Archived: Cranford Residential Home

Updated 22 April 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was conducted by two inspectors, an assistant inspector, and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Cranford Residential Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Cranford Residential Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post. However, they have since resigned. The nominated individual has also resigned. An interim management consultancy company currently oversees the running of the service until a new manager is appointed. They are working closely with the provider and have taken on the nominated individual role on a long-term basis. The provider also plans to engage the work of an external auditing company to review the work of the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Notice of inspection

This inspection was unannounced on 7 and 9 February 2023. On the 14 February 2023, we gave feedback to the provider, registered manager, nominated individual and the consultant care company.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We reviewed information we had received about the service since the service was registered. We used information gathered as part of our monitoring activity that took place on 6 May 2022 to help plan the inspection and inform our judgements.

We spoke with health and social care professionals who are either in contact with the service or regularly visit the service.

We used all this information to plan our inspection.

During the inspection

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who may not be able comment directly on their care.

An Expert by Experience spoke with 8 people living at the home and 2 relatives on 7 February 2023, and 10 relatives on 10 February 2023, to gain their feedback on the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We spoke with 11 staff and gave them an opportunity to respond to us by e-mail. We also spoke with the registered manager, the nominated individual, the care consultants and the prov

Updated 22 April 2023

About the service

Cranford Residential Home a residential care home providing accommodation and personal care to up to 26 people. The service provides support to older people, including people who are living with dementia. At the time of our inspection there were 20 people living at the service; one of whom was on a short stay arrangement.

Accommodation is provided over the ground floor and first floor. There are two flights of stairs in the home (one is for staff use only) and a passenger lift, which enabled people to access the first floor. The majority of bedrooms had ensuite facilities. The lounge and the dining room are on the ground floor. At the side of the home is a large open mature garden.

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

During the inspection a number of concerns were identified and shared with the provider while we were on site. The provider took quick action to engage a consultant care company to manage the home and oversee the governance. From 12 February 2023, an interim manager from the consultant care company was based at the home with additional support from an operations manager. The provider also engaged a legal team to ensure they took the appropriate action to investigate the conduct of one staff member. The provider took the matter seriously and has worked alongside CQC and other agencies to address the issues.

During the inspection, we saw due to poor risk assessment decisions, risks to people’s safety were not reduced. There was poor oversight of people's oral health care. Risks to people’s health were not always effectively monitored. A lack of regular environmental checks and fire training potentially put people at risk of harm.

Staff deployment did not consistently meet people’s care and social needs. When shifts ran below planned staffing numbers, staff said people’s personal care and entertainment were often impacted. Call bell records showed staff did their best to respond in a timely way but there were occasions when wait times were lengthy.

Care staff undertook training, such as moving and handling. However, not everyone had completed a course on dementia awareness despite the care needs of many people living at the home. Some staff told us they had received training in safeguarding and knew their responsibilities. However at the time of the inspection, not all staff had completed this course. This had not been addressed by the registered manager or the nominated individual.

The culture and the way the home was managed left staff feeling unsupported and overwhelmed at times. Staff were working additional hours to cover sickness, vacancies and absences; they were demoralised and saddened by the negative changes in the atmosphere and the management of the home.

Poor governance arrangements and oversight meant risks had not been identified or addressed. This included risks related to malnutrition, dehydration, lack of mental and emotional stimulation, poor personal care, staff training and environmental risks. The provider had recruited an experienced manager and nominated individual; we saw evidence of a thorough recruitment process. Despite regular visits by the nominated individual, ineffective action was taken to address concerns being raised.

Despite these issues, people living at the home did not raise concerns regarding their safety or well-being. Visitors said their relative was safe at the home; they had confidence in the staff team. For a few people in the lounge we saw how they enjoyed a quiz and an exercise class run by an agency member of staff, who obviously knew them well and laughed and joked with them. We could see how people who been sleepy and quiet became engaged with others by the social interaction.

Despite staff administering medicines being constantly interrupted with queries or phone calls, people told us they got their medicines on time. The storage and administration of people's medicines was safe. The risk of the spread of infection was well managed as staff were aware of their responsibilities. For example, people commented on the cleanliness of the home and the running of the laundry. People said their clothes were well cared for and did not get lost.

People living and visiting the home were complimentary about the attitude of staff. For example, “It’s alright, I’ve settled in, the staff are all very nice”, “There are better places, but the staff are kind”, and “My dad is happy here, he’s content.” A visiting health professional told us staff were “very caring and compassionate.” Despite the staff often being extremely busy, we saw staff were kind and thoughtful towards people living at the home. When they spoke about people, they were respectful, and it was obvious from their conversations they knew people well.

People’s individual tastes and preferences were catered for. For example, one person said they liked porridge and a bowl of crisps for their breakfast which we saw being served to them. Other people said they enjoyed the option of a full English breakfast. Relatives praised the quality of the food and the work of the chef. They said, “He loves the food… he has choices and says it is excellent” and “The food and the chef are brilliant. They are very amenable and know what mum likes.”

Following our feedback during the inspection, the provider took prompt action to contract with a care consultancy company to oversee the management of the home. They adapted their action plan as more information came to light which showed they were responsive and took the concerns seriously. They were upset and shocked. Since the inspection, their actions have placed the well-being and safety of people living and working at the home at the heart of their plan to improve the service. They have provided CQC and the local authority with an on-going action plan for the consultants role and a service improvement plan for the home. They have been open and worked alongside external agencies to ensure people are safe and the staff group are well led.

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 18 August 2018).

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

Why we inspected

Staff and people who had worked at the home contacted CQC with concerns regarding the management of the service, how staff were deployed, staff turnover, and the impact on the quality of care provided. Two relatives also contacted us with concerns linked to falls management, communication and dignity concerns. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We met with the provider on 14 February 2023 to discuss our regulatory response and review their action plan. We participated in whole service safeguarding meetings to monitor the management of the service and the well-being and safety of people living at Cranford Residential Home. We will continue to work alongside the provider and the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.