Archived: Cranford Residential Home

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.

We found the following examples of good practice.

Safe arrangements were in place for people’s relatives and professionals visiting the service. This included reviewing evidence of a confirmed negative lateral flow device (LFD) test result, recent polymerase chain reaction (PCR) test result, vaccination against COVID-19, requirements to show a COVID-19 pass, completion of a risk assessment at point of entry and the wearing of personal protective equipment (PPE) in line with government guidance and hand sanitisation.

Policies, procedures and risk assessments relating to COVID-19 were up to date which enabled staff to keep people safe.

The provider had identified a designated indoor area away from the main building for visitors to undertake lateral flow testing and await results.

There was a leaflet available for visitors explaining the testing process and rationale.

The service was clean and fresh, the service had dedicated ancillary staff who carried out a number of additional tasks, such as cleaning of regular touch points surfaces. Regular infection control audits took place and actions had been followed up when required.

The service introduced infection control grab boxes for deployment should any people become unwell. These boxes contained all essential infection control cleaning materials and a supply of PPE.

All staff had received training and followed correct processes for using PPE and maintaining infection control standards. The provider ensured a sufficient stock of appropriate PPE and there was signage to remind staff and visitors about the correct guidance for donning, doffing and disposing of PPE.

A recent hand washing audit had taken place. The registered manager had purchased an ultra violet (UV) light device that detected insufficient hand washing techniques and encouraged staff to use it as part of the hand washing audit to reinforce the correct technique and importance of hand hygiene.

The registered manager reported good support from local health professionals and the provider.

The staff felt supported and listened to by the management team.

The Cranford Residential Home can accommodate up to 26 people in a detached property situated in the seaside town of Exmouth. The home consists of two floors with a passenger lift providing level access to each floor. There is a main communal lounge, dining area and seating in the large entrance where people could spend their time as they chose. The home has a large landscaped garden which people could use if they chose.

This comprehensive inspection took place on 11, 17 and 19th July 2018. The first and second day of the inspection was unannounced. This meant that the provider and staff did not know we were coming. At the time of this inspection there were 24 people using the service. Three of these people were staying at the service for a period of respite (planned or emergency temporary care provided to people who require short term support).

We had previously carried out a comprehensive inspection in May 2017. At that inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to there not being effective and consistent systems to check some of the safety equipment at the home. The recording of how some risks to people's health were managed was inconsistent. Improvements were needed in how activities were provided, recruitment procedures and how staff were supported. Following the inspection we were sent an action plan which set out the actions the provider was going to take. At this inspection we found the provider had made the improvements and were no longer in breach of these regulations.

There was a new registered manager who registered with CQC in May 2018 (at the last inspection they were working as the acting manager). A registered manager is a person who has registered with CQC 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. Everyone praised the registered manager and the improvements they had made at the home. People said they were happy to approach the registered manager, staff and the provider if they had a concern, and were confident that actions would be taken if required.

The registered manager had put in place a comprehensive quality monitoring system at the service. There were regular audits and checks of the premises and equipment to keep people safe.

Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken. The provider used a new computerised care system where staff completed risk assessments which could be audited by the management team to ensure appropriate action had been taken. Staff were also able to record the support and monitoring checks undertaken on this system.

Staff were well supported. They received regular supervision sessions which gave them the opportunity to discuss their concerns and future development. Staff said they felt involved with the development of the service with regular staff meetings.

A staff member was responsible for co-ordinating activities and there was a varied timetable of events. They were new to their role and with the registered manager’s support had plans to develop activities further. The registered manager had ensured people and their families had been kept informed about changes at the service and asked for their views regarding future developments.

People and their relatives were happy with the way care was delivered and happy with the staff approach. Staff interacted positively with people and had a good knowledge of their care needs. People were cared for without discrimination and in a way that respected their differences.

Relatives were made to feel welcome and where appropriate were involved in the care planning process. Staff provided care in a way that protected people's privacy and dignity and promoted independence.

