This inspection took place on the 25 and 26 April 2017 and was unannounced. This means the provider did not know we were coming.

Cranlea provides personal care for up to 39 older people and people living with dementia.

At the last inspection, the service was rated good overall. At this inspection we found the service remained good.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to protect people from avoidable harm or risk. Staff received safeguarding training and were knowledgeable about their role in keeping people safe. Risks to people, staff and visitors were assessed and regularly reviewed. The service took action to minimise risks where appropriate in order to keep people safe from avoidable harm.

Robust recruitment processes were in place to ensure staff members were suitable to work with vulnerable people. Staffing levels were based on the dependency levels of people living at the home and were reviewed on a regular basis. Our observations and feedback during the inspection were that staffing levels continued to be appropriate to safely meet people’s needs throughout the day and night. Recent changes to staffing to reduce falls had improved this issue.

Appropriate systems were in place for the management of people’s medicines. People were encouraged to maintain their independence, for example through retaining responsibility for managing their own medicines if possible. Medicines were stored and managed correctly by staff who were trained and monitored to manage this safely.

Staff were supported through the provision of training, formal supervision and annual appraisals. Staff confirmed they felt well supported in their roles and spoke positively about the registered manager and their leadership and management of the home.

The service worked within the principles of the Mental Capacity Act 2005. People’s capacity to make decisions about their care and treatment was assessed and where appropriate, “best interest” decisions were made on their behalf. These involved relevant healthcare professionals as well as people’s friends and family members as appropriate.

People were very complimentary about the kind and caring nature of the staff team. Staff had developed strong, caring relationships with the people they supported and were very knowledgeable about their individual needs, likes and dislikes.

People’s needs were assessed prior to them joining the service. Detailed, person-centred care plans were produced which guided staff on how to care for people. These included details of any preferences people may have. People and their representatives were actively involved in their care planning and were also encouraged to voice their opinions about the service in general.

The services activities co-coordinator was noted for their pro-active approach. They had developed a diverse range of alternative activities such as art, music and dementia friendly activity, for groups and for individuals. We noted they were passionate and original in their work.

People’s needs were reviewed on an on-going basis and action taken to obtain the input of external professionals where appropriate. Systems were in place to ensure people had sufficient to eat and drink and to access other healthcare professionals in order to maintain their health and wellbeing.

A range of systems were in place to monitor and review the quality and effectiveness of the service. Action was taken to address what areas for improvement were identified. Complaints were taken seriously and records maintained of the action taken by the service in response to any form of dissatisfaction or concern. The registere

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Care records contained evidence that ‘best-interests’ decision-making had taken place where staff had identified people might not have capacity to provide valid consent.

People were protected from the risk of infection because appropriate guidance had been followed. The registered manager had taken steps to ensure the home complied with the latest guidance on how to prevent the spread of infections.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. People who used the service were protected from harm because the provider had carried out checks to make sure staff were suitable to work with vulnerable adults.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. However, failing to follow the principles and guidance contained within the Mental Capacity Act (2005) increased the risk that people might not be fully protected from inappropriate decisions being made on their behalf.

People experienced care, treatemnt and support that met their needs and protected their rights.

People were not fuly protected from the risk and spread of infection. There was a lack of clarity regarding whether the home was fully compliant with the Department of Health's publication: Code of Practice for health and adult social care on the prevention and control of infections. This increased the risk that the systems in place might not be sufficient to prevent, detect and control the spread of infections.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. However, the failure to obtain full employment histories for some staff meant that people were being cared for by some individuals who had not undergone comprehensive recruitment checks to confirm their suitability.

Comments and complaints people made were responded to appropriately.

We observed part of the morning medicines round and saw medicines, including a cream, being administered in a dining room in front of other residents. Giving medicines in this way does not fully respect people's privacy and dignity.

We spoke with one person about their medicines and the care they received. This person said “Staff are fantastic. If I need painkillers I can get them quickly. They always change the patch, to help with my angina,at the right time each day.”

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2012, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection carried out on 22 and 23 July 2014. Prior to this we last visited the service in August 2013, where we found the service was meeting all regulations inspected.

Cranlea provides personal care for up to 39 older people and people living with dementia. At the time of our inspection there were 35 people living at the home.  

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe living at Cranlea. The staff members we spoke to were knowledgeable about the safeguarding procedures and could talk us through examples of abuse and what to look out for and how they would report it.

The registered manager and senior staff were knowledgeable about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager had completed an assessment tool to assess who would require a DoLS application in accordance with the new guidelines and was working with the local authority to process these.

We looked at the recruitment files for three staff and noted all appropriate checks were completed prior to staff starting work. Staff told us they received sufficient training for their role. We saw regular staff supervisions and team meetings were in place. The registered provider was in the process of rolling out a new appraisal system.  

We spent time observing the dining experience and saw, where required, people were assisted during meal times by staff. We saw people were offered choices and those that did not want the prepared meals were able to specify what they wanted. People we spoke to told us the food was always nice.

Everyone we spoke to told us they had experienced positive care and support they received at Cranlea. We observed positive interactions between staff and people and that there was a very communal feel and a lot of activities were organised if people wanted to get involved.

We noted the service employed an engagement co-ordinator and a wide variety of activities were available to people on a daily basis, both in and out of the home. We saw that the home participated in a number of external pilots and projects, one of which looked at how engagement opportunities could help people with dementia.

People told us they were aware of how to raise a complaint. Staff told us they recorded all areas of concern identified no matter how small. We saw that all complaints were recorded in the complaints log. Details of the action taken and outcome were also included with a copy of investigation notes and written response where applicable.

All staff we spoke to told us the registered manager was approachable and they felt the home had a clear staffing structure. All staff members spoke very highly of the management team and told us they felt well supported in their role.  

We saw there were extensive audits and observations conducted on a regular basis by all levels of management to check the quality of the service that was provided. The registered manager told us an action plan was produced for any areas of development and we saw that this had a priority key, so it was clear to see what needed to be actioned first. The team leaders and care manager told us how they appreciated being involved in the audit process.