Archived: Cranmore

Cranmore is a residential care home providing personal care to five people with learning disabilities, autism and complex needs at the time of the inspection. The service can support up to six people in one building.

People’s experience of using this service and what we found

People continued to be at risk from abuse from one another. Some people could display behaviours that could be challenging to staff and people they lived with. Staff continued to lack the guidance and skill to support people in a positive way. Incidents between people were not always documented or reported to the local authority safeguarding team or the Care Quality Commission.

When incidents between people occurred, there was a lack of guidance for staff to support them to de-escalate situations. Staff accepted incidents of physical abuse between people as normal. Similar incidents of physical and verbal abuse occurred, and staff, the registered manager and the provider failed to put measures into place to prevent these.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This was a targeted inspection that considered risk management and safeguarding under our key question of Safe. Based on our inspection of this area, the service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting did not maximise people’s choice, control and independence.

Right care:

• Care was not person-centred and did not promote people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using the service led confident, inclusive and empowered lives.

Staff lacked understanding on how to support people with autism and learning disabilities. This had a negative impact on people and led to a culture within the service which did not uphold people’s human rights.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 17 June 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider continued to be in breach of regulations. Therefore, this service remained in Special Measures.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about risks to people and incident management. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to abuse and risks to people at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

Following this inspection, we worked closely with commissioning authorities to ensure people were safeguarded from on-going harm. Five people were supported to move out of Cranmore. There is currently no one living at Cranmore.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Cranmore is a residential care home providing personal care to six people with learning disabilities, autism and complex needs at the time of the inspection. The service can support up to six people in one building.

People’s experience of using this service and what we found

People told us that they had been hit, and their hair pulled by a person living at the service, and that staff took no to very little action to prevent it. Staff we spoke with lacked the understanding that people would be upset and hurt by this, and failed to report it as abuse. Numerous incidents between people had been logged inconsistently and not reported to the local authority safeguarding team.

Incidents were not consistency logged and there was no oversight or management of incidents. As a result incidents re-occurred and people were harmed. Care plans and risk assessments were not updated following incidents and there was no mitigation put in place to avoid the incident re-occurring.

The culture of the service was poor. Staff spoke about and to people in a derogatory way; for example, calling them ‘silly’ and saying people ‘threw paddies’. People had been ‘told to go to their rooms’ during incidents. People were not supported in a person-centred way in line with positive behaviour support. People’s rights and dignity were not upheld.

People were unlawfully physically restrained by staff who had been trained but their competency not assessed to ensure they were using the correct techniques. The staff who trained the team on how to restrain people had not had recent training. The methods of restraint used described to us could cause people pain.

Staff lacked the skills, knowledge and guidance to support people. Staff were not trained in positive behaviour support, and punitive practices such as not allowing people to get magazines due to behaviours were used.

There was a lack of infection control measures placing people at significant risk from covid-19. Days before our inspection, staff started to wear face masks and told us they had not previously due to people’s distress with PPE (personal protective equipment). People were observed not to be distressed by the PPE worn, and when we asked staff about this, they told us people could struggle to hear when staff used PPE. The service had a covid-19 outbreak in December 2020 and every person tested positive for covid-19.

There was no oversight or governance in place. The registered manager and provider failed to complete any audits of the service and failed to identify the significant concerns we identified during our inspection. The registered manager and provider failed to meet their regulatory requirement to notify us of safeguarding incidents.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People had unnecessary restrictions placed on them, such as not having access to toilet paper and being locked out of the kitchen. Staff lacked the knowledge and skill to support people in a person-centred way and lacked understanding on learning disabilities including autism and how people may present themselves. This had a negative impact on people’s lives and infringed on their human rights.

Right support:

• Model of care and setting did not maximise people’s choice, control and independence

Right care:

• Care was not person-centred and did not promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 15 November 2017.)

Why we inspected

We received concerns in relation to the management of behaviours, the competency of staff and the risk management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We received concerns relating to mental capacity, and the environment, and therefore we inspected this part of effective only.

We reviewed the information we held about the service. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cranmore on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, staffing and notification of other events at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Cranmore is registered to provide accommodation and personal care for up to six people who have a learning disability and other complex needs. Cranmore is a detached house situated on the outskirts of New Romney. The service had a communal lounge and dining area available with comfortable seating and a TV for people, each person had their own bedroom, decorated and furnished to suit their needs and preference. There was a secure enclosed garden to the rear of the premises. Building works were nearing completion at the time of our inspection to an extension adjoining the main house.

The service had a registered manager, who was present throughout the inspection. 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 and associated Regulations about how the service is run.

A robust system to recruit new staff was in place; this helped to make sure that people were supported by staff that were fit to do so. Throughout the day and night there were sufficient numbers of staff on duty to meet people’s assessed needs. When staff first started to work at the service they were supported to complete an induction programme. Staff continued to be supported with on going training, support and supervision. Staff meetings took place. These all gave opportunity for staff to share ideas and discuss any issues.

Medicines were managed safely and people received their medicines when they should. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and referrals were made when required. People were supported in a safe environment and risks had been identified, and were managed in a way that enabled and encouraged people to live as independent a life as possible.

Records were in good order and contained current information that was clearly laid out; making them easy to use.

Staff understood how to protect people from the risk of abuse. They had received safeguarding training and were aware of how to recognise and report safeguarding concerns. Staff knew about the whistle blowing policy and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Systems were in place to check if people were at risk of being deprived of their liberty. Systems were in operation to obtain consent from people and to comply with the MCA. People were supported to make decisions and choices about all aspects of their lives.

