Hamilton Park Nursing Home provides accommodation with nursing care for up to 34 people. Accommodation is arranged over three floors and all bedrooms are for single occupancy. The home is staffed 24 hours a day and a registered nurse is on duty at all times. The home is located within a short distance of the town.

At the time of the inspection there were 33 people living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin.

People continued to receive effective care. People told us their healthcare needs were met. One person said “My doctor visited me here when I felt poorly.” Another person told us “When I came out of hospital I had a blister on my leg. Since I have been here they have taken good care of it and it has all healed up. I think they do an amazing job.” People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The home continued to provide a caring service to people. One person told us “The staff are great and we have great banter. I am very happy here.” Another person said “I find all the staff very pleasant and caring.” A visitor said “I am very happy with everything and the staff are lovely.” The atmosphere in the home was relaxed and people were supported in an unhurried manner. Staff interactions were kind and respectful.

Improvements had been made to ensure people received care which was responsive to their needs and preferences. People had been involved in planning and reviewing the care they received and we found care plans were reflective of people’s needs and preferences. One person told us “When I first came here I was asked all about the help I needed and the things I liked or didn’t like. They [the staff] wrote it all down so all the staff can see it.”

The service continued to be well led. The registered manager was very visible in the home and knew people very well. People told us the management within the home were open and approachable. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below.

This inspection was carried out on 8 March 2016 and was unannounced.

The last inspection of the service was carried out on 12 August 2014. No concerns were identified with the care being provided to people at that inspection.

Hamilton Park Nursing Home provides accommodation with nursing care for up to 34 people. Accommodation is arranged over three floors and all bedrooms are for single occupancy. The home is staffed 24 hours a day and a registered nurse is on duty at all times.

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.

Care plans did not evidence that people were involved in planning and reviewing the care and support they received. We found one care plan which had not been updated to reflect the changes in the care they received. This could place people at risk of receiving care which was not in accordance with their assessed needs and preferences.

Staff sought people’s consent before assisting them and people told us they were never made to do something they didn’t want to do. One person told us “There is no pressure to do anything. It’s very relaxed here. I enjoyed a nice lie in this morning. That’s never a problem.” Staff had received training about how to protect people’s human rights and we found the service followed the correct procedures where people were unable to consent to important decisions about the care and treatment they received. The service needed to make sure the principles of the Mental Capacity Act were followed for all decisions where a person was unable to give their consent.

People were cared for by a staff team who were well trained. A registered nurse was on duty during the day and at night. They were supported by a team of senior care staff and care staff. Staff were confident and competent in their interactions with people and people told us they felt safe living at the home. One person told us “I feel safer here than I did at home. There is always somebody about to help you.” Another person said “It’s very peaceful here and I feel very safe.”

People told us staff treated them with kindness and respect. One person said “We are like a family here. The staff are all lovely and very kind.” Throughout the day we heard staff checking whether people were happy where they were and with what they were doing. One person said “I am always treated with respect and it’s a comfort to know that they [staff] know what’s important to me. It makes me feel special.”

There were procedures in place to reduce risks to the people who lived at the home. Staff had received training and they knew how to recognise and report any signs of abuse. All were confident in reporting concerns and felt confident concerns would be taken seriously to make sure people were safe. Checks were made on prospective staff to make sure they were appropriate and safe to work with vulnerable people.

People received their medicines when they needed them and medicines were stored securely. Medicines were managed and administered by registered nurses whose skills and knowledge were regularly monitored.

People saw their GP and other health care professionals when they needed. People told us the home was very good if they were unwell and made sure they were referred to appropriate professionals. One person said “They are very good here. If you feel unwell, the nurses or matron [registered manager] will ring the doctor.”

People were provided with opportunities for social stimulation and they were supported to maintain contact with their friends and family. People told us they could see their visitors whenever they wished and that they were always made to feel welcome. This was also confirmed by a visitor we met

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We found the service to be safe because care and treatment was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks. These included reducing the risk of falls, skin damage and malnutrition.

The provider had a range of policies and procedures in place to protect the people who lived in the home. The staff we spoke with had a good understanding about how to report any concerns. The people we spoke with told us they felt safe at the home and they commented on the kindness of the staff. Comments included “I feel very safe here. They wouldn’t let any harm come to you” and “the staff are all very nice indeed.”

