Hamilton House in Buckingham has been rated inadequate overall, following an inspection by the Care Quality Commission (CQC) in March.
Hamilton House 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.
CQC carried out an unannounced comprehensive inspection after receiving information of concern about people’s care, including concerns that the service was not responsive to changes in people’s health. This was the first inspection of the service under a new provider.
Following the inspection, the service was rated inadequate overall and inadequate for being safe, effective and well-led. Caring and responsive were rated requires improvement. The service is now in special measures, which means it will be closely monitored and re-inspected within six months to check that improvements have been made.
Rebecca Bauers, CQC’s head of adult social care inspection, said:
“When we inspected Hamilton House, we were very concerned the provider was not able to recruit and retain enough staff who were suitably trained to care for people and keep them safe. We saw many examples of the impact on people who lived there. For example, people who were distressed and needed urgent assistance were being ignored. Calls for help to go to the toilet and get dressed went unanswered. It was also very concerning that one person had been told by night staff not to keep pressing their bell. This is unacceptable, people should be able to call for help whenever they need it and leaders need to ensure there are enough staff to respond quickly.
“The lack of staff was impacting on every area of people’s care, putting them at real risk of harm. The service didn’t respond quickly enough when people’s health needs changed. Time critical medication wasn’t being issued when it should be, and people with pressure sores who should have been repositioned every two hours were often left for much longer, in one case, for nearly nine hours. One person felt unwell in the morning, but as the service didn’t respond quickly enough, that person ended up in hospital in the evening.
“Staff told us they didn’t feel the service was well managed and said they got mixed messages from senior managers. All of these incidents could have been avoided if managers improved their oversight of the service, assessed staff skills and competencies, and focused on promoting continuous learning to improve the quality of care.
"Following the inspection, we told the provider to make a number of improvements to ensure people receive safe care. The provider responded immediately with an action plan to address the immediate concerns and mitigate risks to people. We will continue to monitor the service in conjunction with partner agencies. Our priority is for the safety of people living in the home and the quality of care they receive.”
CQC found the following during this inspection:
- The service was not effectively managed and monitored to ensure safe, effective, caring and responsive care was provided. Records were not accurate, complete and up to date.
- There were not enough staff to meet people’s needs, and staff were not suitably inducted, trained and supervised in their roles to promote safe and effective 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.
- People's nutritional and hydration needs were identified but not consistently met. People who needed supervision with their meal had to wait an hour after others had started their meals to helped to eat and people complained their meals were cold.
- Personal care records, daily records, bowel monitoring and repositioning charts showed gaps in recording and records including accident reports were not consistently reviewed and signed off. Where they were, they did not address shortfalls in the records and measures were not put in place to mitigate risks.
- 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.
- Person centred care was not provided, and people did not have access to a range of activities to meet their needs. People were generally left alone in their rooms with little engagement from staff.
- People were not supported to be involved in decisions about their care and were not always given a choice about which food and drink they might like. When people requested a male or female member of staff to support them with their personal care this was not always provided.
- Accident reports weren’t completed after an accident occurred and there were gaps in the records which made it difficult to establish how the accident had occurred. This meant that lessons weren’t being learned to prevent similar incidents from occurring again.
- People described staff as kind and caring, however some staff practice did not promote people's privacy, dignity and choices. Very few staff knocked on people’s bedroom doors before entering.
- Systems were in place to safeguard people, however practices needed to improve to ensure procedures were followed to safeguard people.
- The service was not suitably maintained, fit for purpose or hygienic. Areas of the home had damp patches on the wall, stained ceilings, damaged floors, broken tiles and equipment, and the garden was a trip hazard. Flooring in the bathroom and showers was badly stained. Water temperatures in some of the hand basins were too high placing people at risk of scalding.
However:
- Staff told inspectors they were clear about their responsibilities in relation to safeguarding people and people said they felt safe.
- The provider confirmed the recruitment and retention of staff had been challenging because of the COVID-19 pandemic, the ruling around compulsory vaccinations of staff and the impact of Brexit, however, they were committed to recruiting permanent staff to improve continuity of care to people.
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