Cross Park House

Cross Park House is a residential care home which provides accommodation and personal care for up to 23 people. At the time of our inspection there were 17 people using the service.

People’s experience of using this service and what we found

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

People were protected from the risk of abuse as staff were aware of their safeguarding responsibilities and how to report any concerns. There were adequate numbers of staff with the appropriate skills and experience to meet people’s needs. Staff were recruited safely and received an induction and training to ensure they could meet people’s requirements.

People’s medicines were managed safely and given as prescribed. Staff followed infection control guidance and had access to Personal Protective Equipment (PPE).

People were supported by staff that were caring and treated them with dignity and respect.

People’s needs and choices were assessed, and their care was reviewed regularly. Care records identified people’s individual risks and how these should be managed to reduce the risk of harm.

Staff understood their roles and responsibilities and felt confident in their role. Staff liaised with other health and social care providers to ensure people’s health and care needs were met.

People were supported to have maximum choice and control of their lives and supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to maintain relationships with their families and had access to a range of activities both within the service and community.

The provider carried out regular audits of the service to oversee the quality of the care provided. This included competency checks of staff to assess whether staff were working in line with best practice.

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

Rating at last inspection and update

The last rating for this service was good (published 30 November 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Without exception all the people and relatives we spoke with praised the home. People’s felt safe and well cared for. People’s preferences were respected and staff were sensitive and attentive to people’s needs. Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well. The management of the home was described as “good” and “exceptional”.

There were sufficient numbers of staff employed to ensure people’s needs were met. Staff had time to sit and engage people in conversation and to support people’s involvement in social activities. Recruitment practices were safe and staff were well-trained.

Risks to people’s health, safety and well-being were assessed and management plans were in place to ensure risks were mitigated as much as possible. Staff were aware of their responsibilities to safeguard people.

People received their medicines safely and as prescribed. Medicine management practices were safe.

Décor and signage supported people living with dementia to orientate around the home. The environment was safe and equipment regularly serviced to ensure it remained in safe working order.

Consideration was given to providing a variety of leisure and social activities for people to enjoy. The home maintained links with the local community by providing trips to local places of interest and inviting local community groups to visit the home.

Quality assurance processes undertaken by the registered manager and the registered providers ensured people received high quality care that met their needs and respected their preferences. People and their relatives were involved in making decisions about their care.

More information is in the Detailed Findings below.

Rating at last inspection: Good (report published 13 May 2016)

About the service: Cross Park House is a residential care home that is providing personal care to 23 older people. The service is designed for people who have a dementia or other physical health needs. At the time of the inspection, 21 people were living at the home.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The home remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The home 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.

This inspection took place on 25 and 26 February 2016 and was unannounced. At the time of our inspection there were 21 people using the service. People had a range of needs with some people being more independent and others requiring more support with their mobility and care needs. The majority of the people who lived in Cross Park House were living with dementia.

We carried out a previous inspection on 17 June 2014 and identified concerns with the systems for managing medicines in the home. At this inspection we found sufficient action had been taken in relation to the management of medicines.

People, relatives, staff and healthcare professionals expressed confidence in the care provided at the home and the home’s management. Relatives felt their loved ones were safe and well looked after. Staff had received training in safeguarding people and knew how to raise concerns if they were worried about anybody being harmed or neglected. Staff had received information about whistleblowing and felt confident about doing this if they needed to. Staff knew how to raise concerns and contact details for external bodies were available. Relatives and staff felt confident that any concerns they raised would be acted upon quickly and effectively by the management.

Following our previous inspection the registered manager had taken steps to improve the home’s medicines management. They had sought advice from professionals and had implemented new systems and audits. On our inspection we found some small discrepancies in the medicine records but we were assured that people were receiving their medicines as prescribed. Immediate action was taken to implement further spot checks and reminders for staff.

People, their relatives and healthcare professionals spoke very highly of the staff and the care people received. People’s care was person centred and took into account their social and wellbeing needs. Staff told us they had enough time to meet people’s needs and throughout our inspection we saw staff care for people in a personalised and unhurried manner. Staff had time to sit and talk with people and engage people in activities.

Activities were provided every afternoon and responded to people’s interests and preferences. People were encouraged to engage in activities and were given high praise for participating. Where people did not want to participate or were unable to, staff spent time with them individually to ensure they did not get lonely.

Staff received sufficient training to meet people’s needs well and further training was available to those who wanted it. Staff were encouraged to become champions in some areas and were provided with specific training in those areas. Learning from this was shared amongst the staff team and helped ensure people received care which reflected current best practice. Staff received supervision and appraisals and were encouraged to share their views and ideas.

There were robust recruitment processes in place to ensure that suitable staff were employed. Staff performance was monitored with supervisions and spot check observations and poor practice was picked up and acted upon.

Staff were knowledgeable and confident when they spoke about people’s care needs. Staff had received training in, and understood the principles of the Mental Capacity Act 2005 and the presumption that people could make their own decisions about their care and treatment. The registered manager had a good understanding of the laws regarding the Deprivation of Liberty Safeguards and had made appropriate applications to the local authority.

Staff knew the people they cared for well, including their histories, their interests and likes and dislikes.

