Archived: Cramlington House

Cramlington House is a care home providing personal care for up to 63 people, some of whom are living with a dementia related condition. There were 63 people living at the service at the time of our inspection.

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

Systems were in place to help prevent people, staff and visitors from catching or spreading infection. Every staff member and visitor had their temperature taken at the door and were given appropriate PPE to wear. Every visitor also had to have a lateral flow test, complete a health declaration, wash their hands and use hand sanitiser upon entering the home.

The environment was very clean and hygienic. The provider had enhanced cleaning practices. This allowed more regular cleaning of frequently touched surfaces such as door handles and handrails.

The provider monitored PPE stock levels to ensure adequate amounts of PPE were available at all times.

Staff had completed training in Infection prevention and control (IPC) as well as putting on and taking off their PPE. The provider was constantly reviewing this with staff to ensure they followed current guidance.

The provider had employed a COVID-19 marshal who was dedicated to arranging testing, visiting, and carrying out checks to ensure staff remained competent in IPC practices.

Staff supported people’s social and emotional wellbeing. People received visits from relatives in a dedicated room and visits complied with government guidance. People were also supported to keep in touch with their family members via garden pod visits, window visits and video or telephone calls.

People and staff were taking part in the COVID-19 regular testing programme.

The provider had, at the peak of the pandemic, paid for taxis to bring staff to work to avoid the use of public transport.

The provider had measures in place to keep people safe and provide them with safe care and treatment. This included quality monitoring checks in place.

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 26 March 2019).

Why we inspected

A targeted infection prevention and control inspection was planned. We also received some concerns regarding the care people received. This was included as part of this inspection. We found no evidence to substantiate any of the concerns received. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns or to check infection prevention and control procedures. 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.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service: People, relatives and professional visitors told us it was a homely home with kind, friendly, helpful staff. People using this service benefitted from an outstandingly responsive service.

Care was highly personalised and tailored to meet people's needs. Care staff knew people and their relatives extremely well. They took care to involve and include them and were highly responsive to people’s needs. The quality of activities and experiences provided by wellbeing coordinators and care staff was exceptional.

The home was safe, clean and well maintained. Staff had received training in the safeguarding of vulnerable adults and knew the procedures to follow in the event of concerns.

The design of the home took into account best practice, particularly in relation to the needs of people with a dementia related condition.

Staff received regular training including bespoke dementia training developed in-house. This had been accredited by an external training provider, and staff demonstrated a good understanding of people's dementia care needs.

People were well supported with eating and drinking and enjoyed the food at Cramlington House.

Staff were very caring and we saw numerous examples of kind and compassionate care.

The provider and registered manager were supported by a carefully selected senior management team, who had various strengths to bring to the organisation which the provider used to full effect.

There was a strong focus on caring for staff to enable them to provide the best care possible. The provider strived to meet their support and development, and health and wellbeing needs, and had achieved bronze and silver awards in better health at work.

The service continued to have a good track record and close links with the local community.

Rating at last inspection: Good (published 20 July 2016).

Why we inspected: This was a planned inspection which was based upon the previous rating.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate and high quality care. Further inspections will be planned for future dates.

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

This inspection took place on the 16 and 20 June 2016 and was unannounced. The inspection was carried out by one inspector.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since August 2014. 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 were complimentary about the service and the staff who supported them. This was echoed by their relatives. Staff were complimentary about the support they received from each other, the registered manager, the operations manager and the provider. Healthcare professionals said they enjoyed a good working relationship with the service.

People told us they felt safe living at the home and we saw they were appropriately and safely supported in their daily lives. Safeguarding policies and procedures were in place to monitor and respond to any matters of a safeguarding nature and we saw that historically these had been dealt with correctly by the registered manager. Staff were aware of their personal responsibility to report incidents of a safeguarding nature and they had received training in safeguarding vulnerable adults. Risks that people had been exposed to in their daily lives and within the environment of the home had been assessed and mitigated against. Accidents and incidents were monitored, analysed and measures were put in place where necessary to prevent repeat events.

Recruitment procedures were robust and medicines were managed safely and appropriately in line with best practice guidance. Staffing levels were sufficient on the days that we visited the home to meet people's needs and staff confirmed that they were not unduly rushed in the pursuit of their duties. When people called for assistance we observed staff attended to them promptly to meet their needs. Staff were trained in key areas relevant to their role such as moving and handling, and also in areas such as Non Abusive Psychological and Physical Intervention (NAPPI) training, which was relevant to the needs of some of the people they supported. There was a thorough induction package in place and supervisions and appraisals took place regularly to provide support to the staff team.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and applications to deprive people of their liberty lawfully had been made to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken in line procedures set out in the MCA, and records about such decision making were maintained.

People were supported to eat and drink in sufficient amounts to remain healthy. There were monitoring tools in place which ensured that where there were changes in people's health and wellbeing this was identified and actions were taken to prevent any deterioration in people's conditions. For example, food and fluid charts and positional change charts were used, where people were at risk of malnutrition and pressure damage.

