Archived: Crossroads House Care Home

Crossroads is a care home which offers care and support for up to 47 predominantly older people. At the time of the inspection there were 42 people living at the service. The majority of these people were living with dementia. The service uses a detached house over three floors. There is a passenger lift for people to access the upper floors.

The service is required to have 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 had a registered manager in post.

Most staff had received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided. However, one member of staff who was new to the role and had been working at the service since January 2017 had not been provided with moving and handling training. This member of staff was supporting people to move and transfer. The registered manager addressed this issue immediately and we were told following the inspection that this member of staff had now received this training.

The service had a process for recruiting new staff where necessary checks were made before a person began working with vulnerable people. Staff files contained Disclosure and Barring checks and references. However, one staff file contained no references. The registered manager told us that these had been obtained over the phone. This information was not recorded in their file. Two further staff files only contained one reference. The registered manager assured us this would be addressed immediately.

The service held money on behalf of three people living at the service. This money was held in individual zip bags for each person. We checked the records of the money held against what cash was present at the service. Two people’s records did not tally with the money held. This was discussed with the registered manager and the head of care who were the only two people to have access to this money. Following the inspection we were advised by the registered manager that the money had been found in the safe and had been placed correctly in each person’s zip bag.

Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. Such risks were reviewed as people’s needs changed.

Staff were supported by a system of induction, training, and supervision. Care staff had not received annual appraisals. The registered manager assured us this was being commenced.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service displayed information for staff and visitors regarding how to raise any safeguarding concerns they may have.

The service was warm and comfortable with bedrooms personalised to reflect people’s individual tastes. People were able to move freely around the various areas of the service as they wished. Electronic fobs were worn by some people to facilitate their access through specific doors which were locked to other people. This helped ensure people’s independence was supported whilst keeping them safe. There were no unpleasant odours throughout the service. The housekeeping team worked hard to ensure that the service was kept clean and in good condition. Bedrooms and communal areas were regularly deep cleaned.

People were treated with kindness, compassion and respect. There were many positive interactions seen between people and staff with people showing great fondness for the staff, approaching them for support and guidance in a relaxed manner.

The service used an electronic medicines management system. The management and system for the administration of medicines was robust. People had received their medicines as prescribed. Regular medicines audits were consistently identifyied if any errors occurred.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service. Staff told us they felt well supported by the approachable management team.

The service had identified the minimum number of staff required to meet people’s needs and these were being met. The service was fully staffed at the time of this inspection.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

The premises were well maintained. The service had provided orientation around the service to meet the needs of people living with dementia. For example, each person had a different bedroom door design and colour to help people to recognise their own bedroom.

Care plans were held on an electronic system. Information was easily accessible and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews although this was not clearly recorded on the system.

People had access to meaningful activities. An activity co-ordinator was in post who arranged meaningful activities for people. These included housework chores such a pairing socks, arts and crafts, music, games and events that involved families and friends.

The registered manager was supported by a head of care on a day to day basis, along with regular contact with the operations manager and the provider.

This is a summary of what we found-

The majority of people that used the service at Crossroads House Care Home had a dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people had we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

Is the service safe?

At the time of the inspection the service was safe.

During our inspection we observed staff supported and spoke with people in a respectful manner.

From our observations, staff spent quality time with people, supporting them. There was a good, happy atmosphere in the home. We observed people felt relaxed to approach and engage with staff for support and assistance.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of the DoLS legislation and was in the process of submitting applications to the Local Authority following the new Supreme Court Judgement. We saw from training records that staff had undertaken training in the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). This demonstrated that the manager had knowledge about the legislation and of the responsibilities associated with it.

There was a safe and robust recruitment process in place which ensured people who lived at the care home were not at risk.

Is the service effective?

At the time of the inspection the service was effective.

People's health and care needs were assessed and individual care plans were in place to guide and direct staff to meet a person's health and social care needs. However, we found care plans were not always reflective of people's care needs.

We found people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Documentation showed staff who worked at Crossroads House Care Home were subject to a robust induction and associated training applicable to their role. From our observations, we found staff to be knowledgeable in supporting people with dementia care.

Is the service caring?

At the time of the inspection we found the service to be caring.

We observed people who lived at the care home were relaxed when engaging with staff.

From our observation, it was apparent that staff were kind, caring and responsive to people. We observed staff were always present in communal areas of the home, to be able to respond to people's request for support or assistance.

We observed that staff took opportunities to engage in meaningful conversation with people and encourage social activity.

Is the service responsive?

At the time of the inspection we found the service to be responsive.

We read from people's care records that external health care professionals such as GP's, district nurses (DNs) and a psychiatric nurse (CPN) were accessed for people to support the staff with people's ongoing health care needs. One member of staff we spoke with told us, 'I've never worked in a place where there are so many professionals coming in and out'.

During our inspection we observed staff responded to people's needs when requested and staff took an individual approach when working with a person.

Is the service well-led?

At the time of the inspection we found the service to be well-led.

The service had a manager who was registered with the Care Quality Commission.

