Crossways Nursing Home

Crossways Nursing Home is a nursing care home which was providing personal and nursing care for 14 people at the time of the inspection in one adapted building. The service can support up to 18 people living with dementia, physical disabilities and who may have other mental health needs or learning disabilities.

The home had ten single rooms and four shared rooms with shared bathroom facilities on both the ground and first floors. The home has a living room, dining room and kitchen available for people to use.

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

People received care and support in a safe way. Their risks were assessed and there were good measures in place to reduce risks to people’s health, safety and wellbeing. The home was clean and tidy, medicines were managed safely and incidents were reported and acted upon where things went wrong.

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 received support which was effective in helping them achieve positive outcomes and quality of life, such as preventing skin damage and maintaining good nutrition and hydration. The service ensured people had access to healthcare services and worked with other providers to ensure they received care which met their needs.

People appeared comfortable and were laughing and joking with staff. People’s relatives told us they felt confident in the care provided. One person’s relative told us, "The [staff], the patience they have with [loved one], it’s amazing." Another relative said, “They are wonderful, she is well looked after.”

Staff were caring and kind in their approach. Staff demonstrated patience and respected people’s privacy. Staff promoted people’s independence wherever possible. The service helped people plan for the future and provided high quality end of life care. Staff supported people with hobbies and activities which interested them and helped prevent social isolation.

The service was well-led and had improved and embedded robust quality assurance measures to identify any issues with quality or safety in the service. There was a positive culture of inclusion and a homely atmosphere which was welcoming to people’s families.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 November 2018) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

A focussed inspection was undertaken (published 12 June 2019) to review whether the provider had taken action in response to a Warning Notice and found that these issues had been resolved.

At this inspection we found improvements had been made and sustained and the provider was no longer in breach of regulations.

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 Nursing 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.

Crossways Nursing Home accommodates 18 people in one adapted building. At the time of our inspection there were 11 people living at the home, some of whom were living with dementia.

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

People’s experience of using this service:

This was a focused inspection following up on previous concerns, which looked at both the safe and the well-led domains. Although, both of these domains are now rated good, it does not change the overall rating for the service, which remains requires improvement. More information is in the full report, which is on the CQC website at: www.cqc.org.uk

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.

Individual and environmental risks were managed appropriately.

Management processes were in place to monitor and improve the quality of the service. There was a positive, open and empowering culture.

Rating at last inspection:

The service was rated as requires improvement at the last full comprehensive inspection (published 18 November 2018).

Why we inspected:

At the last inspection we identified three breaches of the regulations. Following that inspection, we asked for an action plan and issued a Warning Notice, which required the provider to be compliant in respect of a repeated breach of Regulation 17 ‘Good Governance’ by 30 November 2018.

This was a focused inspection to check whether the provider had taken action in respect of the Warning Notice to ensure they were compliant with Regulation 17 ‘Good Governance’. Therefore, the inspection only looked at two key questions as to; was the home safe? and was the home well-led?

At this focused inspection we found the provider had taken action required and the service was no longer in breach of this regulation.

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 services rated as requires improvement.

Crossways nursing home 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.

The service 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.

Crossways Nursing Home provides nursing and residential care for up to 18 people with various needs including people living with dementia, diabetes and other health conditions. At the time of the inspection the provider was caring for 13 people.

The home comprised two floors and a large garden in a village near Basingstoke. There are 10 single rooms and four double rooms for residents, some with en-suite bathroom facilities. There is a lift for people to access both floors, as well as a communal lounge and dining room. There is also a large garden at the rear of the property which is used by residents and relatives.

Crossways was last inspected in August 2017 and was rated requires improvement. We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, related to person-centred care, the need for consent and good governance. Following the last inspection, we asked the provider to make the necessary improvements to ensure they became compliant with the regulations.

At this inspection we found the provider had made the necessary improvements to meet the requirements of regulation 9 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

At this inspection we found there were three breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, two continued breaches in the need for consent and good governance and one breach of safe care and treatment.

People's care plans contained assessments of their needs and some information about their individual preferences. Some people’s care plans included details about their life histories and relationships. However, care plans were not always accurately completed, as care and support plans contained errors and inaccurate language which were not reflective of people’s needs. People were exposed to the risk of not receiving person-centred care as care plans did not contain sufficient information to support staff to provide individualised care which reflected people’s needs and choices. In addition, inaccurate language and unclear guidance in care plans also exposed people to the risk of receiving unsafe care.

The provider did not comply with all the requirements of the Mental Capacity Act 2005 (MCA) when delivering care and support to people. The provider had not always documented mental capacity assessments and best interest decisions to ensure MCA requirements were met at all times. Following the inspection, the provider sent us evidence that some actions had been taken to address these omissions. However, these were not sufficient to meet the requirements of the regulation.

The provider had not always ensured that effective systems were in place to assess and monitor the quality of the service provided to ensure appropriate action was taken to improve the quality and safety of the care people received. The provider's service improvement plan and quality assurance audits had identified a number of required improvements. However audits carried out were not always effective in ensuring improvements were sustained or embedded and had failed to identify risks to people’s safety, including unlocked gates in the garden.

