Inspection on 04/09/06 for Cranmer House

This inspection was carried out on 4th September 2006.

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

Cranmer House 02/10/07

Cranmer House 14/03/06

Cranmer House 20/12/05

Cranmer House 19/01/05

Cranmer House 26/07/04

Cranmer House 06/01/04

Cranmer House 08/09/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Cranmer House Cranmer House Norwich Road Fakenham Norfolk NR21 8HR Lead Inspector Mrs Jacky Vugler Key Unannounced 4th September 2006 09:30 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 Cranmer House DS0000035495.V311482.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. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cranmer House Address Cranmer House Norwich Road Fakenham Norfolk NR21 8HR 01328 862734 01328 856228 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) www.norfolk.gov.uk Norfolk County Council-Community Care Kirsty Dianne Grand Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to accommodate 21 service users who are older people not falling within any other category. 14th March 2006 Date of last inspection Brief Description of the Service: Cranmer House is a 21-bedded home, run by the Local Authority in conjunction with the Local Health Trust as a joint provider Unit( JPU). The residential portion of the building only is subject to inspection by the Commission for Social Care Inspection. The Home is situated close to the centre of Fakenham and all local amenities. The home consists of a two-storey building, with the residential care unit being located on the first floor. All bedrooms provide single occupancy with en-suite facilities. Some communal facilities, including the dining room, are located on the ground floor that is accessed via a shaft lift. The home has a newly resurfaced car park, gardens to the front and an enclosed garden. All are accessible to residents. The fees are £368.72 a week and the only extra cost is hairdressing as displayed in the hairdressing room. Newspapers, activities and medical requirements are free of charge. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection taking place over two days. Not all of the National Minimum Standards were assessed on this occasion. Where a standard has been assessed, not all of the sub-elements, as set out in the National Minimum Standards, may have been assessed. The following judgements have been made using available evidence including a visit to this service. Cranmer House is gradually changing how it provides care, with a move towards mainly short-term care being provided in the future. Staff described the transition so far as being quite smooth. The Manager and her staff are commended for the way that this change is being implemented, as evidence suggests that residents, their families and staff have all been involved. At the time of inspection there were seven short term care residents and a further three were admitted during the afternoon. Ms Grand, Manager, was present throughout the inspection. A tour of the premises was undertaken and many records were viewed. Four residents, one visitor and three staff were spoken to. Nine comment cards were received from residents and eight from relatives or visitors. The results of these were very positive and 100 were satisfied with the care they received. What the service does well: What has improved since the last inspection? Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 6 Since the last inspection the home has purchased two medicine trolleys to ensure safer storage of medications. Also a better system is now in place for the recording of medications. Pre-admission assessments from the social workers are now emailed for emergency admissions, ensuring the information reaches the home before the resident is admitted. Care staff hours have been increased to enable the Care co-ordinators the additional time they need for the increasing number of short-term care residents. The residents have been moved to the first floor so they are together and the care co-ordinators now have an office on this floor. Staff said that the care plans have improved, and one for a short-term care resident has been revised specifically to suit them. Staff are looking forward to the change saying everybody gives 100 and there is a lot of job satisfaction with shortterm care. 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. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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 Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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): 3 Quality in this outcome area is good. Prospective residents have an assessment of their needs conducted prior to admission to the home and have been assured that these needs will be met. EVIDENCE: This home is gradually changing the client group to be cared for and is moving towards short-term care provision. Referrals for this home take place through the social worker teams and assessments are always obtained before admission. These assessments give a good indication of the prospective residents dependency levels. In the event of an emergency admission, the social workers assessment is first emailed to the home to ensure the information is available prior to the residents admission. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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): 7, 8, 9 and 10 Quality in this outcome area is good. The residents health, personal and social care needs are set out in an individual care plan. The home has excellent support from other healthcare professional to ensure the residents needs are fully met. The home generally has safe procedures in place for the administration of medications and the medication records and storage were very well kept. However a requirement has been made regarding an isolated practice, which is considered to be unsafe. Residents feel that they are treated well and that staff respect their privacy and dignity. EVIDENCE: Three care plans were looked at in detail and a further two were viewed. These included three for short-term and two for long term residents. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 10 In all cases the care plans contained good detail of care required and relevant risk assessments including moving and handling, falls and bedroom doors left open. The care plans were regularly reviewed and signed by the residents. It was noted that residents admitted for short term care, who had previously stayed in the home, had their care plan updated on re-admission. There is a good amount of input from other healthcare professionals. A local GP visits daily and does a weekly ward round with a Consultant from the hospital. An assistant occupational therapist works for thirty hours a week and a qualified occupational therapist visits at least weekly. A physiotherapist visits twice a week and the dietician, speech and language therapists, McMillan nurses, diabetic nurse visit when necessary. A social worker is designated to Cranmer House and she attends the weekly ward round and liaises with the manager. The home uses a monitored dosage system prepared by the pharmacist. As a result of the previous inspection, two medication trolleys, one for short term care and one for long term care are in use. The medication administration records (MAR) are well recorded and contain a photograph of the resident. Medications are counted in and signed. All controlled drugs in use were correctly recorded and stored, and in correct numbers. The records for the short-term residents were also in good order and with a photograph in place. Risk assessments for residents self-medicating were signed and a lockable storage space was provided in their rooms. Lockable plastic boxes had been purchased for use in residents en-suite rooms to store creams etc. and this is good practice. On the 1st day of inspection (1.9.06), some medications, although written on the MAR were unnamed. Staff said that they had run out and a box had been borrowed from the nursing unit where they have stock medications. It is required that medications are re-ordered for residents before they run out and that they are only dispensed from a named container prepared by a pharmacist. On the following day of inspection (4.9.06) this situation had already been rectified. This prompt action is acknowledged. From discussion with residents and the comments returned it is evident that the residents feel well cared for and that their privacy and dignity are respected. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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, 14 and 15 Quality in this outcome area is good. Residents find there are opportunities for them to participate in social activities and they have a choice of how they spend their day. The open-visiting policy enables residents to maintain contact with their family and friends. Residents are helped to exercise choice and control over their lives. Service users receive a varied and balanced diet. EVIDENCE: Some activities are provided in the home, but none of the residents spoken with wanted to join in any of these. One comment card received from a resident said activities were provided and staff encouraged all persons to join in. Some residents, however, said that they preferred to go to the adjoining day centre to join their activities as they had previously attended prior to admission. They said that staff supported them in this decision. A care assistant from the day centre and a carer from the home have both trained in reminiscence and they run joint sessions, which is reported that the residents enjoy. Photographs were seen of successful events organised by the Friends of Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 12 Cranmer House, for example a harvest supper, fish and chip supper and a strawberry tea. The home operates an open-visiting policy and many visitors were seen during the course of the inspection. Residents could entertain their visitors in their own room or one of the communal areas within the home. Residents spoken with gave examples of how staff supported them to exercise control over their lives. One gentleman liked to go to the snug area after lunch to read the newspapers. Menus seen showed the meals offered to be varied and nutritious. The residents spoke of the choices of menu offered at all meal times and they said they enjoyed the meals, although one felt they were a bit bland. Meals are served in a very pleasant, newly refurbished dining room with a laminated menu on each table. The manager meets with the cook quarterly to discuss any feedback from questionnaires and the cook liaises with the dieticians at the hospital regarding special diets, for example, gluten free. The kitchen environment has recently been improved and there were no recommendations from the recent environmental health officers visit. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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 and 18 Quality in this outcome area is good. The home has a complaints procedure in place and residents feel that their concerns will be listened to and taken seriously. Residents are protected from abuse. EVIDENCE: The Norfolk County Council complaints policy and procedure is in place and displayed in the home along with the how to make a complaint leaflet. Few in-house complaints have been received and they have been dealt with appropriately. One example was the poor quality napkins, which were changed, and the resident noticed when she returned for respite care. One comment card received from a resident said, I feel able to talk through any concerns with all the care team and receive the time and support I require. A file of compliments and letters was also seen. Staff demonstrated a good understanding of adult protection issues. They have all received training and those spoken to said they would always report any suspicion of abuse. All staff have a Criminal Records Bureau Disclosure in place before commencing their post. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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, 20, 21, 25 and 26 Quality in this outcome area is good. Residents live in a safe, well-maintained environment. Bathrooms are well decorated and homely. The home is clean, pleasant and hygienic. EVIDENCE: The many improvements to the premises have continued. The outside entrance to the home has been upgraded and is now very attractive and welcoming. The manager said that work is in hand to improve the security of the front door and this must continue. The gardens are accessible and well maintained. The administrator has a desk in the reception area. A part of this area has been sectioned off with a wooden divider and is called the snug. This is a very cosy area and one of the residents spoken with said he liked to sit in it and read the newspapers that are provided. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 15 The statement of purpose, service users guide, inspection report annual development plan and a photograph of the manager are displayed in reception. On the day of inspection there was a bird table in this area, which a previous resident had made for the home to raffle. There was also a photoraph album of him making these bird tables. New carpets have been fitted and the dining room has been refurbished with matching furnishings. The garden area overlooked by the dining room has been upgraded with a patio table and chairs, large planted pots, raised flower beds and lighting. All the residential beds are now on the first floor as well as the unit which will be opened for re-ablement. Care staff are based on this floor as well as the care coordinators office. New carpets have been fitted and it has been redecorated throughout. Although some of the windows are of the old metal style, they are in good decorative order and some have new catches. All bedrooms have an en-suite facility and are fitted with a television, radio and wall clock. The lounge has been refurbished and has a television, Hi Fi and a plumbed in water dispenser. The long term residents and staff were involved with these plans. The bedroom doors in one corridor are fitted with automatic closures. Windows on this floor are restricted and valves have been fitted to control the temperature of the hot water. On the ground floor is a therapist room for use by the occupational therapist and the physiotherapist. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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 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): 27, 28, 29 and 30 Quality in this outcome area is good. Residents needs are met by the numbers and skill mix of staff ensuring they are in safe hands at all times. The home operates robust recruitment and selection procedures. Staff are trained and competent to do their job. EVIDENCE: On the day of inspection, there were four long stay and ten short stay residents accommodated. These numbers will increase over time as the home will accommodate fifteen short term care clients and five re-ablement clients. In recognition of the fact that the care co-ordinators time will be pressured with the increase in short term care clients, there have been increases to the staffing establishment through the Cranmer project group. The care hours have been increased to allow the care co-ordinators more time for their duties. From observation during the inspection and the duty rotas supplied, it was evident that there are sufficient care staff to provided to meet the needs of the residents. This was verified by the comment cards returned from residents and relatives who said staff provide more than adequate care and attention at all times, staff are always available, staff are prompt to act on anything said. The home also employs an administrator for 23.5 hours a week. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 17 From the completed pre-inspection questionnaire and training files it is evident that 50 of staff have achieved the NVQ level 2 and two care co-ordinators have achieved the NVQ level 3. All staff have a Personal Development file and these show all records of their induction and foundation training and among other things, their mentors name and on the job shadowing dates. Their Training and Development files contain evidence of all training undertaken including mandatory training and details of when upates are due. The training provided is extensive and appropriate to the residents needs. Staff spoke of the good training opportunities offered and the ease by which it was booked. All staff have received training for protection of vulnerable adults. The follows robust recruitment and selection procedures. Recruitment files for five staff were seen and these contained all the information to ensure the residents are protected. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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 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): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is excellent. The home is run and managed by a well qualified and competent manager. The home is run in an open and inclusive manner. The home is run in the best interests of residents. Residents financial interests are safeguarded. Staff are approopriately supervised. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 19 Ms Grand is a Registered Nurse and has also completed the Royal College of Nursing Leadership course. During the inspection she demonstrated a good knowledge of the people coming into her care. The home is currently going through a change to its registration and this has involved a lot of changes to the premises, which are now nearly completed. The changes have also meant moving residents to other rooms and staff reported that the change over was explained to the residents, their families and staff. They said there have been general meetings held to discuss this so that everyone has been kept informed and they felt it had gone quite smoothly. One comment card received from a relative said that as a result of the changes, morale amongst the long term residents left, was very low. However, this was not noticed during the inspection. The manager is commended for the smooth transition within the home. Residents and staff all commented that Ms Grand was approachable, with staff saying Kirsty is great, very approachable, she is a very good manager, brilliant, very supportive and everyone has been kept well informed of the changes going on, residents have been kept informed as well as families. The home has a quality assurance system in place. How was your stay leaflets have been distributed to residents and they will be audited this month. Some comments from received leaflets have already been acted upon, for example, bins with lids are now provided in en-suite bathrooms and the service users guide and a letter are sent to residents pre-admission. Other recent surveys conducted include, catering and staff well-being. A comprehensive medication audit is conducted by the manager monthly as well as many other audits. The home currently holds money for two residents and the cash and the records for these were checked and found to be in good order. The home has a supervision policy and staff sign a supervision agreement. Supervision records were seen and they take place three-monthly. In addition, group supervision meetings take place at night as well as night staff meetings, which are recorded. Staff spoke of the benefits of their supervision. The care co-ordinators received training before giving supervision to other staff. The accident records are well recorded and the manager keeps an incident overview, which is updated three-monthly and highlights any patterns to accidents. Service certificates were seen for all the lifting hoist and bath hoists as well as the passenger lift. The fire records were seen and these were in good order and up to date This month fire drill training is booked with the Fire Officer. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 x x x 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 x 3 4 x 3 Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 21 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 OP9 Regulation 13 Requirement The registered person must ensure that medication is reordered before it runs out and that it is only administered from a named container prepared by a pharmacist. Timescale for action 08/09/06 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 OP19 Good Practice Recommendations It is recommended that work continues to ensure a more secure front door. Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Cranmer House DS0000035495.V311482.R01.S.doc Version 5.2 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. 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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