Inspection on 20/09/05 for Cranham Court Nursing Home

This inspection was carried out on 20th September 2005.

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

Cranham Court Nursing Home 22/01/08

Cranham Court Nursing Home 16/06/06

Cranham Court Nursing Home 05/02/06

Cranham Court Nursing Home 21/02/05

Cranham Court Nursing Home 19/10/04

Cranham Court Nursing Home 26/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cranham Court Nursing Home 435 St Marys Lane Upminster Essex RM14 3NU Lead Inspector Roger Farrell Announced Inspection 20 September 2005 11:00 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. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cranham Court Nursing Home Address 435 St Marys Lane, Upminster, Essex RM14 3NU 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) 01708 250422 01708 227728 The Holmes Care Ltd Mrs Indumati Lakhani CRH Care Home 82 Category(ies) of OP Old age (82) registration, with number of places Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. 82 beds for elderly infirm. 2. Minimum staffing notice. Date of last inspection 21 February 2005 Brief Description of the Service: Cranham Court Nursing Home is registered to provide accommodation and nursing care to eighty-two older persons. Originally opened in 1982 with twelve places, considerable expansion has occurred with the addition of a rear extension in the late nineteen-eighties, and the well-designed Woodlands Unit being opened in 1995. Currently there are fifty single, and sixteen double bedrooms. The original house with rear extension, and the more modern Woodlands Unit are operated as separatly. One of the owners, Mrs Lakhani, has managed the home since it opened, with each of the two distinct units having a Care Manager, both of whom have been at the home for more than ten years. It is set in eleven acres of attractive, well maintained woodlands and grounds, the original house retaining many of its distinctive architectural features. Due to its location, the families of prospective residents are told that access by public transport can be difficult. The range of care needs is wide – from those who are mentally alert but have physical frailties, some of whom need to be nursed in bed - to people showing signs of mental deterioration. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 20 September 2005, starting at 11am through to 7.45pm. The owner and manager, Mrs Lakhani was available through the day to assist with the checks. She was again well prepared, having the necessary records available and presenting them in an efficient manner. She is good at keeping the Commission informed, and this had included sending an update on the progress with the building requirements from the last report. The inspector is grateful for the high return of questionnaires. This included twenty from residents, nine from relatives, and four staff who sent comments. It was also very helpful that eleven health and social care staff care, and others who visit the home in their professional roles made returns. In addition to the views received during the visit, these opinions have influenced the scoring and conclusions of this report. This visit covered most of the key standards, and included looking at the assessment of prospective residents; care and treatment records; meeting with a group of nurses that involved the two care managers, including talking about care practices, resident dependency levels and staff supervision; checking the arrangements for responding to complaints and allegations; looking at staff arrangements, including training and vetting; having a meal with a group of residents and meeting others in their rooms; checking parts of the building; and going through health and safety files. What the service does well: This is a very well run care home. The manager’s many years of experience is evident in the way she has developed worthwhile and effective managerial, monitoring and administrative system. Yet she remains open to new ideas, and is keen to take on board service developments. She approaches the involvement of regulators, including from the Commission, with good grace, and a helpful and cooperative attitude. This level of professionalism is equally apparent in the calm and knowledgeable way she oversees the day-to-day care of residents. The positive outcomes can be illustrated by the following: The families of three residents who had passed away in the recent period wrote letters to the inspector expressing their appreciation of the care their loved ones received at Cranham Court. One included the following – “The family took great comfort and solace knowing {our relative} was receiving one hundred percent of tender loving care from Matron and all her wonderful staff. Living so far away…. our visits were often unannounced. We always found a happy atmosphere {and our relative} clean, content and wanting for nothing. I thank you in anticipation in making our comments known to whom it may concern.” Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 6 Another relative wrote – “The staff were excellent, very kind and caring. {Our relative’s} room was kept clean at all times and she always looked fresh and clean everyday….We couldn’t have asked for her to have been in a better place for the last few months of her life.” Another relative sent the Commission a copy of her letter to the manager that said – “Mum was only at Cranham Court for a relatively short period of time but she was very happy there and greatly appreciated all the kindness shown to her by staff. The fact that she chose to return to Cranham Court for her final days is a testament to how ‘at home’ you had all made her feel. She felt peaceful and calm in Cranham, and at ease and content with the care she received.” What has improved since the last inspection? 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. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 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 Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 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. Despite some problems getting information from hospitals, the standard of assessment and chasing-up referral information has improved. Recent residents said they were very satisfied with how they were helped move in. One new resident said – “I have been here three weeks and yes, this is my first time in a home…..I received a good welcome. The staff do chat to me to see if I’m alright. I would say that I am very happy with things so far.” EVIDENCE: The inspector discussed the referral and assessment process with the manager, and with the two head nurses who take a lead in this area. This included difficulties they have experienced in being given information by hospital nurses due to guidelines on protecting personal information. The inspector also looked in detail at the early stage documentation for two of the residents who had moved in quite recently, and spoke with one of these, as well as another new resident. Overall, the samples seen on this occasion were satisfactory. This included the ‘Pre-Admission Assessments’, and the ‘Assessment and Activities of Living’ forms, making comment under a range of appropriate headings. These were Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 9 completed with brief but adequate comments. Despite the problems getting information from ward staff, files contained a good range of relevant referral reports – including a detailed ‘nursing needs assessment’; social worker reports; hospital transfer letters; and reports from occupational therapists and ‘mental state assessments’. There was good follow-on information and initial assessments carried out soon after the person moved in. The last report carried over a requirement asking for improvements in paperwork covered by this important area. Based on the findings at this visit, this has been successfully achieved. One relatively recent resident who had moved in eight weeks earlier talked about his reluctance to move to a care home, but said his daughter ‘promised she’d find me a nice place, and I trusted her judgement.’ He added – “{The staff} can’t do enough, they couldn’t care for me better. They really have helped me settle. The garden is beautiful, and I do go outside with my daughter. What more could I ask for.” Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 10 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, and 10. The quality of care and treatment notes has got better, and this reflects well on the staff teams. Additionally, the comments of residents, and the high return of questionnaires help the inspector conclude that the standard of personal care, nursing attention and health monitoring is satisfactory. One health care worker wrote – “On the occasions I have visited the home the staff have been pleasant and helpful. I have seen nothing which has made me think that the residents are not well cared for.” EVIDENCE: The inspector looked at a sample range of service users’ files from both units, including for some residents with higher dependency needs. The weak spots were generally those that were the responsibility of others – whilst some referral reports seen were fine, some social work reports still lacked sufficient detail. One highlight was examples of residents’ personal histories completed with families. The main core elements are being used well. This includes the ‘Assessment of Activities of Living’, the ‘Care Plan’ sheet (including those with the ‘nursing intervention’ instructions), with monthly review entries. A broad range of risk assessments are available in areas such as skin viability, nutrition, psychological needs; social ability; and moving and handling. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 11 A small number of errors were pointed out, such as the wrong date on a review record, and putting details of an eye-test and tissue viability nurse visits on the wrong sheet. Some entries are still quite brief, and there can be an overuse of some stock phrase, such as ‘appears well’ in the day-to-day notes. However, the main conclusion is that there has been a significant improvement in the overall quality of care and nursing notes compared to examples seen over the previous couple of years. They now have in use a comprehensive and worthwhile range of clear forms and monitoring charts. This included the additional records used for those with higher medical needs, such as catheter care, pressure sore treatment, and nutritional and fluid balancing charts. There are GP contact sheets, and another for other health care professionals such as dentist, optician, dietician and so on. One area discussed in the meeting with nursing staff was the assessment, monitoring and where necessary, treatment of skin condition. One of the ‘monthly audits’ maintained by the manager covers pressure sores, including progress and what equipment is being used. The service users’ files have suitable records, including ‘Waterlow Assessments’, body charts, and tissue viability nurse contact and advice sheets. With one exception, all six people currently being treated for pressure sores had been admitted with their ulcers in their present or more advanced state. One nurse said – “The tissue viability nurses visit each week. Some new residents are very frail and it is a challenge to achieve healing.” One Tissue Viability Nurse wrote – “The staff have always referred patients when they experience difficulties managing a wound. The recommendations I have made have always been followed. I have no problems with Cranham Court. “ Over the evening meal the inspector asked a group of residents about the help they receive with personal care, as well as covering this matter with two residents who spend most time in their rooms. All responses were favourable. One comment was – “I would say that it is satisfactory. Staff are sensitive. I have no complaints. If I had I would raise it. {The Care Manger} comes to see me every day to check that things are satisfactory.” Another area the inspector asked about was the response to call bells. With one exception, all said that response time was satisfactory. One person said – “I do not experience a problem…they come in a reasonable time.” Another person said – “They do move the cord when I am put in my chair….they do make sure it’s in the right place.” The room of the one resident who said she did have problems was checked, and indeed the call cord was missing. Evening staff could not offer an explanation, but stressed it was normally in place and occasionally used by this person. A further series of bedrooms were checked in that unit, and in all instances the cords were in the right place so they could be reached whilst in bed. Subsequently the inspector saw a record of routine checks of the call system, including call cords in bedrooms. Two residents who were in their rooms with the doors open said that this was their choice. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 12 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) 15. Good levels of satisfaction were again expressed about the standard of meals. Staff were seen to be attentive in helping those who needed assistance, and gently persistent in encouraging others who were not keen to eat. EVIDENCE: This group of standards were covered in the last announced inspection report, with all areas scored as ‘met’. There is a four-week cycle of menus. The inspector spoke with ten residents about the quality of meals and all commented favourably. One resident wrote saying - “The choice of food and type of food could be better.” The cook again said that there were no restrictions on the quality of stocks that could be ordered. The manager does carry out ‘monthly quality surveys’, focussing on different areas, and food is one topic that has been covered. One resident who takes her meals in her room said food arrived at a suitable temperature. There were a good variety of choices at the evening tea sitting, those at two tables confirming that this was normally the case, and that every evening there was home-made cake. Staff were attentive to individual needs, taking time to explain the choices and encouraging two people to eat more by providing a variety of options on their plates. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 13 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 and 18. The inspector is satisfied that the manager takes complaints and concerns seriously, and is fully aware of the procedures that need to be followed. Inspectors have found a good level of cooperation from the manager and staff when issues have been raised in the past. Staff have received training on protection procedures. EVIDENCE: The ‘policy on complaints for service users’ is available, and the procedure is on display around the building, including contact details for the Commission. The inspector looked at the ‘complaints and compliments file’. This is good evidence of how the manager takes complaints seriously, responding to those raising issues by letter, keeping notes of her investigation, and identifying how she will endeavour to respond with service improvements. Residents who responded with a view on this matter said that they felt they could raise concerns. One relative wrote saying they had to insist on better moving and handling practice, have had concerns about meals being rushed, and that some notes not detailed enough, but added – “The complaints are immediately addressed but sometimes they should not have been necessary.” This family did say that they were satisfied with the overall care provided. All the required guidance covering protection procedures is available – including ‘No Secrets’; the homes policy (’Strategy if Abuse of a Resident is Suspected, Witnessed or Has Occurred’); a ‘Prevention of Abuse Policy’; and a copy of the local procedures. In their meeting with the inspector staff gave adequate responses on this matter, including their duty to ‘whistle blow’. They confirmed that they had received training from Havering Council on this responsibility. They also confirmed they have been given a copy of General Social Care Councils code of practice. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 14 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) 19, 21, 23, 24 and 26. The modern ‘Woodlands Unit’ is bright, airy and well designed for those with mobility difficulties, including spacious communal rooms. It also meets the needs of those who are nursed in bed, and those who prefer ‘bedsit’ arrangements. The owners have ideas on how to improve the design of the older section. The main improvements asked for in last year’s report to do with the older sections have been tackled. The standard of maintenance and attention to safety monitoring is good. EVIDENCE: Overall the integration of the newer wings has worked well, the more modern Woodlands Unit having many merits including good space and wide corridors. The main design shortfall is that the large lounge in the ‘main house extension’ sits in the centre of the building, with the bedrooms arranged around the periphery, meaning that this main communal room has no windows other than in the ceiling. It is therefore short on natural light and ventilation. This was raised as a main problem in last year’s report. Since then improved extractors have been installed in the reinforced ceiling window lights. New carpet has been laid throughout this communal area, and this has solved the problem of Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 15 odour referred to last year. The attractive vaunted dining room has been decorated recently. Last year’s report also said bathrooms in the ‘main/extension building’ were ‘basic and shoddy….with poor lighting; strip lighting with no covers; have signs of wear and tear such as scuffed walls and a cracked pane of glass; broken locks; and ad hoc repairs such as plugs attached with string. Such poor quality contrasts strikingly with other high standards achieved in other areas of this facility.’ Two bathrooms have now been upgraded. They have new baths positioned in the centre so help can be given from both sides. New electric hoist chairs had arrived, but were the wrong type. Replacement models were due, and it was expected that these improved facilities would be in use very soon. All four staff who wrote to the inspector made gave favourable ratings, but two said that the owners needed to be more attentive to modernising older facilities. At this visit the inspector looked at a sample of bedrooms in all sections. Overall, a good standard was found, again most obviously in the newer Woodlands Unit. All had some degree of personalisation, such as family photos and ornaments. A number of rooms have ‘twin shared’ toilets – that is a toilet accessible to two neighbouring bedrooms. There is screening arrangements in double bedrooms. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 16 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 and 30. The home has a relatively stable staff team. Adequate checks are carried out, including for those who have qualified as nurses in India, and work at the home as care assistants whilst doing additional nursing training. There is a supportive approach to training, including doing NVQ qualifications. A number of relatives sent positive comments about staff, including – “I find the staff very friendly and helpful and my mother is happy with the care she receives.” Another comment was – “The majority of staff are friendly, cheerful and helpful.” EVIDENCE: Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 17 The staffing complement is - manager; two care managers (who are the senior nurses); eight full-time, and two part-time RGNs; three senior carers; and 1,350 day care hours per week, and 490 night care hours, equating to approximately forty care assistant posts. This represents the position when most places are occupied. For some months the home has been operating with reduced occupancy levels. This has on average been 75 , with no more than 67 of the 82 places being used. The current pattern of cover is described as: • ‘Main/Extension Unit’ – two RGNs and eight carers on the early and six on the late shifts. Night cover being one RGN and four carers. • ‘Woodlands Unit’ – One RGN (though on two early shifts each week there are two RGNs on duty); and five carers on the early shift, with four on lates. Night cover is one RGN and two carers. This achieves a ‘staff to resident ratio’ of 1:5 through the day, and 1:10 at nights. • In addition there are eleven ancillary staff. Further, the manager assists with some tasks, such as the serving of meals. At this visit all RGN posts were filled, and six carers were qualified nurses doing their UK conversion periods. At present eight care staff have achieved NVQL2; a further five had submitted their portfolios; and seven were hoping to commence in September. Two staff are doing their Diploma in Nursing. This shows positive steps to work towards achieving the required quota of qualified care staff. The nurses who met with the inspector spoke positively about care staff doing qualifications. One said – “We do see the benefits. It helps them gain the essential knowledge. They learn to put into language the skills they use. We are looking forward to working with the new group of trainers who started last week.” There are good records to show adequate systems for vetting staff - including taking up references; obtaining CRB certificates; and holding copies of information that verify identity. Staff files have a handy document checklist at the front. The home has had an inspection by the CRB, and the manager has followed through on the recommendations that were made. This includes applying for CRB certificates once staff from abroad have had a UK address for three months. Prior to oversees staff starting, a police check is obtained from their country of origin. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 18 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) 31, 32, 33 and 38. This is a very well managed home, demonstrated by the methodically arranged policy, procedure and record systems – such as those covering health and safety arrangements. EVIDENCE: The manager is a qualified RGN and Midwife, and has the ENB 941 credit for ‘Care of the Elderly’. She has twenty-three years experience in managing this service. She keeps herself up dated by re-attending the core courses she arranges for care staff. She is doing the RMA/NVQ award. There are clear lines of accountability within the management team, and within the team overall. One nurse commented – “She does tour a lot, speaking to all the residents and staff. She has an excellent memory, and can remember each resident’s diagnosis, even their date of birth. She does listen. She also keeps herself upto-date on clinical issues.” Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 19 The inspector was shown the ‘monthly audits’ file, this being a very good series of quality control systems of checks and audits, including accidents/injuries/incidents; catheterisation arrangements; infection control arrangements; peg feed arrangements; pressure sore care, assistance–call buzzers; and to the Commission. Along with the environmental health and safety checks, these demonstrate good attention to service and facility monitoring. Residents’ comments are included in the revised ‘service user guide’. How residents are helped manage heir money was not checked at this visit, so the requirement on this has been carried forward. The inspector asked to see a wide range of safety documentation at this visit, including those covering fire safety; gas, electricity, and water safety; maintenance of equipment, including lifts; and relevant risk assessments. The standard of record keeping around health and safety matters is very good, inhouse checks being recorded on clear forms in well-sectioned files. Those responsible for these safety systems and records are commended. The inspector said the report on the checks of electrical appliance need to say where these are located. The most recent reports from the fire safety and environmental health inspectors are available, neither raising any problems. An independent infection control audit carried out last year awarded the home the high overall score of 89 , with a number of categories being rated at 100 , including those on wound management; pressure sore prevention; linen and mattress management, and the handling of clinical equipment and waste. Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 20 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 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x 3 x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x x x x 3 Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? One item carried over as it was not covered at this 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 34 Regulation 13 (6) & 17 (2) Requirement The Registered Manager must ensure that comprehensive records are maintained as required by Schedule 4 section 9 (a) and (b). There must be a clear audit trail where any money belonging to service users is handled by any staff member. Financial Procedures must be in place, and be consistently adhered to, that offer service users protection from potential or actual financial abuse. Timescale for action 1/12/05 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. Refer to Standard Good Practice Recommendations Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ferguson House 113 Cranbrook Road Ilford Essex IG1 4PU 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 Cranham Court Nursing Home G55_S0000015588_Cranham Court_V241872_200905_Stage 4.doc Version 1.40 Page 23 - 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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