Archived: Hinton Grange

This unannounced comprehensive inspection was undertaken by two inspectors and an expert by experience and took place on 18 May 2017. At the previous inspection in 22 November 2016 the service was rated as ‘Requires Improvement’. At this inspection we found that improvements had been made and that these had been sustained.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had been trained on how to keep people safe from harm as well as being knowledgeable about to the reporting procedures regarding any incidents of harm. Organisations responsible for investigating safeguarding were made aware of incidents in a timely manner to help assure people’s safety. Accidents and incidents were identified and acted upon when required.

Risks to people had been identified and processes and systems were in place to manage these risks effectively. This reduced the risk of people being exposed to any potential of harm.

People’s nursing and care needs had been assessed and we found that a sufficient number of appropriately recruited and suitably skilled staff were in post to safely meet these needs.

Medicines were administered and managed safely by staff whose competency to do this had been assessed. Where medicines’ administration recording errors had occurred, action had been taken to help ensure that people were safely supported with their prescribed medicines.

Staff had been trained in a variety of subjects such as dementia care, safeguarding, infection prevention and control and food hygiene. Staff, as a result of their training and support from management, had the necessary care skills to meet people’s health and nutritional needs. People were enabled by staff to access support from external health care professionals in a timely manner.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA] and to report on what we find. People were supported to have choice and control of their lives. People's ability to make day-to-day and more complex decisions about their care and welfare were assessed by staff. Restrictions on people’s liberty had been determined as being in their best interests or in the least restrictive way possible such as the use of bed rails. Appropriate applications to deprive people of their liberty had been made and when agreed, authorisations were in place to lawfully deprive people of their liberty.

People were looked after by staff who showed people compassion and respected their privacy and dignity.

People, their relatives or legal representative were enabled to be involved in identifying, determining and planning the review of their care.

People were supported to be as independent as they wanted to be where this was safe. People took part in a variety of hobbies, interests and pastimes. This stimulated people and prevented the risk of social isolation as well as helping them to maintain current skills.

There were effective systems in place to gather and act upon people’s suggestions and concerns. Actions taken in response to people’s concerns were effective in preventing these becoming a formal complaint. This was as well as helping prevent the potential for any recurrence.

The registered manager was supported by a deputy manager, a clinical lead, nursing and care staff, as well as catering and maintenance staff. Staff had the support mechanisms in place that they needed to fulfil their role effectively.

The registered manager and provider had notified the CQC about important events that, by law, they are required to do. People, their relatives or representative and staff were involved and enabled to make suggestions to improve how the service was run. Quality monitoring and assurance processes were in place. Improvement actions identified were acted upon.

After the comprehensive inspection on 7 June 2016, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 22 November 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Hinton Grange’ on our website at www.cqc.org.uk.

Hinton Grange is a two storey building located in a residential area of Cambridge. The service is registered to provide the following regulated activities. Accommodation for persons who require nursing and personal care and treatment of disease, disorder or injury for up to 60 people. At the time of our inspection there were 41 people using the service.

The home had a registered manager in post. They had been in post since 3 November 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our focused inspection on 22 November 2016, we found that the provider had followed their plan which they had told us would be completed by 4 August 2016 and legal requirements had been met.

People were confident that their medicines were administered in a timely manner. Arrangements were in place to ensure that there were sufficient quantities of medicines in place. The management of people’s medicines was in line with guidance from organisations such as the National Institute for Health and Care Excellence. People received their medicines safely and as they had been prescribed.

While improvements have been made we have not revised the rating for this key question: to improve the rating to 'Good' would require a longer term track record of consistently monitoring the quality of the service and delivery of high quality care.

We will review our rating at the next comprehensive inspection.

This comprehensive inspection took place on 7 June 2016 and was unannounced. There were 48 people living at the home when we visited.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the home is run. The registered manager had been in post since August 2015.

Medicines were not always managed safely and the provider had not ensured that there were sufficient quantities of medicines available to meet people’s needs.

Staff had undergone training and were competent to recognise and report any incidents of harm. Potential risks to people and to their health were assessed, recorded and managed so that people were kept as safe as possible.

