Inspection on 05/07/05 for Hinton Grange

This inspection was carried out on 5th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Hinton Grange 21/12/09

Hinton Grange 17/08/09

Hinton Grange 04/08/09

Hinton Grange 17/06/08

Hinton Grange 03/09/07

Hinton Grange 01/08/06

Hinton Grange 20/12/05

Hinton Grange 04/01/05

Hinton Grange 16/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hinton Grange Bullen Close Cambridge Cambridgeshire CB1 4YU Lead Inspector Alison Hilton Unannounced 05 July 2005 @ 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Hinton Grange Address Bullen Close, Cambridge, Cambridgeshire, CB1 4YU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01223 246360 01223 246361 admin.heatherbrook&careuk.com Care UK Community Partnerships Limited Sharlene Van Tonder Care Home with Nursing 60 Category(ies) of Dementia under 65 years of age named registration, with number individuals DE(2), Dementia - over 65 years of of places age DE (E) (28), Mental Disorder, excluding learning disability or dementia - over 65 years of age MD (E) (30), Old age, not falling within any other category OP (30), Physical disability over 65 years of age PD (E) (30) Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Dementia under 65 years of age (DE) 2 named individuals. Date of last inspection 4th January 2005 Brief Description of the Service: Hinton Grange is a purpose built home registered to provide accommodation, support and nursing care for people over the age of 65 some of whom have a mental disorder. 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. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection that took place on Tuesday 5th July 2005 was unannounced and began at 07:47 hrs and finished at 16:30 hrs. There were 57 residents in the home on the day of inspection with a new admission expected during the morning. The manager was present during the inspection. 10 Residents (some of whom had dementia), 5 visitors and 8 staff were spoken to, general files were seen and personnel and resident files were also inspected. What the service does well: What has improved since the last inspection? 1) Care plans were found to meet the standard at the last inspection but there have been improvements in those inspected on the first floor and consequently the home will score 4 for this standard. 2) There were offensive odours when the inspector initially entered the building and inspected various rooms, but within a short period of time these had been dealt with and the home was free from offensive odours before the conclusion of the inspection. 3) The manager has collaborated very effectively with a home also owned by the same provider, on the coast, which (after much organisation) resulted in a ‘holiday’ for a current resident and her spouse. 4) Staff completing NVQ Level 2 felt that having assessors who worked in the home was very positive for them. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 6 5) The home now has a record of any issue raised by residents, their visitors and staff, which means that the manager can see if there are any patterns emerging and therefore action that has to be taken. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4,5 and 6 Residents and their visitors said they had had the opportunity to visit the home before coming to live at Hinton Grange so that they could see what it was like, check the suitability, and talk to the staff and other residents. EVIDENCE: The home does not offer intermediate care. In discussions with residents and visiting relatives it was clear that most residents had been admitted from hospital or another residential placement and it was their relative or friend who had decided on Hinton Grange as a suitable home. Relatives said that they had often visited several homes before deciding on Hinton Grange. Some said that other voluntary agencies had provided them with information and support when they were making their choice. The manager said that prospective residents and their families are encouraged to visit at any time and without warning so that they can gain a true picture of the home. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 9 Pre admission assessments were not on the files seen during the inspection as they are archived after a period of time to ensure the information on file is the most up to date. The manager confirmed this. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 There has been an improvement in the care plans on residents files and these provide excellent, clear information to enable staff to care for residents in a safe and positive way in both the ground floor and first floor flats. EVIDENCE: The care plans seen during the inspection have improved since the last inspection and now include sections on night care (which provides specific information on areas such as when the resident has said he/she would like to go to bed, get up and early morning drink); care plans covering things such as safe environment, ability to use call bell system, meeting nutritional needs (including necessary assistance at meal times and special cutlery), continence, skin viability and personal hygiene. Care plans include agreements for bed rails and wheelchair lap belts (where necessary) that are signed by the resident (where possible) or their representative. Evidence of the completion of regular reviews of the care plans was on file. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 11 The wound care information on one file was found to contain comprehensive notes and full up to date information. It was discussed with the manager that where there are links between areas of a care plan such as continence, skin viability and pressure sore dressings, it could be useful to cross-reference these. This would ensure that the areas were looked at as a whole and not in isolation. Details of visits by health care professionals and others were detailed on residents’ files. On talking with some relatives they also said that if they have any concerns over their relative the staff will request a visit from the Doctor or other appropriate person. One relative felt the home had been exceptional in the way they had supported her in dealing with the hospital her mother had been sent to for treatment. On the day of inspection staff were seen to treat residents with respect and always knocked before entering a room. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 There is a lot of time spent by the home talking to relatives and friends of residents, especially on the extra care unit, to make sure their likes and dislikes are known, ensuring that appropriate choices can be offered. The food seen on the day of inspection was well presented, and appeared to be wholesome. The dining rooms provided pleasant, clean and companionable areas in which to eat. EVIDENCE: Visitors in the home at the time of inspection said they were made to feel welcome. The home operates an open door policy and residents can receive visitors when they wish. Other professionals are also encouraged to visit at any time. The home has three activities co-ordinators. Two are employed in the ground floor units for 16 hrs and 9 hrs respectively. Upstairs adequate activities staff have not always been maintained (although there has been help from the ground floor co-ordinators), but the manager has now managed to fill the post with someone who held the post previously and is very familiar with the home and residents. Friends and relatives said that they often take the person they visit out for lunch or out in the car. Some take them out into the garden at the home to feed the birds. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 13 The home continues to use the cook/chill method for providing meals. On the day of inspection the choices for lunch were Asparagus soup, roast turkey, shepherds pie, roast or mash potatoes, mixed vegetables and cauliflower. For sweet there was Eves pudding, plum crumble with cream or custard. Pureed meals were set out well. The manager said that a new menu was due to start the following day as the result of talks with residents. The new menu would include things such as lamb and lentil curry, beef Bolognese, fish in parsley sauce, broccoli and herb quiche and Hungarian goulash. Sweets would include chocolate sponge, custard rice pudding, tapioca pudding and fresh fruit and yoghurt. There is always a choice from 2 meat and 1 vegetarian dish. Suppers include soup, assorted sandwiches, hot choice such as macaroni and smoked haddock, cheese, onion and potato pie or sausage roll and beans. Followed by fresh fruit or yoghurt. Lunchtime meals were dished up for individual residents and they were asked if they wanted gravy. Food is kept in a heated trolley. In the dining room three residents were being assisted with their meals individually. Staff spoken to said that there were 7 or 8 residents who required assistance and a further two who needed to be encouraged to eat. Some residents chose to remain in their room for lunch. All comments about the food were positive from residents and visitors alike. Many relatives came at lunchtime to assist with feeding their resident relative in pleasant surroundings and with other people. The home had a resident’s forum on 5th May 2005 where specific issues were discussed and actions to be taken detailed. The last relatives meeting was held on 29th April 2004, but the manager said that she is always available to discuss issues with service users, their families and staff. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaints procedure continues to be displayed in the home so that residents and visitors can see the process to be undertaken. EVIDENCE: Most staff said that they had received Vulnerable Adult / Abuse training over the last year. The complaints procedure is on the wall in the entrance hall and as part of the statement of purpose. Relatives said they would speak to the manager if they were concerned about any aspect of care. Residents said that they would speak to carers if they had a problem. Both parties felt the manager and staff would listen and act on their concerns. The complaints book was seen as part of the inspection and the information in relation to the one complaint was dealt with as per the homes own procedure. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 15 It was suggested at the last inspection that any issue raised by residents, visitors, family members etc be recorded. This has now been done and includes issues raised by staff. The manager said that it provides a useful record so that any patterns can be seen quickly. Stair gates, bedsides and wheelchair belts are risk assessed and written agreements are made with the resident or their relative or friend. The finances for the two residents whose files were inspected were seen. One has no money at the home and the other was correct. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 and 26 The home provides all the necessary equipment for residents to ensure their comfort and safety. The gardens are secure and provide a pleasant amenity. The home was free from offensive odours once the cleaners had completed their work after residents had been got up and out of bed, providing pleasant and hygienic surroundings. EVIDENCE: Hinton Grange is a purpose built home on two floors. Downstairs the unit is for people with a diagnosis of dementia. The upper floor for frail elderly residents is accessible by stairs or lift. Both floors have number pads to exit the units. The grounds are accessible and enclosed with private areas to sit in. The manager said that funds had been provided from the company and this money Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 17 will be used to take up paving stones and lay concrete allowing easier level access to the garden for all residents. A safety rail is due to be placed round the whole of the garden. A ramp is also being built. A proposal to use the proceeds from the recent fete to purchase more benches, tables and parasols for the garden has been made. Residents rooms seen during the inspection had small pieces of furniture, pictures, photos and other personal items in evidence. The home has an ongoing re-decoration programme and two areas (a lounge and toilet) were discussed with the manager. These are already areas in line for re decoration shortly. The home has 52 single bedrooms, 26 of which have en-suite facilities. There are 4 double rooms and all have en-suite. There are two baths and two shower rooms on each floor. The home also has ten separate toilets. Grab rails are positioned around the building and in bathrooms. Any specialist equipment necessary to meet the needs of any service user would be provided. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 The home has the number and skill mix of staff to ensure the needs of residents are met. EVIDENCE: Staff spoken to during the inspection were a mix of nurses and carers from both the night care team and the day care team, and ancillary staff in the home. The home does not use agency staff but has numerous staff on a bank system. The home has 21 registered nurses (including the manager), 37 care staff, 3 administration staff, 1 maintenance man, 12 domestics and 6 kitchen staff. Some of the care staff are adaptation nurses who are nurses in their country of origin but need to complete a course before they can act as nurses in this country. Care staff indicated that they were in the process of completing NVQ Level 2. They said that other courses had also been completed including all the statutory courses but also wound care, abuse, a tissue viability Diploma and food hygiene. The manager stated that 6 nurses had recently been on a phlebotomy course and she was hoping all would complete the course as soon as possible. The manager indicated that other courses include customer care, communication skills, dispelling the myths (provided by funeral director), elder abuse and adaptation nurses course. Every Thursday has been set as a training day and staff are expected to attend. A detail of attendees is recorded on computer and updates for required courses such as moving and handling, fire and first aid are highlighted. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 19 Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 34, 36, 37 and 38 Staff receive supervision from staff qualified to do so. Records kept in the home such as accident forms, incident forms and policies and procedures are completed to safeguard residents. EVIDENCE: The manager is a registered nurse and has completed the necessary work for the Registered Managers Award but is waiting for her assessor to send the work for verification. The manager stated that there are three staff qualified to give supervision. The home now has contracts for supervision, which will be completed on each occasion. The manager said that supervision was taking place but was not always recorded. Staff confirmed that supervision is taking place, but is often ad hoc and not documented as it often relates to individual issues. Formal Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 21 supervision is taking place and where documented the notes should be signed by the manager (or supervisor) and supervisee. This will be followed up at the next inspection. The manager was concerned about clinical supervision for nurses as this was not covered within the company. As a manager she is looking at courses that will enable nurses to update their skills and knowledge. Accident forms were well completed with good details. The incident forms require more information so that possible reasons for the incident can be ascertained. It was discussed with the manager that this is especially necessary on the extra care unit so that it can be seen if it the way someone is handled/ spoken to etc is a factor in the cause. It can then be used to put forward a plan of action to change the way individual residents are dealt with. The manager stated that a monthly pharmacy audit is completed in house. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 3 x 2 3 3 Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 36 36 Good Practice Recommendations The registered person should ensure that staff supervision is recorded and agreed by both parties with a signature. The registered person should ensure that nurses receive clinical supervision. Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 24 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hinton Grange I53 I03 24273 HINTON GRANGE V234704 050705 STAGE 4.doc Version 1.30 Page 25 - 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!