Our inspection of Crossley House took place on 4 June 2018 and was unannounced.

Crossley House 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. The care home accommodates up to 58 people in a two storey, purpose-built building; the top floor specialises in providing care to people living with dementia. At the time of our inspection there were 49 people living at the home.

A registered manager was 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. The registered manager had registered with the Commission in January 2018 and was supported by a newly appointed deputy manager. The home was also supported by the provider's quality manager on the day of our inspection.

People told us they felt safe living at Crossley House. Safeguarding policies and procedures were in place and staff understood how to keep people safe. Assessments were in place to mitigate risks to people's health and welfare. Accidents/incidents were mostly documented and investigated with actions taken as a result. However, we found some accidents had not been fully documented and the registered manager was taking steps to ensure this was rectified.

Medicines were mostly managed safely. Medicines checks were made and errors were reported, investigated and actions put in place to mitigate the risk of reoccurrence. We found this was put in place with an error we found during our inspection. Staff who administered medicines were appropriately trained and their competency was assessed.

The premises was well maintained, clean and light, with a number of communal areas in which people could spend their time. Infection control procedures were followed. People' were encouraged to personalise their bedrooms with their own items such as ornaments and pictures.

Staff were mostly recruited safely, had received appropriate training and sufficient staff were deployed to keep people safe. The service was working to ensure a system for regular staff supervision and annual appraisal was in place. People and their relatives said staff were kind and caring and we observed this during our inspection. Staff respected people's dignity and right to privacy and supported people to remain as independent as possible.

People enjoyed the food offered which was freshly prepared, with choices to suit people's tastes. Staff assisted people where required and mealtimes were relaxed and informal. Where people were at risk nutritionally, referrals were made to the GP or dietician and actions taken such as monitoring food/fluid intake and providing dietary supplements.

People's needs were assessed prior to coming to live at Crossley House to ensure these needs could be supported by the service. Plans of care were drawn up and reviewed and updated regularly to ensure these remained relevant. The service worked with a range of health and social care professionals to meet people's health care needs.

We saw staff sought people's consent when providing care and support. The service was compliant with the legal requirements of the Mental Capacity Act 2005.

A range of activities was on offer for people if they chose to take part. These were tailored to people's interests, including one to one activities where people preferred these. People and their relatives were complementary about the activities co-ordinator, who was enthusiastic and was developing ideas to include more dementia friendly activities.

Complaints were taken seriously at the service. Where a complaint was made, a full investigation took place

Our inspection of Crossley House took place on 24 April 2017 and was unannounced.

Crossley House provides accommodation and personal care for up to 58 older people and people living with dementia. The bedrooms are all single en-suite and communal areas are located throughout the home. At the time of our inspection there were 55 people living at the service.

The home should have a registered manager in position. 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. At the time of our inspection there was no registered manager since the previous manager had commenced the registration process but recently left the service. The home was being supported by an interim manager over a three month period during which the provider hoped to appoint a new manager. A full time deputy manager was in post and the home was also supported by the provider's area manager and quality manager.

People felt safe at the service, staff had received safeguarding training and understood how to recognise and act on signs of abuse. The interim manager was aware all appropriate safeguarding concerns should be reported to the Care Quality Commission as well as the local authority adult protection unit. Accidents were documented and risks to people's safety were assessed although not all risk assessments or analysis of accidents/incidents were in place.

Medicines were mostly managed safely. However, some improvements were required regarding the management and administration of topical ointments and creams and ensuring medicines administration charts were completed. These issues had also been identified through the improved medicines audit process and plans were in place to address this.

Staffing levels were sufficient to keep people safe and staff were recruited safely. A range of staff training had been completed or booked. However, a programme of staff supervision and appraisal needed to be embedded. Staff knew people well and supported them with kindness and compassion, respecting their privacy and dignity.

Care records needed further work to improve person centred planning and to reflect people and/or relatives' involvement. No evidence was found in care records to reflect the use of best interest processes. However, consent was seen to be sought in practice as well as respecting choice and personal preferences. Some improvement was required in documentation such as charts to show how often people were turned in bed when needed. However, the interim manager was aware of these and an improvement plan was in place to update and improve care records.

Some activities were in place according to people's wishes and the interim manager had introduced people to some social activities within the local community.

Complaints were documented although investigation reports needed completing to reflect outcomes.

A range of audit and quality processes were in place and these had identified many of the concerns found at inspection. A service improvement action plan had been developed and it was clear some improvements had already been put in place.

The service was welcoming and the atmosphere relaxed and calm. Staff told us morale had improved and they felt supported by the management team. The interim manager was passionate about continuing with the improvement process and supporting the new manager when appointed.

We inspected Crossley House residential home on the 19th October 2015. This was an unannounced inspection which meant the staff and the provider did not know we would be visiting.

