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Inspection carried out on 3 August 2018

During a routine inspection

Cranmer Scheme is a 'care home'. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Cranmer Scheme is registered to provide accommodation and personal care for up to 16 people who have learning disabilities.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This inspection took place on 3 and 6 August 2018. The inspection was unannounced on the first day. This meant the staff and provider did not know we would be visiting. The second day was announced.

There was a registered manager in post at the time of our 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 2008 and associated Regulations about how the service is run.

People living in the home told us they felt safe and staff had a clear understand of the procedures relating to safeguarding and whistleblowing. Medicines were managed safely however we did find some recording issues which we addressed with the registered manager. People told us they received their medicine as prescribed.

Risk assessments were carried out and reviewed regularly or when needs changed to ensure risks were minimised. Accidents and incidents were managed effectively with trends and themes monitored to prevent re occurrences. The registered manager carried out an annual review of incidents with lessons learnt to prevent this from happening again.

There was enough staff to meet people’s needs and recruitment procedures were robust. Staff told us they were supported by the management team and had regular supervisions with annual appraisals to consider development opportunities. New staff completed an induction programme and staff completed training in line with the provider’s policy.

Staff were caring and kind. People were treated as individuals and staff ensured people made their own decisions when possible about their care and how they wished to live.

Care plans were person centred and detailed with instructions for staff to follow. People’s preferences, likes and dislikes were recorded which helped staff get to know people and to care for them in a way they wished to be.

People were encouraged by staff to remain as independent as possible and people set themselves goals to achieve so they could fulfil their wishes.

Staff supported people with their specific nutritional needs and where a person was at risk of choking, there was clear instruction for staff to follow to prevent an incident. People living in the home had annual health checks and regular appointments with health professionals to maintain their wellbeing.

Staff told us the management team were supportive and described them as “fantastic”. People living in the home felt confident any concerns raised would be addressed by the registered manager.

Audits were carried out to monitor the quality of care being provided and meetings took place with people and their relatives to gather feedback on the service being provided. This meant the provider had an insight into the improvements required within the home.

Further information is in the detailed findings below.

Inspection carried out on 14 January 2016

During a routine inspection

The inspection took place on 14 January 2016 and was unannounced. We carried out an inspection in September 2014, where we found the provider was meeting all the regulations we inspected.

The Cranmer Scheme is a care home without nursing. The care provider, The Jewish Welfare Board, is registered to provide accommodation for up to 16 people who require personal care. This care is provided in two separate houses each accommodating eight people.

At the time of the inspection there was 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.

Support plans contained some information about people’s mental capacity but we could not see how decisions about people’s capacity was made. Deprivation of Liberty Safeguards applications were made appropriately.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

Suitable arrangements were in place and people were provided with a choice of suitable healthy food and drink ensuring their nutritional needs were met. People’s health was monitored as required which included health conditions and symptoms so appropriate referrals to health professionals could be made. A range of activities were provided both in-house and in the community.

People’s needs were assessed and support plans contained sufficient and relevant information to provide consistent, care and support. We observed interactions between staff and people living in the home and staff were caring to people when they were supporting them. Staff knew how to respect people’s privacy and dignity.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment and selection procedures were in place, appropriate checks had been undertaken before staff began work and staff completed an induction when they started work. Staff received the training and support required to meet people’s needs.

The management team investigated and responded to people’s complaints in accordance with the provider’s complaints procedure. People we spoke with did not raise any complaints or concerns about living at the home. There were effective systems in place to monitor and improve the quality of the service provided.

Inspection carried out on 18 September 2014

During a routine inspection

The inspection visit was carried out by one inspector. During the inspection, we spoke with the home manager, deputy manager, care staff, people who used the service and relatives. We observed staff interactions with people who lived at the service, and looked at care records and records used to monitor the quality of service.

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

� 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. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service Safe?

At our last inspection in February 2014 we had raised concerns about the bathrooms at the service and some aspects of food hygiene. Following the inspection the provider forwarded an action plan telling us how they planned to address these shortfalls. They also provided us with regular updates regarding the progress of planned refurbishments. At this visit we found all actions had been completed as planned and people were living in a clean and hygienic environment.

Is the service Effective?

We did not look at regulations under this domain at this inspection.

Is the service Caring?

We found staff we spoke with demonstrated a good knowledge of people�s needs and were able to explain how individuals preferred their care and support to be delivered.

People we spoke with told us they were satisfied with the care they received.

Is the service Responsive?

Care records were detailed and reflected the individual needs of people who lived at the service.

People were involved in their care and were supported to lead fulfilling lives and be part of their community.

Is the service Well led?

We saw the home held meetings for people who used the service to give them the opportunity to share their views and make suggestions for improvements to the service.

The provider had an effective system to regularly assess and monitor the quality of the service that people received. We looked at a selection of reports which showed the provider had assessed and monitored the quality of service provision.

Inspection carried out on 6 February 2014

During a routine inspection

We observed staff interacting with people in a positive, respectful and caring manner. People appeared relaxed and comfortable in the presence of staff. We observed people laughing and smiling during interactions with staff. One member of staff told us, �We try and involve people to participate in everything we do as much as possible and ask for their views. That�s important because it�s their home.�

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

All the people we spoke with told us they liked the home they lived in and the staff who provided care to them. One person said, �The staff are very nice. There is nothing that could make it better. We are all very happy here.� Another person told us, �Staff are lovely, they�re nice. I like it. My bedroom is nice.�

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found that most of the bathrooms and toilets we saw were in need of refurbishment and were not meeting infection control standards. Most of the fridges and freezers we saw were not recording temperatures within acceptable parameters. This meant that people were exposed to unnecesary risk of infection. We have asked the provider to send us an action plan to address these issues.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The service has an effective complaints system available.

Inspection carried out on 5 February 2013

During a routine inspection

We spoke with people who used the service and to staff about the people who used the service. They said they were happy at the home, they nodded and smiled when asked if they liked the home. One person who used the service said �I can ask to go out if there is a carer available.� And �They all ask me what I want.� This gave us assurances that staff knew the needs of people and knew how to deliver the care and support effectively.

Our observations of the service showed that care staff spoke with and interacted with people who used the service in a patient and pleasant manner. Care staff supported people in a sensitive way using differing methods of communication to ensure that people understood what was going to happen.

The people who used the service appeared happy and comfortable with the surroundings. They appeared to be relaxed with the staff in their interactions with them. We noted that people who used the service had access to a wide range of activities which were personalised to their individual needs.

Inspection carried out on 20 January 2012

During a routine inspection

The people we spoke with told us that they were happy at the home or smiled, nodded and answered �yes� when we asked if they liked the home and the staff who supported them.

They said they had regular house meetings where they discuss what they like to do, menus and anything that might be bothering them. They also said they met regularly with their key worker to discuss all aspects of their care and support needs.

One person said, �Staff ask us if everything is alright for us.�

They also told us if they had any concerns or if they were not getting on with someone they would speak to their key worker, manager or relative.

Relatives said they were made very welcome at the home and kept well informed on the welfare of their relative. One said, �Communication is very good, first class.�

People who use the service and relatives we spoke with said they were very satisfied with the care provided. Their comments included:

�I have every confidence in them, they make sure people are well looked after.�

�(name of person) always looks clean with clothes all beautifully ironed.�

�They make sure we have what we need.�

Reports under our old system of regulation (including those from before CQC was created)