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Cranhill Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 6 December 2017

At our last comprehensive inspection of this service on 5 July 2016 we found four breaches of legal requirements were found. This included risk assessments were not always in place, incidents and accidents forms were incomplete, medicines were unsafe, water temperatures were unsafe, checks were not recorded, personal evacuation plans had not been completed. We also found people were not involved in their care plan reviews, staff were not receiving sufficient training and induction and there was a lack of accurate records and no quality assurance systems in place.

Following this inspection the provider confirmed how they were going to meet legal requirements in relation to these breaches.

At the last inspection, the service was rated requires improvement.

We undertook this unannounced comprehensive inspection on the 3, 7 & 9 August 2017. This was to follow up the previous breaches of legal requirements. At this inspection whilst there were improvements there were still concerns relating to previous breaches including shortfalls in staff training and inadequate staffing. Systems were not always identifying shortfalls found during this inspection.

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.

Cranhill nursing home provides care and accommodation for up to 31 people. On the days of the inspection 23 people were living at the home. The home is on four floors, with a lift or stairs. Some bedrooms have en-suit facilities. There are shower facilities and toilets. Communal areas include one lounge, one dining area and a sitting room. There is also a front garden with a patio area.

People were not always supported by adequate staff to meet their individual needs and three people told us they had to wait 10 minutes for their bell to be answered. At the time of the inspection the home had a number of vacant hours. The home was actively recruiting to fill those shortfalls. Following the inspection we received confirmation that the home always sought the same agency staff for continuity. People were not always supported by staff who had received training or an update to ensure they had the skills and competencies relevant to their role.

Where concerns had been raised these were not always being raised following safeguarding procedures to ensure people were being protected from potential abuse. Three people who were at risk of developing pressure ulcers had incorrect mattress settings in relation to their care. There was no daily check in place to ensure these were accurately set in between the monthly audit.

Two people who were losing weight had no action taken to prevent them from losing more weight.

People ate in the dining room or in their room. People who required assistance from staff had to wait for meals to be delivered to their rooms.

Care plans confirmed if people lacked capacity, however where people lacked capacity there was no best interest decision in place relating to their care and support.

Medicines were not always stored safely as we found thickening agent left in two rooms. We also found records relating to creams administered required improving.

People were supported by staff who had suitable pre-employment checks although there was no system in place that checked staff who had worked for the service for years.

Incidents were not always being recorded where staff were being scratched and injured whilst supporting people.

People’s care plans contained important information relating to their likes, dislikes and routines however, one support plan looked at for when a person became upset or distressed could be improved upon.

People felt able to talk to the registered manager and they were accessible. People were supported to maintain relationships that were important to them although they felt activities could be improved.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection areas

Safe

Requires improvement

Updated 6 December 2017

The service was not always safe.

Where concerns had been raised within the service these were not always being raised within safeguarding procedures.

People were not always supported by adequate staff to meet their individual needs and people had to wait for staff to respond when they called the bell.

Medicines were not always stored safely and records relating to creams administered required improving.

People were supported by staff who had pre-employment checks although there was no system in place that checked staff who had worked for the service for years.

Effective

Requires improvement

Updated 6 December 2017

The service was not always effective.

People could be at risk of developing pressure ulcers due to incorrect mattress settings in relation to their care.

People could be at risk due to ineffective systems where people were losing weight.

People could choose where they ate their meals although people who had meals delivered to their rooms had to wait for staff assistance.

Care plans confirmed if people lacked capacity, however where people lacked capacity there was no best interest decision in place relating to their care and support.

Caring

Good

Updated 6 December 2017

The service was caring.

People felt staff were kind and caring.

People’s privacy was respected.

People were support to maintain relationships important to them.

Responsive

Requires improvement

Updated 6 December 2017

The service was not always responsive.

People had care plans that confirmed their likes and dislikes, including what activities they enjoyed, however one care plan did not confirm what support someone might require when they became upset.

People had access to daily newspapers and books although activities were limited due to the home not having an activities co-ordinator.

People were supported to maintain relations with people who were important to them.

Well-led

Requires improvement

Updated 6 December 2017

The service was not always well-led.

Checks and audits were in place to monitor the service although some shortfalls had not been identified prior to the inspection.

Incidents were not always being recorded where staff were being scratched and injured whilst supporting people.

People and staff felt the management team was approachable and supportive.

People and relatives had their views sought although when concerns were raised no action had been taken.