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Inspection on 05/07/05 for Cranford Nursing Home

Also see our care home review for Cranford Nursing Home for more information

This inspection was carried out on 5th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The home continues to provide high quality care with competent staff in a welldecorated, pleasant and homely environment.

What the care home could do better:

Care plans must be expanded to include details of how specific needs will be met. Policies and procedures for are in place for dealing with medicines, all staff must follow these practices in order to fully protect residents. Employment records do not hold all the required information to ensure the protection of residents. This information must be obtained.

CARE HOMES FOR OLDER PEOPLE Cranford Nursing Home 15 Cranford Avenue Exmouth Devon EX8 2HS Lead Inspector Caroline Rowland-Lapwood Announced 5 July 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cranford Nursing Home Address 15 Cranford Avenue, Exmouth, Devon, EX8 2HS 01395 263295 01395 267273 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr John Alan Ward, Baystone Limited Mrs Elizabeth Caroline Mary Sampford Care Home with Nursing 26 Category(ies) of OP - Old Age (26) registration, with number of places Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 2.4.2002 Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 30/9/1996 2.4.2002 Registered for 26 - Elderly General Nursing Care Date of last inspection 07/02/2005 Brief Description of the Service: Cranford Nursing Home is a detached 1920’s 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 ensuite 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. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and arranged with the owners and manager as part of the normal programme of inspection visits. It took place over six hours, between 0930 am and 3.30pm. Two inspectors were present throughout. The inspectors met or saw many of the residents and spoke with the homeowner, the matron and five other members of staff. They looked around the inside of the home and at care planning paperwork and other records. The inspectors closely looked at the care of three service users as a means of sampling the service offered at the home. The owner of the home had completed a pre-inspection questionnaire and one comment card was received from a relative prior to the inspection. What the service does well: What has improved since the last inspection? The home continues to provide high quality care with competent staff in a welldecorated, pleasant and homely environment. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 6 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. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Pre admission arrangements ensure that residents’ needs and wishes are fully understood and that they are helped make the right choice of home. EVIDENCE: Written and verbal information is given to prospective residents before admission; this includes a copy of the statement of purpose and a brochure of the home. Prospective service users have a thorough assessment before their admission to the home and are assured whether or not their needs can be met, evidence was seen of this in the care plans and was confirmed by a relative that was visiting on the day. Prospective service users and their families are encouraged to visit the home before making the decision to live there. A visiting relative said that she had turned up unannounced at a busy time of day and yet had still been made to feel very welcome and had obtained all the information she required. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Service users’ privacy and dignity are met and promoted by the staff and management team at The Cranford. In general procedures in relation to medication are satisfactory. However, not all residents are being properly protected because not all staff are following the current medication policy. EVIDENCE: The home promotes residents’ welfare in co-operation with families and health care professionals, evidence was seen of this in the individual care plans and visiting professionals notes. The inspectors looked closely at three residents’ experience of the home. Their care plans included detailed information about their needs. They were well laid out and easy to read. However, they did not describe how the home was going to meet the identified needs of the residents. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 10 Residents or their relatives are involved care planning, which was confirmed by a visiting relative. The procedures in place for the recording and administration of medication are inadequate and therefore do not protect residents from harm. Records of administration of medicines are inconsistent. Handwritten prescriptions on medication records are not signed and witnessed by two staff. Unlabelled medication was found in the medication trolley. Topical creams were opened but not dated. Upon discussion with the staff they were able to explain how mistakes had been made and were happy to rectify them. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 Social activities and meals are well provided for. Residents are encouraged to maintain contact with their families or friends as they wish. EVIDENCE: Residents were sitting in the lounge or in their own rooms as preferred, and are able to walk freely around the home. Residents’ social preferences and interests are recorded in their individual care plans. Residents are encouraged and supported to maintain links with their families and with the community. A visitor said that she visits regularly and is always made very welcome. Meals provided at The Cranford are varied and nutritional. The cook visits the residents twice daily to inform them of the meal of the day and offer choices as required. Much of the produce used is organic and is purchased locally fresh from a farm and delivered to the home. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents’ complaints are taken seriously. Arrangements for protecting service users are satisfactorily protecting them from the risk of harm or abuse. EVIDENCE: The home has a detailed complaints procedure that is clearly displayed. All residents have a copy of it. A visiting relative confirmed that she had been given a copy. The complaints book showed that complaints and the actions taken to resolve them are fully recorded. Training records showed that all staff have had recent training in issues relating to abuse. Two members of staff were asked and confirmed this. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23,24,25,26 The residents live in a homely, safe and attractive home. EVIDENCE: The home’s environment is very comfortable and provides the residents with an attractive and homely place to live. Residents’ rooms suit their needs and have been personalised. The home was exceptionally clean throughout. The laundry and the sluice room were immaculate. All service users’ rooms are individually and naturally ventilated by double glazed windows, which have been fitted with window restrictors. Rooms are centrally heated, radiators being controllable in service users’ own rooms. All radiators have been covered. Emergency lighting provided throughout the home is checked monthly. The homes’ water tanks are checked annually for Legionella. All bath taps are fitted with thermostat valves to provide water close to 43C. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 Staff are employed in sufficient numbers to meet residents needs. Recruitment arrangements are not fully protecting service users. EVIDENCE: On the day of the inspection the owners, the matron, one RGN and six care assistants were on duty. A laundry person is employed every day, as are two domestic staff. Staff have time to spend talking with residents and seemed unhurried and relaxed in their work. The inspectors looked at three staff files selected at random. Not all Criminal Records Bureau (CRB) POVA checks had been undertaken and one file had only one proof of identification and one reference. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The residents live in safe surroundings. The home takes seriously their responsibility to ensure residents’ safety and well being. EVIDENCE: Mandatory checks and tests are carried out with regard to fire safety and all were satisfactory. The staff undertakes regular training in fire safety. The accident book was well documented. All the radiators are guarded to prevent harm from burns. Water temperatures are regulated to prevent harm from scalding. All the windows are restricted to prevent harm from falling. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 16 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x 3 3 3 4 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 17 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 29 Regulation 19(1)(b) Schedule 2 Requirement The regfistered person must obtain the required information and documents in respect of persons carrying on, managing or working at a care home. (This relates to making sure personnel files contain all the information required in Scedule 2 of the care homes regulations). Timescale for action 01/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 9 9 Good Practice Recommendations Care plans should be expanded to clearly show how identified needs will be met. Topical creams once opened should be dated (expiry date of 28 days from opening.) Hand written drug charts should be signed by two people. Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 18 Commission for Social Care Inspection Exeter Office, Suites 1 & 7 Renslade House Bonhay Road EXETER, EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cranford Nursing Home D54-D06 26689 Cranford 227537 050705 Stage 4.doc Version 1.30 Page 19 - 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. 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