There was a sufficient number of staff on duty to care for people safely. Where there were any shortfalls the provider used the services of a local care agency, although this was only required occasionally.

The registered manager was passionate about staff receiving training and developing their skills. Staff were up to date with training and 90 percent of the staff were completing a higher qualification in health and social care to enhance their knowledge and skills. Staff also undertook additional training courses linked to the needs of the people using the service. Equality and Diversity and inclusion including human rights was part of the provider's mandatory training requirements.

Care records contained detailed risk assessments and care plans which reflected people’s individual needs. People were receiving care that was tailored to their individual needs. Care plans contained detailed information, including life history, to help staff support people in a personalised way. People had individual personal emergency evacuation plans in place. Accidents and incidents were recorded and analysed to look for patterns or trends. Regular maintenance checks and repairs were carried out and all areas of the service were clean and tidy.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The registered manager had been working with the local authority Deprivation of Liberties (DoLS) team regarding submitted appropriate DoLS applications. Capacity assessments were being undertaken and best interest decisions were being recorded.

People were supported to maintain their health and wellbeing and had access to health professionals when needed. People were very happy with the food they received. There was a varied menu containing well balanced nutritious options. Snacks and drinks were available if people required them. People's weights were monitored regularly and advice sought from health professionals if there were any concerns.

Staff meetings took place every two months and staff felt able to discuss any issues with the registered manager. Feedback was also sought from people using the service and relatives through regular meetings and surveys.

The staff were committed to ensuring people experienced end of life care in an individualised and dignified way. The registered manager had developed a leaflet to help guide people and relatives through the end of life stages. There were numerous thank you messages from relatives regarding the good quality care people had received at the end of their lives at the service.

There was a complaints procedure in place and people knew how to make a complaint if necessary. The registered manager had received three complaints since our last inspection. They had responded to the complaints in line with the provider’s policy and had made changes as a result of lessons learnt.

The first two days of the inspection were unannounced and took place on 22 and 24 May 2017. We returned on 6 June 2017 to provide feedback to the providers and this was announced to ensure they were available. On this inspection, we judged there were two breaches of regulation relating to recruitment and the management of health and environmental risks. We have made two recommendations relating to supporting people’s social interests and achieving good governance.

The previous registered manager had been in post for approximately a year and resigned in April 2017. The providers had made CQC aware of this change and the action they had taken to address these changes. They had arranged for their training consultant to become an acting manager until their newly recruited manager started. The provider advised us that a new manager had been appointed and was due to start in July 2017. 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.

Cranford Residential Home provides accommodation for 26 people, including people living with dementia, a mental health need and a learning disability plus sensory loss. On the first and second days of the inspection there were 20 people living at the home. This had increased to 21 on the third day as a person had returned from hospital.

Since the last inspection, the registered manager had resigned. A new manager had been appointed and their induction planned. In the meantime, the training consultant had recently stepped into the role of acting manager. The provider and the acting manager told us after an induction period, the aim was for the new manager to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 said they felt safe and secure living at the home. They were positive about their relationships with staff, for example in a survey one person said, ‘Good atmosphere with caring staff and I can always talk to someone. I do feel you care and that is important.’ People were protected from potential abuse and avoidable harm. Staff had undertaken safeguarding adults training and understood their responsibility to reports concerns immediately. There were sufficient numbers of suitable staff available at all times to meet people's individual needs.

The providers had a good relationship with staff and the acting manager. Through investment they showed an on-going commitment to improve the experience of people living and working at the home, including refurbishment. They said they were going to be more pro-active in the running of the home in the future as they had not identified some systems were not in place to ensure the environment was safe and some safety checks were not routinely completed. Improvements were also needed to how staff were recruited and trained. Information within the service user guide needed updating, which included the complaints information.

People using the service also fed back that the current arrangements for activities and social interaction did not meet their needs. We have made a recommendation about supporting people to meet their individual interests. Communication about changes within the home still needed to be developed to include people living at the home, although this had improved for the staff group.

