Inspection on 25/09/07 for Cranford Nursing Home

This inspection was carried out on 25th September 2007.

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

Cranford Nursing Home 21/09/09

Cranford Nursing Home 30/08/06

Cranford Nursing Home 16/11/05

Cranford Nursing Home 05/07/05

Cranford Nursing Home 07/02/05

Cranford Nursing Home 11/10/04

Cranford Nursing Home 12/03/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Cranford Nursing Home 15 Cranford Avenue Exmouth Devon EX8 2HS Lead Inspector Dee McEvoy Unannounced Inspection 10:00 25 September 2007 th X10015.doc Version 1.40 Page 1 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 Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 2 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. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranford Nursing Home Address 15 Cranford Avenue Exmouth Devon EX8 2HS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01395 263295 01395 267273 Baystone Limited Martin David Ough Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may providet he following category of service only: Care home with nursing- Code N to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category- Code OP The maximum number of service users who can be accommodated is 26. 30th August 2006 Date of last inspection Brief Description of the Service: Cranford Nursing Home is a detached 1920s building in a quiet residential part of the East Devon town of Exmouth. It provides residential accommodation to 26 older people who require nursing care. It is situated in attractive gardens. Accommodation is provided on two levels, and has a passenger lift and large staircase. Accommodation is provided in 24 single and 1 double room. 22 single rooms have en suite facilities. The home has a large, welcoming reception hall where seating is provided. Baystone Ltd. owns the Home and the responsible individuals are involved in its day-to-day management. The home’s statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home, a statement of terms and conditions and details about living at the home. This is made available to all potential residents before they make a decision about living at the home. A copy of the most recent inspection report is available on request. Information received from the home indicates that the current fees are £730 to £850 weekly depending on individual needs. Services not included in this fee include hairdressing, chiropody, toiletries and personal shopping, laundering of delicate clothing or dry cleaning, televisions, visitors meals and transport at 25p per mile. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, in order to hear their confidential views of the service, prior to our unannounced site visit. Completed surveys were received from 14 residents; 3 relatives, 6 staff and 4 health and social care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. We spent 10 hours at the home, speaking with people living there, their relatives and staff. We also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and four people were spoken with in depth to hear about their experience of living at the home. During our visit we met and spoke with two relatives. We also spoke with 8 staff, including the owners, the registered manager, nursing, care and ancillary staff, individually or in a small group. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Finally the outcome of the inspection was discussed with the owners and the registered manager. What the service does well: People living at this home were generally very happy with life at the home; one person told us, “The home has lived up to my expectation and I haven’t been disappointed”, another said, “I have no regrets about moving here”. Relatives told us about the “high standards of care” provided at the home, one said, “I am really impressed with how they have coped”. Relatives were confident that their relative was “getting the best care”. People spoke highly of the staff; we were told that staff were “respectful, friendly, kind, marvellous and caring”. One relative said staff always appeared Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 6 happy at work and that “staff keep a sense of humour. I think they are saints!” During our visit staff were attentive and friendly in their approach to people living at the home. We saw staff skilfully meet the needs of individuals and ensure that individuals were offered choices. Good information is available to people to help make a decision about whether this home would suite their needs. A good admissions process ensures that the home can meet people’s needs. People’s health care needs are well met and the home works with other professionals, such as GPs and nurse specialists to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were generally happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. People feel confident that their complaints or concerns will be addressed. There are systems in place to ensure that people living at the home are protected from harm or abuse. The environment is clean, comfortable and safe. People were very happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Many people praised the staff team for their caring approach and attitude. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. Staff are well trained and relatives and professionals were confident that they had the skills to meet the needs of the people living there. Staff are recruited robustly to ensure that people are protected. The home is well managed, with systems in place to ensure that people ‘have their say’ about the development of the service. Overall, health and safety is well managed and people are safeguarded from harm. What has improved since the last inspection? One requirement was made at the last inspection to ensure that medicines were stored safely. This has been met. This New documentation has been introduced for assessment and care planning that will ensure a more consistent approach. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 7 Medicines were stored securely, with the exception of medication stored in the fridge. Since the last inspection medication with a limited effectiveness once open has been dated to ensure it is used within the appropriate time. The owners continue to refurbish and up-grade the home. Major work is being undertaken to replace the boiler and hot water system. Further redecoration and replacing of carpets is planned. 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. The summary of this inspection report can be made available in other formats on request. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information about the services offered here is available to people to help them decide if the home will suite their needs. People benefit from an improved admission practice, which ensures that the home is able to meet their needs. EVIDENCE: The majority of people responding with surveys (11 of 14) told us they had been given enough information about the home before deciding to move in. (Two people did not answer this question). One person wrote, “We had very good recommendations about the home. We visited to inspect and got an information pack”. Another person wrote, “I know I could not be in a better place”. Some people spoken with told us they had visited the home before making a decision; one person said that their family had visited several homes with them and that “this was the best”. Another person told us they liked the home when they first visited and was “very happy”. One relative wrote, “I Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 10 visited several nursing homes. We were of the opinion that Cranford was the most suitable”; another relative told us, “I was impressed when I came to visit”. There is a guide to the home, the Statement of Purpose, which gives people an idea of what to expect of the home. A copy of this and the most recent inspection report is available in the hallway and one relative told us they had read it and found it useful. 11 of the 14 people contacted said they had been given a contract which helps to make sure people are clear about the terms of their stay, their rights and responsibilities. (Two people did not answer this question). Individual contracts were seen, which contained information about the cost of care, which room was to be occupied and other terms and conditions. The individual or their relative/representative had signed contracts. The home has introduced a new format to the assessment records, which provides nursing staff with a good model for assessing people’s needs. This has improved the overall quality of information available. Most pre admission assessments identified care needs in sufficient detail on which a plan of care could be written. The manager visits people at home or in hospital before they move to the home to talk about and assess their needs and ensure that the home is able to meet their needs. As regular reviews arise, the new format is being used for all people living at the home, ensuring the consistency of records. All relatives responding with surveys felt confident that the home was meeting the needs of their relative, one wrote, “A very high standard of care” and another said, “The care given by the home is good”. Staff surveyed said they had not been asked to care for people outside of their area of expertise, suggesting the home admits people appropriately. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems in place generally inform staff about peoples’ care needs, although lack of adequate detail in some care plans may prevent truly individualised care for everyone. People’s health needs are well met with good multidisciplinary working, and the management of medication is generally satisfactory, helping to protect people’s welfare. People feel they are treated with respect and that their privacy is upheld by caring staff. EVIDENCE: Surveys received from 10 people living at the home showed that they “always” received the care and attention they needed, three people said they “usually” receive the support they needed. Relatives told us they felt their relatives’ needs were “always” met. One relative wrote, “I call at different times & have always left feeling thankful that my mother is looked after with such care & attention”. Another relative said, “Very caring and competent & always a cheerful atmosphere. I am very happy with the situation”. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 12 All health and social care professionals contacted said that people’s needs were “always” met by the service, one wrote, “I would be happy to have a relative looked after there”. A new care planning system has been put in place since the last inspection, which helps to ensure that staff have enough information about people’s individual needs. Three care plans were looked at during this inspection. They generally detail individuals’ needs and wishes and are developed with the individual and/or family member. One relative told us they had been “fully involved” in care planning and thought this was very valuable and gave her confidence that individual needs are considered and planned for. Two of the care files we looked at contained important information about people’s past life and occupation, providing staff with an understanding of the individual. There was some good detail about peoples’ likes and dislikes - for example, what time they liked to get up or go to bed. Some aspects of people’s care plans, such as their physical needs, were more detailed than other areas, such as psychological or social needs. In one file the person’s preferred daily routine had not been recorded to ensure that they receive the care they need in a way they prefer. Care plans consider the needs of people with diabetes, and records show their condition is monitored. However, there are no clear guidelines to ensure an agreed range of acceptable results for blood sugar levels to ensure all staff know what to do should levels