During our inspection the manager and the assistant operations manager were both present; we observed that they were visible, that they took time to speak with people.

The provider had a system in place to identify, assess and manage risks to health, safety and welfare of people using the service and others. However, the system was not always effective as we found care plans were not always reflective of people's current care needs. The system for updating and reviewing care plans was found to be inadequate.

All staff told us that they found the management of the home and provider 'approachable'. One member of staff told us, 'It's one of the best homes I've worked in for all aspects of care'it's not regimental'it's really calm'I love it.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by the staff at Crossroads.

People were cared for in an environment that was safe, clean and hygienic. Staff demonstrated that they understood their roles and responsibilities in relation to infection control.

Care plans were mostly individualised and contained some information that directed and informed staff to provide appropriate care and support.

Newly appointed staff received an induction prior to starting work which included a period of shadowing more experienced staff.

Mandatory training was up to date and staff received further training specific to the needs of the people they supported.

We did not see any evidence of systems in place to make sure the managers and staff learnt from events such as accidents and incidents.

Crossroads alerted the local authority and the Care Quality Commission when notifiable events occurred or they had any concerns regarding people who used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies in care homes. While no applications have needed to be submitted, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Staff felt that risks were managed appropriately, and they used effective risk management procedures to protect people who lived at the home. People and their belongings were safe because the service assessed and managed the risks associated with the environment.

Is the service effective?

During our inspection we observed staff caring for people. It was clear from our observations and from speaking with staff, and relatives of people who used the service, that staff had a good understanding of people's needs.

Some people who lived at Crossroads were not able to communicate effectively due to their healthcare needs. On the day of our inspection we spoke with five people who were living at Crossroads. Comments included: 'it's very good' and 'they (staff) can't do enough for you, they are always there when you need them'. We also spoke with four relatives who were visiting people who lived at the home. Comments included: 'it's fantastic here, staff are wonderful with X', 'there is always so much going on for people, they don't just sit and sleep all day like you see in other places' and 'there is a lovely atmosphere here'.

People, and/or their representatives, were not always involved in the assessment of their needs. We did not see people, or their representatives, had signed reviews to show they had read and agreed to the content of the care plan.

Risk assessments were carried out to ensure people were protected from the risk of harm and guided staff on any action needed to minimise risk.

Staff had the skills and knowledge to meet people's assessed needs, preferences and choices at all times. People were supported to enable them to be as independent as possible. People's needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

People's records were not kept in a way that made the information easily accessible to staff, and information was not always accurate and current.

Staff had effective support, induction, supervision and training.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff we spoke with were knowledgeable regarding the individual needs of the people they supported. Some life histories had been started by staff with people and their families.

Crossroads had varied communal areas where people who lived there could choose to spend their time.

People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One visitor told us: 'The staff here must be hand-picked, they are very special'.

We saw people were given a choice of food at mealtimes. People who lived at Crossroads all spoke very positively about the food they were provided with. We saw fruit and snacks were available throughout the day from outside the 'shop' which was set up as a greengrocers display, and we saw people help themselves as they walked past.

We saw families and friends of people who used the service, and external agencies, had commented positively about the home, staff and the care provided to people who lived there.

Is the service responsive?

Crossroads had dedicated activity coordinators who supported people who lived at the home to take part in occupation that they enjoyed.

Many people who lived at Crossroads had complex health needs and were either unable, or not inclined, to join in group activities. These people were offered one-to-one occupation such as games, reading books and reminiscence.

We saw people who lived at the home were supported to make choices such as where they wanted to spend time and what they would like to eat.

We were told best interest decision meetings took place when decisions were not able to be made by the person themselves.

People's care needs were regularly reviewed; however, this was not always done with the involvement of the person or their representative.

We saw the registered manager at Crossroads had a file of compliments and thanks received by the service.

We did not see any evidence of quality assurance or seeking the views and experiences of the people who used the service, or their representatives. This did not ensure the service was reviewing the quality of the service provided.

Is the service well-led?

The registered manager held staff meetings and was aware of the culture of the service. However, we were told there were no formal records of such meetings.

The service had carried out investigations, where required, into concerns when they were raised.

People who lived at Crossroads had regular support from the district nursing team, community psychiatric nurses, social workers and GP's from the local GP practices. This ensured people received appropriate care in a timely way.

The registered manager did not have sufficient resources and support available to develop and drive improvement.

Staff told us they were offered relevant and useful training on a regular basis. Staff also told us they felt supported by the registered manager and could approach them at any time if they had a concern.

However, the people who lived at Crossroads House predominately had dementia type illnesses and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences of people, we used our Short Observational Framework for Inspection tool (SOFI). The SOFI tool allowed us to record how people spent their time, the type of support they received and whether they had a positive experience.

We undertook observations of staff interacting with people who used the service. We saw staff respond and approach people in a kind and calm manner. We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for. We saw that people's privacy and dignity was respected by the way that staff assisted people.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

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. We found there were enough qualified, skilled and experienced staff to meet people's needs.