Each person had a care plan which was written in a person centred way. This care plan detailed their support needs and also detailed what people were able to do for themselves and how staff should help them maintain their independence. Where people were at risks relating to their health, their wellbeing or their safety, these had been identified. Staff had sought advice from external healthcare professionals and had created plans to minimise risks for people. People’s care plans and risk assessments were regularly reviewed and updated with any changes.

People were supported to eat and drink enough to ensure they maintained good health. Staff knew people’s likes and dislikes around food and these were recorded in their care plans. People were offered a choice of meals to meet their preferences and their needs. Where people required their food to be served in specific ways, such as mashed or pureed, this was served in an appetising way. People were provided with encouragement and support where needed and advice had been sought where people had lost weight or had lost their appetite. Meal times were a social event which people enjoyed.

The home was welcoming, open and friendly. Staff told us they cared deeply for all the people who lived in the home and felt they were part of their family. People’s relatives told us they felt the home operated as one big family and they felt their loved ones were supported by staff who really cared for them. Staff had gone above and beyond to give people a high quality of life. We heard laughter, chatting and gentle friendly banter throughout our visit. Staff showed affection for people and communicated with them in ways which relaxed them and comforted them.

The registered manager had worked hard to make the home accessible for people who lived with dementia. The environment had been altered to make people more aware of their surroundings and able to maintain some independence. There were objects throughout the home for people to pick up and handle and staff regularly organised reminiscence sessions which people enjoyed.

Relatives, staff and healthcare professionals spoke highly of the registered manager. The leadership structure at the home was clear and staff were confident in their responsibilities. The registered manager had an effective quality monitoring system in place which was used continually to review and improve the service. People’s views, opinions and feedback were sought through the means of meetings and surveys.

There were 21 people living at the home at the time of the inspection. As part of this inspection we spoke with four people who used the service, the Registered Manager, three members of staff and six visitors including five relatives. We also reviewed records relating to the management of the home which included four people's care plans, daily notes, people's turning charts, medicine records, four staff files, the home's policies and procedures and quality assurance folder.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People's needs had been assessed and regularly reviewed. There were plans in place to ensure people's care was delivered in a way that ensured their safety and welfare. There were clear policies and procedures relating to infection control. There were not suitable arrangements for the recording of medicines or the auditing of medicines.

Is the service effective?

People told us they were satisfied with the care they received. We saw from care records that people's care needs had been appropriately assessed and care plans reflected these needs. Where people's needs had changed, care plans had been updated to reflect these changes.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed understanding and gave encouragement when supporting people. Staff communicated clearly and at an appropriate pace with the people they were supporting. People's preferences had been obtained by the home and were included in people's care plans.

Is the service responsive?

The home responded to people's changing needs and sought advice and guidance from relevant healthcare professionals. Actions had been taken to respond to accidents and incidents. Staff told us the service encouraged feedback and responded to this appropriately.

Is the service well-led?

Quality assurance processes were in place in the home. We saw evidence of people and their relatives being asked for feedback and this being responded to and acted on. We saw that several audits and internal inspections had been carried out and that issues identified had been acted upon. Staff told us they were asked for their feedback and felt their opinions had been listened to and used to improve the home.

We looked at the care records of seven people and recruitment records for three members of staff. We looked at records relating to training of staff, management and administration of the service.

People told us they enjoyed living in the home, the staff 'were very caring and always happy to help'. Some people living there told us they preferred to stay in their room although they also visited the lounges for activities and meals and if they wanted company. People told us 'If I want anything I just ask, the staff are all kind'

We saw that outings were arranged, with the use of the minibus, and a variety of people visited the home providing entertainment, as well as visiting animals, including a donkey.

People had quarterly meetings, with members of their family and friends invited to attend. People told us notices about the meetings were put up in the home inviting them to attend. Staff also had quarterly meetings.

We saw that various quality and assurance audits were in place and monitored weekly and monthly. We saw evidence that the correct procedures were followed when employing staff and that mandatory training was undertaken, with a high number of staff undertaking higher level qualifications.

People told us the home was very easy to contact, the manager or the deputy manager were always available and they would have no hesitation about passing on any concerns they may have.

We saw improvements to record keeping at the home. Care records had been improved to show what care had been given. Kitchen records showed that kitchen hygiene management at the home was good. Additional training monitoring systems had been introduced to highlight when staff were due training updates and staff supervision.

We saw improvements had been made in decision making processes where bed rails were used on peoples' beds.

Changes had been made to the environment. During our inspection in August we saw that two ground floor bedroom doors had key chains fixed to the outside of them. We judged at the time that these could be considered as restraint. On this visit we saw that the doors had been transformed into windows. A fire risk assessment had been performed to show that the doors had not been present for fire escape purposes.

People told us they had been asked about their religious beliefs and people enjoyed the activities organised. People told us they enjoyed the food provided at the home and told us the food was 'Superb".

People spoken with said they felt safe and knew how to raise any concerns with the home. Three people being nursed in bed with bed rails in place and two ground floor bedrooms had chains fixed to the outside of the doors. These methods could be seen as restraint. There was no evidence to show these methods were an appropriate way of keeping people safe.

The Environmental Health team had inspected the home in July and found shortfalls in kitchen management. We observed that improvements had been made. The EHO have not reinspected.

There was a mandatory training programme in place. However some staff had not received updates in the last three years.

The standard of record keeping at the home varied. We saw examples where records had not reflected the care that had been provided.