Enter & View Report: Hamilton Park Nursing Home
This is a report of a visit carried out by the Somerset LINk Enter and View team. It is part of
an ongoing project to identify and share good practice examples relating to the dignity in
The visit was conducted by Somerset LINk authorised representatives David Boyland, Gillian Pearce and John Hawkins and supported by Jonathon Yelland from the Somerset LINk Host organisation Help and Care, on the 4th October 2011.
The Enter and View team identified a number of good practice examples relating to dignity in care during the visit and also made several recommendations which it hopes will help the home to make further improvements. All of these are listed in the report and the accompanying Recommendations Action Sheet.
A written response from Hamilton Park Nursing Home is required within 20 days of receiving this report and recommendations. We look forward to hearing the home's view of the report and what action they intend to take on the recommendations made.
Observations and recommendations
Hospital discharge had been identified as problematic among other care homes and the team took the opportunity to ask the manager about the home's experiences in this area.
The home had experienced difficulties when residents are discharged from hospital to Hamilton Park. Residents are usually only discharged with one week's supply of medication. This causes difficulties when new residents come to the home for the first time straight from hospital. Often it takes longer than a week for new residents to change GP's which results in the home having difficulties in getting residents' medication, once the initial prescription provided by the hospital has run out.
Residents are sometimes discharged from hospital late in the afternoon or evening. This means that settling residents into the home, places demands on staffing as fewer staff are on shift in the afternoon and evening than earlier in the day. Given adequate notice the home could ensure that additional staff can be made available on shift. The home has asked hospital ward staff not to discharge residents after 4pm without prior notice but there are instances when this happens. Discharge of residents from hospital later in the day and without prior notice being given to the home can often occur due to unforeseen circumstances such as medical emergencies or transport problems at the hospital concerned.
Hospital Discharge - Recommendations:
- It is recommended that the home inform the hospitals and the CQC about these issues relating to hospital discharge. A form for reporting these issues called 'Improving Discharge Form' can be obtained from the hospital link social worker.
There appeared to be enough staff available to support residents during the Enter and View Visit. Staff spoken to said they enjoyed working there and felt well supported. When staff were asked what they would change, they said they would like the opportunity to take residents on more trips.
Staff - Good Practice:
- During previous Enter and View visits, residents and visitors remarked that staff training is paramount to the quality of service received. Staff training was discussed with the manager and it was noted that most staff have a relevant NVQ qualification level 2 and some staff have NVQ level 3 or 4 in health and social care. A training record for staff was seen by the E&V team and observed to be very comprehensive. The following training courses, offered by the home, were specifically noted as good practice relating to 'Dignity in Care:'
- MUST (Malnutrition Universal Screening Tool)
- Equal opportunities
- Staff spoken to say that they felt well supported with training and supervision.
Staff - Recommendations:
A broad range of activities is important as it can provide residents with choices about meaningful ways in which to spend their time especially when residents are no longer able to access outside activities. Some homes have noted that engaging residents in activities is difficult and have struggled to find meaningful activities to offer. Below we have identified activities offered by the home and further activities identified during other Enter and View visits for the home to consider.
Activities - Good practice:
- A monthly newsletter was noted to detail activities on offer and activities are also displayed in communal areas.
- An annual survey of activities is undertaken and the results are circulated to residents.
- Volunteers come to run a bingo session each Friday.
- The home has a 'Residents Fund', which is used to pay for some activities.
- The home has given one of the staff a specific role in organising activities.
- Arm chair exercise.
- Pip the Whippet weekly visit.
- Crossword and Puzzles and board games.
- Arts & crafts.
- Songs of Praise.
- Balloon Tennis.
- Ball games.
- Hairdressing and manicures.
- Occasional trips out.
- Film afternoons.
- Card making.
Activities - Recommendations:
It is recommended the home consider the following activities list, identified from Enter and View visits to other care homes.
- Knitting circle;
- Quizzes and Bingo;
- Drumming for the brain;
- Regular trips into town;
- Britannia Inn pub lunch;
- Time put aside for staff to spend one to one time with residents;
- Residents encouraged to walk around the garden;
- Nintendo Wii exercise;
- Visits from the owl sanctuary;
- Visits by the 'Old Fashion Sweet Shop' (based in Taunton);
- Visits by Clothes Direct;
- Visits by the Donkey Sanctuary;
- Model making.
- Visits by the local vintage motorcycle club or classic car club (often these clubs organise charity ride outs and welcome the opportunity to stop of for a tea break).
Control and Choice:
The manager informed us that residents can get up or go to bed when they wish. One resident said that she goes to bed when her turn comes. Another resident said they like to stay up late. This conflicting information meant that the E+V team were unclear about how much choice residents had about when to retire to bed or get up. It is, however important that residents are given a daily choice about when they get up or retire to bed, as set times can encourage residents to become institutionalised which can result in diminished ability to make choices.
