Inspection on 04/08/09 for Hinton Grange

This inspection was carried out on 4th August 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Hinton Grange 21/12/09

Hinton Grange 17/08/09

Hinton Grange 17/06/08

Hinton Grange 03/09/07

Hinton Grange 01/08/06

Hinton Grange 20/12/05

Hinton Grange 05/07/05

Hinton Grange 04/01/05

Hinton Grange 16/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Hinton Grange Bullen Close Cambridge Cambridgeshire CB1 4YU     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Alison Hilton     Date: 0 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Hinton Grange Bullen Close Cambridge Cambridgeshire CB1 4YU 01223246360 01223246361 manager.hintongrange@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd care home 60 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) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 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 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 Care Homes for Older People Page 4 of 26 Over 65 0 0 60 0 60 60 0 60 Brief description of the care home 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 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Care Quality Commission (CQC) carried out a key unannounced inspection of Hinton Grange on Tuesday 4th August 2009 at 07:10 hrs using the Commissions methodology described below. This report makes judgements about the service based on the evidence we have gathered. Staff (including night staff), people who live at the home and the manager were spoken to. An Annual Quality Assurance Assessment (AQAA) was completed and returned to the Commission prior to this inspection. Surveys were sent to people living at the home, their relatives and care staff working there. Information they provided will be in the body of the report. A number of records were seen including staff files, care files for people living in the home together with other relevant documents and charts, medication administration records and training information. Care Homes for Older People Page 6 of 26 A short observational tool for inspection (SOFI) was undertaken in the dementia unit. This is an observation of any interactions there are between people who live in the home and any other person, and whether these are positive or not. The details are noted every five minutes over a period of two hours and we use the details as evidence shown in the body of the report. The last Key Inspection was on 17/06/08 and an Annual Service Review (ASR) on 27/04/09. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may wish to live in the home have the relevant information they need to ensure the home and the staff working there can meet their needs. Evidence: A copy of the Statement of Purpose and Service User Guide are kept in the foyer of the home together with a copy of the inspection reports from the Commission. The information was up to date and contained all the necessary details. People who would like to live in the home have an assessment of their needs. Some information was very basic and would not provide enough detail for the manager to decide if staff could meet that persons needs. For example the assessment for one person was that they were unable to walk in or outdoors, but there was no indication as to what equipment or aids were needed. This was discussed with the manager who will ensure more detail of a persons needs and how they must be met is recorded. Care Homes for Older People Page 10 of 26 Evidence: Information was provided by the placing authority where they assist with funding and examples were seen during the inspection. The information they provided was adequate. People spoken to said they or their family had visited the home before they came to live there, and this is encouraged by the staff. The home does not provide intermediate care and so Standard 6 is not applicable. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Records must be maintained and completed appropriately to ensure the health and wellbeing of those living in the home. Evidence: Three files for people who live in the home were seen. Some of the information they contained was very good and focused on the person, however there were areas where the information was very limited. One person had consent to bed rails noted on file as there was a risk of rolling out of bed. The risk assessment for the bed rails indicated there was a high risk of entrapment because of weakness or disability, therefore bed rails should not be used. There was no indication of the date of the assessment or who had completed it. This was brought to the attention of the manager who said she would immediately arrange for this person to have a low bed which would mean bed rails were not necessary. This will be checked at the next inspection. One good care plan contained information about a persons behaviour during personal care and how to handle them to ensure the safety of staff and the person. There was evidence that people are seen by their GP and other health professionals Care Homes for Older People Page 12 of 26 Evidence: when necessary and this was confirmed by some of those spoken to during the inspection. One file showed that a person was losing weight but had been seen by the GP, dietician and speech and language therapist. The nurse on the nursing floor was asked to show us the Medical Administration Record (MAR) sheets for one person in the home. On doing so it was evident that there was one medication (Bisoprolol 1.25mg to be taken at 8am) on the sheet that did not appear to have been administered since the start of the new blister pack. The nurse said the medication had been administered but could give no explanation as to why the MAR sheet had not been completed by any nurse. The blister pack was seen and the number of tablets were correct if they had been given. The manager was asked to accompany the inspector to see the error and on looking at the records the nurse said she had filled in the chart for the days she had been on duty and administered the medication. The manager and nurse were informed this was not acceptable and that information relating to non administration or error must be detailed on the back of the MAR sheet and any other documentation completed as necessary by staff in line with the homes policies and procedures. Several other MAR sheets were checked and