Random inspection report
Care homes for older people
Name: Address: Hinton Grange Bullen Close Cambridge Cambridgeshire CB1 4YU two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Alison Hilton Date: 1 7 0 8 2 0 0 9 Information about the care home
Name of care home: Address: Hinton Grange Bullen Close Cambridge Cambridgeshire CB1 4YU 01223246360 01223246361 manager.hintongrange@careuk.com www.careuk.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Care UK Community Partnerships Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 0 60 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 60 60 0 60 The maximum number of service users who can be accomodated is: 60 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP Dementia - Code DE Mental Disorder, excluding learning disability or dementia - Code MD Physical disability - Code PD Date of last inspection Care Homes for Older People Page 2 of 9 Brief description of the care home Hinton Grange is a purpose built home registered to provide accommodation, support and nursing care for up to 60 people over the age of 65 years, some of whom have a mental disorder or have been diagnosed with dementia. It is a two-storey building, surrounded by safe, well maintained enclosed gardens, and is situated in the suburbs of Cambridge close to local amenities and shops. Public transport to the city of Cambridge is readily available. Hinton Grange Care Home provides 52 single and 4 double occupancy bedrooms some of which have en-suite facilities. There are 4 separate bathrooms, 4 separate shower facilities and ten toilets. The home is on two floors. The ground floor has the extra care unit, which caters for residents with dementia or other mental health diagnoses. The first floor can be accessed by lift or stairs and provides residential and nursing care. Carers and nurses provide 24hr care in the home. Copies of inspection reports are kept in the foyer at Hinton Grange. The cost of care at Hinton Grange is available from the office on request. Care Homes for Older People Page 3 of 9 What we found:
On Tuesday 4th August 2009 we completed a key unannounced inspection, which raised serious concerns in relation to medication and food and fluid charts. An immediate requirement was left and a letter of serious concern was sent on 5th August 2009. On Monday 17th August 2009 we returned to Hinton Grange to assess compliance and complete a random inspection. We went to the first floor where we found the medication trolley locked but with the morning medication blister packs (for all people in the unit) left on top. The nurse was administering medication in one persons bedroom and she could not see the trolley. We viewed the Medication Administration Record (MAR) sheets for one person and found that disposable aspirin 75mgs and Bisoprolol 125mgs had been signed as given for the following day 18/08/09. All other medication was signed as being given on the 17/08/09 (the day this inspection was taking place). On looking at the blister packs for the two named medications there were 21 tablets left for each. There should have been 20 tablets of each remaining, assuming no further errors had been made. However if the entries for the 18/08/09 were included, nine tablets of each medication would have been administered leaving 19 tablets. The risks remain that trained and registered nurses are not competent to administer medication in line with their professional guidelines. The manager stated she had audited all MAR sheets on Friday 14/08/09 and the errors are therefore thought to have been made after that time. We also looked at food and fluid charts for people who had problems maintaining their weight or could possibly dehydrate. We viewed care plans in the home to check information relating to food and fluid in particular, but looked at other areas if there were concerns. Two care plans showed that peoples identified care needs were not adequately recorded or how they were to be met. However, care staff we spoke to were able to explain the needs of the two people, but did not have clear instructions in the care plans on how care was to be offered. There is a risk that people will not receive the care they need and not all care provided will be recorded. The care plans are computer generated and stored there, although some elements had been printed and placed in a file. The plans consisted of a Care Plan summary, Care Plan report, daily progress notes report and Evaluations. The Care Plan summary for one person dated 26/01/09 stated she was on a soft/pureed diet and free fluids. Her care plan report relating to eating and drinking activity, dated 18/08/09, showed brief details of her needs. It stated the goal was to maintain her weight and ensure she gets a healthy diet. There was not enough information on how staff would meet those needs. There was no guidance on how staff should assist or encourage her with food intake or the frequency or types of foods and fluids to be offered. There were instructions to observe for changes in her eating and to inform the dietician and GP as needed. Her care plan showed that she had weak and frail skin and unable to maintain her safe environment and that she is chair bound and bed bound and could easily become isolated in her room. We went to her room and she was sitting in a chair with her legs resting on another chair. She looked well presented but the room had a strong odour of urine. There was a food and fluid intake chart in the room. There was one entry at 8am for 200mls of tea and porridge 1 (one) pot and 1 (one) pot of Forticreme. We visited the room at 11:55am. This was the only record of food and fluid intake. There were no other records from previous days in the file, managers office or any other location in the home.
Care Homes for Older People Page 4 of 9 There was no reference in her eating and drinking plan about any fluid charts being needed. There had been input from the Dietician approximately two months earlier when Forticreme had been recommended, but no request for fluid or food charts to be kept. There were no further visits noted in the multidisciplinary visits record. There were monthly weight records that showed no major changes. The manager was unable to find any reason this person was on a food and fluid chart or who had requested the charts to be completed. One person was calling for assistance and we went to her. She was complaining of severe pain in her abdomen and we asked a carer to come immediately. She had been unable to summon help as her call bell cord was out of reach. The carer summoned the nurse who told the person she was unable to give further medication as she had taken her paracetamol. She then said she would look and see if there was anything else she could give. The care plans were seen and they showed that this person had seen the GP on 03/08/09 and on the 07/08/09. There was no care plan in relation to handling pain. Food and fluid charts were in place and those from 13-16/08/09 were seen and fluid varied between 500mls and 810mls a day. There were no details in the information shown to us on the day of inspection that showed how much fluid this person should be drinking. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 9 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 6 of 9 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Staff must write a detailed plan of care with the person living in the home. This is to ensure the health, care and social needs of people living in the home are met. 18/08/2009 2 9 13 Staff must ensure the safekeeping of all medication. This is to ensure medication cannot be taken by people it is not prescribed to. 18/08/2009 3 9 13 Staff must make accurate 18/08/2009 records of medication administered to people in the home. This is to ensure any prescribed medication is given for the health of a person in the home. Care Homes for Older People Page 7 of 9 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 9 of 9 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
