Crossways Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulations in relation to safeguarding and the premises. Safeguarding concerns were not always identified and reported. The provider had not always managed environmental risks.
 

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The Service did not always have a proactive culture of safety. Staff had not always appropriately documented incidents where people had experienced emotional distress. This increased the risk of actions not being taken to mitigate future risks.

However, where people had experienced falls, these accidents had been reviewed and appropriate action had been taken such as communicating with people’s relatives and seeking medical advice.

The service did not always maintain safe systems to manage risks people could experience. The providers' systems were not always operated effectively, ensuring that people's health and safety needs were consistently assessed and monitored, including injury monitoring. This is covered more in the 'safeguarding' and 'involving people to manage risks' part of the report.

However, records showed people were supported to attend appointments with external health professionals such as GPs and Mental Health services.
 

People were not always protected from potential abuse. We identified an allegation made by a person that had not been identified and reported to the local authority safeguarding team. We identified unexplained injuries that the provider had not investigated and reported appropriately. This meant there was an increased risk that people were not always proactively safeguarded from abuse. The provider made retrospective safeguarding referrals when we shared our concerns.

However, staff knew how to escalate and report safeguarding concerns. A staff member said, “I would go to the manager or the nurse in charge. If they didn't do anything, I would go to the head office or the local authority.”
 

The service did not always plan care to meet people’s needs safely. Some people were known to experience emotional distress when receiving support with personal care. However, their care plans and risk assessments did not contain enough information about how staff should support them. This increased the risk of them not being supported safely or consistently.
However, in relation to people’s health conditions the provider had worked with people to understand and manage risks. People’s care plans provided information about how to support them with health conditions such as diabetes and skin health. A person told us, “Because I am in bed all the time, [staff] constantly check for sores.”
 

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment and facilities were maintained to support the delivery of safe care.

We identified concerns in relation to fire safety due to openings in 2 walls that break fire separation and ill-fitting fire doors. This increased fire-related risks to people. In response to our concerns, the provider commissioned a new fire risk assessment and fire door survey. Some window restrictors were not fitted with tamperproof fittings in line with national guidance on managing the risk of falls from heights in care settings. In response, the provider replaced these.

CQC received concerns that there was not always an adequate hot water supply in the service to meet people's needs, and that staff, at times, had to carry jugs of hot water from the kitchen into people's rooms. During the inspection, we identified that hot water from taps was not always available in people's rooms at a comfortable temperature, and staff confirmed that at times, hot water was transported in jugs from the kitchen. The provider could evidence attempts they had made to rectify this before the inspection. However, this had yet to result in a permanent fix that ensured people always had access to adequate hot water for their hygiene needs. We also identified water outlets that could get hot enough to scald. In response to our concerns, the provider secured areas where water could get too hot and completed a risk assessment. The provider had also arranged for thermostatic mixing valves that prevent water from getting hot enough to scald to be installed.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. There were enough staff deployed to meet people’s needs. Staff and people, we spoke with confirmed the service was staffed appropriately. A person said, “I also like to have the same staff and that is really good in this place.” Staff were recruited safely.

The provider did not always assess or manage the risk of infection. Poor maintenance of flooring and communal bathrooms made these areas at risk of poor IPC practice. We observed on 2 occasions that external waste bins were overflowing, even though the bins next to them had space. These areas did not promote good IPC practices.
However, we observed people's bedrooms and communal lounges were clean. The service was free from malodour.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Overall, we observed medicines were stored and administered safely to people. The provider had regularly audited medicines and taken action where needed.