Crossways Healthcare Limited

Crossways Healthcare Limited is a residential care home providing personal care and accommodation for up to 25 people aged 65 and over in one adapted building. At the time of this inspection, there were 22 people using the service.

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

The owner was committed to making sure that people were supported in a caring, respectful and dignified way. We saw many examples of staff supporting people in this way throughout our inspection. Relatives and people also gave us consistent and positive feedback about how the staff and owner were very caring.

Staff knew people well, including their personal history and individual preferences. People had care plans and they and other relevant people in their lives were involved in the planning, reviewing and delivering their care.

Staff were aware of people’s individual communication needs and used the most accessible means to share information with them and gain people’s consent about their support.

There were regular activities that were responsive to people’s individual needs, with a specific focus on people living at the home who had dementia. People were encouraged to maintain their cultural interests, had regular visitors and often went out into the local community.

The owner and registered manager had a clear vision that this service should be a genuine home to people, where they were as comfortable and at ease with the environment and the staff as when they had lived with their families. All people and relatives we spoke with felt this was the case and they were involved in helping to develop the service.

There was a positive, inclusive and open culture at the service. Staff were committed and motivated to displaying the right values to deliver high-quality person-centred care and help realise this vision. Staff said they felt supported by the registered manager and that their opinions were valued, listened to and respected.

There were quality assurance systems to help identify and manage any safety and quality risks. Where these had been identified these were acted on quickly. Staff had received safeguarding training and understood how to recognise signs of abuse, including discriminatory abuse, and what they should do to help prevent this.

Risks to people were assessed, regularly reviewed and managed safely. People received safe support with medicines. The service was clean and hygienic. People had personal emergency evacuation plans (PEEP), fire drills and inspections took place and the physical environment was regularly checked to make sure it was safe.

The service had enough suitable staff working during each day and night to support people safely. There were safe recruitment practices. Staff received regular training, including in subjects specific to people’s needs such as dementia, behaviours that may challenge and equality and diversity.

People’s needs were holistically assessed, and staff supported them to get the support they wanted and needed and have a good quality of life.

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.

People’s health was effectively monitored. Staff helped people make referrals and worked well with other health and social care professionals to help make sure their healthcare needs were met.

People said the quality and choice of food and drink available was very good. People with specialist eating and drinking needs had support to access specialist advice and resources such as Speech and Language therapists and nutritionists.

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 13 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Crossways provides personal care and accommodation for up to 25 people. On the day of our inspection there were 21 older people at the home, some of whom were living with dementia. The home is spread over two floors with a passenger lift, communal lounges, dining room, gardens and patio.

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

The experiences of people were positive. People told us they felt safe living at the home, staff were kind and compassionate and the care they received was good. One person told us “It’s lovely here. Yes I feel very safe there is somebody about all the time”. Another person said “That is important to me, that I am somewhere safe and that someone is here”. We observed people at lunchtime and through the day and found people to be in a positive mood with warm and supportive staff interactions.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate the risks. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. One member of staff told us “I would always let the manager know if I suspected a resident was being abused or getting poor care”. The registered manager made sure there was enough staff on duty at all times to meet people’s individual care needs. When new staff were employed at the home the registered manager followed safe recruitment practices.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get the medicine they needed when they needed it. People were supported to maintain good health and had access to health care services when needed.

Staff supported people to eat and drink and people were given time to eat at their own pace. The home met people’s nutritional needs and people reported that they had a good choice of food and drink. One person told us “The food is tasty and good they do what I like”. Staff were patient and polite, supported people to maintain their dignity and were respectful of their right to privacy. People had access to and could choose suitable leisure and social activities in line with their individual interests.

The home considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

There was a homely and caring atmosphere at the home. People, staff and relatives found the management team approachable and professional. One person told us “Excellent, you get to know them, I think of them as family”. A relative told us “I am more than happy with the care and support my relative gets. The manager is great”.

Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One staff member told us “It’s good I would say. There’s quite a lot of training going on. I’ve been here a few months now and I’m doing something all the time”.

Resident and staff meetings took place which provided an opportunity for staff and people to feedback on the quality of the service. Feedback was sought by the registered manager via surveys. Surveys results were positive and any issues identified were acted upon. People and relatives we spoke with were aware of how to make a complaint and all felt they would have no problem raising any issues.

The registered manager welcomed and encouraged feedback and used this to drive improvement and change. There were quality assurance processes in place to enable the provider and registered manager to have oversight of the home and to ensure that people were receiving the quality of service they had a right to expect.

People using the service told us the following: 'The staff are very helpful, supportive and caring', 'The food is very good and plentiful', 'The manager is nice and supportive', 'I feel safe here', ' It is like a big family here', 'Every time I come to visit, I found the home clean and staff are very welcoming'.

We found that people were receiving a good level of care and treatment that was appropriate to their needs. The care plans contained a good level of information ensuring that their individual care need and support were met.

We also found that people received a well balanced diet, with their likes and dislikes taken into consideration and people we spoke to said that the food was always very good and plentiful.

The service provided a variety of safe and suitable equipment that were fit for purpose and well maintained. This had a positive impact on the level of mobility of people using the service.

We found that there was a well established team of experienced staff, with a good skill mix.

There was a an informative complaint procedure in place and people spoken to at the service were aware of their rights to raise concern and to be listened.

During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so.

We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.

Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.