Systems and processes were effective in ensuring people were protected from the risk of suffering harm or abuse. Staff were clear about their safeguarding responsibilities and actions to take if someone was at risk of harm. There were safe recruitment processes in place to make sure the provider only employed candidates who were suitable to work in a care setting. Sufficient numbers of suitably qualified staff were deployed by the provider to ensure people were kept safe. Staff received the required training for their role. Records showed mandatory training had been completed by all staff

There were robust arrangements in place for the storage, recording and administration of medicines. Medicines were given by qualified staff who had their competency regularly assessed. People were kept safe from the risk of acquiring an infection and the provider reflected on incidents as a way of preventing reoccurrences.

People were protected from the risk of malnutrition and dehydration. Staff supported people to eat and drink sufficient amounts to maintain a healthy weight and diet. Staff communicated effectively with health and social care professionals to meet people’s care and support needs. Since the last inspection significant improvements had been made to the building to make it more suitable for the needs of people living with dementia.

Staff treated people in a kind and compassionate manner. However, we observed staff addressing people inappropriately, using terms of endearment such as ‘good boy’ or ‘good girl’ when it had not been identified that people wished to be addressed in this manner. We made a recommendation that the registered manager address this with staff to prevent it happening in future.

Staff had developed bonds with people and supported them to express their needs. Staff maintained and promoted people’s privacy and dignity when delivering care and support.

The provider had a robust complaints policy in place and people were supported by staff to express any concerns. The registered manager regularly sought feedback from people and their relatives about the quality of the service provided.

Staff worked effectively in partnership with health and social care professionals to provide care for people.

At this inspection we found three 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 end of the full version of this report.

At this inspection we rated the home as requires improvement. This was the second consecutive requires improvement rating.

Crossways Nursing Home (to be referred to as ‘the home’ throughout this report) is a home which provides nursing and residential care for up to 18 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. At the time of our inspection 14 people were living in the home.

Crossways is a two storey building set in secure grounds in a village on the outskirts of Basingstoke. The home comprises of 10 single rooms and 4 double rooms for residents, some with ensuite bathroom facilities. There is a communal lounge and dining room on the ground floor with a lift that offers people access to both floors. There is a secure garden to the rear of the home which houses a marquee allowing people to enjoy sitting in the garden in all weather conditions. However this was being used to store equipment such as wheelchairs at the time of this inspection.

At our last inspection on 28 and 29 June 2016 we made a recommendation that the provider sought guidance on the environmental factors in the home to ensure they could be adapted to meet the needs of those living with dementia. Additional work was also planned to ensure the home's environment was developed further in order to continue to meet people's needs. At our last inspection we also made a recommendation that the provider actively promoted activities identified as appropriate for those living with dementia.

At this inspection we saw improvements had been made to ensure the environment met the needs of those living with dementia. However more work was required to fully engage people in personalised activities enabling them to live a socially active and enjoyable life.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 (MCA) when supporting people to make decisions. However the provider had not always completed mental capacity assessments and best interest decisions where required, to ensure those requirements of the MCA were met at all times.

People’s needs were assessed and care plans were in place to address their needs. However care plans were not always person centred ensuring each person’s individual needs were met appropriately.

People, relatives and staff were not always encouraged to provide feedback on the quality of the service they received. Quality assurance processes were not in place to enable people to provide feedback identifying where improvements in service provision could be made.

The provider had not effectively implemented quality assurance systems to assess, monitor and improve the quality of the service people experienced.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. People's safety was promoted because risks that may cause them harm had been identified and guidance provided to staff to help manage these appropriately.

People told us they there were sufficient numbers of staff deployed in order to meet their needs. The provider was able to adapt their staffing levels appropriately when required, in order to meet changes in people’s needs.

Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.

People received their medicines safely. Nurses received the appropriate training and guidance to enable them to complete their role in relation to medicines safely. Medicines were stored, administered, disposed of and documented appropriately.

Contingency plans were in place to ensure the safe delivery of people's care in the event of adverse situations such as a fire or flood. These were easily accessible to staff and emergency personnel such as the fire service, if required. This ensured people received continuity of care in the event of an on-going adverse situation which meant the home was uninhabitable. These plans were updated monthly to ensure the information contained within remained current and met people’s changing needs.

People were supported to eat and drink safely whilst maintaining their dignity and independence. We saw that people were able to choose their meals and were offered alternative meal choices where required. People's food and drink preferences were documented in their care plans and were understood by staff. People were supported to eat and drink enough to maintain a balanced diet.

Staff promptly engaged with healthcare professionals to ensure people's identified healthcare needs were met and to maintain people's safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which apply to care homes. The registered manager showed an understanding of what constituted a deprivation of a person's liberty and was able to discuss the processes required in order to ensure people were not deprived of their liberty without legal authority.

People told us that care was delivered by caring staff who sought to meet their needs. We saw that people had friendly and relaxed relationships with staff.

People knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way.