We observed that staff were competent and professional in their interactions with people who lived at the home. During our inspection we observed people were relaxed and appeared very content with the care and support provided.

We looked at the personnel files for three members of staff. These showed the home had followed robust recruitment procedures which meant that risks to people who used the service were minimised.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Staff carried out regular health and safety checks to make sure that the building was maintained to a safe standard. These checks included testing the fire detection system and hot water temperatures.

Is the service effective?

We found the service effective. The care plans we looked at had been regularly reviewed. This meant that people received care and support which met their up to date needs and preferences. Records showed that the home liaised with people's relatives and representatives as appropriate and that the individual was involved in the review of their care plan where appropriate.

Staff told us they were provided with up to date information about the people who lived at the home. They said “we have a handover at the start of our shift and this keeps you up to date with how people are.”

The two visitors we met were complementary about the care their relative received and the staff who supported them. They made the following comments “I am very happy with everything” and “I don’t have any complaints. If I did I would go straight to the matron as I know she would sort things out straight away.”

The people we spoke with did not raise any concerns about the care and support they received. Comments included "they wait on you hand and foot” and “the staff are good. They help me to have a shower every morning. I’ve seen the doctor since I’ve been here and I have special cream which the staff help me with.”

We saw that where people had been assessed as being at high risk of pressure damage to their skin, they had been provided with appropriate pressure relieving equipment. We also saw people were supported to change position at assessed frequencies.

Is the service caring?

Staff interacted with people in a gentle and kind manner. People who lived at the home and visiting relatives were complimentary about the staff who worked at the home. They said “we have always found the staff to be kind and caring. I am very happy with everything” and “they couldn’t be kinder. They really will do anything they can to help you."

One person told us “the staff help me to be as independent as I can be. I like that. When I moved here they spent time asking me about what I wanted and what I liked. Everyone is helpful and kind.”

Is the service responsive?

We saw that staff were responsive to any changes in people’s well-being. For example we read a person’s care records which showed they had recently been losing weight. We saw staff had monitored the person’s weight at two weekly intervals and had monitored their diet and fluid intake. We saw staff had recently forwarded the records to the GP and requested a visit as there had been no improvements.

Two people told us they had recently been seen by a dentist and were due to receive new dentures this week. The care records showed people had access to a range of health care professionals. These included chiropodist, doctor, dentist, optician and specialist health care professionals such as diabetes clinicians and mental health practitioners.

The staff we spoke with were knowledgeable about the needs and preferences of the people they supported. They knew about the things which were important to people.

Is the service well led?

We found the service was well led. There was a registered manager in post. A registered manager is a person who has been registered by the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We observed staff were competent and professional in their interactions with people who lived at the home. The manager and staff spoken with told us that the home benefited from a stable staff team with little staff turnover. This meant that people were supported by staff who knew them well.

We saw that there was a clear staffing structure in place which meant that senior staff were always available to support less experienced staff.

A record of formal supervision sessions for staff had been maintained and we saw staff supervisions had either taken place or were planned to take place. We looked at the personnel files for three members of staff. Supervision records showed their skills and competencies had been reviewed and they had been able to discuss any training needs. This meant that systems were in place to monitor the skills, competencies and performance of the staff who worked at the home.

The manager sought the views of people who lived at the home. We saw a number of ‘feedback’ surveys where people had been able to express a view on outside entertainers and in-house events such as Easter and Christmas parties. Surveys were due to be sent to people to seek their views on the quality and choice of meals at the home.

Annual surveys were sent to people who lived at the home and their representatives to seek their views on the quality of the service provided. We read the results of the last survey. These showed a high level of satisfaction with the standard of care provided and of the staff team. We saw 90% of people were satisfied with the overall care provided by the home. The survey did not identify any areas of concern. We read the findings of a staff survey. This showed staff were positive about the training and support they received.

When we visited 26 people were using the service. We spoke with 15 people, three visitors and three members of staff. We also spent time observing how staff interacted with the people who lived at the home. Staff interactions were kind and respectful and staff offered people assistance in a discreet and dignified manner.

