Crossways Nursing Home

We found the following examples of good practice.

There were systems in place to support safe visiting such as screening questions, temperature checks and checks on lateral flow tests and for professional visitors, checks on vaccination status. There were designated visitor areas including the use of a pod for those who wished to use it. People and relatives were happy with current visiting arrangements.

The service had good signage to inform people and visitors about the risks of COVID-19 and how to reduce them to keep everyone safe.

Staff had received training in infection prevention and control (IPC) as well as how to safely put on and remove Personal Protective Equipment (PPE) such as gloves, masks and aprons. Staff competence was checked by the registered manager and staff wore PPE correctly and told us they had plenty of supply.

The service was clean and tidy and well maintained. The registered manager conducted audits to check quality standards and ensure guidance was being followed. Policies were in place to guide staff on how to work safely should there be an outbreak of COVID-19.

People’s experience of using this service: One person told us, “I tell staff if I feel unwell, they ask if I need a tablet and then say we’ll keep an eye on you. They do and then call the doctor if they think best.”

One person’s relative also told us their views of the home, “The staff seem to work together as a team. There’s always people about and the manager is always about. I am always made welcome. It’s bright and airy in here, some of the areas could do with an update. I can get [relative] out into the garden in their wheelchair but I think others have difficulty getting out.”

People received a good standard of nursing care at the home. We were told by relatives how their relatives’ health had significantly improved since they moved to Crossways. When people were unwell or needed more specialist health support, referrals were made to these professionals in a timely way. Actions were then taken in the meantime to promote people’s physical health.

People had good risk assessments in place and received their medicines as prescribed. There were good levels of staff to meet people’s physical care and nursing needs. However, some people and their relatives felt that staff worked too long and too many shifts and were tired. The management team had not reviewed the potential impact this had on the quality of care delivery.

There were various safety checks completed in relation to the building to ensure people were safe. Safe staff recruitment checks were in place. Staff had a good understanding about what potential harm or abuse could look like. But they lacked the knowledge of how to share concerns outside the service.

Staff including the nurses received regular competency checks and training. Staff felt supported in their role and comfortable approaching the registered manager and one another for support.

Good systems were in place to respond and support people who were at risk of choking when eating and for those who needed to gain weight. However, people did not always have a positive dining experience, especially those who stayed in their rooms. Choice for people who were living with dementia was not promoted in relation to their food and drinks. The management team had not meaningfully assessed this aspect of people’s day to day life. We saw some poor practices in relation to staff assisting people to eat in their rooms.

People spoke positively about the staff. Referring to them as caring and kind. We saw some kind interactions from staff during the inspection. However, we also found that staff practice was not always personable to people. There was not a culture of staff spending time with people, talking with them, checking they were comfortable, or promoting their social wellbeing.

People told us that they enjoyed the activities that took place. We saw an activity co-ordinator spending time with some people during the inspection. However, there were people who spent all their time in their bed or bedrooms. There was little consideration given to these people. The management team had not completed any checks and in a meaningful way to see if people were okay with spending all their time in their bedrooms, or if they wanted more from their daily experience. We found that there were missed opportunities during our inspection of staff engaging with people or trying to improve their experience at the home.

People, their relatives, and we noticed that the environment of the home looked tired. There was a renovation plan in place, which was slowly being completed. The registered manager told us that the work will have finished by Christmas 2019.

The management team were completing audits and checks on elements of the care delivery. However, they had not fully considered people’s daily experiences living at the home, and if this could be improved upon. The registered manager was responsive to all the issues we raised. However, the registered manager and the provider’s own quality monitoring systems had not identified these shortfalls and they had not taken action to try and correct them.

There were breaches of the Health and Social Care Act 2008.

Rating at last inspection: Good (this report was published on 13 October 2016)

Why we inspected: This was a scheduled and planned inspection based on previous rating.

Follow up: We have asked for an action plan and will return to the home to check for improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Crossways Nursing Home provides nursing care and support for up to 30 people, some of whom maybe living with dementia.

At the time of our inspection 24 people were using the service.

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 and associated Regulations about how the service is run.

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and minimise any unnecessary restrictions on their liberty.

There were sufficient staff with the appropriate skill mix available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service.

Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. If required, staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

People and their relatives commented positively about the standard of the care provided. Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories.

People’s views were listened to and they were actively encouraged to be involved in their care and support. Staff ensured that people’s privacy and dignity was upheld. Any information about people was respected and treated confidentially.

People’s needs were assessed before coming to live at the service and the care plans reflected how their needs were to be met. There was a complaints procedure to enable people to raise complaints.

There was a culture of openness and inclusion at the service amongst staff and people who used the service. A variety of audits were carried out, which were used to drive continuous improvement.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

People told us they felt safe. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The provider's robust recruitment processes ensured that people were supported by adequately trained and experienced staff, who also administered people's medicines safely. People were also protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Is the service effective?

Detailed care plans were in place, and people told us their needs were being met. Staff received training to support people with various care needs. They also sought additional support from other health and social care professionals, to ensure positive care outcomes for people using the service. We found people were provided with nutritious food that enabled them to maintain their health and wellbeing.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with the staff, that they had a good understanding of the needs of the people they supported. People told us the staff were caring. One person said, "The staff are really nice. If I ask for something, they get it for me."

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to engage in a variety of activities of their choice.

Is the service well-led?

The service had a registered manager in post. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their relatives, staff, and other professionals. We found that they took account of the comments to improve the service.

We observed that staff interacted well with the people using the service and made sure they were fully involved in making decisions about their care and support. We found that people's capacity to consent was recognised and where appropriate, they

were able to exercise consent in most daily activities.

One person told us, "I am happy living here and the staff are really kind." Another person told us, "The care is second to none. Staff know me and my needs and really care for me." One relative said, "They look after her really well. If I have a concern I can talk to people straight away and it is dealt with."

We observed that care plans were person centred, with risk factors being appropriately assessed.

Staff felt well supported at work and said they found the home manager to be approachable. They received supervision and were supported with appropriate training and development to assist them in their roles.

We observed a robust complaints policy prominently displayed. Both staff and people told us they would feel able to raise any concerns or issues that they had.