Care Home: Claridge Nursing Homes (Hampton Grange) Limited

What the care home does well Information about the service in general and specific areas such as menus and activities are made readily available in the reception area and in people`s bedrooms. There is enough staff for people to receive personalised health and personal care and have their social needs met. A lot of effort goes into involving people`s supporters in their care. Medication is managed safely and these are always administered by a qualified nurse. There is always a first aider on duty. A wide range of activities are being provided and these include ordinary daily tasks to help make life feel as normal as possible. There is now a full time activities organiser and the full activities diary is well advertised. People who stay in their rooms are offered private sessions and visiting entertainers also go around to see these people. The food provided is varied and nutritious and takes people`s dietary needs, wishes and preferences into account. One man said he likes his own copy of the weeks menu and he showed us this in his bedroom. The meal observed was calm and people were using several rooms so the groups were small and the atmosphere calm and unrushed. Great effort is going into monitoring and promoting good nutrition for people at risk of malnutrition. The creative approach to meals and drinks is proving successful and has resulted in the Home reaching the finals of a West Midlands competition on this subject. The home is well maintained, safe, clean and attractive. Ongoing improvements are being made and staff said repairs are dealt with quickly. Routine safety checking systems are in place. Staff feel well supported and training is well planned and organised. There is a clear management structure and each shift is lead by the nurses on duty on each floor. The owner and manager use a variety of quality assurance methods, including finding out what people think about the home in quarterly surveys. Meetings are held with people living in the home and also with friends and relatives. The information gathered is used to help them improve the service. A relatives support group has recently been set up and is proving popular. The manager, Sue Huxley, was registered by us in September 2009. Although she was not available on the day of the inspection, feedback showed that people find her approachable and committed to making the service as personalised as possible. What the care home could do better: The positive care we witnessed staff giving to people needs to be supported by clearnursing care plans that are kept up to date with each person`s current support needs and wishes. The guidance for staff needs to be widened so all nursing areas where support is required are covered in the plan, for example: safety, emotional and behavioural needs. Certain areas of staff training could be further developed and more care staff should gain qualifications. When arrangements are in place to protect vulnerable people from specific known risks the agreed safeguards must be maintained at all times and staff must stay vigilant. Consideration should be given to people`s right to have personal information about them kept confidential. Currently all care records are on display in bedrooms and are unsecured. The manager needs to improve the quality of record keeping in some areas. Random inspection report Care homes for older people Name: Address: Hampton Grange Nursing Home Hampton Grange Nursing Home 48-50 Hampton Park Road Hereford Herefordshire HR1 1TH 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: Jean Littler Date: 0 5 0 5 2 0 1 0 Information about the care home Name of care home: Address: Hampton Grange Nursing Home Hampton Grange Nursing Home 48-50 Hampton Park Road Hereford Herefordshire HR1 1TH 01432272418 01432274265 admin@hamptongrange.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Suzanne Huxley Type of registration: Number of places registered: Conditions of registration: Category(ies) : Hampton Grange Nursing Home (Hereford) Ltd care home 42 Number of places (if applicable): Under 65 Over 65 42 0 old age, not falling within any other category physical disability Conditions of registration: 0 42 The maximum number of service users who can be accommodated is 42. The registered person may provide the following category of service only: care home with nursing - Code N; to service users of the following gender: either; whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD; Old age, not falling within any other category - Code OP. Date of last inspection Care Homes for Older People Page 2 of 11 Brief description of the care home The Health Authority first registered Hampton Grange as a nursing home in 1992. The property comprises of a large Victorian house and purpose built extension and is set in fairly extensive grounds on the banks of the River Wye. The home is located in a residential area about a mile from the centre of Hereford and is on a main bus route to the city. The home provides 42 places for older people who have nursing and/or personal care needs arising from general ageing, physical disability or terminal illness. A Statement of Purpose and Service User Guide are displayed in the main reception area of the home. All new residents receive a copy of the Service User Guide. It is possible to request the information in alternative formats i.e. Braille, large print and audiotape. A schedule of fees is available from the home, and a copy of the last inspection report can be viewed at the home. Care Homes for Older People Page 3 of 11 What we found: We (the Care Quality Commission) carried out this inspection unannounced, which means no one at the home knew we would be arriving. One of our inspectors spent a day at the home and looked at a cross section of things. While we were at the home we met some of the people who live there, spoke to some of the staff, and family members of two of the Service Users. We saw some parts of the building and looked at some of the most important records such as those about care needs, medication and staff training. We were able to see staff supporting people and we got a picture of day to day life in the Home. We found out how activities and food are organised and saw the meal served at lunchtime. Some weeks earlier the owner and manager sent us their annual quality assurance assessment (AQAA for short). This is a document which services are required to send to us to tell us what they do well, what they think they need to improve and what their plans are to achieve these changes. The AQAA showed that improvements have been made during the last year and that people using the service have been consulted about what can be changed to enhance their quality of life further. We also received feedback from 9 people who live in the home and from 10 staff who all returned surveys to us. The feedback was very positive. Staff told us there is a good team spirit, appropriate training, people living in the home have their individual needs catered for and the home is being well manged. One worker said, Since I started I have had a lot of help and support with my personal development and training. The families are made welcome and there are activities each day to meet individual and group needs. The manager is always coming up with new and exciting ideas. People using the services told us that there is