there were no errors in these. The manager has completed medication audits and there have been Regulation 26 visits by the provider, none of which has picked up this error. One person had been prescribed Diazepam PRN (to be taken when necessary) and the MAR sheet showed this had not been required for the preceding three weeks (the extent of that MAR sheet). The nurse said there had been no occasions when it had been needed. It was suggested that the staff speak to the prescribing GP to see if the medication could be removed from her chart, making errors less likely. Some files seen for those living in the home showed there were several people who were on food and fluid charts. Although they had been filled in with amounts, no-one had added the total amount of fluid people had drunk during the day or how much food had been eaten. There were no details as to how much fluid it was advisable for each person to consume each day or any recording of when food or fluids were refused. This poor recording means people could be at risk of dehydration or malnutrition. The manager was informed of these issues and she immediately went to the units to ensure everyone had fluid available, staff were instructed to fully complete charts. In a later conversation the manager informed us that night staff now add the fluid measurements and a copy of each chart is placed in the managers tray for her to audit the following day. She has also looked at further training for staff. This will be looked at during the next inspection. (See also Daily Life and Social Activity). Care Homes for Older People Page 13 of 26 Evidence: Information on the care of pressure areas was clear but in discussion with the manager it was suggested that each pressure area be documented separately. This would make it easier to see when a wound had healed, or where a change to the care of a specific area had been made. People living in the home said they were treated with dignity and where personal care was necessary this was done in private. Care plans are reviewed and evidence of this was seen on the computer, however the computer system does not update information on care plans in a time effective way. Staff have to type information a number of times, which means some areas of the file are not fully up to date. There were some concerns about what happens if the computer system goes down and the files are not available on line. The manager is aware. Staff surveys showed they felt the home delivers excellent care, although there is always room for improvement. The home is always clean and tidy. One relative survey showed they felt the home provided good personal care, food and laundry facilities. Another said they care well for clients. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can take part in activities if they want to, giving them choice. People living in the home do not enjoy all the meals, which could lead to weight loss. Evidence: People visit their relatives in Hinton Grange regularly and there were several in the home during the inspection. The visitors signing in book also shows regular visits by family and friends of those living in the home. There is a new activities co-ordinator in post since May this year. She has had some training and has dates for further training this week. The manager said she has put the co-ordinator forward to complete NVQ Level II in activities. The co-ordinator works 35 hrs per week and covers both floors with some assistance from two other staff. Some activities she provides are music for health, taking people to the shops, exercise groups, games, assisted gardening, hand massages and manicures. She also comes in early to assist with the morning cups of tea and breakfast, which gives care staff the time to get people up and this was evident on the day of inspection. She was given details of the National Association for Providers of Activities (NAPA), which provide information and suitable courses for activites co-ordiantors. Care Homes for Older People Page 15 of 26 Evidence: There was information on some files of peoples interests, but there needs to be more detail so that people can be encouraged to participate in things they may have enjoyed in the past as well as trying new things. It was discussed with the activities co-ordinator that things like folding napkins could provide suitable stimulus and sense of well being for a person with dementia if that is an activity they may have done at home or as part of a job. There are many other examples of those types of activity within a residential setting if thought about. People had choice about whether they participated in an activity and this was recorded in their notes and confirmed by people we spoke to. One survey returned by a person living in the home showed they have a good activities co-ordinator. The meals are still cook chill although the manager is making every effort to get the company to employ a chef in the home, which will give much more choice to people living there. Details in the surveys returned showed people want better food and more choice with a cook on site. Relatives agreed. We completed a SOFI in the dementia unit observing the interactions for five people who live in the home. The activities co-ordinator was flexible and good at engaging with people. Four people had positive and useful interactions, but one person had been consistently ignored by staff and other people in the home. At one point there had been five staff in the room but she was still excluded from any conversation. She was not offered a drink during the observation (1hr 40mins) and the care plan for this person states the need for fluid and food charts to be completed because of concerns over dehydration and malnutrition. The manager immediately left the room to ensure all those living in the home had access to fluid and check when this person specifically had been given fluids. (See also Health and Personal Care). Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff need to understand the policies and procedures on safeguarding to ensure people who live there are protected. Evidence: The Commission has not received any complaints about the service. Details provided in the AQAA showed that there had been 10 complaints dealt with by the manager. On discussing them she was clear about her role and responsibility and the companys policies and procedures. All staff spoken to said they had received training in the Safeguarding of Vulnerable Adults (SoVA). They were aware of what constituted abuse but were less clear about what their role was and how they should report an incident and that this must be done as soon as possible to the appropriate manager and not left until the end of a shift. The manager was informed and stated most staff had completed e learning but she would check competencies. It was suggested that she contact the Safeguarding team who have a training provision available. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home benefit from a safe and clean environment with access to well kept gardens. Evidence: Details in the AQAA and a tour of the building provided evidence that there has been some decoration of dining areas, bedrooms and hallways. There has been new flooring in some areas of the home. There were new pictures in the hallways and some were historical, relating to places those who live in the home would know. There were textured pictures and boxes attached to the walls in the dementia unit that allow people to take things out and fiddle with them and either put them back or leave them and staff will put them back. When we were looking round the baskets had things like spectacles and small cuddly toys in them. The gardens remain accesible to those on the ground floor and are used by people as part of gardening activities. Peoples rooms suit their needs and many have their own TV, radio and other personal items. There was some odour early in the morning but this had gone later in the day after the cleaners had been round. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff on duty meet the current needs of those living in the home. Evidence: Details in the AQAA showed that a training plan has been completed for the year and staff have signed up to complete NVQ Levels II and III. There are also long distance learning courses that staff are completing on health and nutrition, equality and diversity, and palliative care. In discussion with the manager she said that these are marked and if they do not reach a certain standard the person has to complete further questions before a pass is given. The manager is in the process of looking at how she will measure competency once courses have been completed. Staff are receiving regular supervision and those spoken to during the inspection confirmed this. Three staff files were seen and all had the necessary paperwork and no-one started work in the home before the full and satisfactory PoVA First or Criminal Record Bureau (CRB) check had been received, ensuring the people living in the home were protected. The rotas were seen and on each floor there are 2 nurses and five care staff between 8am and 2pm; 2 nurses and three care staff between 2pm and 8pm and 1 nurse and Care Homes for Older People Page 19 of 26 Evidence: two care staff between 8pm and 8am on duty each day. Some staff work long days i.e. from 8am to 8pm, but they have days off and do not work excessive hoursthat would put other staff or residents at risk. Surveys receieved from staff (4) gave a range of views about training with 2 saying they felt they received an induction that covered everything they needed to know about the job, one that it mostly did and one that it only partly did. Three felt they were given training that was relevant, kept them up to date, gave them knowledge about health care and medication and understand the needs of those they care for, however one person felt they did not receive training to keep them up to date or knowledge about health care and medication. One person commented that although there was a mixed group of residents there were more females they felt there should always be a female member of staff on duty but this was not always the case at weekends on nights when it has been all male carers on duty. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has an open door policy for staff and people living in the home (and their relatives) to ensure consistently high levels of care. Evidence: Details in the AQAA show that the manager has been in post since November 2008. There is a deputy manager who is a registered nurse. The fire information was seen together with details of staff who had completed fire drills. The manager said she ensures all staff have been involved with fire drills and that included night staff and those seen confirmed this. Staff confirmed they received regular supervision from either the manager or her deputy. Some comments in the staff surveys included the manager could spend more time on the floor to get to know residents; the manager could nip bad habits in the bud if Care Homes for Older People Page 21 of 26 Evidence: she spent more time on the floor; manager and senior staff could be more supportive and listen to concerns and act on serious issues; care staff do exactly as they please; need meetings so staff can discuss things. Care Homes for Older People Page 22 of 26 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 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 1 9 17 The registered person must maintain a record of medication administered to any person living in the home. This is to ensure people are given medication as prescribed. 07/08/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 8 17 Suitable food and fluid charts must have sufficient and suitable details recorded. This will ensure peoples dietary needs are adequately met. 10/08/2009 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 1 7 Care plans should be updated as soon as possible after any change in circumstances so that any care given is appropriate and necessary. Pressure areas should be documented separately so that information is specific, which ensures nothing is missed and a chronological detail of treatment is evidenced. Page 24 of 26 2 8 Care Homes for Older People 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 3 4 12 18 Staff should be inclusive in their dealings with everyone living in the home to ensure a positive experience for all. Staff need to understand the companys policies and procedures in the event of a safeguarding issue so that people who live there are protected. Care Homes for Older People Page 25 of 26 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). 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