Three residents spoken to said that they couldn't get out and about half as much as they would like to and two residents said they felt imprisoned. This is an issue which seems common to many residential homes. It has been made worse since the mobility component of Disability Living Allowance was removed for people receiving residential care. Many people can no longer afford taxis. Some homes have found creative solutions to enable people to get out and about more. (Please see the below recommendation listing ideas and suggestions.)
Control and Choice - Good Practice:
- A local vicar visits once a month and holds a service at the home.
- A 'resident and visitors / relatives' meeting is held annually and incorporates a barbeque.
- The home does not use life story books but ask for background information about residents prior to admission.
- A residents' survey asked the question, 'Would residents know who to complain to?'
- The E+V team asked the manager if residents are encouraged to maintain life skills or hobbies. The manager noted that these are encouraged and gave examples where by residents were encouraged to partake in gardening, looking after the green house, and one resident played an organ that was donated to the home. The manager noted that they received a grant from a well known supermarket to make raised gardening beds.
- Staff were seen to spend one to one time with residents.
- Quality audit surveys are conducted regularly and the E+V team were shown a selection.
Control and Choice - Recommendations:
- It is recommended that meetings for residents and visitors are held monthly. Monthly meetings enable residents to discuss issues while they are current and maintain a greater input and control into the service they receive. Past enter and view visits have highlighted that activities, and meals are a popular topic that residents wish to influence; therefore it is recommended that catering staff and staff who have a responsibility for activities are present.
- It is recommended that information about how to complain, raise an issue or make a suggestion is placed in the residents information pack. Information about advocacy services, the Care Quality Commission and the Somerset LINk should be included.
- It is recommended that the home consider seeking ways to enable residents to get out and about more frequently. Some homes have contacted other organisations such as a local Stroke Club or Scouts group to share transport costs or facilities. Other homes have a friend's society or volunteers who organise support to get out and about. The local volunteer bureau may also be able to help. One home approached a local taxi company and negotiated discount fairs for residents at certain times.
- Staff were noted to communicate respectfully to residents offering them choice and reassurance. Some residents were also observed to have pictorial communication tools.
- RNID - Action for Hearing, estimate that 80% of older people requiring residential care are likely to have some significant hearing loss. The home was noted not to have a hearing loop. The recommendations below make suggestions about this.
- The E+V team noted that more people with computer skills or a wish to learn them are now requiring residential care and this is likely to increase over time. The E+V team passed on information obtained during a visit to The Elms Residential Home near Yeovil where the home had accessed a grant to enable residents to use the internet. The grant provided specially adapted computers and aids. According to the SCIE (Social Care Institute for Excellence), the 'Get Connected' Investment Project is a capital grant scheme for the registered providers of adult social care in England and independent sector organisations supporting personalisation in adult social care. It enables providers to improve access for users, carers, visitors and staff to information and communications technology (ICT) so they can use the power of the internet to communicate, learn and train. Please note the details in the below communication recommendations section.
Communication - Good Practice:
- A suggestion box was situated by the front door.
- Satisfaction surveys are undertaken and include seeking views on areas such as; Activities and Wellbeing; Quality Assurance; and Relatives and Visitors Views.
- A deaf resident was observed to have a pictorial communication card to hand.
- Shift handovers are held at one end of the main dinning/ living area. This ensures that staff are at hand to support residents in the dinning/ living area. The E+V team asked staff how they manage issues of confidentiality when discussing handover information in the same room as residents. Staff noted that they meet at the other end of the dinning room to where residents are seated and did not think that confidential information would be overheard. The manager commented that confidential information is written on handover sheets and that any confidential discussions needed would take place in the office and not in the dinning room. The handover that takes place in the dinning / living area is more about general issues concerning the day to day running of the home.
- It is recommended the home seek advice from the RNID (Action for Hearing) regarding use of audio aids and loop systems.
- It is recommended that the home investigate the government grant called 'Get connected.' More details can be found at http://www.scie.org.uk/workforce/getconnected/faq.asp
Eating and Nutritional Care
The E+V team were invited to take lunch with the residents. The meal served was thought to be adequate although several residents did not appear to like their meal. Some residents were seen to be using plastic infant cups with lids. Some of these infant cup lids appeared to have teeth marks on them, these should be checked and those damaged replaced for hygienic reasons. Bibs were also used for some residents as opposed to serviettes which the E+V team considered to be more dignified. The manager explained that laundry costs and hygiene are factors as to why bibs are used. The E+V team felt that using bibs and infant cups did not portray an age appropriate positive image and that the benefits, in terms of eliminating negative connotations, could be improved by using serviettes and adapted cups more suited to adult usage.
Portion sizes appeared to be the same for each resident. It is important that individual preference and need is reflected in all elements of nutritional care including preferred portion sizes. In addition for those residents who may require longer to eat a meal, it is good practice to offer two smaller portions thus doing away with the need to reheat meals and this is also reflected in the below recommendations.
Eating and Nutritional Care - Good Practice:
- Residents were offered a choice of meals.