enough staff to meet their needs, the food is good and the home is comfortable. Some comments included: They look after me very well; The staff are lovely; The home is clean and we are well fed; I am very happy, the food is wonderful, the staff are kind and the manager is a God send. Our discussions with people living in the home, relatives and staff showed that people are treated as individuals and those using the service feel they are having their health and care needs met in a personalised manner. The staff seemed very caring and were aware of the need to help people maintain their preferred routines and independence as long as possible. Two family members spoken with confirmed that they are fully consulted about their loves ones care. They said they are encouraged to spend time at the home and provide care directly if they wish to, for example, assisting with meals. They have full access to the care records so they can see how their relative has been while they were away. One said her father visits regularly and is provided with a meal to eat with his wife, his special dietary needs are provided for. Care Homes for Older People Page 4 of 11 The care records for one person were looked at in detail. The persons needs had been changing over previous months and then significantly after a recent hospital stay. The records had not been kept up to date to show how all her support needs were being met. For example, the Mobility plan said she was still using a walking frame when she could no longer walk, even when aided by staff. The nurse spoken with had a different view of the current moving and handling arrangements than a carer who was asked. The nurse said if the person is tired then a hoist is used, however there were no details of which type of hoist or sling should be used or how many staff were needed. The scoring on the persons Nutritional risk assessment had not been changed to show that she had lost weight recently even though it was noted that this assessment had been reviewed monthly. Discussions with staff and the records in the persons Lifestyle care plan showed that good efforts were being made to encourage her to eat well. There were areas of care missing from the care plan completely, such as, how the person was being supported with agitation. Again discussions showed that this had been considered and Mental Health professionals were involved. The person had had many falls in 2010 but the records were not clear as to how this risk had been managed. The bed rails assessment did not make it clear when rails had been used and who had been consulted. It was not clear who had been consulted about the Mental Capacity Assessment that the manager had completed, although staff said her next of kin would have been involved. The accident report for one incident did not include all the details and staff had to provide these to us verbally. Two people had been involved in a safeguarding incident. Both were vulnerable adults with some cognitive impairment. This was appropriately referred to the local multi-agency Safeguarding Team, chaired by the Local Authority, where decisions were made about how to protect the victim. This persons care plan did not contain a protection plan to guide staff about how she was to be kept safe. Discussions showed that the agreed arrangements were in place, such as an alarm on her bedroom door. However, at the inspection her dignity was not being protected as she was exposed and her bedroom was open. In the week after the inspection a cleaner moved the door alarm by mistake and another incident occurred. The manager has assured us that she has taken more robust action now and arrangements are being checked hourly. The training matrix showed that staff are given essential safety and awareness training in core areas and routine updates are provided. A lower percentage have completed First Aid, Dementia Awareness and Understanding Challenging Behaviours. Currently only 9 of the 21 care staff (who are not nurses) hold a NVQ qualification in Health and Social Care. Efforts are ongoing to increase the level of qualified staff and 5 others are working towards an award. The home was warm and quiet and people seemed comfortably seated in the various lounge areas. It is positive that the providers are aiming to extend the property and stop using shared bedrooms. Privacy screens are used but the nature of peoples needs particularly at the end of their life means single rooms would help provide privacy and dignity. At the last Key Inspection in July 2007 we judged that people using the service experienced Good outcomes. We have used all of this information to help update our view and we found that overall people are still receiving Good outcomes. In some areas the service has been improved such as the range of activities, the promotion of good Care Homes for Older People Page 5 of 11 nutrition the environment and the life style care planning. Significant shortfalls were found in the care planning system on the nursing side, that guide staff how to meet peoples needs. We are, however, confident that the owner and manager will act on our requirement and this area will be quickly improved. What the care home does well: What they could do better: The positive care we witnessed staff giving to people needs to be supported by clear Care Homes for Older People Page 6 of 11 nursing care plans that are kept up to date with each persons current support needs and wishes. The guidance for staff needs to be widened so all nursing areas where support is required are covered in the plan, for example: safety, emotional and behavioural needs. Certain areas of staff training could be further developed and more care staff should gain qualifications. When arrangements are in place to protect vulnerable people from specific known risks the agreed safeguards must be maintained at all times and staff must stay vigilant. Consideration should be given to peoples right to have personal information about them kept confidential. Currently all care records are on display in bedrooms and are unsecured. The manager needs to improve the quality of record keeping in some areas. 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 7 of 11 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 8 of 11 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 12 The assessed health and support needs for each person must be clearly explained in their plan of care. This is to make sure staff know what care to provide to each person to promote their health and wellbeing and ensure they are protected from harm. 30/06/2010 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 2 28 30 Continue efforts to increase the number of care staff who are qualified. Provide training such as first aid, dementia awareness and understanding challenging behaviour to a higher percentage of care staff to better equip them for their work role. Review the storage arrangements for personal information about people using the service, consider their legal right to have control over who sees this information. Page 9 of 11 3 37 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 4 37 Put in place a system that ensures all relevant situations and incidents are reported to the Care Quality Commission. Care Homes for Older People Page 10 of 11 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. 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