Staff were positive about the team work at the home and the improvements being made to support them carry out their job. For example, steps were being taken by the acting manager to address overdue supervisions, improve inductions and provide a range of training. Work had taken place to improve staff understanding about the importance of recording. Areas for further improvement were identified during the inspection but this was addressed and records had improved by the third day of inspection.

Staff respected people’s choices and valued people as individuals knowing when to change their approach based on their knowledge of the person. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. There were systems to monitor the quality of the service, including responding to suggestions for improvements. Medicines were well managed.

People were offered a choice of meals. They were supported with their health needs and had access to health professionals, when necessary. They told us staff were caring and respected their privacy and dignity.

We judged there were three breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

We brought forward this comprehensive inspection because we received concerns regarding the care provision and the staff levels at the service. We last visited the service in June 2014. The service was compliant with the standards inspected and no breaches of regulations were found.

In April 2015 the provider had made changes to their registration with the Care Quality Commission (CQC) and had removed two regulated activities. This meant they no longer provided a service for people with on-going nursing needs. People living at Cranford Nursing Home were now under a residential service contract and any nursing needs were being met by the community nurse team.

When we visited there was a registered manager in post. However their employment ended with the provider on the last day of our visit. They had applied to CQC to remove their registration. A registered manager is a person who has registered with CQC 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.

The provider made us aware that the deputy manager and two senior care staff had also submitted their resignation. People and staff expressed concerns regarding the loss of the registered manager and other senior staff. The provider recognised the upset this had caused people and staff and were working to develop a stable workforce. They confirmed they were actively looking to recruit a new manager and senior staff and would keep CQC updated on the situation on a weekly basis.

There were adequate staffing levels to meet people’s needs. Although people concerns were expressed regarding recent staff reductions and a proposed staffing level change. The provider confirmed this would not be something they would be considering in light of the staffing issues. Staff had clear leadership roles at the home with delegated responsibilities.

People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. The provider used the services of a care consultant to deliver training. Care staff had received training to take over some roles previously completed by nurses. Staff had developed skills and knowledge to meet people’s needs. Staff relationships with people were strong, caring and supportive. Staff delivered care that was kind and compassionate.

Measures to manage risk were as least restrictive as possible to protect people’s freedom. Medicines were safely managed on people’s behalf.

Care plans were personalised and recognised people’s health social and psychological needs. People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.

People were supported to eat and drink enough and maintained a balanced diet. People were positive about the food at the service.

The premises and equipment were managed to keep people safe. The provider was undertaking repairs and refurbishments.

The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. Where there were concerns or complaints, these were investigated and positive action taken.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

This planned inspection was undertaken as part of our on-going monitoring but also to follow up on required improvements which had been made in relation to care and welfare and records management, following our previous inspection in February 2014. Following the inspection the provider sent an action plan to us detailing the improvements being made.

On the day of our inspection there were 20 people living at Cranford nursing home.

We spoke with seven people using the service and six visitors, the providers, registered manager and eight staff supporting them.

Following our visit we contacted the hospice team who regularly visits the home to support people living there to ask their views.

Is the service safe?

The service is safe because the registered manager ensured that recruitment procedures at the home were robust and effective. They ensured staff on duty had the appropriate qualifications, skills and experience required to ensure people's needs were met.

The registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLs). The registered manager told us there had been no reason to restrict or deprive people using the service of their liberty, in line with Deprivation of Liberty Safeguards legislation.

The home had suitable arrangements in place to reduce the risks of people receiving inadequate nutrition or becoming dehydrated.

Is the service effective?

The service was effective because we found people's health and care needs were assessed and their care plans and assessments were reviewed monthly. Specialist dietary, mobility and equipment needs had been identified in care plans where required. This showed that people were having care delivered effectively or in accordance with their assessed needs.

It was clear from our observations and from speaking to people and staff, they had a good understanding of people's care and support needs and they knew them well.