Crossley House is owned by Hadrian Healthcare. The home provides accommodation and personal care for up to 58 older people and people living with dementia. On the day of our visit there were 58 people living in the home. The service met the regulations we inspected against at their last inspection which took place on 10 September 2014.

The home had 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 and associated Regulations about how the service is run.

People who used the service were supported by staff that were kind, caring and respectful of their privacy.

People told us said they felt safe living at the home. Staff understood safeguarding issues and described to us what potential abuse might look like and how they would deal with it if they saw anything which concerned them. Accidents and incidents were monitored and reviewed to

identify any issues or concerns.

The registered manager told us each person who used the service had been assessed for their level of dependency and this information was used to determine the minimum staff number needed to run the home. In addition to this system they monitored people’s needs and staff feedback on the number of staff needed, and was able to show us when they increased the number of staff when necessary. Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home

People who needed assistance with meal preparation were supported and encouraged to make choices about what they ate and drank. People told us they were happy with the standard and

range of food and drink provided at the home. Catering staff kept records regarding people’s individual dietary requirements and preferences.

The care staff we spoke with demonstrated a good knowledge of people’s care needs, significant people and events in their lives and their daily routines and preferences.

Staff spoke positively about the culture and management of the service. Staff said that they enjoyed their jobs and described management as supportive. Staff confirmed they were able to raise issues and make suggestions about the way the service was provided in one-to-ones and staff meetings and these were taken seriously and discussed.

People told us they felt the staff had the right skills and experience to look after them safely. Staff confirmed they had access to a range of training. Staff told us, and records confirmed that regular supervision took place and that they received annual appraisals.

There were safeguards in place to help protect the people who lived there. People were able to make choices about the way in which they were cared for and the staff listened to them and knew their needs well.

Relatives of people living at the home were happy with the service. There was evidence that the staff and registered manager at the home had been involved in reviewing and monitoring the quality of the service to make sure it improved.

The procedures to manage risks associated with the administration of medicines were followed by staff working at the service. There were suitable arrangements for the safe storage, management and disposal of medicines.

People were assessed against a range of potential risks, such as poor nutrition, falls, skin integrity and mobility. Where other risks had been identified assessments had been carried out to ensure people received appropriate care. Advice from healthcare professionals was sought if further experience was required.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care, as necessary. A range of activities were offered for people to participate in, both inside and out of the home. People and relatives told us if they had any concerns they would feel happy to discuss these with senior staff or the registered manager. People told us any issues they had raised had been dealt with quickly and to their satisfaction. Records had been kept of formal complaints, including information on investigations carried out and action taken in response to complaints.

The manager had knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Libertys Safeguards (DoLS) legislation and referrals for a DoLS authorisation had been made so that people’s rights would be protected.

There was a system in place to monitor the quality of the service and action had been taken when necessary to make any improvements.

Robust quality monitoring systems were in place which covered areas such as meetings, feedback and audits. All areas of the service were reviewed regularly.

The registered manager provided good leadership and people using the service, healthcare professionals, relatives and staff spoke highly of the registered manager and told us they promoted high standards of care.

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During our inspection we looked for the answers to five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

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

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff we spoke with understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed with them, and they were involved in writing their plans of care.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People knew how to make a complaint if they were unhappy. People told us they had never needed to make a complaint but if they did they thought complaints would be investigated and action taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff had attended several training courses which took into account the needs of the people who used the service. This ensured that people's needs were met.

During the inspection we spoke with seven people who used the service and three people’s relatives. Most people we talked with spoke highly about the care received. All the relatives we spoke with said the home was effective in picking up health related issues and they all praised the skills of the staff.

Some of the comments included:

“They take good care of her. I would recommend this place.”

“Nothing wrong with this place, staff and food are nice.”

“I am happy here, no concerns.”

“All good, I have nothing to worry about.”

People appeared well cared for, for example they were appropriately dressed in clean clothing and looked clean and neat. We observed staff engaged people in conversation and provided companionship to people. We saw staff were attentive to people's needs; for example they assisted them at mealtimes, with toileting and in mobilising.

We found the provider had systems in place to ensure valid consent was obtained from people before they provided care or treatment.

People’s needs had been assessed so that appropriate care could be planned and delivered.

We found the premises was of suitable design and layout , had a homely feel and was well maintained.

The provider had robust recruitment arrangements in place to ensure those employed were suitable for the role.

The provider had a complaints system in place and there was evidence they had promptly responded to and investigated concerns raised.

People told us they were happy with the care and support provided. They told us the home was clean and comfortable. People spoke positively about the staff, these are some of the comments people made: “Staff care about me”, “They are all lovely” and “Carer is like my own daughter”. People told us the food was good and said their individual tastes and cultural needs were catered for.