Care Home: Hinton Grange

What the care home does well The staff have a training schedule that provides them with the statutory courses as well as specialist courses for things such as dementia, Parkinson`s, wound management, impact training and National Vocational Qualifications. What has improved since the last inspection? Care plans and their content have improved and provide some good detailed information so that staff can meet the needs of people who live in the home. What the care home could do better: The times people are turned, have food or fluid should be actual not approximate, this would provide accurate information if it is needed. Staff must only work the number of hours permitted by the Home Office if they are in the UK on a student visa. This is expected to be managed by the home. Records made when medicines are given to people must be accurate and complete to demonstrate that people receive their medicines as prescribed. We expect this to be managed by the home rather than make a requirement on this occasion. Key inspection report Care homes for older people Name: Address: Hinton Grange Bullen Close Cambridge Cambridgeshire CB1 8YU     The quality rating for this care home is:   two star good 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: 1 8 0 5 2 0 1 0 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 24 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Hinton Grange Bullen Close Cambridge Cambridgeshire CB1 8YU 01223246360 01223246361 manager.hintongrange@careuk.com www.careuk.com Care UK Community Partnerships Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 60 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 Care Homes for Older People 1 7 0 8 2 0 0 9 60 60 0 60 Over 65 0 0 60 0 Page 4 of 24 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 5 of 24 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: two star good 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 inspection on Tuesday 18th May 2010 between the hours of 07:00 hrs and 15:50 hrs. There were two inspectors for some of that time and also a pharmacist inspector. The pharmacist inspector looked at all areas to do with medication and its administration and safe keeping. Details of these findings are in the report. One inspector completed a short observation in one lounge. This allowed us to observe practice and interaction between staff, people who live in the home and others. Information about our findings is detailed in the report. We spoke to people who live in the home, night staff, day staff, acting manager, service improvement director, ancilliary staff and relatives. We looked at the files for some staff and people who live in the home, and other Care Homes for Older People Page 6 of 24 records that are required to be kept. There were seven surveys returned by people living in the home and four by staff. Details of their comments are in the report. Care Homes for Older People Page 7 of 24 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 24 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 24 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 have sufficient information available to allow them to decide if their needs can be met by staff in the home. Evidence: The information provided in the Statement of Purpose and Service User Guide would allow people who may wish to live in the home to decide if the staff could provide the care they needed to meet their needs. People and their families are encouraged to visit the home before they make any decision to live there. Pre-admission assessments had been completed for people whose files we inspected. Other information had been received from local authorities and discharging hospitals, which provided further details. Hinton Grange does not provide intermediate care and so Standard 6 does not apply. Care Homes for Older People Page 10 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Input from health professionals and comprehensive care plans ensure the health and social care needs of people living in the home are met. Evidence: The care plans for four people were seen. There has been a marked improvement in the quality of these and the information contained in them. Details were up to date and informed staff of the personal needs of individuals. On one file there was an excellent description of how a person behaves, followed by the methods staff should use to help the person become less agitated. It included how to approach the person and how to speak to them. Staff have to record incidents of agitation on a chart and they said this was done, but the incidents had become less as staff had improved the way in which they dealt with situations. There was evidence that charts were completed for food and fluid intake. Totals showed that people were receiving good amounts of fluid. Turn charts for people cared for in bed were seen and these had all the necessary details in them. All the charts showed everyone given food/fluids and being turned on the hour. It would be useful if Care Homes for Older People Page 11 of 24 Evidence: more accurate times were detailed. The acting manager was made aware of this. Pressure area care was well documented and included details of the type of bed in use, moving and handling methods and required frequency of turns. There was evidence that a wide variety of professionals are involved in the home including GPs, District Nurses, Dieticians, Tissue Viability Nurse, Speech and Language Therapist, Parkinsons Nurse and Community Psychiatric Nurses. There were appropriate referrals and where specified actions were required from health professionals, these were being completed. We looked at