Holy Cross

Holy Cross is a care home that provides personal and nursing care for up to 56 people, some of whom are living with dementia. At the time of the inspection there were 48 people living in the home.

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

People felt very safe living in the home and with the support they received from staff. People and relatives were complimentary about the staff, describing them as “friendly,” “supportive” and “caring.” Comments included, “I feel safe because the place is well staffed and they are very approachable, caring and the place has a good atmosphere about it” and, “The staff are very friendly, and I can have a bit of banter with them. I could not be treated better anywhere else.”

Staff safeguarded people from abuse. Risks to individuals and the environment were well managed. One relative said, “It’s clear that information is appropriately shared and all staff clearly know [family member] well. The whole atmosphere is of happy residents and happy staff, which has enhanced [family member’s] safety.” There were enough staff to meet people’s needs. The provider learned from accidents and incidents to mitigate future risks. Medicines were safely managed. Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices.

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

The home was well managed. A staff member told us, “Our manager has been a member of staff at Holy Cross for many years. She understands what the home is all about and is very hands on and approachable.” The provider, registered manager and staff promoted a positive culture in the home. People and relatives were complimentary about the home and care people received. The provider had an effective quality assurance process in place which included regular audits. People, relatives and staff were regularly consulted about the quality of the service through daily communication, surveys, meetings and reviews.

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

Rating at last inspection

The last rating for this service was good (published 4 March 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we decided to undertake a focused inspection to review the key questions of Safe and Well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection. We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holy Cross on our website at www.cqc.org.uk.

Follow up

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

Holy Cross is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Holy Cross accommodates 56 people in one adapted building. Accommodation is provided on two of the four floors. One of which provides accommodation for people with nursing care needs. On the day of our inspection there were 50 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We last inspected the service in November 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

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

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Holy Cross.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. Support plans were in place that recorded people’s plans and wishes for their end of life care.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

Holy Cross Care Home is registered to provide nursing and residential care for 56 older people. At the time of our inspection there were 52 people living at the home.

The home did not currently have a registered manager. The registered manager had left the home in September 2015. A new manager had recently been appointed. 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 told us they received good care from kind, caring and considerate staff. People told us the home was a good home to live in and the care was good. One person said, “I am content here”, and, “This is a good home.” People were supported to be as independent as possible by staff who knew their needs well.

People, family members and staff consistently told us the home was a safe place to live. One person said, “I love it here. Staff are so kind and helpful, nothing is a problem. Yes I feel perfectly safe here.” One family member said, “[My relative] has been in a couple of homes and this is by far the best, I have no concerns at all and would recommend it to people.” One staff member commented, “Safe, yes…We have everything in place.”

Staff had a good understanding of safeguarding adults and whistle blowing. This included how to report concerns. One staff member said, “Yes, [concerns] would be dealt with appropriately. In 18 years I have never thought about using it [whistle blowing procedure].” There had been no recent safeguarding concerns logged.

People were assessed to help protect them from a range of potential risks. Where risks had been identified action was taken to help keep people safe, such as high protein drinks and meals and monitoring people’s food and fluid intake where people were at risk of poor nutrition. Medicines were managed safely and people received their prescribed medicines on time.

There were usually enough staff to meet people’s needs quickly. The registered provider assessed staffing levels to ensure there were enough staff on duty. One staff member described staffing levels as, “Fine, we can see people quickly.” Recruitment checks were carried out before new staff started their employment.

The home was clean and tidy with no unpleasant odours. People had personalised their rooms. Regular health and safety checks were carried out. There were procedures in place to deal with emergency situations, including an ‘Emergency Plan’ and Personal Emergency Evacuation Plans (PEEPs). There was an electronic reporting system for incidents and accidents which automatically alerted senior staff that there had been an incident.

Staff told us they were well supported and received the training they needed. One staff member commented, “Very supported, [senior manager’s name] is always there for support if I ever need it. I have never felt unsupported.” Records showed that staff supervisions, appraisals and training were up to date.

People were asked for their permission before receiving care. Staff confirmed they would respect a person’s decision. One staff member said, “It’s their choice. We always ask first. If they refused we would offer another alternative such as a full body wash for example.”