fall outside of the range. Risk assessments were in place and generally reflected behaviour or situations which may cause harm to people, for example poor mobility, falls and the use of equipment such as bed rails. Moving and handling assessments and plans, skin care and tissue viability and continence assessments were in place and generally provided staff with the instructions needed to deliver care. People told us they “always” or “usually” receive the medical attention they needed. Health professionals responding to CSCI surveys felt that the home “always” or “usually” consulted with them appropriately about people’s health care needs, and that staff acted on any advice given. One GP wrote, “Always seem to seek advice appropriately”. One relative told us how their Mother’s condition had improved since moving to Cranford. People’s nutritional needs are assessed and records of people’s weight shows that they either gain or maintained weight after admission to the home. One person is prescribed supplement drinks to improve their nutritional intake and the care plan states that these are needed twice a day. Currently the home is not keeping a record to indicate that this is happening as prescribed (refer to standard 9). Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 13 Care files showed that people have access to outside professionals such as G.P, specialist consultants, palliative care team; chiropodist and optician in order to ensure their health care needs are met. People’s personal care is well attended to. People were well dressed and groomed, and attention to their personal care was good. Many female residents were wearing make up and jewellery, one told the inspector, “I see the hairdresser regularly”. The male residents were smartly dressed and well shaved. Staff spoken with and observed demonstrated a good understanding of the people’s needs and preferences. The home’s medication storage and records were looked at. The fridge used to store medicines does not have a suitable lock, which could present a risk to people. Other storage was satisfactory, including the arrangements for storing of controlled medicines. Suitable arrangements are in place for the safe disposal of unwanted medication. Medicine Administration Records (MAR) were looked at; where hand written entries had been made, two signatures had been obtained to ensure accuracy, this is good practice. Where variable doses of medication are needed, accurate records were available with the actual dose given. On several occasions, codes were not used where medicine had not been given. Some people are prescribed creams to be applied daily. In some cases records were poorly complete indicating that this may not be happening. No record is kept of when prescribed supplements have been given. Medication with a limited ‘shelf life’ once open had been dated to ensure they were used within the timescale suggested by the manufacturer. People spoken with told us that staff respect their privacy and dignity, one person told us, “Staff are always polite and respectful”, another said, “I find them (staff) sensitive and caring people”. One relative wrote, “My mother is treated with complete dignity & respect. She is always beautifully turned out”. During our visit, staff were polite and friendly when delivering care. We saw staff knocking on people’s bedroom doors and addressing them in a respectful way. All health and social care professionals responding with surveys felt that staff respected people’s privacy and dignity. It was evident that staff had established a good rapport with people. The home works with palliative care professionals to ensure people receive the care they need at the end of their lives. One relative told us, “The staff are so kind” and described how staff maintain and respect privacy during family visits. A good standard of care is given to people during this time, ensuring that they receive appropriate attention and pain relief. The home involves family members, and we were told by one relative that they could and do visit at any time. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible and people are supported to exercise control over their daily lives. Social activities generally meet peoples’ expectations and preferences and people enjoy a balanced diet which takes into account the likes and dislikes of individuals. People benefit from contact with their family and friends, which is encouraged and supported by the home. EVIDENCE: People told us the routine at the home was fairly flexible, one person told us, “I am free to get up and go to bed when I choose”, another said, “There are no rules here”. Seven people returning surveys told us that there were “always” activities at the home they could take part in; two people felt this was “sometimes” the case. Five people did not respond to this question. Activities are organised, and one member of staff is allocated time three afternoons a week to provide some stimulation and interest for people. An ‘Activities’ photo album showed people enjoying organised social events, such as garden parties and fetes. Trips out are organised occasionally, including a recent trip to a local nursery. The home Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 15 uses community transport to help get people out and about. Some people spoken with during our visit were happy with the activities provided, one was particularly happy with the regular bingo session, we were told, “I have never played before and it is such fun!” Other people told us they enjoyed the piano recitals held and one person said, “There are opportunities to do different things here”. Regular activities include, keep fit session, arts & crafts, flower arranging and musical events. One person wrote, “I enjoy the keep fit, games, skittles, piano recitals, aromatherapy, and bingo”. Another person said they would enjoy the opportunity to go out more often. Some one to one activities are also provided, such as reading with or to