accident and incident logs in the home and found they were well recorded. Where possible the risk of falls especially from bed had been dealt with by the provision of new beds that can be lowered to floor level and a special mat placed by the side. There was evidence of how this prevented serious injury during the inspection when someone was found by us on the specially designed mat beside their bed. Staff attended and the person was assisted back to bed having been checked for injuries. We looked at the practices and procedures for the safe handling, storage and recording of peoples medicines. Medicines are stored securely for the protection of residents and the temperature of the rooms where the medication is stored is monitored and recorded regularly to ensure medication is of suitable quality. The temperatures of the fridges used to store medicines are also monitored and recorded regularly and were acceptable. We found a used cream in one persons room for which there was no record made on the persons medication record. We looked at the medication and medication records for several people resident in the home. Records are made when medicines are received into the home and when they are disposed of and, in general, these were in good order. We found a few gaps in the records made when medicines were given to people giving no indication whether medicines were administered and if not, the reason why was not recorded. We found some discrepancies in that the quantity of medication left over did not always tally with what should have been if the records were correct. Some hand-written medication records did not clearly indicate the date on which medication was given to residents. We have not made a requirement about the accuracy and completeness of medication records on this occasion but expect this to be managed by the home. For one person we found that they had run out of medication and although further supplies had been ordered the person had been left without a medicine for 8 days as the order had not been chased up by staff. The record made that the medication had Care Homes for Older People Page 12 of 24 Evidence: been omitted as supplies had run out was unclear. Some people were prescribed medicines to be given as directed and we found that care plans carried verification of the dose to be given and that these were regularly reviewed. Comments made by people living in the home were as follows:- I am very well looked after. The carers are very kind, I am very happy with the treatment my (family member) gets. Always nicely dressed and clean, The staff at all levels are extremely caring and very pleasant. We highly recommend this home, The home cares for my (family member) as an individual, knowing thier likes and dislikes. X enjoys the activities and speacial events such as the Valentine meal for couples. The garden is of great benefit during the summer. X is always clean and tidy, Care and consideration to residents is excellent by all staff no matter what level and Staff are always happy and friendly. Care Homes for Older People Page 13 of 24 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. There are a range of activities that people can choose to participate in so that they can maintain interests and are stimulated. Evidence: People are encouraged to take part in activities that take place, but can choose not to. On the day of inspection there was a jazz duo playing upstairs whilst people had a buffet lunch. People appeared to be enjoying the band and the informal lunch and staff said many were eating more than they usually did and in some cases eating when they did not normally do so. The atmosphere was relaxed and there were many smiling faces around the room. We spoke to the activities co-ordinator who explained that many people living in the home did not want big trips out, but wanted things like a picnic in the garden, which would be arranged when the weather improved. In the minutes of the relatives meeting 5/5/10 it was noted that a local ice cream van had been arranged to call once a month, song and dance entertainers had been arranged and a summer fete was being organised. In the minutes of the residents meetings 8 & 21 April people had asked for scrambled Care Homes for Older People Page 14 of 24 Evidence: or fried eggs and these were provided on request. There were cooked breakfasts on three days a week but on the other days they could be provided if requested. People we spoke to said the food had improved since they got the cook back and no longer had cook chill meals. We were shown visual menus which use pictures of the meals to be served to prompt anyone who is unsure of the choices on offer. Staff were clear that they would also use other methods such as showing the person the actual meal to ensure they had a proper choice. At tea and coffee times the staff also offer cakes, biscuits and fresh fruit and were heard to encourage people to have something from the trolley. Visitors are made welcome at Hinton Grange and are encouraged to visit and be involved in their relative/ friends life. This includes attending meetings, joining in activities and any outings arranged. The local school is intending to send young people to the home to talk to residents. This was done last year and was positive for the young people and those living in the home. The acting manager said that some young people had returned to the home to visit people they became close to. One inspector completed a short observation in one of the lounges and noted that some staff missed opportunities to engage with people when they were checking on them in lounges or dining areas. One staff member was seen