A nurse from the hospice team told us the people they support were well cared for and that the home contacted them promptly for advice if they had any issues.

Is the service caring?

The service was caring because people were supported by staff who were understanding and sensitive to their needs. We saw that staff showed patience and gave reassurance and encouragement when supporting people.

People at the home told us they were happy at the home. Comments included, 'I have never been in such a nice place, I could not wish for better' and 'the food is classic English food, very nice' and 'I cannot fault the home at all'.

Is the service responsive?

The service was responsive because the home had appropriate systems in place for gathering, recording and evaluating information about the quality and safety of the overall service. Systems were in place to make sure the registered manager and provider learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People told us they knew how to make a complaint if they were unhappy. A complaint was received during our inspection we saw it was acted upon promptly and in line with the homes complaints policy and procedure. People can therefore be assured that the home acts upon complaints, they are investigated and action is taken as necessary.

We saw the provider acted promptly to put in place locks to ensure archived records were stored safely at the home.

Is the service well-led?

The service is well lead because we saw the registered manager who does not have a health qualification and as a requirement of CQC is supported by a registered nurse as the clinical lead. The hospice nurse told us 'The manager is approachable and very enthusiastic to get it right'. People we spoke with were positive about the registered manager comments included 'I can always tell X' and 'She (the registered manager) always listens'. This showed that the registered manager was demonstrating effective leadership at the home.

The providers are based at the home. We found they worked with the registered manager and the staff to ensure the standards people expected at the home were maintained. For example we saw the providers working with the manager to implement training and new documentation at the home.

The information we received related to people who used the service, not being supported to take adequate fluids and diet. Information also referred to poor documentation and a decline in the care provided at the service.

At the time of our visit there were 23 people living at the home, we spoke with six people and two visitors. We also spoke with the manager,director, two nurses, five care workers and two ancillary workers.

People who required anticipatory care and support were not consistently having their care needs met. Care was not consistently monitored. Care workers did not have clear guidance to provide consistent care.

People who were able to express their wishes were prioritised. People who were unable to ask for assistance were not always made a priority.

People told us that the carer workers were very kind and nothing was too much trouble.

There was a variety of healthy and nutritious food and drink available.

Not all records were reviewed or updated regularly. Some care records had not been reviewed for four months and some records had not been completed accurately.

Visitors told us they had been kept involved and informed. One commented, 'It is absolutely brilliant, I can't fault it'.

Care workers demonstrated a good knowledge of how each person was affected by their condition and of the principles of person centred care.

People enjoyed living at the home. One person said 'they are all very nice here'. Another person said 'I get everything I need'.

We saw that people's privacy, dignity and independence were respected. For example, personal care needs were attended to in private. People were supported to maintain their abilities for example being supported to feed themselves and to remain continent.

People were helped to remain healthy because their health care, health promotion and social and psychological needs had been assessed and actions had been taken to address these needs.

People said they felt safe and were very complimentary about care workers. They said 'they are very kind'. We saw there were enough care workers and staff on duty with the right skills, to meet people's needs.

Records were kept securely. However, care plans were inconsistent and poorly organised with gaps in information. This could result in a risk of unsafe or inappropriate care.

We observed people's care as a way of understanding their experience. We saw that staff were attentive, kind and respectful. People were supported to make choices, for example in relation to what time they got up and what they ate. We saw records that showed what food people were offered at tea time.

We saw in care records that referrals to health care professionals had been made when required. We saw that where recommendations had been made that staff followed this advice.

We saw staff moving people, including those who were unable to move themselves, correctly with the appropriate equipment. All staff were trained in moving and handling and further training had been booked.

Staff had the knowledge and skills to safeguard people from abuse. They were employed in sufficient numbers.

We last visited the home in September 2012. At that inspection we identified some concerns with regard to people's care and welfare. We asked the provider to take action which they agreed would be completed by the end of January 2013. We will be revisiting the home again in January 2013 to check on compliance with that issue.