This inspection took place on 15 and 16 May 2018 and was unannounced. The service was last inspection in October 2017 and was rated as ‘Requires Improvement’.

Crossways Residential 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 Residential Home accommodates 23 people in one adapted building.

The was a manager in post who had recently applied and been interviewed to become the registered manager of the home. 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.

People felt safe and were supported by a group of staff who were aware of their responsibilities to raise and act on any concerns they may have. Staff were aware of the risks to people and were kept up to date with any changes in people’s care needs. Staffing levels were based on people’s dependency levels and plans were in place to increase staffing at particular times of the day to ensure people’s needs were met.

People were supported to take their prescribed medicines. Concerns regarding infection control issues had been responded to and actions had been taken, though more work was required in this area. Where accidents and incidents took place, the information was regularly reviewed and analysed for any trends and where appropriate, actions were taken.

People were supported by staff who had received an induction that prepared them for their role. Staff felt well trained and were offered additional training and support in order to improve their skills and knowledge.

People’s dietary needs and preferences were catered for and people were supported to make choices at mealtimes. Drinks were readily available to ensure people remained adequately hydrated.

Health care plans were in place which identified people’s particular healthcare needs and how to support them to maintain good health. People were supported to access a variety of healthcare services and where guidance was provided by healthcare professionals, it was followed.

The environment was well sign posted to assist people when walking around the service. The provider had plans in place to improve the environment for the people living at the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People described staff as kind and caring and enjoyed warm and friendly relationships with those who supported them. Staff treated people with dignity and respect and were mindful to respect people’s choices regarding how they wished to spend their day. For those who required the support of an advocate, arrangements were made to ensure people were able to access these services.

People were involved in the development of their care plans and were supported by staff who were aware of their likes and dislikes and how they wished to be supported. Some activities were available for people to participate in, but people had asked to be supported to access the community and staffing levels were not in place to support these additional requests.

People were supported to raise complaints which were investigated and responded to appropriately. People’s end of life wishes were respected.

People considered the service to be well led and were complimentary of the manager and the changes they had introduced to the service. Staff felt supported by the manager and were on board with the changes they had introduced to the service.

A variety of audits were in place to assess the quality

This focused inspection took place on 19 September 2017 and was unannounced. At our last inspection in April 2017 we rated the provider as ‘requires improvement’. In August 2016 and December 2016 the provider was rated as ‘inadequate’ and placed into ‘special measures’. In April 2017, the provider demonstrated some improvements had been made and as a result the provider was taken out of special measures. However, the provider was not meeting the requirements of the law in relation to the effective governance and management of the service.

Following the inspection completed in April 2017 we asked the provider to ensure they were meeting all legal requirements by a specific date. We completed the most recent inspection in September 2017 to ensure the required action had been taken. We found while improvements were still required the provider was meeting the basic requirements of the law.

Crossways Residential Home provides accommodation and personal care for up to 23 people. At the time of our inspection there were 19 people living at the service, most of whom were living with dementia.

There was no registered manager in post although this is a legal requirement at this service. 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. An acting manager was in post and was responsible for managing the day to day service. The provider confirmed they were in the process of recruiting a permanent manager who would register with the Care Quality Commission.

People were supported by a staff team who understood how to recognise signs of abuse and how they should report concerns. People were protected by staff who were taking steps to minimise the risk of harm such as injury to them. People received their medicines safely and as prescribed.

People were supported by sufficient numbers of care staff to keep them safe. Pre-employment checks were completed on staff members prior to them starting work.

People and relatives felt the current manager was making improvements in the service. People were increasingly more involved in the development of the service and encouraged to share their views. People were supported by a staff team who felt supported in their roles.

Quality assurance and governance systems had improved although further improvement was still required.

This inspection took place on 04 and 05 April 2017 and was unannounced. At the last inspection completed on 06 and 07 December 2016 we identified multiple breaches in regulation. The provider was in breach of the regulations around providing person-centred care, dignity and respect, obtaining consent and following the Mental Capacity Act 2005, safe care and treatment, safeguarding people, meeting people’s nutritional needs, staffing levels and training, safe recruitment practices and good management of the service. The provider was also not submitting all required statutory notifications to CQC. A statutory notification is required when significant events arise such as serious injury or allegations of abuse. As a result of these findings we rated the service as ‘Inadequate’ and it remained in special measures. The provider submitted an action plan telling us how they would make improvements. This service first entered special measures following the completion of an inspection in August 2016.

Crossways Residential Home provides accommodation and personal care for up to 23 people. At the time of the inspection there were 17 people living at the service, most of whom were living with dementia. The registered manager had left the service in January 2017. There was a new manager in post who was in the process of becoming registered with CQC. 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.’

People were not always protected by a staff team who understood how to manage risks to them effectively. People were sometimes moved in way that increased the risk of injury to them. People were however protected by a staff team who understood how to recognise and report any signs of potential abuse or mistreatment of people.

People were supported by sufficient numbers of care staff. However, staff were not effectively deployed in order to ensure they were available to meet people’s needs. People were supported by care staff who had been recruited safely. People mostly received their medicines as prescribed. However, some improvements were needed with the administration of topical creams. Steps to make these improvements were already in place at the time of the inspection.