Each person had a plan of care which was personalised to their needs and preferences. The people we spoke with were positive about the care and support they received. Comments included “It’s lovely here and I feel very well cared for. The staff are kind and attentive” and “I have no complaints at all. I think the care is very good.” A visitor said “I am very happy with everything and the staff seem very nice.”

The home’s safeguarding procedures minimised risks to the people who lived at the home. People told us that they felt safe and they commented on the kindness of the staff. They told us that they would feel confident in raising concerns if they had any.

Systems were in place which meant that staff received appropriate levels of support and training to enable them to meet the needs of the people who lived at the home.

All records relating to the people who used the service had been securely stored to ensure confidentiality. Care records were up to date and they reflected the current needs and preferences of the people who lived at the home. This meant that the risks of people receiving unsafe or inappropriate care were reduced.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes were treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a practising professional. We talked with five of the people who lived in the home and the visiting relatives of two other people. We also observed the care and support provided to other people who were unable to communicate verbally with us. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us that the majority of the staff treated them with dignity and respect but there were some exceptions. One person said “Some staff are excellent, some are good and others are mediocre. The very good ones are very respectful and kind and make up for the others”. Some people said they were happy with the care they received. We were told “Staff don’t rush me it’s all done properly. I’ve got no complaints”; “When the staff hoist or turn me they always talk to me and they do a good job” and “Staff are very good and will sit with you if you are feeling upset”. But three of the people we spoke with identified issues with the behaviour of one particular member of staff. We spoke with the manager about these concerns. They told us they would closely monitor the member of staff’s behaviour and take appropriate action if they treated people disrespectfully.

We asked people if they had been involved in decisions about their care. One person said “They explain things to me and I just need to ask if I want to know anything”. But another person said “I know they have care plans but I haven’t been asked about mine”. People could make certain choices about aspects of their daily living but their personal preferences were not always sought. We were told “There are male and female care staff. I wasn’t given a choice but I have got used to it now and don’t mind” and “I very rarely have a male carer but it doesn’t bother me. I’m sure if I asked for another carer that would be OK”.

People were generally satisfied with the meals provided. We were told “There’s a set lunchtime menu but we can choose an alternative cooked meal from whatever is available in the kitchen, or have a sandwich, or an omelette” and “We get lots of choice and there is a good selection for breakfast and supper”. People also told us they were given enough to drink. One person said “There is plenty of choice of tea, coffee, juices and water at meal times and at other times”.

Most of the people we spoke with told us they had not experienced or witnessed any abuse. We were told “I’ve never seen anyone treated badly”; “I can’t say anything bad about the staff” and “If I had any concerns I would talk to the Matron or the deputy and they would deal with it”.

The people we spoke with told us there were enough staff to meet their needs. We were told “If anyone has an accident or falls then staff are there in an instant”; “If I need anything the staff will get it, they are very good that way” and “They come quickly when called”.

People spoken with during our visit told us that they were able to make choices about their day to day lives. They said; ‘I can choose what time I go to bed and what time I get up in the morning’, ‘I can spend time in my room when ever I want to’. People said; ‘the staff don’t make you do anything you don’t want to do’.

People told us that staff always respected their privacy by knocking on doors before entering and ensured doors were closed when assisting people with personal care.

People told us that they were satisfied with the care they received but no one spoken with was aware that they had a plan of care.

Everyone asked was happy with the care that they received. Comments included “I’m well looked after here” and “I am quite satisfied with everything”. We spoke with two visitors who confirmed that they did not have any concerns with the care their relative received.

On the day of the visit everyone living at the home appeared well presented demonstrating that staff took time to support people with personal care and dressing.

Staff spoken with during our visit were able to demonstrate a good understanding of people’s assessed needs and preferences.

Each person spoken with during our visit told us that they felt “safe and well cared for” and the majority of people spoken with commented on the kindness of the staff.

Everyone said that they would be comfortable in raising any concerns or worries with the manager or a member of staff and one person said; ‘the manager will listen and act on what you say’.

People living at the home told us that staff were available when they needed them. They said; “when I use my call bell, the staff come quite quickly”

People spoken with during our visit told us that they found the staff and manager approachable and that they were “kept up to date” with what was going on in the home. Two people told us that they had been informed about the home’s plans to extend the building.