Cranham Court Nursing Home

Cranham Court Nursing Home is a care home located in Upminster, Essex. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Cranham Court Nursing Home is registered to provide nursing care to older people, some of whom have dementia or palliative care needs. The service accommodates 68 people across two separate units, each of which have separate adapted facilities. The Main and Extension unit is a nursing and residential facility and the Woodlands unit, specialises in providing care to people living with dementia.

On the day of our inspection, 61 people were using the service in total.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Each unit was managed by a registered nurse. They were supported by the the registered manager, who was also known as Matron.

At our last comprehensive inspection on 1 November 2016, we found the provider did not meet legal requirements to ensure the service was safe or well led. This was because care and treatment was not provided to people in a safe way and the provider did not always operate effective systems to monitor risks to people’s health, welfare and safety.

The provider wrote to us to let us know what action they were taking to meet these requirements.

We visited the service again on 4 May 2017 to look at the progress of their action plan and found there were still some improvements required as there was a continuing breach of health and social care regulations. We wrote to the provider and sent them a Warning Notice to be compliant by 4 August 2017.

At this inspection, we found that the service was compliant and was now meeting legal requirements.

We saw that improvements had been made and the service was now safe. People told us they felt safe living at Cranham Court Nursing Home.

Medicines were managed safely and administered by staff who were trained to do so.

The premises were safe, clean and regularly maintained. There were enough staff on duty. However, the provider was currently relying on agency staff to fill in for staff on leave, vacancies or any sickness absences. The provider was in the process of trying to recruit more permanent staff. The provider had safe recruitment procedures in place and carried out checks on new employees.

Risks to people were identified to ensure they remained safe. It was not always clear how the risks were managed and we have recommended that these are more clearly set out.

Staff had received training on safeguarding adults and were able to describe the actions they would take if they had any concerns about possible abuse. The provider also had a whistleblowing policy, which staff were aware of and they knew how to report any concerns they had.

Staff were supported with regular training, meetings and supervision. Staff work performance was reviewed on a yearly basis and they were encouraged to develop their skills.

The provider had systems in place to support people who lacked capacity to make decisions for themselves. Staff received training in the Mental Capacity Act 2005 and were knowledgeable about the processes involved in assessing people’s capacity.

Staff ensured people had access to appropriate healthcare, when needed and people's nutritional needs were met.

Staff were aware of people’s preferences, likes and dislikes. People were treated with dignity and their choices were respected, although we found that some people’s personal health information was displayed inappropriately. We have made a recommendation about this.

People were involved in the planning of their care and received care and support to ensure their individual needs were met. Some people’s care plans were incomplete with regards to their personal histories, thoughts and preferences. We have recommended that efforts are made by the provider to ensure they are completed more thoroughly to ensure they remain person centred.

People were encouraged to participate in activities and remain as independent as possible. However, the activities programme was not always sufficient and no activities took place during our two day inspection. We have made a recommendation about reviewing the structure of activities to ensure a more stimulating environment.

People and their relatives were able to make complaints and the registered manager investigated these.

Staff felt supported by the management team. Their responsibilities and requirements when providing care were discussed in staff meetings.

The registered manager had systems in place to monitor the quality of the service provided to people and made further improvements when required.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report of our last comprehensive inspection, by selecting the 'all reports' link for Cranham Court Nursing Home on our website at www.cqc.org.uk.

Cranham Court Nursing Home provides accommodation, nursing and personal care for up to 68 people. On the day of our visit, 61 people were using the service. The service is located in Upminster, Essex and is divided into two large units; the Main and Extension unit, which is a nursing and residential unit and the Woodlands unit, for people with dementia.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found the provider had taken sufficient action to ensure medicines were stored, administered, recorded and ordered more effectively, safely and appropriately. We also found that steps had been taken to make sure equipment such as wheelchairs were used more safely by using the footrests on them to move and transfer people.

However, there were still concerns relating to people obtaining and receiving their medicines on time. At our last inspection, we found that some people had missed important doses of medicines for more than one day. This was due to a change in the ordering system between the GP, pharmacy and Cranham Court which caused delays. This meant that some people received their repeat prescribed medicines late. These issues were mostly resolved after the ordering system reverted back to the previous system of ordering monthly instead of three monthly.

Although there were improvements, we noted that one person had missed important medicines for nearly two weeks due to staff not taking sufficient action to obtain their medicines. There was a failure to effectively assess the risks and ensure that the person received their medicines more efficiently, after they were admitted to the service. We have also made some further recommendations around training in administering certain treatments such as eye drops, creams and ointments.