Staff encouraged people to be involved and feel included in their environment. People were offered activities and participated in social activities when they chose to do so. Staff knew people and their support needs well. The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. Staff understood people’s likes and dislikes and dietary requirements and promoted people eating a healthy diet.

Staff told us the service was well led and they felt very supported by the registered manager to make sure they could support and care for people safely and effectively. Staff said they could go to the registered manager or service provider at any time and they would be listened to and suggestions discussed. Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. The registered manager and provider had good management oversight and were able to assist us in all aspects of our inspection.

Cranmore is registered to provide personal care and accommodation for up to six people who have learning disabilities and range of health and support needs. These included; autism, Prader Willi Syndrome, diabetes and some complex and challenging behavioural needs.

At the time of inspection six people lived at the service. People told us they liked the service, they were happy and staff were kind. They thought the home provided a safe, relaxed and comfortable living environment.

Cranmore is a detached house situated on the outskirts of New Romney. The service had a communal lounge and dining area available with comfortable seating and a TV for people, each person had their own bedroom. There was a secure enclosed garden to the rear of the premises. Building works were being carried out at the time of our inspection to build an office complex in the garden and an extension adjoining the main house. This meant people were unable to use a separate dining area in the service because it was being used as a temporary office.

A registered manager was in post. A registered manager is a person who has registered with the care Quality Commission to manage the service. 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.

Cranmore was last inspected in June 2014. At that inspection it was rated as ‘Requires improvement’. A number of breaches of Regulation were found during that inspection and the provider sent us an action plan to tell us what actions had taken place to make improvements. The action plan stated that the breaches had been addressed by mid-September 2015.

At this inspection we found improvements had been made, but some areas required further input to make them better. However, we also found some new breaches of Regulation.

Recruitment processes were not sufficiently robust to demonstrate that identified potential concerns were considered and if needed mitigated.

Staff supervision had lapsed and did not meet the service’s policy; this meant opportunity had been missed to address some elements of staff practice.

People’s aspirations were not effectively developed or maintained; goal setting and reviews were not adequately evaluated or recorded.

Some records were incomplete and auditing and quality monitoring frameworks remained ineffective to identify and address these and other concerns found during the inspection.

Medicines were safely administered and stored. Checks ensured sufficient medicines were ordered, the right amount was given and that people received the right medicines when they were supposed to.

Staffing had increased, was flexible and kept under continuous review; there were sufficient staff to safely support people’s needs.

Items requiring replacement, maintenance or repair received prompt attention and a maintenance schedule planned the completion of remaining work.

Risks were evaluated, measures were put in place to keep known risks to a minimum and staff knew how to keep people safe. People told us they felt safe in the service and when they were out with staff. Staff had access to the local authority safeguarding protocols, and knew which incidents should be referred for investigation.

Authorisations and decisions, made under the Mental Capacity Act 2005 to deprive people of their liberty, were notified to the Care Quality Commission when they needed to be.

All staff had an understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards, they understood in what circumstances a person may need to be referred and when there was a need for best interest meetings to take place. Advocacy services were made available to people.

People had personalised records detailing their care and support, including well developed support plans for their emotional and behavioural needs. People were supported to access routine and specialist health care appointments. People told us staff showed concern when they were unwell and took appropriate action.

People were supported to attend activities and staff had received necessary training to support people confidently and safely.

People felt comfortable in complaining, but did not have any concerns. People, relatives and visiting professionals had opportunities to provide feedback about the service provided both informally and formally and this was acted upon.

We found a number of breaches the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

People told us they made choices about their lives such as about what to do, what to eat and when to get up and go to bed. People were aware of their care plans, had contributed to what was in them and had signed the information.

People said they liked the staff and that staff gave them support and encouragement to gain independence skills and to experience new activities. One person told us 'I like my keyworker she is really nice'.

People told us they liked their rooms; they kept them clean and tidy themselves to the level of their ability, and had chosen their own colour schemes. They said the home was comfortable. One person told us 'I like my room, sometimes I go there in the evening and listen to music or play games' and 'it is always clean and tidy'.

People were aware of who they could speak with if they were concerned about anything. They told us they would speak with the manager or staff and that they had opportunities to voice any concerns at their keyworker and house meetings.

During this inspection we spoke to people who used the service. People continued to be happy with the care and support provided. One person did speak to us about a small concern they had. They said this had not been an issue on the day of the inspection, but over the previous week. With their consent we spoke to staff who told us they were aware of the concern. Staff said the issue had arisen because the upstairs hoover had broken. This had been discussed at a recent staff meeting and until a new one was purchased it had been agreed staff would carry the hoover upstairs for people to use. The individual was satisfied with this outcome.

Staff had received an appraisal to ensure they had the opportunity to discuss any learning and development necessary in order to meet people's needs. Staff felt well supported.

People told us they were satisfied with the care and support they received. One said, 'I like living here'. People were aware of their care plan although did not always know the detail. People said that they had the opportunity to discuss their care and support with staff.

People told us that they felt safe receiving a service and spoke positively about the staff. One said, 'I like all the staff, they help me when I need help'.

People told us they had the opportunity to discuss any concerns, give their opinions and be involved in decision making at their residents' meetings. They said that when they raised concerns these were 'sorted out'.