- Staff supported residents appropriately during lunch and it was thought that there was enough staff available to meet the needs of residents.
- Residents were appropriately encouraged by staff to eat enough and offered extra portions if required.
- Staff are trained in the use of MUST (Malnutrition Universal Screening Tool)
- Residents were given plenty of time to finish their meals.
- Residents can choose to take meals in their rooms.
- Often the first sign of malnutrition and illness is the loss of weight. The home regularly weighs all residents, unless they refuse. Resident who refuse are made aware of any associated risks, if they are still not happy to be weighed this is respected.
Eating and Nutritional Care - Recommendations:
- It is recommended that the home use serviettes instead of bibs.
- It is recommended the home seek out new two handed cups as those currently used are worn and resemble infant cups. Many styles are available that are suited to adult use.
- It is recommended the home retain a list of residents' food preferences and preferred portion sizes for each resident and that this is available for catering staff to refer to. This information can be taken from individuals care plans. Where needed, two smaller portions can be given to avoid the need to re-heat meals.
Hydration - Good Practice:
- Residents were offered a choice of water or cordial at lunch time
- Drinks are offered between meals.
- Staff were observed to help residents stay hydrated by encouraging them to drink at least 1 glass of water or cordial during lunch.
- An early morning tea round is offered.
- Jugs of water available in residents rooms.
- Routine observation observations throughout the day and night observe hydration. A tool called 'Waterlow' assessment is used.
- Waterlow assessment tool is used to look at the hydration of residents and fluid intake is monitored as and when a need is identified.
Hydration - Recommendations:
Pain Management - Good Practice:
- Some staff are linked with a nurse from the local hospice training is shared and this is then disseminated to other staff including night staff. 3 staff attend quarterly meetings with the local hospice and good practice and training is shared. This includes medical courses such as syringing and lymphoma management.
- Routine observations are observed throughout the night. These include:
- Visual checks to make sure the resident is safe in bed;
- Ensuring pressure mattresses are working correctly,;
- Turning the resident if needed to prevent pressure sores,
- Administering medication if required.
Pain Management - Recommendations:
The E+V team discussed incontinent pads with the manager. Following a continence assessment by the Primary Care Trust (PCT), the manager noted that only three pads a day were allocated per person. This was felt to be poor practice and in conflict with measures that preserve dignity and respect. The manager said that they buy in additional pads so that residents can use as many as they require. The Somerset LINk will make enquiries to the PCT about this and inform the home of any information received.
Personal Hygiene - Good Practice:
- Staff were observed to use alcohol hand gel.
- A hairdresser visits the home regularly.
- Staff are trained in infection control.
- The home pays for additional continence pads and uses as many as are needed.
Personal Hygiene: Recommendations
Practical Assistance - Good Practice:
- A student nurse from Plymouth University and students studying for their 'NVQ 3 in Social Care' from Bridgwater have been offered work placements at the home.
- A person who has a learning disability volunteers at the home.
- The home is able to provide safe keeping for residents' money or valuables.
- Opticians and dentists make regular visits to the home.
- The home provides staff escorts to medical appointments at no additional cost.
Practical Assistance Recommendations:
Privacy in Practice: Good Practice
- The home and staff were seen to be respectful of residents' privacy.
- Residents informed us that most staff always knock before entering their room.
- Residents can have their own phone line in their room.
- Most bedrooms have en suite facilities.
- Commodes are given where needed to residents' who do not have en suite rooms.
Privacy in Practice - Recommendations:
No single sex toilets were provided in communal areas and this was viewed as poor practice for a home of this size. The E+V team were unsure if this could be rectified by the plans that are in place to extend the building.
It is recommended that the home look at possibilities for providing single sex toilet facilities in communal areas.
Social inclusion in Practice:
The home has tried hard to involve the local community and several good practice examples have been identified below.
Social Inclusion - Good Practice:
The manager informed the E+V team that two residents had access to a local coffee morning.
Local schools visit and perform plays and entertain residents.
Gospel singers from a local church have visited to entertain residents at Christmas.
The home has an annual BBQ and relatives and visitors are invited.
Social Inclusion Recommendations:
It is recommended that the home contacts local 'Active Living Centres and local groups such as the WI (Women's Institute) to seek opportunities for residents to participate in activities in the local community.
What Residents Said about the home:
- The E+V team spoke to, many of the residents during the visit. Their comments are listed below.
- The staff are very kind.
- The staff are helpful.
- It feels like a prison I can't get out and about.
- I don't get out as much as I would like to.
- I don't fancy taking part in any of the activities. There isn't much to do.
- I have my friends here and my family visit often.
- Staff always knock when they come into my room.
- I don't like the food much.
- The food is OK but nothing special.
- The food is fine, just not my cup of tea.
- I like watching the fish.
- I like watching films there are lots to choose from.
For more information
For more information read the full report or contact Jonathan Yelland on firstname.lastname@example.org.