The premises had been designed with people's dementia care needs in mind. For example, pictorial and written signage was displayed around the home to highlight toilets, dining areas and bedrooms to assist people with orientation.

Staff and people enjoyed good relationships and there was a positive atmosphere in the home. People were involved in the service and explanations were given to people by staff when they delivered care. Staff presented people with choices so that they lived their lives in the way that they wanted to. People were encouraged to be as independent as possible and they were treated with dignity and respect at all times. Care was person centred and care records reflected people's current needs and any risks that they were exposed to. These records were regularly reviewed, well maintained and securely stored.

People were supported and protected from the risks of social isolation as there was a wide variety of activities for them to pursue should they choose to both internally within the home and externally within the community.

People, their relatives and staff described an open culture within the home and we found a welcoming and homely atmosphere. Staff were accountable for their actions and understood the responsibilities they were given. The requirements of the provider's registration were met and we were satisfied that notifications of deaths and other incidents were made in line with the requirements of the Care Quality Commission (Registration) Regulations 2009. A number of audits were carried out including those related to medication, infection control and health and safety. Other checks and monitoring of the service delivered were carried out to identify any issues or shortfalls. Action plans were utilised as a tool through which to drive improvements and feedback was obtained from people, their relatives, staff and healthcare professionals linked with the service.

Overall we found that medicines were not always safely handled and improvements are needed.

We found that improvements still needed to be made in regard to the management of medicines.

We considered all the evidence we had gathered under the regulations we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found.

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people, for example when assisting them with mobility. People appeared content and looked well cared for. Our observations confirmed that generally most people were very independent and staff encouraged this, whilst ensuring that they offered assistance to people if they required help. People told us that they were happy with the care and support they received from the service. One person said, "You get to know them (staff) here, they help you. The staff are always nice."

Staff were fully aware of people's care and support needs. Staff told us, and people confirmed that they pursued activities both inside the home regularly and within the community. On the day of our visit a small group of people enjoyed an outing to the beach for fish and chips. This showed the provider promoted people's well-being.

Is the service responsive?

The provider had arrangements in place to review people's care records regularly and we saw that amendments were made to people's documentation as their needs changed, to ensure this remained accurate and any issues were promptly addressed.

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as district nurses or doctors they received this care. One visiting GP told us, "I don't have any concerns here. If anything they phone me a lot. I have not seen anything that concerns me when I have come here."

People had a wide variety of foods available to them and confirmed that they were given choices. People's weights and food and fluid intakes were monitored if needed and referrals had been made to dieticians where necessary, to ensure they received specialist input into their care to remain healthy.

Is the service safe?

People told us they felt safe and the care that we observed was delivered safely. Risks that people may be exposed to in their daily lives and in relation to their care needs had been considered. We saw that instructions had been drafted for staff to follow to ensure people remained as safe as possible in light of these identified risks.

We reviewed the procedures that the provider had in place for safeguarding vulnerable adults and found that these were appropriate. Staff were trained in safeguarding and were fully informed of their own personal responsibility to report any incidences of harm, abuse or suspected abuse.

We reviewed the arrangements in place for the management of medicines. We found that these arrangements were not appropriate as controlled drugs were not effectively managed and individual stocks of medicines did not always tally with what had been received and administered. We have set a compliance action and we have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of medicines.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We discussed the recent Supreme Court judgement handed down on 19 March 2014 in the case of 'P v Cheshire West and Chester Council and another' and 'P and Q v Surrey County Council', about what constitutes a deprivation of liberty. The regional manager advised us that they were aware of this ruling, and had already liaised with their local authority safeguarding team for advice on their responsibilities and the arrangements they now need to put in place, for people in their care.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "Staff are always nice, I have nothing against the staff." Another person told us, "Staff are lovely." It was evident from speaking with staff and through our own observations that staff had a good knowledge of the people they cared for and their needs.

Staff told us that they felt supported by the manager and the provider, although supervisions did not happen very often. We discussed this with the regional manager who advised that a new system is currently being introduced to address this.

Is the service well-led?

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. A newly registered manager was appointed and in place. Staff said they felt supported by her and people and relatives that we spoke with felt the service was managed effectively.

The provider had policies and procedures in place which gave direction and instruction to staff.

Meetings for staff, people and their relatives were held regularly. Audits related to medication, care planning, health and safety and infection control were carried out to identify any issues or concerns. We saw that the provider had drafted action plans where issues needed to be addressed, in order to ensure that the service remained effective and well led.

We found people's needs were assessed and care was planned in line with their needs. One relative told us, 'X is happy here, she likes her meals. She gets anxious but the carers are wonderful with her. I was consulted about her care plan and updated regularly about any changes.' Care plans were regularly updated and contained clear information about individuals' care.

The home was clean and we saw there were effective systems in place to reduce the risk and spread of infection. Staff told us they had received training in infection control and demonstrated good practice during the inspection.

We found staff recruitment procedures were in place and records showed these were followed when new staff were appointed. We saw appropriate checks were undertaken before staff began work.

People's personal records were accurate, fit for purpose and held securely. Staff records and other records relevant to the management of the service were kept in an appropriate form.