The service followed safe recruitment procedures to ensure staff were safe to provide care to people and had carried out recent Disclosure and Barring Service checks for long serving staff.

There were improvements in communication among staff from each unit to share good practice. The registered manager demonstrated an understanding of their role and responsibilities. We noted a range of weekly and monthly audits, including medicine and health and safety checks. However, we found there were still ineffective systems to routinely monitor the safety and quality of the service provided that ensures all people's needs are met.

We identified one continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At our previous inspection in October 2014, we found breaches of legal requirements in relation to inconsistent medicines management and insufficient staffing. During this inspection we found that improvements had been made to staffing, however there were still shortfalls relating to medicines management and this also identified some concerns about how the service was managed overall.

Cranham Court Nursing Home provides accommodation, nursing and personal care for up to 68 people. On the day of our visit 61 people were using the service. The home is located in Upminster, Essex and is divided into two large units; the Main unit, which is a nursing and residential unit and the Woodlands unit, for people with dementia.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe most times with the exception of three people who remembered a time when an incident happened. Some people were supported by staff on a one-to-one basis as a result of these incidents. Staff understood their responsibilities and how to recognise and report abuse.

Medicines were not managed safely. We found inconsistencies in covert medicines management, the current medicines ordering systems and the way in which medicines records were completed. Medicine room temperature checks to ensure medicines were stored at the correct temperature were not recorded on one unit. This left people at risk of receiving ineffective medicines.

There were appropriate risk assessments in place to manage any risks to people and the environment. Staff could explain the actions they would take to mitigate any identified risk. Prior to the inspection we had received a concern about a people having a specific skin condition. We found evidence that the service had taken appropriate steps to try and establish the cause and take the necessary measures to resolve it.

The premises had been refurbished and was clean. There were effective infection control procedures in place. Appropriate health and safety checks and weekly fire drills took place to ensure the environment was safe.

The home followed their recruitment procedures to ensure staff were safe to provide care to people, although the service had not carried out recent Disclosure and Barring Service checks for long serving staff. We have made a recommendation about staff recruitment checks to ensure staff remain suitable to support people throughout their employment.

People were supported to access health care services in order to maintain their health. We saw evidence of input from the GP and that referrals were made appropriately.

Care plans were personalised to an extent and they were reviewed when people’s needs changed.

We observed people were treated with dignity and respect.

Staff undertook training and received supervision to support them to carry out their roles effectively. The registered manager and the staff team followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff training records showed they had attended training in MCA and DoLS.

People told us they could express their concerns and were confident that they would be resolved. Complaints and compliments were received and responded to appropriately.

Activities were not always suited for people living with dementia. We made a recommendation for the provider to seek best practice guidelines.

People thought the service was run well by an approachable management team. Staff felt supported and were provided with guidance. We found that each unit worked independently and that there was not enough effective communication among staff from each unit to share good practice.

The registered manager demonstrated an understanding of their role and responsibilities, however we found there were ineffective systems to routinely monitor the safety and quality of the service provided.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a relaxed and comfortable atmosphere within the home and the staff we spoke to understood how to support people, assisted them to make choices and maintain as much independence as possible. An agency member of staff told us "people here are well cared for," another said "we encourage people to do what they can".

In order to protect the people who used the service, we saw that staff were knowledgeable regarding safeguarding and about people's needs and preferences. Staff were observed to treat people as individuals and delivered care in a personalised way.

There were several processes in place to monitor the quality of service being provided including meetings for people who used the service their relatives and representatives. We saw that people were also involved through questionnaires and one to one discussions.

Relatives we spoke to told us they were very happy with the standard of care. Comments included "never had any cause for concern, care is extremely good," "won't get any better care, I have recommended it to others" and "the staff always keep me informed".

People who use the service were positive about the care and treatment they received at the home. They confirmed that staff assisted them when they needed support with their care and that staff were very helpful. People also told us they had good access to health care professionals such as doctors, district nurses, dentists and chiropodists.

We spoke to people about safety. They told us that they felt safe and that if anything ever happened they would be happy to speak to the manager.

Staff were supported in their training and in their everyday working environment. All staff that we spoke to said that they were happy with the training they received. Rota's showed that the provider had taken measures to ensure that there was always enough staff on duty to provide an effective, safe service.

We found that all areas of risk had been appropriately assessed and that the provider carried out regular checks and reviews. Policies and procedures were comprehensive and appropriate to ensure the delivery of a safe, effective service.