CQC report explained · a nursing home
What the CQC found at Hamilton House
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People's risks were assessed and monitored, medicines were given safely, recruitment checks had improved and infection controls were effective. Two people at risk of seizures did not have formal seizure care plans, but the provider took immediate action.
- Effective?
- Good
- The report does not give a rating or detailed findings under the Effective key question.
- Caring?
- Good
- The report does not give a rating under the Caring key question. Inspectors did observe that people appeared relaxed and happy with staff.
- Responsive?
- Good
- The report does not give a rating or detailed findings under the Responsive key question.
- Well-led?
- Good
- Inspectors found clear management responsibilities, regular audits, an open culture and a commitment to improving care. Staff worked as a team and with outside health and social care professionals.
What inspectors found, March 2023
Rated Good; inspectors found safe, well-led care, but two people did not have formal seizure care plans.
The inspection was unannounced. One inspector and an expert by experience visited on 24 February 2023. They spoke with people, relatives, staff, managers and the provider. They observed care and checked care records, medicines records, recruitment files and management audits.
The home was rated Good for Safe and Well-led. Inspectors found that medicines were managed safely, risks were assessed and staff recruitment had improved. Infection prevention arrangements were also found to be effective.
There was one shortfall. Two people at risk of seizures did not have formal seizure care plans. Inspectors said the risks were being managed and the provider took immediate action. The previous overall rating was Requires Improvement, published in December 2019, so the report records an improvement.
Safe medicines
Staff were trained and assessed as competent. Records showed that medicines were given as prescribed and that additional monitoring needs were recorded.
“Systems and processes were in place to make sure people received their medicines safely and as prescribed.” from the report
Improved risk management
The home had improved how it assessed and managed risks since the previous inspection. It also used incidents, such as falls, to make changes to staffing.
“People had their individual risks assessed and monitored.” from the report
Safer recruitment
Inspectors found that recruitment checks had been completed before staff started work.
“Records showed references and Disclosure and Barring Service (DBS) had been obtained before staff commenced their employment.” from the report
Strong management systems
The home had clear lines of responsibility and used audits and an action plan to monitor and improve care.
“Governance systems were in place to monitor the quality of the service.” from the report
Positive culture
People, relatives and staff gave positive feedback about the management. Inspectors saw a person-centred and constructive culture.
“Through our observations and speaking with people, relatives and staff, it was clear that the culture within the service was positive and constructive.” from the report
Missing seizure care plans
seriousTwo people who were at risk of seizures did not have formal care plans explaining how staff should support them. The provider took immediate action and inspectors said the risks were being managed.
“However, we noted that two people who were at risk of experiencing seizures did not have formal seizure care plans in place.” from the report
- 01What immediate action was taken to put formal seizure care plans in place?
- 02How will staff recognise and respond to a seizure, and how is this recorded in each person's care plan?
- 03How do you use the dependency tool to check that staffing levels continue to meet people's needs?
- 04What changes were made after the previous inspection's concerns about recording emotional risks and learning from incidents?
- 05How do your audits check that care plans and medicines records remain accurate and up to date?
This was an unannounced inspection covering Safe and Well-led, including infection prevention and control; the report did not give ratings for Effective, Caring or Responsive. This explanation was written from the published report of 18 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, December 2019
Rated Requires Improvement; inspectors found kind and responsive care, but safety checks and management systems were not yet reliable.
This was an unannounced follow-up inspection on 3 December 2019. Inspectors spoke with six people, two relatives, eight staff members and other professionals. They reviewed care, medicine and staff records, as well as management systems.
People and relatives were positive about the care. Staff were described as friendly, skilled and approachable. People were supported to make choices, maintain routines, eat and drink well, access healthcare and take part in activities.
The main problems were that risk assessments did not always give staff clear instructions, one incident had not been recorded properly, and recruitment checks were not robust when references were missing. Medicine competency checks and staff supervision had also not yet started.
The home was rated Good for Effective, Caring and Responsive. It was rated Requires Improvement for Safe and Well-led, giving an overall rating of Requires Improvement. The new provider had made improvements, but inspectors said some changes still needed to become established.
Kind, respectful staff
People and relatives said staff were friendly, warm and skilled. Inspectors saw that staff knew people’s individual needs and preferences.
“People told us staff treated them kindly and were friendly and warm in their approach.” from the report
People’s choices respected
People were involved in care planning and could choose routines such as when to get up and go to bed. Staff asked for consent before providing care.
“People told us they were able to keep the routines they preferred.” from the report
Good response to health needs
The home worked with healthcare professionals and acted when people’s health changed. Relatives said staff escalated concerns quickly.
“A relative told us staff had been quick to escalate their concerns with other professionals when their family member became unwell.” from the report
Activities and community links
People took part in meaningful pastimes, enjoyed visiting entertainers and were supported to go shopping and visit local cafés.
“People were supported to access the local community going out shopping and visiting nearby cafés.” from the report
Provider had started improvements
The new provider had introduced electronic care planning, audits and an improvement plan. Some furniture and signage had also been improved or ordered.
“During this relatively short period they had made significant improvements.” from the report
Risk guidance was incomplete
seriousRisk assessments did not always explain clearly how staff should support people who might put themselves at risk when distressed or agitated. One altercation was not recorded on an incident form for senior review.
“Risk assessments had not always been developed to include clear guidance for staff when supporting people who might put themselves at risk when distressed or agitated.” from the report
Recruitment checks needed strengthening
seriousWhen requested references were not provided, there was no process to reduce the risk of employing someone unsuitable for the role.
“When these had not been supplied as requested there were no processes in place minimise any risk.” from the report
Medicine competency checks had not started
needs fixingStaff had received medicine training, but senior staff administering medicines had not yet had their practical competence assessed by management.
“Although there were plans to introduce medicine competency assessments for relevant staff these had not yet been implemented.” from the report
Staff supervision had lapsed
needs fixingRegular face-to-face supervision meetings had not been taking place. The provider had recently assigned senior staff responsibility for completing them.
“Staff had not been supported by regular face to face supervision meetings.” from the report
Environment was difficult for people with dementia
needs fixingThe three-floor layout was hard to navigate and there was limited signage and use of colour. Some areas were tired and needed updating.
“There was limited signage or use of colours to help people with a cognitive impairment to move around independently.” from the report
- 01How have you improved risk assessments so they give staff clear instructions for people who may become distressed or agitated?
- 02How do you now check references when a requested reference is not provided?
- 03Have all staff who administer medicines completed practical competency assessments?
- 04How often are staff now receiving face-to-face supervision, and how is this recorded?
- 05What changes have been made to signage, colours and the layout to help people living with dementia find their way around?
This was an unannounced follow-up inspection covering all five key questions; the service was newly registered with the new provider in September 2019, and the previous rating and enforcement action were used to inform this inspection. This explanation was written from the published report of 20 December 2019 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.
Every inspection of Hamilton House
2 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- March 2023Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2019Requires improvementSafe: Requires improvementWell-led: Requires improvement
- July 2019
Registered with the Care Quality Commission on 10 July 2019.
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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