Staff did seek people’s consent and were using the Mental Capacity Act 2005, however this practice was not yet consistently being used across the service. People were supported to meet their nutritional needs, however further support was required to assist people during mealtimes. People were supported by a staff team who had recently undergone additional training. However work was still required to ensure the staff team’s skills and knowledge enabled them to support people effectively in all areas of their care. People were supported to access healthcare professionals in order to maintain their day to day health needs.

People were mostly supported in a dignified way, however further support at mealtimes was required. Most care staff were kind and caring in their approach however this was not consistent across the staff team. Some interactions with people were not kind and caring. People were offered choices however staff did not always understand how to communicate these choices effectively. People were supported to maintain independence in some aspects of their care although this was not consistent.

People’s needs were not consistently met as some care staff did not understand specific support needs. Care plans did not always contain clear guidance to staff around how to support people effectively. People were involved in some activities and trips out.

People, relatives and staff were positive about the changes made within the service. Everyone felt more involved in the service and fe

The inspection took place on 6 and 7 December 2016 and was unannounced. At the last inspection completed in August 2016 we rated the provider as ‘inadequate’ and the service was placed into special measures. We found the provider was in breach of the regulations around providing safe care, the need for consent, dignity and respect, providing person centred care, ensuring there were sufficient numbers of staff who had the required skills and effective quality assurance and management. At the inspection completed in December 2016 we found the provider had failed to make the required improvements.

Crossways Residential Home provides accommodation and personal care for up to 23 older people. At the time of the inspection there were 20 people living at the service, many of whom were living with dementia. A registered manager was in post. 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.

People were not protected from potential abuse and mistreatment as concerns were not identified, reported and investigated. Plans were not put in place to protect people from further harm. Risks to people living in the service were not sufficiently recognised, assessed and mitigated. People were not supported by sufficient numbers of care staff. People were not protected from the risk of the recruitment of inappropriate staff as recruitment checks were not sufficient. People mostly received their medicines as prescribed. However, improvements were identified as being required in the safe management of people’s medicines.

People were not always supported by care staff who had been given the required skills and knowledge to support them safely and effectively. People’s rights were not upheld by the effective use of the Mental Capacity Act 2005. People’s nutritional needs were not always met. People were not always given access to approprate support from healthcare professionals when required.

People told us care staff were caring and we saw some positive interactions between staff and people. However, staff were not given the skills to recognise when care practice was not caring or dignified. The provider and registered manager did not recognise when people were not supported in a caring way. People were not always sufficiently involved in decisions about their care.

People did not always receive care that met their individual needs and preferences. People were not enabled to be fully involved in the review of their care and care plans did not accurately reflect their needs. Activities were made available for people to participate in. However day to day leisure opportunities had not been developed to meet people’s individual needs and preferences. People felt their complaints were heard by the provider.

The provider and registered manager had failed to ensure sufficient improvements were made in the service since the last inspection we completed in August 2016. The provider and registered manager had failed to develop effective quality assurance and audit systems. As a result they continued to fail to identify areas of poor care, risks to people and where improvement was required in the service. The culture within the service was accepting of people’s distressed behaviours and areas of poor practice were not recognised and challenged.

We found the provider was not meeting the regulations around safeguarding people from abuse, safe recruitment of care staff, safe care and treatment, consent to care, dignity and respect, providing person centred care, effective management of the service and submitting statutory notifications to CQC. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection complet

The inspection took place on 23 and 24 August 2016 and was unannounced. Since our last inspection, the provider of this service has changed. This was the first inspection under the new ownership of the service.

Crossways Residential Home provides accommodation and personal care for up to 23 older people. At the time of the inspection there were 20 people living at the service, many of whom were living with dementia. A registered manager was in post. 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.

People were not protected from potential harm due to ineffective risk management processes. The risks to people were not effectively identified and managed by staff members. People were not supported by sufficient numbers of staff to meet their needs. The registered manager was aware of the requirements of safe recruitment practices. People received medicines that needed to be taken on a regular basis as prescribed. Where people needed medicines on an ‘as required’ basis their needs had not been identified and therefore staff could not be certain these were given as prescribed. People were supported by a staff and management team who could describe signs of abuse and knew how to report concerns. However, staff had failed to recognise when poor care practices may be considered potential abuse and put people at risk of harm.

People’s rights were not protected where they were unable to consent to their own care and treatment. Decisions were not made on people’s behalf in line with the Mental Capacity Act 2005. People were being deprived of their liberty without the correct legal applications having been made and without less restrictive options being considered. Staff did not always have the knowledge and skills to support people effectively. People’s dietary needs had not always been correctly identified and understood by staff. People’s day to day health needs were met through regular access to healthcare professionals.

People’s dignity was not always upheld and promoted by care staff and their independence was not always promoted. People were supported to make some choices about their care and people felt staff were caring towards them.

People’s needs were not always met by the care they received. Care plans did not outline people’s needs and preferences or the care being delivered. People did not always have sufficient access to leisure opportunities and meaningful activities. Complaints recorded were responded to appropriately by the registered manager.

People were not protected by quality assurance systems that ensured all issues within the service were identified and the required improvements made. People had involvement in the service through meetings and surveys. People were supported by a staff team who felt supported by managers but not always fully involved in the staff team or development of the service.

The provider was not meeting the requirements of the law regarding safe care and treatment, staffing levels, consent, dignity and respect, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for an