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Cranhill Nursing Home Requires improvement

Reports


Inspection carried out on 3 August 2017

During a routine inspection

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 carried out on 5 July 2016

During a routine inspection

The inspection took place on 5 July 2016 and was unannounced. The care home was last inspected on 21 August 2013 and met the legal requirements at that time. Cranhill Nursing Home is registered to provide nursing and personal care for up to 31 people. There were 25 people living in the home on the day of our visit.

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.

People were assessed before they moved into the home to ensure their needs could be met. Initial care plans were devised with input from people and their relatives. Follow up reviews did not always include people and their relatives.

Most risks to people were assessed, however, actions were not always taken to reduce the risks and keep people safe.

People did not always receive personalised care that was responsive to their needs. Care plans did not always reflect that people’s individual needs, preferences and choices had been considered.

Governance systems were not in place to monitor and mitigate the risks relating to the health, safety and welfare of people.

People were supported to have their nutritional needs met.

The provider had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. Where people were deprived of their liberty this was done lawfully.

People who were supported by the service felt safe. Staff understood how to safeguard people, and knew the actions they would take if they suspected abuse.

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

Inspection carried out on 21 August 2013

During a routine inspection

We carried out a follow up inspection to check compliance had been achieved with: Respecting and involving people who use services. The manager sent us an action plan following our previous visit to tell us how compliance was to be achieved.

The people we spoke with told us the staff respected their privacy and they were cared for in a dignified manner. One person whose choice was to stay in their bedroom said “I stay in my room all the time, the staff are in and out and they always knock before they enter.”

We observed the way staff interacted with people. At lunchtime people were given time to eat their meals at their own pace. We heard staff ask people if they needed help to take their medicines. We saw another member of staff spend time with one person who stayed in their bedroom. The conversation between staff and this person was friendly and showed the staff understood the best approach to use with people that lived at the home.

Overall people told us the meals were good and one person said the meals were “excellent”. Other people said “the potatoes are hard sometimes,” and “they always serve the same vegetables.”

People told us the management of their medicines was handled by staff and they were happy with this arrangement.

People told us they approached the manager with complaints. One relative of a person who lived at the home said “If I was worried I would see the manager. She does listen and so does the deputy.” We saw the complaints procedure was on display which told people how to complain and reassured them their concerns would be taken seriously.

Inspection carried out on 5 December 2012

During a routine inspection

We spoke with three people that lived at the home, three relatives and one social and health care professional.

The three people we asked said the staff were good and they were cared for in the way they wanted, but were not able to say if they were involved in the planning of their care. They also told us there were activities and in-house entertainment organised and they were able to join in.

The three relatives and social and healthcare professional we spoke with said the staff were good and they knew how to meet the needs of the people who lived at the home.

When we spoke with the staff, they referred to the people who lived at the home by the room number they occupied rather than their names. We read where staff had recorded inappropriate judgemental comments about people’s behaviour which showed a lack of understanding of people’s needs. During our observations we saw there was a lack of interaction between staff and people using the service. We found people at the home were not fully respected as individuals and as a result staff showed a lack of insight into the people’s needs.

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