in response?
This was an unannounced comprehensive inspection covering all five key questions and infection prevention and control, and it checked whether improvements from the previous inspection had been made. This explanation was written from the published report of 14 March 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2022
Rated Inadequate and placed in special measures; inspectors found serious risks in medicines, staffing, care, records, premises and management.
This was the home's first inspection since it registered with CQC. It was unannounced and took place over three days. Inspectors spoke with people, relatives and staff, observed care, meals, activities and part of a medicines round, and checked care plans, staff records, audits and safety records.
Inspectors found serious and widespread problems. Risks were not managed properly, medicines were sometimes given late or not as prescribed, and there were not enough suitably trained staff. People experienced delays with personal care, call bells, meals and medicines. The home was not clean or well maintained, and records and checks were not reliable.
People described some permanent staff as kind and caring, and systems for complaints and staff recruitment were in place. However, care was not consistently respectful, personalised or responsive. The overall rating was Inadequate, with Safe, Effective and Well-led also rated Inadequate, and Caring and Responsive rated Requires Improvement.
Kind permanent staff
People were mainly positive about permanent staff and described them as kind, caring and friendly. Inspectors also saw one staff member engage positively and discreetly with people during lunch.
“People were mainly positive about the permanent staff and described them as "kind, caring and friendly".” from the report
Recruitment checks
The home had checks intended to help prevent unsuitable staff from being employed.
“Checks included Disclosure and Barring Service (DBS) checks, written references, health declarations, and proof of identity and of address.” from the report
Complaint process
A complaints policy was in place. Complaints were recorded, investigated and answered according to the home's policy.
“Complaints were recorded, investigated and responded to in line with the providers policy.” from the report
Some safety checks
Some checks were completed for fire alarms, portable appliances, gas safety and legionella.
“Checks were completed on areas of the service that posed a risk to people's health and welfare such as fire alarm equipment, and portable appliance testing (PAT).” from the report
People were at risk of harm
seriousChoking, pressure sore, dehydration, environmental and fire risks were not properly controlled. The report says action was not taken consistently to prevent avoidable harm.
“Risks to people were not mitigated which resulted in safe care and treatment not been provided.” from the report
Medicines were not always safe
seriousSome medicines were given late, including a Parkinson's medicine, and records did not always show what had been given or why. PRN medicines did not always have suitable protocols.
“Safe medicine practices were not always promoted.” from the report
Not enough trained staff
seriousStaffing levels were not sufficient, with frequent use of agency staff and gaps on the rotas. Inspectors saw long waits for care and call bells that were not answered promptly.
“Sufficient numbers of suitably trained staff were not provided, and the high use of agency staff led to inconsistent care for people.” from the report
Poor cleanliness and maintenance
seriousThe home had unpleasant smells, urine in bathrooms, dirty kitchen and laundry areas, damaged fittings and other hazards. Some fire and electrical safety concerns were referred to the Fire Authority.
“The service was not suitably maintained, clean or fit for purpose.” from the report
Care was not personalised
seriousCare plans lacked clear, individual instructions and did not always reflect people's choices or changing needs. People had limited activities and some communication needs were not supported.
“Person centred care was not provided.” from the report
Weak management and records
seriousAudits did not identify serious problems, and records had gaps or conflicting information. The home did not show that it had learned from incidents or complaints.
“Good governance was not established, and” from the report
- 01What has changed to make sure time-critical and PRN medicines are given safely and recorded correctly?
- 02How many permanent and agency staff are now on each shift, and how are call bell response times monitored?
- 03Which repairs, cleaning improvements and fire safety actions have been completed, and what work remains?
- 04How are Mental Capacity Act assessments and best-interest decisions now recorded for people receiving one-to-one care or using bed rails?
- 05How are individual activities, food, drinks, personal care choices and communication needs now recorded and checked?
This was an unannounced first inspection of the newly registered home covering all five key questions, the premises, care and infection prevention and control measures. This explanation was written from the published report of 29 April 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk. The report was longer than we could read in one go; the later sections may not be reflected.
Every inspection of Hamilton House Care Home
6 rated inspections over 8 years: the service has improved, from Requires improvement to Good.
- March 2023Goodcurrent ratingup from InadequateSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- April 2022Inadequatedown from GoodSafe: InadequateEffective: InadequateCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- September 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2017Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2016Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- April 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2020
Registered with the Care Quality Commission on 13 May 2020.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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