The registered provider followed the requirements of The Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations were in place for 20 out of 52 people. MCA assessments and best interest decisions had been made on behalf of people who had been assessed as not having capacity.

Although most people had a pleasant lunch time experience, some people had to wait a long time before receiving their meals. People gave us positive feedback about the meals they were given. One person commented, “The food here is good and you get a good portion.” People were encouraged to choose what and how much they wanted to eat.

Staff had a good understanding of how to support people who displayed behaviours that challenged. They had a clear understanding of the individual strategies for each person, such as offering a cup of tea, encouragement or distraction.

People were supported to access health care when required. One family member commented, “I would recommend this home to anyone. The family is kept up-to-date and the doctor is contacted if needed.”

People’s needs had been assessed before and after they were admitted into the home. People had been actively involved in the assessments. Detailed, personalised and up to date care plans were in place for each person. Regular reviews were held involving people who used the service and sometimes family members.

Staff responded quickly to help and support people. One person said, “I only have to ask and staff respond.”

A range of activities were available throughout the day, including a weekly visit from a hairdresser, outings and bingo. A daily church service was held. Activities for people living with dementia could be improved. One staff member said, “More specific activities to the needs of people with dementia.” The registered provider’s dementia strategy contained actions to improve activities. Volunteers visited to offer people manicures, foot baths and one to one chats.

People and family members knew how to make a complaint. There was a complaints procedure for people and visitors to access if they wanted to make a complaint. People and family members could attend regular meetings to give their views about the care provided at the home. A comment box was available for people to make suggestions.

Staff told us the new manager was approachable. One staff member said, “If ever I have a query I can go to the senior or the manager. They are definitely approachable, always about, always there.” There was a positive atmosphere in the home. Family members told us staff welcomed them when they came into the home. One staff member commented, “Very friendly atmosphere and a homely atmosphere, always has been.”

Some staff members were not aware of the registered provider’s values. One staff member responded, “Don’t think so” when asked whether there was a set of values.

Staff had opportunities to give their views through attending regular staff meetings. One staff member said, “[Staff] can give their views at any time of the day.”

The registered provider had an annual audit programme to check on the quality of people’s care. Most audits were up to date and had been successful identifying areas of improvement. Medicines audits had been successful in identifying gaps in MARs but had not identified that a medicine in stock was out of date.

The registered provider carried out an annual quality survey to gather people’s views about the service. Feedback from the most recent in 2015 had been positive.

One relative said 'The care is phenomenal; the staff are experienced and understand my relative's needs'. Another relative said 'Brilliant, the care is 100%, I cannot fault it, the staff are lovely.' One relative said there were plenty of activities 'They make seasonal decorations, play carpet games and there is a good atmosphere and activities every day'.

We saw that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard and the provider had systems in place to identify risks and monitor the quality of service provided. There was an effective complaints system in operation.

We spoke with people about the care they received at Holy Cross Care Home. They told us they received regular medical care from their GP, and also from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required. One person told us, 'The girls are wonderful. They go beyond the call of duty in making sure we are okay'.

People told us there was always staff around and that they had chosen to stay in their room. One person told us, 'I like staying in my room. I am not a good mixer and always preferred my own company'. Another person we spoke with told us 'I stay in my room when I want and join others in the lounge when I want. It has nothing to do with staffing'.

The activities coordinator had detailed records of activities that individuals had been involved with, including one to one activities with people who were not able to join in group activities. The information board gave details of forthcoming activities such as manicure and polish, indoor bowls, decorate you own cake, pamper session (hand and feet) and Easter activities.

People told us they received regular medical care from their GP, and also from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required.

We spoke with three relatives who were visiting at the time of the inspection. Relatives told us they had no concerns and felt the people who used the service were protected from harm. One relative told us, 'The Sisters are a hard act to follow but so far I feel confident about the present owners. They are a religious organisation as well so I feel confident'. Relatives and people who used the service told us they would know what to do if they had any concerns about the service they received.

We asked the people who used the service and relatives whether they thought there was enough staff in the home to meet their needs. All the people we spoke with told us there was always enough staff to support people with their care.