This inspection took place on 12 October 2018 and was unannounced. We last inspected this service in October 2015 where the service was given an overall rating of good. At this latest inspection the service remained ‘Good’

Hamilton Court is a care home which is registered to provide care to up to 13 people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home specialises in the care of people with a learning disability and mental health support needs. On the day of our inspection there were 13 people living at Hamilton Court.

The service had a registered manager who was present during our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager understood their responsibilities about safeguarding and staff had received safeguarding training. The provider had effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were carried out.

Staff understood people who used the service, their relatives and the staff did not raise any concerns about staffing levels. The registered manager showed us a staffing rota and told us that staffing levels were arranged according to the needs of the people using the service.

We found that there were appropriate arrangements in place for the safe management, administration and storage of medicines. Records showed that managers carried out checks to make sure people had taken their medicines. Staff who administered medicines had received training in this.

People had their risks identified and detailed care plans to mitigate these risks. People were kept safe as there was sufficient staff to respond to their needs and keep them safe. People received their medicines as required. People were protected as appropriate checks were completed on staff before they commenced work.

People’s consent was sought by staff where ever possible, and all staff understood they should gain people’s consent where possible. Where people were deprived of their liberty for reasons of safety this was agreed with the local authority so that the least restrictive options were used.

Staff treated people with dignity and respect and helped to maintain people’s independence. People were given choices by staff to participate in activities. People who used the service had access to food and drinks and were supported to have food they enjoyed.

People, their relatives and health care professionals had been involved in the planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people to meet their needs.

People and relatives had confidence that they or their loved ones would receive a good standard of care. The provider had systems to allow them to monitor and improve the service as well as ensure potential risks were well managed. People’s views were sought by the provider and these were acted upon. Most staff felt well supported by the management team. The provider understood their legal responsibilities and how to maintain a current knowledge of any changes in the law or social care.

This was an unannounced inspection. At the last inspection carried out on 12 and 13 March 2015 we found that the provider was not meeting the regulation in relation to not having effective arrangements in place to ask and act on people’s consent and not ensuring that action had been taken to seek authorisation where restrictions were in place. After the inspection the provider sent us an action plan setting out the improvements that they would make. At this inspection we found that the provider had made the required improvements.

Hamilton Court is a care home which is registered to provide care to up to 13 people. The home specialises in the care of people with a learning disability and mental health support needs. On the day of our inspection there were 12 people living at Hamilton Court.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were protected from risk because measure were in place to ensure risks to people were managed. Staff understood the different types of abuse and knew what action they would take if they thought a person was at risk of harm.

Staff were aware of the signs that would indicate that a person was unhappy, so that they could take appropriate actions. Staff were able to describe what constitutes abuse and the reporting procedures they would follow.

People were supported by adequate numbers of staff on duty.

People were supported to receive their medication as prescribed. Medicines were safely managed. Staff who administered medicines had received training in this.

Staff received the training and support they needed to carry out their role effectively. Training included some specific training relevant for the needs of the people who lived at the home.

Staff were kind and compassionate in the way they supported people. People were supported to pursue interest and hobbies that were of interest to them.

Staff sought people’s consent before providing care and support. Staff understood the circumstances when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) were to be followed.

People had access to food and drinks and were supported to have food that they enjoyed.

People were supported to stay healthy. Opportunities were provided to support people to see health professionals and to attend health related appointments.

People told us that improvement had been made since our last inspection. Our findings at the inspection supported this view. Systems to monitor the quality of the service had been embedded and were effective.

One the day of our inspection there were 12 people living at the home. We talked with the manager and looked in detail at the records for three people. We observed how people were being cared for and talked with two people who lived there. We visited on a weekday and some people were out of the home attending various day activities. We talked with three staff members and two visiting professionals who worked for the health authority. We also spoke with three relatives. One relative said, “It is really very nice, we’re really happy with the care, and we feel very welcomed.”

People’s needs were assessed and planned. People received care in the way they wanted and as identified. External health professionals such as specialist consultants and community nurses were involved in their care so that people's health care needs were monitored and met. People were involved in a variety of interesting activities. One person said, “I like it here, we go to the park.”

There were sufficient staff who were trained and supported in their role to meet the needs of the people who lived there. Staff had the information they needed if they had any concerns or there was an allegation of abuse. Staff had a good knowledge and understanding of the individual needs of people and all the interactions were friendly, positive and informal. One member of staff said “In staff meetings we can just say what we feel.”

People received their medicines as prescribed by their doctor to ensure their health needs were met.

Robust audit systems were in place for monitoring and improving the quality of the service, when needed, for people living in the home.

We spoke with the manager of the home and two care staff on duty during our visit. We met with four of the people who lived here and looked at their care plans. Other people were out due to college commitments.

We observed how people were cared for and how people spent their day to help us to understand their experiences.

We saw that people were relaxed and appeared comfortable with the staff supporting them. We saw that staff treated people with dignity and respect. Staff carried out their role in a pleasant manner and with patience. One person told us, “I am very happy, I like the staff.”

An independent interpreter helped us to speak with people so they could to tell us what it was like to live at their home.

People chose how they spent their time and what they ate and drank. Care plans are detailed so that staff have enough information to support people to meet their needs in the way that people chose.

Staff knew how to protect the people living there so that they were safeguarded from harm.

Staff receive regular training to give them the skills and knowledge to know how to meet people's needs and ensure their well being. One staff member said, "We are registered with Skills for Care. Our training is thorough and very good."

People who live here and their relatives were asked for their views about the home and

these were listened to.

The inspection took place on 12 and 13 March 2015 and was unannounced.

We last inspected Hamilton Court on 14 January 2014. At that inspection we found the provider was meeting all the regulations.

Hamilton Court provides accommodation and support for up to 13 people with a learning disability and enduring mental health support needs. There were nine people living at the home when we inspected.

Hamilton Court is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A registered manager was not in post. However, following the recent resignation of the manager the provider had promptly appointed a new manager who was not yet registered with CQC.

People who could tell us told that they felt safe living at the home. Relatives that we spoke with told us that their family member was safe and well cared for at Hamilton Court. Staff understood their responsibility to take action to protect people from the risk of abuse and harm because the provider had systems in place to minimise the risk of abuse.

Staff had a limited understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We found that the provider was not meeting the requirements of this legislation which serves to protect people’s human rights.

Staff were caring and had an understanding of the needs of the people they were supporting. Improvements were in place so that staff received the training and supervision that they needed to carry out their role.

People, relatives and staff told us that there were enough staff to care for people and keep them safe.

The maintenance and up keep of the home had not always ensured that people’s privacy and dignity was respected. Although steps were in place to ensure that the home was refurbished so it was safe and suitable for people.

People received their medication as prescribed and medication was stored safely.

There were some systems in place to assess and monitor the quality of the service. However they had not been timely and effective. We identified two breaches in the regulations. The action we told the provider to take can be seen at the back of the full version of this report.