to interact with people in an affectionate and appropriate way and this made a positive difference to them. Other staff appeared task orientated and did not take the time to talk to people in a meaningful way. One person was giving hand massages and these were well received but could have gone on longer, and although the massage was on one person opportunities to include others in conversation could have been better used. There are two part time activities co-ordinators and a vacancy for a further 24hr post. Staff commented in the surveys returned that all staff are cheerful and good activities days are arranged. Care Homes for Older People Page 15 of 24 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. There is a procedure for dealing with allegations of abuse to protect people living in the home and this is understood by staff. Evidence: The acting manager stated that there have been no complaints or safeguarding issues since the last inspection. Deprivation of Liberty has been discussed with the local authority in relation to two people living in the home and information is documented. The complaints procedure is detailed in each unit and in the foyer of the home. We asked if there was any information about safeguarding and the acting manager said it was in each unit office. Further information in the form of posters was immediately put on the notice board of each unit, detailing what abuse is and who to contact in the event of suspecting abuse is occurring. Staff were aware of how to deal with safeguarding issues but less clear about who has overall responsibility. Care Homes for Older People Page 16 of 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and tidy, which means people have a pleasant and homely place to live. Evidence: There were no malodours in the home. People we spoke to said the cleaning had improved. All areas are well maintained and there is a secure garden that means people who have dementia and other confusional states can remain safe. The new head of housekeeping was spoken to and she said she was provided with anything she required to enable her team to keep the home clean. She said that her staff are in the home seven days a week but at weekends also cover the laundry and kitchen duties. Care Homes for Older People Page 17 of 24 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. There are sufficient staff who are trained to a good level to meet the needs of people living in the home. Evidence: We looked at the files for three staff who had started recently. All the necessary documents were on file. It was noted that as students they were exceeding the hours they were permitted to work. The acting manager stated this had already been noted and the person who completed rotas was in the process of amending them to ensure all staff worked only their permitted hours. The manager is aware that the number of hours can be increased outside term time. Staff we spoke to and information provided in the four surveys returned to the Commission showed they had received the necessary training as well as specialist training in areas such as dementia, impact training (which several staff commented had been very good), safeguarding and files showed some staff completing Health and Social Care NVQ Level III. Some staff had not completed the e-learning training required by the acting manager and letters were on their files giving them dates by which the training had to be completed or action will be taken. There are vacancies for night staff (24hrs); domestic (14hrs); and care (48hrs). Care Homes for Older People Page 18 of 24 Evidence: One comment made by a person living in the home was that it is very difficult to understand some staff members who have a strong overseas accent. Another comment was that at times staff appear under pressure, which linked with a comment from a realtive that their family member required extra help because of their level of dementia and the resulting issue of hand cleanliness, which they felt could be improved with extra staffing. Staff comments showed that new staff are made welcome. Staff treat people as individuals and there is good personalised care. Care Homes for Older People Page 19 of 24 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 current management arrangements are working and the changes being made are improving outcomes for people who live there. Evidence: The acting manager will remain in post until the new manager (who starts on 28 june 2010) has had time to settle in. Staff said they had been supervised and there was evidence on files to confirm this. During the inspection it was evident that staff, relatives and residents were comfortable with the manager and the service improvement director being in the home. Staff said they felt the two managers had provided the leadership needed to move the home forward and felt a lot more positive about the home and what care was being provided. The caretaker oversees the fire drills and logs. We spoke to him and he showed us the Care Homes for Older People Page 20 of 24 Evidence: records of fire drills. These showed who has taken part and includes all night staff. Staff (including night staff) said they were regularly involved in drills and had used some of the eqipment including fire extinguishers. Care Homes for Older People Page 21 of 24 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 22 of 24 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, 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 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 23 of 24 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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