This was an unannounced, comprehensive inspection visit completed on 10 and 11 October 2018.

Crossways is a ‘care home’ providing residential care. 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 home provides care to a maximum of 24 people. At the time of the inspection, there were 22 people receiving care at the service with one person in hospital.

The service had a registered manager 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.’

At our last inspection on 30 and 31 March 2016 the service was rated good in all key questions. This was because staff knew how to keep people safe, with good adherence and implementation of risk assessments and care plans.

Staff treated people respectfully, placed value on provision of food and fluids, and meeting specialist dietary requirements. People’s care records were completed to a consistent standard, with quality monitoring and oversight of care provided by the management team.

During this inspection, we received high and consistent praise in relation to this service. People and their relatives were positive and enthusiastic about the quality of the service provided. We found that people were supported to have maximum choice and control over their lives and staff worked with them in the least restrictive ways possible; with the policies and systems in the service to support this practice.

Staff treated people with care and compassion, and took pride in their caring roles. Staff understood how to identify and report safeguarding concerns to keep people safe. Staff approach and people’s records demonstrated adherence to the principles of the Mental Capacity Act.

People accessed a variety of meaningful activities arranged within Crossways to reduce social isolation and spent time with relatives, friends and accessing the local community.

People and their relatives knew how to make a complaint, and were encouraged to give feedback to the management team, however there had been no formal complaints in the 12 months prior to the inspection. The service provided high standards of care to people who required support with complex health needs and those approaching the end of their life.

Crossways had excellent governance systems in place which enabled the service to continuously learn, improve and sustain high quality person-centred care.

This inspection took place on 30 and 31 March 2016 and was unannounced.

Crossways provides residential care and support for up to 24 older people. Some people also stay at Crossways for periods of respite or convalescence, before returning to their own homes. At the time of our inspection, 22 people were living in the home.

The service is required to have a registered manager 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 safe in the home. Staff had a good understanding of safeguarding and knew what constituted abuse. Staff knew how to keep people safe and reported any issues of concern appropriately. Risk assessments were clear and detailed and reviewed regularly. Staff acted in accordance with the guidance and protocols that were in place to help reduce the risks for people. People received their medication on time and in the manner the prescriber intended.

Staffing levels were sufficient to meet people’s needs appropriately and all the staff on duty had the skills and knowledge to support people effectively and meet their needs in a timely manner. Appropriate and safe recruitment practices were followed, to ensure staff were suitable to work with people in a care environment.

Staff received good support from each other as well as from senior staff and management. Staff received good levels of supervision and the management team were approachable.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The management team ensured the service operated in accordance with the MCA and DoLS procedures and staff demonstrated a clear understanding of the MCA, DoLS, capacity and consent. People were supported to make their own decisions and choices as much as possible.

People received enough food and drink to meet their individual needs and staff had a good understanding and knowledge of people’s dietary needs.

Prompt referrals were made to healthcare professionals as needed and any advice or guidance given was followed appropriately by staff. There was also consistent monitoring and appropriate communication by staff, regarding people’s healthcare needs and any changes.

People were fully involved in planning and reviewing their own care and staff appropriately supported people, when necessary, to make informed choices for themselves.

The staff were kind, caring and compassionate. People were treated with dignity and respect and their privacy was always upheld. People were also supported to do as much for themselves as possible, in order to enhance and maintain their independence.

People had access to activities that complemented their interests and enhanced their wellbeing. Visitors were welcome, without restrictions. People were listened to and their complaints were welcome. Any complaints were fully investigated and actions taken to improve the quality of care provided.

There were effective systems in place to monitor the quality of the service and these were used to develop the service further. Staff and people living in the home were involved in making decisions on how the home was run.

Record keeping and management systems were in good order, with effective auditing and follow up procedures in place. An open and inclusive culture was demonstrated in Crossways, with clear and positive leadership evident.

We conducted this inspection to follow up concerns identified at our previous inspection which was carried out on 8 October 2013. Our previous inspection found that suitable recruitment arrangements were not in place.

As a result of the October 2013 inspection we required that the provider supply us with an improvement action plan, which we received. This plan told us what improvements would be made and when they would be completed by. This follow up inspection was carried out to establish whether improvements had been made.

We found that staff files had been updated to ensure that all required information was present. These records had also been re-organised and all staff files followed the same format. Recruitment and interviewing guidance/prompts were available. We also noted that a recruitment and selection checklist was being used to ensure all necessary steps were taken when employing staff.

We were satisfied that, due to the improvements made, people were protected from the risks associated with the employment of staff because appropriate recruitment arrangements were in place.

One person told us when talking about their health needs, “They make you an appointment, it is stuck to.” Another person told us, “It’s a high standard here.” A third person said, “I don’t want to be in a home, but as I need to be, this place is fantastic.”

We were satisfied that the home took steps to ensure people consented to their care and support. People we spoke with told us that staff talked them through what tasks they were carrying out when giving personal care and ensured they were comfortable and in agreement. One person told us, “They always make sure I’m right with what they’re doing for me.”

Medicines were stored and managed safely. We observed part of the lunchtime medication round. The staff member demonstrated the process they carried out to ensure that the correct person received the correct medication.

We found that staff recruitment processes were not sufficiently robust. We found gaps in the obtaining of references and verification of staff identity. We were unable to establish people's backgrounds, histories and skills which meant there was a risk that unsuitable people could be employed.

The provider had an appropriate complaints procedure in place.

During our inspection we observed people coming and going, in and out of the home, as they chose. One person went to a morning service in the nearby church, another person went shopping in town and a third person went out for a walk with their relative.

One person said that Crossways was the only home they had wanted to move to. They told us they knew a number of other people living in the home and that the location was ideal for them.

Two people we spoke with said that they were cared for very well by the staff. One person said, "I never go any more than 2 hours without staff checking on me and offering choices of drinks and snacks. They always make sure my drinks jug is full and there is always plenty of fresh fruit available." Another person told us, "I like it here very much, the food is always very good and the staff are always very kind."

People's private rooms were individual, in accordance with their choices, and they were able to have their personal possessions around them.

We saw that people were able to choose where they wanted to be in the home and could access all the communal areas. One person we spoke with told us they were very happy with their room and pointed out how spacious it was. During our inspection, we observed that three people had arranged to meet up for a chat in the sun lounge after lunch.

We saw that there were a number of systems in place to assess and monitor the quality of service provided at Crossways.

We spoke with four people who lived in the home. They told us that their needs were met and that they were consulted about the care and support that they were provided with. People were complimentary about the staff that cared for them and told us that the staff always treated them with respect and that their privacy was respected. They told us that there were enough staff on duty to assist them and that they felt safe living in the home. They also told us that the environment was comfortable and clean and that they were provided with all the equipment they needed.