We carried out a review of the data available to us about Cross Way House Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Cross Way House Care Home, you can give feedback on this service.
The home had a registered manager. A registered manager is a person who has registered with the CQC 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’s experience of using this service:
Management processes were in place to monitor and improve the quality of the service. However, these were not always effective and did not always identify opportunities for improvement.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, the records for best interest decisions did not always reflect individual decisions. We have made a recommendation about the documenting of best interest decisions.
People lived in an environment that was clean, with no odorous smells. Comments from people included, “It’s spotlessly clean in here.”
People told us they felt safe and there were appropriate systems were in place to protect people from the risk of abuse.
There were enough staff to meet people’s needs. The provider had effective systems in place to ensure safe recruitment practices.
People’s needs were met in a personalised way by staff who were competent, kind and caring. Staff respected people’s privacy and protected their dignity.
Individual and environmental risks were managed appropriately.
People were empowered to make their own choices and decisions. They were involved in the development of their personalised care plans.
People felt listened to and knew how to raise concerns.
The home has been rated Good overall as it met the characteristics for this rating in four of the five key questions. More information is in 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 requires improvement (published 9 April 2018) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.
Why we inspected:
This was a planned inspection based on the previous inspection rating.
Follow up:
We will continue to monitor the intelligence we receive about this service and plan to inspect in line with our re-inspection schedule for those services rated as good.
Cross Ways Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cross Ways Care Home can accommodate up to 24 older people, some of whom live with dementia and some of whom live with a learning disability. At the time of this inspection there were 23 people living at the home, with one person due to move in on the day of our visit.
At the time of our inspection visit there was 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.
The service has a history of not meeting the regulations. At an inspection in July 2016 we rated the service inadequate and took enforcement action to ensure the service improved. At our inspection in December 2016 we rated the service overall as requires improvement. The provider had met most of the requirements we had previously identified but still needed to make improvements around staffing and records. We issued requirement notices and the provider sent us an action plan telling us what they would do. At this inspection we found that the provider had completed their action plan but further improvements were still needed.
Prior to moving into the service, staff carried out pre admission assessments to identify if the service could meet people’s needs. Care plans were developed but these were not always person centred or reflective of people’s current needs and it was not always evident how staff responded to changing needs. Although people expressed no concerns about the meals, it was not always clear what action had been taken when concerns about people’s nutrition were identified.
Although the provider had multiple audits and systems to assess the quality and safety of the service, not all of these were effective in identifying concerns and taking action to make improvements.
We were concerned that there was no system in place to assess the level of staff needed at night time. Staffing levels during the day met people’s needs.
Permanent staff’s knowledge of people was good and they were able to talk about risks associated with people’s needs and how these were managed. However, records did not reflect that all risks associated with people’s needs had been assessed and plans developed to reduce these risks; meaning agency workers did not have the information they would need to ensure people were always supported safely.
Improvements in recruitment records had been made and the recruitment of staff was safe. People could be confident their medicines were safely managed and administered. The service was clean and tidy.
Staff and the registered manager understood their responsibilities to safeguard people. Concerns were reported and investigated appropriately. The registered manager ensured that learning from errors took place to make improvements.
Staff were supported through induction, supervision and training which enabled them to carry out their role effectively.
People were supported to access other professionals by a team of staff who worked together. Equipment was managed in a way that supported people to stay safe and the environment supported people to use this independently. People enjoyed the activities provided.
Staff understood the need to ensure people provided consent to their care and were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Where needed this had been applied appropriately. People felt staff were kind and caring. Staff were observed to support people in a discreet, patient and compassionate manner. They showed respect for people’s privacy.
Complaints were investigated and responded to appropriately. Feedback was sought from people, their relatives, professionals and staff. Feedback sought was acted upon. The registered manager was described positively by everyone we spoke with. People, staff and relatives were enabled to approach them at any time and felt confident they listened and acted upon their concerns.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Crossway House provides accommodation for up to 24 people. At the time of our inspection we were told there were 20 people living at the home some with a learning disability and some older people. The age of people accommodated varied from 59 – 98.
