Care Home: Cranham Court Nursing Home

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What the care home does well People told us the staff were “excellent”, “kind and caring”, “friendly” and “cannot be faulted”. We observed staff working with people in a sensitive manner with the privacy and dignity of individuals protected. Relatives told us “staff are fantastic”, “I was constantly impressed by their dedication” and one person reported that their relative was “loved and cared for in every possible way”. The home is very well managed. Care plans are comprehensive with the necessary risk assessments in place and documentation is regularly reviewed to meet the changing needs of the service users. Health and personal care is of an excellent standard, and there are no offensive odours in the home. Staff have developed very good working relationships with health and social care professionals and this has resulted in service users being referred quickly for further health care treatment or advice. Good working relationships with the local St. Francis Hospice means that staff have undertaken palliative care and this has enabled an increasing number of service users to end their lives at the home, thus preventing inappropriate hospital admissions. Many of the service users told us that “the grounds are wonderful with lots of places to sit in the sunshine, and it is a real pleasure to watch the birds.” The internal environment is well maintained and individual rooms are personalised by the occupant. Menus are varied and offer several choices and there is a pictorial menu available to aid those people who are living with dementia. Many of the service users told us that “the food is good and there is always plenty.”Cranham Court Nursing HomeDS0000015588.V377064.R01.S.docVersion 5.2A variety of training opportunities are available to staff, and supervision and appraisals take place in accordance with legislation. We observed that the staff work together as a team to ensure that people living at Cranham Court are always put first, and this was confirmed during conversations with many of the service users. Complaints are received in a positive manner and the outcomes are used to improve services to people. All staff are aware of the safeguarding of vulnerable adults, and currently there are no safeguarding issues at this home. What has improved since the last inspection? Care plans are more person centred, and work continues on this documentation. Mealtimes have been reviewed and we observed staff being in attendance and giving assistance in accordance with the needs of the individual service user. Any assistance was given in a sensitive manner. A record of the dietary intake of people is now being maintained and this shows that people are receiving a balanced and varied diet in accordance with their needs and wishes. Resources are now available in the lounge areas to encourage people to participate in activities. However, staff are very aware of the need to ensure that service users are now more actively engaged in activities of daily living such as washing and dressing, ensuring mobility, and being able to feed themselves. One person who was not able to feed himself is now making good progress and is able to feed himself. Another service user was immobile and is now mobile. These activities are very important for the independence of the individual and can also be quite tiring for that person. To encourage this independence is very time consuming for the service user and staff member, but is ultimately very beneficial. A variety of entertainment activities are also available for those service users who wish to participate. What the care home could do better: Due to a change in the legislation, the controlled drugs cupboards must be reviewed so that siting and type of cupboard is in line with the new legislation. A copy of the applicable guidance was left with the manager at the end of the inspection. Hand written entries onto MAR (medication administration records) should have two signatures to ensure correct transcribing of information. Also protocols must be developed for all PRN (as required) medication, and all prescribed medication including creams and fortified drinks such as ensure/fortisip must be recorded on the MAR sheets when administered.Cranham Court Nursing HomeDS0000015588.V377064.R01.S.doc Version 5.2 It is also important that staff and service users are reminded that fire doors (this also means bedroom doors) should not be propped open. If service users want their bedroom doors open then these should be fitted with devices that will enable them to be automatically closed in the event of the fire alarm sounding. Key inspection report CARE HOMES FOR OLDER PEOPLE Cranham Court Nursing Home 435 St Marys Lane Upminster Essex RM14 3NU Lead Inspector Mrs Sandra Parnell-Hopkinson Key Unannounced Inspection 24th September 2009 08:00 DS0000015588.V377064.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 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 indu@cranhamcourt.co.uk The Holmes Care Ltd. Mrs Indumati Lakhani Care Home 82 Category(ies) of Dementia (82), Old age, not falling within any registration, with number other category (82) of places Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing- Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 82 22nd January 2008 Date of last inspection Brief Description of the Service: Cranham Court Nursing Home is registered to provide accommodation and nursing care to eighty-two older people. Currently there are fifty single, and sixteen double bedrooms, rooms also have en suite facilities. The original house with rear extension, and the more modern Woodlands Unit are operated separately. 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 living with dementia. On the day of the inspection the range of fees for the home was between £537.00 and £675.00 per week. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 stars. This means the people who use the service experience excellent quality outcomes. This was an unannounced inspection visit which took place on the 24th September 2009 over a period of 6.5 hours. We had the opportunity to speak with many of the service users, some staff and visitors. The manager was available during the inspection process. We examined a sample of various records and other relevant documentation and other evidence was taken from the AQAA (annual quality assurance assessment) which is a self-assessment document required by the Commission. What the service does well: People told us the staff were “excellent”, “kind and caring”, “friendly” and “cannot be faulted”. We observed staff working with people in a sensitive manner with the privacy and dignity of individuals protected. Relatives told us “staff are fantastic”, “I was constantly impressed by their dedication” and one person reported that their relative was “loved and cared for in every possible way”. The home is very well managed. Care plans are comprehensive with the necessary risk assessments in place and documentation is regularly reviewed to meet the changing needs of the service users. Health and personal care is of an excellent standard, and there are no offensive odours in the home. Staff have developed very good working relationships with health and social care professionals and this has resulted in service users being referred quickly for further health care treatment or advice. Good working relationships with the local St. Francis Hospice means that staff have undertaken palliative care and this has enabled an increasing number of service users to end their lives at the home, thus preventing inappropriate hospital admissions. Many of the service users told us that “the grounds are wonderful with lots of places to sit in the sunshine, and it is a real pleasure to watch the birds.” The internal environment is well maintained and individual rooms are personalised by the occupant. Menus are varied and offer several choices and there is a pictorial menu available to aid those people who are living with dementia. Many of the service users told us that “the food is good and there is always plenty.” Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 6 A variety of training opportunities are available to staff, and supervision and appraisals take place in accordance with legislation. We observed that the staff work together as a team to ensure that people living at Cranham Court are always put first, and this was confirmed during conversations with many of the service users. Complaints are received in a positive manner and the outcomes are used to improve services to people. All staff are aware of the safeguarding of vulnerable adults, and currently there are no safeguarding issues at this home. What has improved since the last inspection? What they could do better: Due to a change in the legislation, the controlled drugs cupboards must be reviewed so that siting and type of cupboard is in line with the new legislation. A copy of the applicable guidance was left with the manager at the end of the inspection. Hand written entries onto MAR (medication administration records) should have two signatures to ensure correct transcribing of information. Also protocols must be developed for all PRN (as required) medication, and all prescribed medication including creams and fortified drinks such as ensure/fortisip must be recorded on the MAR sheets when administered. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 7 It is also important that staff and service users are reminded that fire doors (this also means bedroom doors) should not be propped open. If service users want their bedroom doors open then these should be fitted with devices that will enable them to be automatically closed in the event of the fire alarm sounding. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. (Standard 6 is not applicable to this service) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. EVIDENCE: Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. The proprietor, who is also the manager, and staff put a high value on responding to individual needs for information, reassurance and support. Prospective residents and their families and friends are encouraged to visit the home to help the decision making process. We Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 10 spoke to one resident who told us “my family visited the home and told me it was in a great setting, and that the staff seemed really kind and caring.” The service has developed a comprehensive statement of purpose and service user’s guide and considers the different styles of support, treatment, philosophies and specialist services required to meet the needs of people using the service. All new residents receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The service ensures that it receives a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of this prior to admission. Self-funding residents have a pre-admission assessment undertaken by a highly qualified member of staff. Information is gathered from a range of sources including other relevant professionals, and with the individual’s agreement, the views and interests of family and friends are taken into account. The assessment focuses on achieving positive outcomes for people and this includes ensuring that the facilities, staffing and specialist services provided by the home meet the ethnic and diverse needs of the individual. All residents receive a contract to which they have agreed. It gives clear information about fees and extra charges which is reviewed and kept up to date. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11. People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Residents receive effective personal and healthcare support using a person centred approach with support provided based upon the rights of dignity, equality, fairness, autonomy and respect. Staff are very aware that the way in which support is given is a key issue for people, and care plans clearly record a person’s personal and healthcare needs and detail how these will be delivered. Equality and diversity issues are seen as important at this home, and staff ensure that care is person led, personal support is flexible, consistent and is able to meet the changing needs of the residents. Staff were observed to Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 12 show respect for the preferences of individuals, and demonstrated expert knowledge about the needs of the residents. We saw that staff responded appropriately and sensitively in all situations involving personal care, and ensured that this was conducted in private and at a time and pace directed by the person receiving the care. This was confirmed to us by all of the residents to whom we were able to speak to. One lady told us “nothing seems to be too much trouble for the staff, they are always smiling, kind and caring.” Staff members were seen to be very alert to changes in mood, behaviour and general wellbeing and responded appropriately. Aids and equipment are provided to encourage maximum independence for residents, and staff are very aware of the important of encouraging residents to maintain as many of the skills to daily living as is possible. This can be very time consuming for staff, and also can be very tiring for residents who are elderly and frail. However, with support and encouragement several of the residents have made great improvements since moving into the home, and one person was able to return home. Staff are trained and competent in health care matters particularly in the care of individuals who remain immobile for long periods of time, and the incidence of pressure ulcers sustained at the home is extremely low. Some residents are admitted to the home from hospital where they have sustained pressure ulcers, and the home has successfully treated these. All residents have access to a GP, chiropodist, dentist, optician and other health care professionals. Nutritional screening is undertaken and referrals made to a dietician or nutritionist where necessary. Various risk assessments are in place where appropriate, and according to the individual needs of a resident. A relative wrote “To all the staff at Cranham Court, thank you so very much for the care and kindness you show in taking excellent care of our Mum.” The home has developed efficient medication policy, procedure and practice guidance and regular audits are undertaken by the manager and the local pharmacist. We looked at medication records and these were found to be up to date, with the exception of the recording of prescribed creams and fortified drinks. All prescribed medication must be recorded on the MARs (medication administration records). The home has a sustained record of full compliance with the administration, safekeeping and disposal of controlled drugs. We did speak to staff and the manager about the good practice of having two signatures when transcribing information by hand from medication packs to MARs; the need to have written protocols around the administration of PRN (as required) medication, and due to recently introduced legislation, the need to re-site the controlled drugs cupboards to an external wall. A copy of the new legislation regarding the storage of controlled drugs was left with the manager at the end of the inspection. The home provides excellent care for residents who are terminally ill or dying. The staff have developed excellent working relationships with health care professionals, including the local GPs and St. Francis Hospice. The wishes of Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 13 individual’s about dying and terminal care and the arrangements they want after death are openly and sensitively discussed, where possible, during the development of a person’s care plan. Staff are proactive and are sensitive to the particular religious or cultural needs of the resident and his/her family. There are clearly recorded, respected and known to the staff delivering the care. All staff receive training and practical advice and have continuous support and opportunities to discuss any areas of anxiety and concern. Staff have received training in the use of syringe drivers, peg feeding, catheter care but the home does not currently take people who have nasal gastric feeding or subcutaneous fluids). Both the home and the Commission have received many letters of thanks for the care provided at Cranham Court. One relative wrote “thank you so much for all that you did to make my father’s last days so comfortable. All of you were so kind and attentive and I know my dad really appreciated all that you did. Thank you for everything.” Another relative wrote to us saying “My father recently passed away, and prior to his death he had spent many months at Cranham Court Nursing Home. Could I please take this opportunity to say how pleased I was with all aspects of Cranham Court. The staff were extremely friendly, caring and were always forthcoming with any information as to what my father had or had not been doing. His daily records were available to see if needed. The home is sited in nice grounds, was always clean and the food was of good standard. I would like to say that the care shown by the staff was commendable and made us feel at ease, knowing that Dad was being well looked after at Cranham Court. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style, and are supported to develop and maintain their skills to daily living. EVIDENCE: The service has a strong commitment to enabling residents to develop or maintain their skills to daily living, including social, emotional, communication and independent living skills. Individuals are supported to identify their goals and work to achieve them. This may sometimes mean that residents who are elderly, sick and frail may get very tired and need more rest time. Although entertainment activities such as jigsaw puzzles, board games, painting, quizzes and group activities are available, many of the residents do not choose to participate. One lady told us that “I like to spend my time in my room because I enjoy reading and am not interested in painting, playing games or things because I find them patronising because I am not a child.” Staff were observed to be encouraging residents, but often without success. However, it Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 15 was apparent that many of the residents enjoy listening to music and singing and staff ensure that this activity happens on a regular basis. The service has recently recruited a new activities co-ordinator who will be taking the lead on entertainment activities such as organising functions, trips and some group activities. The service is committed to the principles of inclusion and