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Cranham Court Nursing Home, Upminster.

Cranham Court Nursing Home in Upminster is a Nursing home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs, dementia, diagnostic and screening procedures and treatment of disease, disorder or injury. The last inspection date here was 14th December 2017

Cranham Court Nursing Home is managed by The Holmes Care Limited.

Contact Details:

    Address:
      Cranham Court Nursing Home
      435 St Mary's Lane
      Upminster
      RM14 3NU
      United Kingdom
    Telephone:
      01708250422

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Good
Caring: Good
Responsive: Requires Improvement
Well-Led: Good
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2017-12-14
    Last Published 2017-12-14

Local Authority:

    Havering

Link to this page:

    HTML   BBCode

Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

24th October 2017 - During a routine inspection pdf icon

This unannounced inspection took place took place on 24 and 25 October 2017.

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 heal

4th May 2017 - During an inspection to make sure that the improvements required had been made pdf icon

This inspection took place on 4 May 2017 and was unannounced. At the last inspection on 1 November 2016 we found the service to be in breach of the regulation relating to having systems in place to ensure equipment was used in a safe way and for the proper and safe management of medicines. This also meant the provider did not have effective systems and processes to assess, monitor and mitigate the risks to the health, safety and welfare of people in the service.

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 conc

1st November 2016 - During a routine inspection pdf icon

The inspection was unannounced and took place on 1 November 2016.

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

3rd January 2014 - During a routine inspection pdf icon

During our visit we saw that staff treated people with dignity and respect. Staff were seen to knock on doors before entering and provided assistance in a kind and discreet manner. People that we spoke to were very positive about the home and staff team and comments included, “I think it's brilliant", "staff are friendly and helpful" and "don't think you will find any better than here."

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".

21st February 2013 - During a routine inspection pdf icon

People who used the service told us that they were happy living at the nursing home. They told us that staff were kind and treated them with respect.

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.

1st January 1970 - During a routine inspection pdf icon

This was an unannounced inspection over three days on the 28, 29 and 31 October 2014. During the visit, we spoke with six people using the service, seven friends and relatives, eight care workers, five nursing staff and the 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 and associated Regulations about how the service is run.

In January 2014, our inspection found that the service was compliant with the regulations we inspected against.

Cranham Court is a care home registered to provide accommodation and nursing and personal care for up to 82 people who require personal care and may also have dementia. The service is located in the Upminster area.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

A number of the medicine records for people using the service were incomplete without a written explanation.

The number of staff on duty in one part of the home was inadequate to fully meet people’s needs. You can see what action we told the provider to take at the back of the full version of the report.

We found two areas that required improvement.

Although part of an organisation, the home stands alone and does not receive the required support to transition to the organisation’s procedures.

We recommend that the organisation reviews the support given to the home to become integrated within its structure.

We saw that the home provided a safe environment for people to live and work in apart from the corridor area, on the ground floor within the older part of the home that presented a hazard due to its incline.

We recommend that the organisation risk assesses the areas highlighted.

Apart from the recording of medicine administered we saw that the records we looked at were clear, easy to understand, up to date and reviewed regularly. We sampled eight care plans from different areas of the home that were clearly recorded, fully completed, regularly reviewed and underpinned by risk assessment. The staff at all levels of seniority were well trained, knowledgeable, professional and accessible to people using the service and their relatives.

People said they were happy living at Cranham Court, with the service they received, the staff who delivered it and way it was delivered. They told us staff were caring, responsive to their needs and the home was well managed. This matched our observations during the inspection visit.

Three people living at the home thought there were enough staff to meet their needs although three others said they had to wait to have their needs met. Five friends and relatives and six staff also felt there were not enough staff particularly during busy periods. We saw that during some periods of the day staff struggled to meet people’s needs in a timely way.

The staff we spoke with had appropriate skills and training, were familiar with people using the service and understood their needs. This was reflected in the care and support we saw given that was professional, supportive and compassionate.

The home’s management team had clear and transparent care philosophies and values. These were reflected in the good care practices that we saw staff following. The organisation had

introduced new procedures that staff had not adequately had explained to them, regarding recording in the social aspects of the care plans.

People told us and we saw that the registered manager operated a policy of being available to people when they wanted to speak with them, encouraged feedback from people who use the service, their relatives and monitored and assessed the quality of the service provided.

 

 

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