The home did not have a registered manager in place. 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. Since the last inspection the home has had two peripatetic managers who work for the provider. Following this inspection one of these managers had stopped working at this home, but the provider had recruited a manager who had not started working in the home yet. The provider told us the plan was for the newly recruited manger to work with the peripatetic manager for a period of time to ensure consistency.
At this inspection we found progress had been made in all areas and where the provider remained in breach of the regulations the impact and possible impact on people was low. The service had demonstrated that they were no longer “inadequate” overall and therefore were no longer in special measures.
Staff understood the principle of keeping people safe and appropriate referrals had been made to the local safeguarding team. Risk assessments had been completed and staff were aware of the risks facing people and how to minimise these risks. Staffing levels met the needs of people during the day time shifts but there was concerns that the staffing levels at night did not meet people’s needs in a timely fashion.
Recruitment checks had been completed before all permanent staff started work but records for agency staff were not available.
Medicines were administered and stored safely by competent staff.
There was a training programme and staff enjoyed the training and felt it equipped them to do their job. Staff undertook a comprehensive induction and supervision had started and there was a plan going forward to ensure all staff received supervision. Staff had a good knowledge of the Mental Capacity Act (2005) which had been incorporated into people’s records. People enjoyed their meals with choices being available and there was support for those who needed it. People were supported to access a range of health professionals.
People received personalised care which took into account their choices and preferences. We have made a recommendation that the care plans are always followed. People felt confident they could make a complaint and it would be responded to.
People felt the staff were caring, kind and compassionate. The home had an open culture where staff felt if they raised concerns they would be listened to. Staff felt supported by the management team and were clear about their roles and the values of the home. Records were not always accurately maintained. There was an effective quality audit system.
We found five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which had been breached at the previous inspection had now been met. Two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 have been repeated, regarding staffing levels and maintaining accurate records. We have made a recommendation regarding staff following care plans. You can see what action we told the provider to take at the back of the full version of the report.
The last inspection took place in November 2013, which was to follow up a requirement made at the previous inspection in July 2013, which related to records. We found the necessary improvements had been made and the home was compliant in November 2013.
At this inspection, some staff understood the principle of keeping people safe, but we witnessed some situations where people were not safe. Staff also told us about previous incidents, where people and staff had not been safe.
Risk assessments had not always been completed to ensure staff were aware of people’s risks and how to minimise the risks, to ensure people’s safety.
Staffing levels had not been planned to meet the needs of people and at times there was insufficient numbers of staff to meet people’s needs.
There was a training programme but we could not be assured the training staff had gave them the skills and knowledge to meet people’s needs. Recruitment checks had been completed before staff started work to ensure the safety of people.
Medicines were administered and stored safely.
Staff had a basic knowledge of the Mental Capacity Act but people’s records did not show people’s capacity to make specific decisions had been assessed. This meant people did not have their mental capacity assessed and restrictions may have been placed on people without their agreement or being in their best interest.
People enjoyed their meals and were offered a choice at meal times.
People were supported to access a range of health professionals.
People did not always have their needs planned to be met in a personalised way, which reflected their choices and preferences had been considered. This meant staff may not always have the best information on how to meet an individual’s needs and preferences.
People felt confident they could make a complaint and it would be responded to. The recording of complaints needed to improve.
People felt the staff were caring and kind and compassionate. Staff felt supported by the acting manager. Quality assurance processes in the home were not robust and did not identify the gaps in the provision of the service. Records were not always accurately maintained and this was not an effective part of the quality audit process.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate
care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.
We found breaches in 7 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 You can see what action we told the provider to take at the back of the full version of the report.
We saw that people had their privacy and dignity maintained whilst being supported with care. Care needs had been assessed and personalised care plans were in place which included guidance for staff on how to support people.
The home was generally clean and well maintained. People had personalised their rooms with their own possessions including their own furniture.
We spoke with four members of staff. They said that they enjoyed working at the home and that everyone got on well together. Staff said they were well supported and that they were provided with the training and information they needed to support people effectively. They told us that management were supportive and approachable. We saw staff speaking with the provider and they seemed relaxed.
We found concerns with the record keeping of care plans and assessments. They had not all been reviewed and updated to show what care should be offered when needs had changed.