people. This was seen during our visit. People are able to choose whether to take part in activities or not, others said they enjoyed spending time in their rooms and chose not to take part. Some people are also supported to continue with previous interests and hobbies outside of the home; one person is assisted to maintain her role with a local committee. One relative told us, “They try hard to put on events and stimulate people”, another wrote, “Mother is far more stimulated here than her previous place”. There is no restriction on visiting times and throughout the day visitors came to the home and were made to feel welcome. Relatives told us that they could visit at any time and that they felt welcome at the home, one wrote, “I am encouraged to visit anytime that suits me”. Relatives said the home kept in touch with them and informed them of any changes or events affecting their relative, another relative wrote, “All staff are very approachable & keep us informed about anything that’s happening”. One relative told us, “The staff are prepared to listen” and another said, “I have been involved in decisions, they do consult with us”. One relative said it would be nice if they were offered a cup of tea when visiting, two other relatives spoken with during our visit said they were always offered refreshments. 11 people responding with surveys felt that staff listened and acted on what they said, two said this was “mostly” the case. People were given choice throughout the day, for example what they wanted to eat and drink, where they sat, what clothes they wore and people said that they were able to choose when they got up or went to bed. When one person became restless in their chair but couldn’t express what they wanted to do, staff skilfully assisted, taking her for a walk and chatting until she was happy and relaxed again. Surveys showed that people “always” or “usually” enjoyed the food served at the home. People we spoke with all said how good the food was. They described the choices available and were full of praise for the regular cooks. The cook speaks with most people daily to discuss what is on the menu and find out what people would like for supper. The cooks are experienced and knowledgeable about people’s dietary needs and preferences. All relatives contacted commented on the high quality of food provided, one said, “Beautiful meals provided”, and another said, “Food is of a very good standard”, a third Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 16 wrote, “In the area of meals the kitchen will endeavour to meet individual requests”. People can choose where to have their meals; several people choose to eat in the dining room. People can choose when to have their breakfast and many people have breakfast in their room; individual trays are laid with butter, marmalades and jams. The atmosphere in the dining room at lunchtime was convivial; tables were nicely laid with menus and condiments. Staff were available to assist people in a discreet manner where needed. The lunchtime meal was very nicely presented and appeared to be well balanced and nutritious. We heard staff offering people a variety of drinks including beer and wine with lunch. Those people requiring a pureed diet had each component of the meal separated on the plate, which looked appetising and colourful. A list of special occasions seen in the kitchen included dates important to people who lived at the home such as birthdays, anniversaries, etc. One person told about the efforts made by the home to ensure her special day was celebrated, “I have recently had my 100th birthday. Absolutely everything was done to help me celebrate and make it a day to remember for myself & family who came”. The kitchen was well stocked with supplies, including fresh fruit and vegetables and a good supply of dried goods. The cook told us that all food was of “fantastic quality” and that the home does not “scrimp” on food. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Staff are aware of the procedure to follow to protect people from abuse or harm. EVIDENCE: People living at the home know who to speak with should they have any concerns or complaints and most were aware of the complaints procedure. One person told us, “I have nothing to complain about but would soon tell them”, another said, “I could talk to any one about concerns”. All relatives contacted were aware of the complaints procedure and said they knew who to speak with if they had any problems. The home has received two ‘minor’ complaints/concerns since the last inspection, and records show that these were dealt with in a professional manner and that people were happy with the outcome. No complaints have been received by the Commission in respect of this service. All staff responding with surveys said they were aware of the adult protection procedure in place to protect people living at the home. Staff spoken with said they had received training to help them recognise any poor practice or Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 18 evidence of abuse and all were aware of their responsibility to report any concerns. People living here felt well cared for and described staff as “kind, caring, polite and friendly”. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy a good standard of accommodation that is attractive, clean, homely and well maintained. EVIDENCE: The home has a programme for redecoration and improvement to ensure that people enjoy a good standard of accommodation. Major renewal of the plumbing system is in progress and once this has been completed the owners plan to start redecorating all communal areas and bedrooms where vacant. New carpets have been purchased and will also be laid. People spoken with were happy with the accommodation provided, one person said, “This is a lovely place”, another said, “I appreciate the lovely gardens”. The gardens around the home are accessible and used by many people, weather permitting. A gardener is employed to keep the gardens and lawn looking nice. Several individual bedrooms were visited with people’s Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 20 permission. Bedrooms were comfortable and personalised with sentimental items, photographs and small pieces of furniture. The home has the necessary equipment to assist people and meet their needs. Aids, hoists, and assisted toilets and baths are installed which are capable of meeting people’s individual needs. Staff told us they had the equipment they needed to ensure that care was provided safely. There was a lack of call bells in lounge, with one or two people only having access to a bell to alert staff to any needs. During the day one person became very distressed about the behaviour of another resident and felt it was her responsibility to call staff to attend. This was discussed with the owners and manager. It was accepted that some people were unable to use a call bell and the owners identified other ways of ensuring that people in the lounge were checked more frequently to lessen this problem (also refer to standard 27). A new plumbing system is being installed, which ensures that water is delivered at a safe temperature in order to prevent accidents from scalding. The home was clean and free from offensive odours throughout. People responding with surveys said the home was “always” clean and fresh. Relatives also told us that the home was kept clean and odour free. One relative told us, “The home is always immaculately clean”, another wrote, “The cleanliness of the home seems good” and another said, “The place is always clean”. People also commented on the flowers arranged around the home, one person wrote, “Fresh flowers make the home attractive”, and a relative told us, “There are always lovely flowers around the place which are bright and cheering”. Good infection control is maintained through staff training and practice. Staff have the necessary protective equipment, such as gloves and aprons. There is liquid soap and disposable towels in toilets and bathrooms to promote good standards. The laundry is well equipped and managed by an experienced member of staff. The necessary equipment is available, such as two washing machines and two dryers. Sheets are sent to an external laundry. A red bag system is used for any soiled laundry ensuring staff are protected. The laundress takes great care with people’s personal items of clothing. People spoken with said they were very satisfied with the laundry service provided and that their clothes were taken care of and always nicely pressed and returned in good condition. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 21 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff numbers and the skill mix are satisfactory and ensure peoples’ needs are met in a timely and proper way and people benefit from having experienced and friendly staff who have a good understanding of their needs. People are protected by the robust recruitment practice followed at the home. EVIDENCE: Several people spoke highly of the staff. Comments included, “Overseas staff are wonderful”, “Staff are out of this world”, “I find them sensitive and caring people” and “Staff are very nice”. Relatives also praised staff saying, “They are so kind”, “Very welcoming, cheerful staff” and “Staff are very caring on the whole”. People told staff were “always” or “usually” available when needed. People felt they received the care and attention they needed. When asked people told us that staff come quickly to answer bells, one person said, “I have all the help I need”, another said, “They (staff) are there when I need them, and another person told us, “I am very happy with care and help I get”. All relatives responding with surveys felt that the home gave the support required and could meet the different needs of people living there. The manager and staff felt that generally staffing levels were good. One staff member said, “We are never left short” and another said, “We have enough Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 22 time not be rushed when giving care”. During our visit staff were seen to attend to people in a timely way. Bells were answered promptly and although busy during the morning, there was a calm and orderly atmosphere. Sufficient ancillary staff, such as kitchen staff, cleaners, laundry staff and a gardener are employed in satisfactory numbers to ensure that standards relating to food, cleanliness and the general environment are met. However, it was observed that people sitting in the lounge could be without staff supervision in the morning for up to 40 minutes. Some people do not have access to a call bell to alert staff to their needs, other people do ring the bell on their behalf, but more staff presence would avoid this. One relative also mentioned this lack of staff presence in the lounge. This was discussed with the owners and the manager, who were keen to find ways of ensuring that people’s needs were regularly monitored during the day in these communal areas. Staff morale at the home is very high and staff felt valued; several people described the job satisfaction they get from working here, comments from staff included, “The Cranford is happy place to work”, “The owners of the home are very kind & caring. I always look forward to going to work in a very happy & friendly atmosphere” and “I am very happy in my work place. Our priority is the residents & I feel they are well cared for & very happy. I have worked here for over 4 years and I hope am there when I retire”. Three staff recruitment files were looked at. These were clear and contained all the required documentation including satisfactory police checks to ensure that people living at the home are protected from unsuitable staff. The AQAA shows that over half the care staff at the home have achieved a nationally recognised qualification in care (NVQ 2 or above). All staff responding with surveys said they had received an induction training when they first starting working at the home to help them understand how the home works and how to care for people safely. Staff also said they receive relevant training to help them do their job well. All staff felt well supported. Individual staff training records are being developed and staff are responsible for up-dating their training log. Training records looked at showed that several staff had attended first aid training, common eye problems and care, nutritional up-dates, dementia care and other mandatory training. One member of staff told us, “Training opportunities are very good here,” another said, “They pay for all our training”. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 23 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home is well managed, and run in the best interest of the people living there. Satisfactory systems are in place to promote the safety and health of people living and working at the home. EVIDENCE: Since the last inspection the manager has been registered with the Commission, and appears to have settled into his role well. He is currently working towards completing the Registered Manager’s Award, which will consolidate his knowledge. Staff felt the manager was approachable and friendly. One wrote, “I think the home runs quite smoothly at present”. The owner are very involved in the day to day running of the home and staff and people living at the home spoke highly of them. Staff told us, “The owners Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 24 are caring, kind, thoughtful and generous hearted people, not solely concerned with profit” and “Mr & Mrs Ward are smashing employers & they are always there for the staff & will listen to any comments that you wish you to make & will act on them if needed”. One G.P wrote, “Excellent nursing home, well run, nice atmosphere” and a visiting contractor at the home told us they visit many care homes and in their opinion, “This is a lovely place, well run, nice atmosphere. One of the best I’ve been to”. A quality audit has been undertaken since the last inspection to gather people’s views relating to the running of, and the quality of life experienced at the home, including standards of care, quality and variety of food, activities, cleanliness, laundry, privacy and management and administration at the home. The results of the survey show a high level of satisfaction. A basic summary of the last satisfaction surveys has been collated and is available for people to see. The majority of staff told us that they receive regular supervision, which provides an opportunity for them to talk about their work and training needs. Regular staff meetings are also held to ensure that staff are kept up to date with any relevant issues relating to people’s needs, work practices, training information and CSCI inspections. All staff responding with surveys and those spoken with during our visit felt well supported by the manager, the owners and other staff. The home does not manage people’s finances. Where necessary relatives assist people to manage their finances. The home will invoice people retrospectively for services such as hairdressing, chiropody and other personal items which may be needed. Health and safety at the home is generally well managed. During our tour of the building no immediate hazards were identified. Where necessary, staff have received mandatory training including, fire safety, moving handling, infection control and food hygiene. Staff and records confirmed this. One person is trained in several areas of health and safety and takes responsibility for fire safety, which appears to be dealt with well; the fire log showed that equipment was regularly checked and serviced. The home does have a fire risk assessment, which is currently being up-dated to conform to new legislation. This person also carries out a regular tour of the building to check for health and safety hazards, and attends to minor maintenance and repairs. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 25 The AQAA showed maintenance or servicing of gas and electrical systems was up-to-date. Also that other equipment, such as the lift and hoists were serviced regularly. Windows checked on the first floor had been restricted to prevent accidents, and radiators were covered to prevent burns. Any accident involving people living or working at the home are recorded. At present this information is held in one file rather than in individual files. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X X 3 4 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 4 X 3 X 3 3 X 3 Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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. 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. Refer to Standard OP3 Good Practice Recommendations It is recommended that all initial assessments be comprehensively completed prior to the person moving into the home and that assessments are reviewed to ensure that individual needs can be met. It is recommended that information in care plans be more detailed to include details of how individual people prefer their care to be given and all information should be regularly reviewed with the involvement of people or representatives. Diabetic care plans should clearly state how needs are to be met and record agreed levels for blood glucose monitoring. It is recommended that codes be used when prescribed medication is not given. The medicines fridge should have a secure lock to ensure medicines are stored safely. Any prescribed medicines, such as creams, and supplement drinks should be recorded when given. It is recommended that records of incidents and accidents DS0000026689.V339692.R01.S.doc Version 5.2 Page 28 2. OP7 3. OP9 4. OP38 Cranford Nursing Home be kept in line with Data Protection. Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Cranford Nursing Home DS0000026689.V339692.R01.S.doc Version 5.2 Page 30 - 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. 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