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Inspection on 05/02/06 for Cranham Court Nursing Home

Also see our care home review for Cranham Court Nursing Home for more information

This inspection was carried out on 5th February 2006.

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

Despite the awkward design of the new extension in relation to the main building, the home is well run. The majority of staff have been employed in the home for many years and are well versed in the operations of the home. Service users are generally well cared for and a relaxed relationship was observed between some staff, service users and visiting relatives. Service users have their social interests met through unrestricted access to visitors and a variety of activities.

What has improved since the last inspection?

A comprehensive review of financial processes was carried out following the last inspection. As a result the home no longer holds service user funds or administers them on their behalf. The manager informed the inspector that this has reduced the administration time required for financial recordkeeping and ensures that risks of abuse of service user funds are minimised.

What the care home could do better:

More attention to detail is required in relation to medication records as records by some staff are inconsistent and are misleading. There must also be clarity interms of when and how concerns relating to service users who refuse their medication should be dealt with. Service users must be given the assurance and confidence that their wishes and feelings are valued and will be carried out. Current practices leave service users feeling they have no control or choice over their activities of daily living. Repairs must be undertaken to a chest of drawers in a named service user`s room.

CARE HOMES FOR OLDER PEOPLE Cranham Court Nursing Home 435 St Marys Lane Upminster Essex RM14 3NU Lead Inspector Georgia Chimbani Unannounced Inspection 5th February 2006 1:45 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 Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 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. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 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 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) 01708 250 422 01708 227 728 THE HOLMES CARE LTD Care Home 82 Category(ies) of Old age, not falling within any other category registration, with number (82) of places Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 82 BEDS FOR ELDERLY INFIRM MINIMUM STAFFING NOTICE Date of last inspection 20th September 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 separately. 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 it’s 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 DS0000015588.V282166.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Sunday afternoon and was for duration of 3 hours and 15 minutes. Present at the time of the inspection were two members of the nursing staff, both of whom assisted fully with the inspection process. The registered manager, Mrs Lakhani arrived towards the end of the inspection and the inspector was able to give her feedback on the inspection process and outcome. The inspection covered key standards that had not been inspected at the last announced inspection. Compliance was confirmed with a requirement made at the last inspection relating to service user’s finances. Five requirements are made following this inspection, relating to: medication, service user choice, complaints records and a minor repair. The inspector is confident that the registered persons will ensure compliance within the set timescales. Discussions were held with approximately 10 relatives and 6 service users. Feedback was generally positive, however negative feedback was received from some relatives. No requirements have been made in response to their issues of concern as the inspector saw no evidence at the time of the inspection to support their claims. This information was relayed to the manager during the inspection. What the service does well: What has improved since the last inspection? What they could do better: More attention to detail is required in relation to medication records as records by some staff are inconsistent and are misleading. There must also be clarity in Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 6 terms of when and how concerns relating to service users who refuse their medication should be dealt with. Service users must be given the assurance and confidence that their wishes and feelings are valued and will be carried out. Current practices leave service users feeling they have no control or choice over their activities of daily living. Repairs must be undertaken to a chest of drawers in a named service user’s room. 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 DS0000015588.V282166.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 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 the following standard(s): 0 EVIDENCE: Standard 3 was assessed at the last inspection. Standard 6 was not assessed at this inspection, as the home does not provide intermediate care. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 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 the following standard(s): 9 Medication practises at the home must be tightened through accurate and consistent recording and follow up action to ensure the health and safety of service users is not compromised. EVIDENCE: The inspector was able to check medication records for both units. Most records in both units were generally up to date. The controlled drugs register in Woodlands was checked and found to be up to date and accurate. Records of temperatures of the room where medication is kept and of the fridge were available for inspection. The inspector noted that in a situation where medication was changed following a telephone discussion with a doctor, a written record was maintained in the communications book before written confirmation was received from the doctor. It was noted that in a situation where a named service user did not take a prescribed tablet, the medication administration record [MAR sheet] did not accurately reflect this. The MAR sheet had been signed by a member of staff to indicate that medication had been given when in fact a code should have been used to explain the reason why the service user did not take their medication. The registered persons must ensure that where medication is not Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 10 administered MAR sheets must accurately show the reason for non administration. MAR sheets in the main unit where up to date and accurately completed. Further examination of MAR sheets revealed that some service users had refused medication for up to 4 weeks. Discussions with a nurse on duty indicated that they were unsure if any action had been taken in relation to this. The concern was the service user’s continual refusal of specific medication could have a negative effect on their health. The inspector raised this with the manager of the home at the end of the inspection. The manager informed the inspector that she believed this had been raised with the doctor but she would follow this up. The registered persons must ensure that where service users refuse medication over a period of time, action is taken their health is not compromised. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 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 the following standard(s): 12, 13 and 14 Service user’s social interests are appropriately met. There must be more consistency in fulfilling their wishes regarding their daily routines so that service users feel valued by the home. EVIDENCE: Discussion with nursing staff revealed that the home has an activities coordinator who alternates between the two units and facilitates activities such as bingo and skittles. Some service users mentioned the activities co-ordinator by name when they were asked about activities at the home. A relative informed the inspector that all attempts were made to meet the social interests of service users and cited an example where their parent had asked to go visit the London Eye. A booking had been attempted but it was fully booked at the time and this was to be explored again in the summer. Discussions with service users indicated that there was a high level of satisfaction with the activities offered in the home. One service users informed the inspector, “You don’t feel inhibited, you have the freedom to choose what you want to do and have the choice to participate or not.” The inspection took place on a Sunday afternoon and the inspector observed relatives arriving and departing at various times. Discussions with some relatives confirmed that there were no restrictions on visits to the home. There Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 12 appeared to be no clear consensus on the ability of service users to exercise choice over their daily lives. An interview with one service user revealed that they were happy with their current waking up and bed times. Another service user felt staff overlooked their individual wishes. For instance they preferred to go to bed at 9pm but sometimes they had to wait until 9.30 or 9.45 pm as staff would state they were too busy. The registered persons must ensure that service user’s choices regarding their life at the home are respected. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 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 the following standard(s): 16 The home must make attempts to improve the confidence of service users and relatives about addressing complaints to the management of the home. EVIDENCE: Discussions with relatives visiting at the time of the inspection indicated their dissatisfaction with the service offered by the home. They cited offensive odours, dirty clothing, soiled wheelchairs and poor standards of personal care for their relative. The inspector saw no evidence at the time of the inspection to confirm this and raised this with the relatives. They explained that this was a regular occurrence however the day of the inspection was an exception. It was suggested that home might have been aware of inspector’s visit. The inspector assured them the inspection was unannounced and the home had no way of knowing that the inspector would be arriving. It was clear that these concerns had not been raised with the manager and the inspector encouraged them to do so next time such situations occurred. The inspector was unable to view the home’s complaints record as this was kept in the manager’s locked office. The complaint record must be available for inspection at all times. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 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 the following standard(s): 19 The home is maintained to a high standard. Attention must be given to minor repairs to ensure a safe and comfortable home for all service users. EVIDENCE: During a tour of the building the inspector observed that the home is well maintained with bright décor and spacious rooms. No outstanding major repairs were seen, however the handles of a chest of drawers in a ground floor bedroom in the Woodlands unit were missing. The registered persons must ensure that these are replaced. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 0 EVIDENCE: The key standards relating to this section were inspected at the last inspection. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35 A review of financial practices at the home has promoted the independence of service users. EVIDENCE: At the previous inspection a requirement was made for a review of financial procedures to ensure the protection of service user’s funds. A discussion with the registered manager who arrived towards the end of the inspection revealed that the home no longer held or dealt with service user’s finances. Service users were now responsible for administering their funds with assistance if required from their families, local authority representatives and solicitors. This standard is assessed as met. Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 17 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 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 1 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X X X X X X X STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X X Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 18 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. 1. Standard OP9 Regulation 13(2) Requirement The registered persons must ensure that where medication is not administered MAR sheets are accurately showing the reason for non-administration. The registered persons must ensure that where service users refuse medication over a period of time, action is taken to prevent their health being compromised. The registered persons must ensure that service user’s choices regarding their life at the home are respected. The registered persons must ensure complaints records are available for inspection at all times. The registered persons must ensure that the handles on a chest of drawers in a named service user’s room are replaced. Timescale for action 05/06/06 2 OP9 13(2) 05/06/06 3 OP14 12(3) 05/06/06 4 OP16 17(2)(3)( b)Sched4, 11 23(2)(d) 05/06/06 5 OP19 05/06/06 Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cranham Court Nursing Home DS0000015588.V282166.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford 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. 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