promotes and fosters good relationships with the wider community. Residents have the opportunity to develop and maintain important personal and family relationships, and visitors are always made welcome. Several residents told us that members of their family visit daily and are always made welcome. The spiritual needs’ of residents is seen as very important, and arrangements are made for ministers of religion to visit the home. The service respects the human rights of people using the service with fairness, equality, dignity, respect and autonomy underpinning the care and support being provided. All of the people we spoke to during this visit told us that they enjoyed the food. Comments included “the food is excellent here”, “I can’t fault the food” and “the chef is really good and takes a lot of trouble to give us what we want.” The needs of residents from an ethnic minority are also catered for, and this is done with support from the family. We noted that the menu for the day was written up on a board in the lounge areas. A number of alternatives are always available such as salads, jacket potatoes with a variety of fillings and omelettes. People make their choice of meals on the day, and a record is maintained of the meal chosen. Staff also maintain a record of the dietary intake for all of the residents. We found that the chef had a good understanding of the likes and dislikes of individuals. Drinks and snacks are available to all of the residents throughout the day and night. The chef has also produced menus in a pictorial format and this is used to help residents who have cognitive impairment to choose a meal. Some residents choose to take their meals in the dining room which was pleasant, and the tables laid appropriately. Other residents choose to take their meals in the lounge or in their bedrooms. Staff were observed to be giving assistance, where appropriate, in a calm and sensitive manner and at a pace dictated by the resident. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: We viewed the complaints log and found that complaints are recorded appropriately and the outcomes are used as a learning tool to improve services to the residents. The ethos of the home is that it welcomes complaints and suggestions about the service. A copy of the complaints procedure is given to residents and their families. Residents told us that staff do listen to them and act in accordance with their wishes. In discussions with some staff members it was evident that they recognise the importance of taking the views of residents seriously and of listening to and responding to issues raised. The home has an open culture where individuals feel safe and supported to share any concerns in relation to their protection and safety. Policies and procedures regarding safeguarding vulnerable adults are available to staff and give them clear guidance about what action should be taken. Access to external agencies or advocacy services is actively promoted. There is a clear system for staff to report concerns about colleagues and managers which Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 17 ensures that concerns are investigated in line with local policies and procedures. Staff who whistle blow on bad practice are supported. In discussions with some staff they were able to demonstrate a clear understanding when an incident needs to be referred to the local authority as part of the local safeguarding procedures. All staff working within the home are fully trained in safeguarding adults, and knowledge and understanding in this area is constantly checked at supervision and team meetings. Individual staff are also trained to respond appropriately to physical and verbal aggression and fully understand the use of physical intervention as a last resort. Staff demonstrated an understanding of what restraint is and alternatives to its use in any form are always looked for. Equipment which may be used to restrain individuals, such as bed rails, keypads, recliner chairs and wheelchair belts are only used when absolutely necessary, and within a risk assessment process. Currently there are no safeguarding issues at this service. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. EVIDENCE: We undertook a tour of the whole building and found all areas clean, well maintained and free from offensive odours. Staff were also observed to be practicing good infection control procedures. The grounds are very well maintained and offer a very pleasant environment for residents to sit and enjoy the sunshine, wild life and gardens. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 19 The home has both single and double bedrooms, but shared bedrooms are only used in limited situations and only by agreement with the people concerned. Currently the home has some married couples who want to share a bedroom. All residents are encouraged to personalise their bedrooms, and we saw evidence of this during our visit. One lady told us “my room is just like home from home. I have my own furniture, a small fridge and lots of lovely pictures and photographs.” The communal spaces are well furnished and there is a large quiet lounge that provides people with the opportunities to meet relatives and friends in private. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the residents, and are in sufficient numbers and of good quality. A programme of redecoration and refurbishment is in place, and work has just begun on the redecoration of parts of the main building. During the visit we noticed that some bedrooms doors were being propped open. This is not acceptable due to fire safety, and any doors where residents request them to be propped open must be fitted with magnetic door closures who are activated by the fire alarm. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the home. EVIDENCE: The service has a well developed recruitment procedure and the recruitment of good quality carers and nurses is seen as integral to the delivery of an excellent service. There is a very low level of staff turnover and this has given a competent and consistent service to residents. The service is proactive rather than reactive in its staffing, recruitment and training, with planning for the potential needs of people who may use the service in the future. The result of this is a diverse staff team that has a balance of all the skills, knowledge and experience to meet people’s changing needs. Management prioritise training and facilitate staff members to undertake external qualifications and training beyond basic requirements. Recent training Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 21 has included palliative care, syringe drivers, moving and handling, health and safety, Mental Capacity Act, Deprivation of Liberties, communication and dementia. The staff team were observed to be supportive of each other, and shared skills and knowledge with colleagues. Residents told us that the staff are very kind, caring and nothing was ever too much trouble for them. Training is targeted and focused on improving outcomes for residents. Both internal and external trainers are used to deliver this training. The manager demonstrated a very good understanding of equality and diversity throughout the recruitment, induction and training process. The content of the induction and probationary periods are robust and service specific. Whilst the majority of staff were seen to be communicating and interacting well with residents, it is important that all staff members understand the importance of this. Some college students are currently doing some work based opportunities at the home, and it is as important that these students understand the importance of talking to residents when assisting them or sitting with them. On the day of the inspection staffing levels were appropriate to meet the needs of the residents. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. EVIDENCE: The manager has the required qualification and experience, is highly competent to run the home and to meet its stated aims and objectives. The manager has sound knowledge of both strategic and financial planning, and demonstrates effective financial planning and budgetary control skill. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 23 The manager was able to describe a clear vision of the home and communicates a clear sense of direction. She was able to demonstrate a sound understanding and application of ‘best practice’ operational systems, particularly in relation to continuous improvement, customer satisfaction and quality assurance. All records and documentation are maintained to a high standard with regular audits being undertaken of areas including accidents, complaints, deaths at the home and medication. The manager was able to demonstrate service specific good practice areas, understanding current legislation and proposed developments, and the importance and purpose of having effective quality assurance systems. Equality and diversity, human rights and person centred thinking are given priority and the way the home is run shows an understanding of people’s needs in these areas. At all times the manager provides an excellent role model for other employees, and this was confirmed during our discussions with staff. Staff are required to follow the policies and procedures of the home and have easy access to training materials and documents. Regular supervision is undertaken for all staff members in accordance with regulations, and this includes 1:1 sessions, team meetings and care practice observations. The AQAA (annual quality assurance assessment) contained comprehensive information and was fully supported by appropriate evidence gathered during the inspection. The service demonstrates a high level of self-awareness and recognises the areas that it still needs to improve. The service has efficient systems to ensure effective safeguarding and management of residents’ money and valuables, and currently the home does not hold money for residents. Residents, and where appropriate, their families can gain access to records and contribute to them, and this was supported in a letter to us from a relative who told us “the staff were extremely friendly, caring and were always forthcoming with any information as to what my father had or had not been doing. His daily records were always there for us to see if needed.” Working practices in the home are safe and there are clear audits in place to monitor trends indicating a steady reduction in the number of preventable accidents. The home has a comprehensive range of policies and procedures to promote and protect residents’ and employees health and safety. Maintenance records were up to date with the necessary checks and certificates in place. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 24 The manager and staff have a good understanding of risk assessment processes which is underpinned by promoting independence, choice and autonomy. There have not been any DOLS (deprivation of liberty safeguards) referrals to a local authority. Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X X 3 X 3 Cranham Court Nursing Home DS0000015588.V377064.R01.S.doc Version 5.2 Page 26 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 (2) Requirement Timescale for action 31/10/09 2 OP19 23 (4) The registered persons must ensure that 2 signatures are recorded when transcribing written information from medication packs to MARs. All prescribed medication including creams and fortified drinks, must be recorded on the MARs. Also to comply with current legislation the controlled drugs cupboards must be re-sited in accordance with the requirements which were left with the manager during the inspection. Protocols to be developed for the administration of PRN (as required) medication. Compliance will ensure the safety of both residents and staff. The registered persons must 05/10/09 ensure that the home complies with fire regulations in that fire doors (which include bedroom doors) are not propped open but are fitted with magnetic door closures activated by the fire alarm, where a resident chooses to have his/her bedroom door open. This will ensure the safety DS0000015588.V377064.R01.S.doc Version 5.2 Cranham Court Nursing Home Page 27 of the residents in the event of a fire. 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.V377064.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission London Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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