The provider's values and philosophy of care were available to people and staff. Staff understood these and people and relatives told us these standards were evident in the way that care was delivered.

The registered manager and staff promoted a culture which focused on high quality care in a warm and welcoming homely environment. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we have told the provider to take at the end of the full version of this report.

Crossways Nursing Home is a home which provides nursing and residential care for up to 18 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. At the time of our inspection 16 people were living in the home.

Crossways is a two storey building set in secure grounds in a village on the outskirts of Basingstoke town centre. The home comprises of 10 single rooms and 4 double rooms for residents, some with ensuite bathroom facilities. There is a secure garden to the rear of the home which houses a marquee allowing people to enjoy sitting in the garden in all weather conditions.

The home has a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

Staff provided care to those living with dementia however the environment did not always support people to move around the home safely and to remain independent. Corridors were not often well lit and flooring was not always appropriate to support those with limited eyesight. This would not assist those with limited vision as a result of their condition to be able to move effectively around the home.

We have made a recommendation that the provider seeks further guidance on the environmental factors which can be adapted to meet the needs of those living with dementia.

The provider was not always able to provide person centred activities for all persons to ensure they lead full and meaningful lives.

We have made a recommendation that the provider promotes activities identified as appropriate for people living with dementia to those living in the home.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Detailed recruitment procedures were in place to protect people from unsuitable staff.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding. Fire drills were documented, known by staff and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Nurses responsible for administering medicines had received additional training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.

People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed and diabetic diet, received these and the food was pleasantly presented.

People were supported by staff who had received an effective induction and period of support from more experienced members of staff. This enabled them to acquire the skills and confidence to deliver safe effective care. Regular supervisions ensured that staff were able to express concerns and they felt supported as a result.

People were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf of people who lacked the capacity to make a specific decision for themselves. Documentation showed people’s decisions to receive care had been appropriately assessed, respected and documented.

The staff and registered manager promptly engaged with other healthcare agencies and professionals to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications had been submitted to the supervisory body to ensure that people were not being unlawfully restricted.

Staff demonstrated they knew and understood the needs of the people they were supporting. People told us they were happy with the care provided. The registered manager and staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

People had care plans which were personalised to their needs and wishes. They contained detailed information to assist staff to provide care in a manner that respected each person’s individual requirements. Relatives told us and records showed that they were encouraged to be involved at the care planning stage, during regular reviews and when their family members’ health needs changed.

People told us they did not always know how to complain however all said they would speak with senior staff if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular meetings and participation in the completion of annual survey questionnaires.

The provider’s values were displayed within the home but were not immediately known by staff. However staff were able to describe how the registered manager wanted people to treat residents and they demonstrated they knew these standards. We could see these standards were evidenced in the way care was delivered.

The registered manager and staff promoted a culture which focused on providing care in the way that staff would wish to receive care themselves. The registered manager provided strong leadership and fulfilled the requirements of their role as a registered manager. The registered manager had informed the CQC of notifiable incidents which occurred at the service allowing the CQC to monitor that appropriate action was taken to keep people safe.

During our inspection we spoke with 6 people who used the service and two visiting relatives. We also spoke with four staff including the home manager. One person we spoke with told us 'I have no fault to find, everyone is perfectly lovely.' A family member told us 'they are very supportive of my relative, staff make sure they encourage her not to always stay in her room.'

We observed staff talking to people in a respectful manner. Staff called people by their preferred name. We saw that people appeared relaxed and happy sitting in the communal area. People we spoke with told us that they would sometimes sit in the garden and that they also had a summer house they could use.

We found that the home trained staff correctly before they undertook any responsibility for administering medication. Staff we spoke with confirmed that only the trained nurses would administer medication.

Staff we spoke with told us that they felt supported by the home manager and other team members. They said that there were always adequate numbers of staff available on each shift. They also told us that cover would be sought for any staff absences. Records we reviewed showed that staff had access to training relevant to their roles.

People were provided with a choice of suitable and nutritious food and drink. People's dietary requirements, such as likes and dislikes, were detailed in their care plan. We spoke with the cook who explained that they used this information to support their menu planning.

The provider had systems in place to monitor and evaluate the quality of services provided. People living in the home, their relatives and staff were able to express their views and opinions.

Several residents were very frail so chose to remain in their rooms for much of the time. Most of the residents living at Crossways suffered with dementia and as such were not able to talk with us about all aspects of their care. We spoke with a relative who was very complimentary about the care their relative received. They told us that 'this home gives the best care of the four my mother has been in'. They told us that they could see there were areas of the home that were in need of updating but that this was in progress. They said 'care is more important than the fabric of the building'.

Staff received appropriate training and support. Training files and supervision records were up to date. We spoke with three staff who told us that despite there not being a registered manager at the time of our visit they felt supported by management and could raise issues or concerns. Staff members told us they thought they worked in a positive team that worked well together. They said their focus was on the residents, ensuring they had the correct support.

The provider had a system in place to monitor and assess the service provided and staff and residents were able to express their opinions.