There was a sufficient number of staff on duty to meet people’s assessed needs and staff had been recruited in a way that ensured that only staff suitable to work in a care environment were employed. Staff had undertaken a range of training courses so that they were equipped to do their job well.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS), which apply to care services. People’s capacity to make decisions for themselves had been assessed. Appropriate applications had been made to the relevant authority to ensure that people’s rights were protected if they lacked mental capacity to make decisions for themselves.

People were supported to maintain good health and their healthcare needs were met by the involvement of a range of healthcare professionals. People were given sufficient amounts of food and drink and the nutritional needs of people who required special diets were met. The environment was not always used in a way that supported people who preferred a calm space to sit in.

There was a range of quality in the care provided. Most staff showed that they cared about the people they were looking after and treated people with kindness, respect and compassion. People found communication difficult with some of the staff. People’s privacy was upheld and personal information was kept securely so that their confidentiality was maintained. Visitors were welcomed to the home at any time.

Care records included care plans which gave staff guidance on how to meet people’s needs so that each person received the care they needed in the way they preferred. People and their relatives knew how to complain and complaints were responded to in a timely manner. A range of activities were provided for people.

People and their relatives were encouraged to share their views about the service being provided to them in a number of both formal and informal ways. Staff were also given opportunities to share their views about ways in which the service could continue to improve. Staff understood the provider’s whistleblowing policy. Audits of aspects of the service were carried out to check that a high quality service was provided. Records were maintained as required.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager at Hinton Grange. At the time of this inspection the person managing the home was on annual leave.

We arrived at Hinton Grange at 6:20am as some of the concerns were in relation to the care that people were receiving at night. We spoke with three people who lived at the home and eight staff, including senior staff. We looked at various records, including staff rotas, and records of the care that people had received.

We considered the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found.

Is the service safe?

We found that there were sufficient staff on duty, both during the day and at night, so that the needs of the people who lived at Hinton Grange were met. There had been a few occasions when staff had called in sick at very short notice, which meant that staff numbers had been reduced. Senior staff told us that they could use agency staff when necessary. Staff said the work was very hard sometimes but we did not find any evidence that shortage of staff had had a detrimental effect on any of the people who lived at the home.

We looked at the charts on which staff recorded various aspects of the care given, such as when people had been assisted to change their position in bed and how much each person had had to drink. These records showed that staff provided the care that each person needed and that the records were monitored. This meant that care was being delivered by staff in a safe and appropriate way.

The provider had a robust recruitment process in place, which meant that all the required checks were carried out to ensure that new staff were suitable to work with vulnerable people.

Is the service effective?

People we spoke with told us they were satisfied with the service they received from the staff.

Records we looked at showed that people were receiving the care they needed, such as being assisted to change position during the night and being given sufficient amounts of fluid to prevent them becoming dehydrated.

Is the service caring?

During the time we spent at the home we saw that people who lived there had good, caring and warm relationships with the staff. One person said, 'Staff are very nice.'

One staff member told us they had returned to work at this care home, 'Because they do care if people have the care they need, they do let people have choices, they do care when people are alone in their rooms.'

Is the service responsive?

People we spoke with told us they had choices in their daily lives. Staff confirmed that people could choose what time they got up and went to bed, as well as making choices about all other areas of their daily lives.

Is the service well-led?

There was effective leadership in place, which ensured that people's needs were met, that they were kept as safe as possible and that a good quality service was provided to people by the staff. One member of staff said, 'It's good. Most days it runs really nice and smooth.'

We found no evidence during this inspection to validate the concerns that were raised with us.

People living in the home and their relatives said the staff provided the care they needed. Staff we spoke with knew people well and about their likes and dislikes. People were given choices as far as possible and in a way that was meaningful.

The health professional said the home was good. There was a routine GP round and if an issue was not an emergency then people were seen during that, however people were referred appropriately by the nurses in the home when serious concerns were raised.

One person told us, "It's boring here. I don't live here. That lady ( a carer) is lovely. She works hard." A relative said that there were good activities provided in the home. There were details of activities that take place on each floor but these are limited as there is only one activities co-ordinator at the moment.

One relative commented that, "I feel very welcome and I am greeted by my name".