Holy Cross Care Home provides residential accommodation for up to 60 older people within a spacious, purpose built property, situated within the grounds of Holy Cross Priory. Nursing care and residential care are provided on two floors. There were 54 people living in the service at the time of our inspection. They also provide personal care in the community. Only one person who lived outside the premises was receiving daily help with their personal care.

At the last inspection, the service was rated: good. At this inspection we found the service remained good and met all relevant fundamental standards.

Staff knew how to recognise the signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks of falls for people.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were of suitable character to carry out their role. Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

At our last inspection, we found that people’s care plans were not personalised enough to enable staff to meet their individual needs. At this inspection, we found that improvements had been made. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. These records helped staff to deliver care that met people’s individual needs.

People were supported to have choice and their independence was promoted by staff who understood people's individual needs. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. The activities provided were varied and met people's social needs.

The provider and the management team were open and transparent in their approach. They placed emphasis on continuous improvement of the service. There was a robust system of monitoring checks and audits to identify any improvements that needed to be made. The registered manager acted on the results of these checks to improve the quality of the service and care.

Further information is in the detailed findings below.

Holy Cross Nursing Home provides general nursing care including end of life care and personal care and support for up to 60 people within purpose built accommodation over two floors. There are also self-contained flats within the grounds where people can live independently or with domiciliary care support. This meant as people’s needs change and increase they could choose to increase the support within their own flat or move in to the care home for 24 hour care and support. This provided people with the assurance of continuity of care and support from staff they were familiar with. There were only two people at this time who received personal care from the domiciliary care service provided at Holy Cross Nursing Home. We spoke to these two people who used the domiciliary care service following the inspection. They told us that the support was excellent and non-invasive, allowing them to be independent.

The inspection took place on the 14 July 2014. There was a registered manager at 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 and associated Regulations about how the service is run.’

There were 53 people living in the service on the day of our inspection. Holy Cross Nursing Home welcomed people from differing faiths including nuns from closed orders. We saw that the staff employed included Sisters of the Catholic faith who were also trained nurses.

People told us they felt safe living at the service. All staff had received safeguarding vulnerable adults training and staff were able to tell us what they would do if they had any concerns. Although the service did not look after people who had a primary diagnosis of dementia, staff had received training on the Mental Capacity Act (MCA) 2005 alongside safeguarding training. Staff also had access to an organisational policy related to the MCA 2005 and Deprivation of Liberty Safeguards (DoLs).

The service provided a safe environment for people, whilst giving them freedom to make everyday choices, such as walking around the grounds and meeting friends and family. Care plans contained individual risk assessments in order to keep people safe. People interviewed felt safe and respected, and there were no obvious safety risks.

Staff told us they felt there were enough staff on duty each day to provide safe care. One staff member said, “We get the work done, so the staffing levels are okay.” Another staff member said, “We have staff that live here and so if needed due to sickness they can be there quickly.” Some staff told us they would like to be able to spend more time with people socially, but this was not always possible. One member of staff told us, “I think this is something we could do better.” One person who used the service told us, “A chat now and again would be good, but they try hard.” Another said, “They are lovely but so busy, they don’t get much time to just sit and talk.” People we spoke with said, “I am well looked after, if I have to wait, it’s because some else needs them.”

Staff told us they were encouraged to progress professionally and attend training appropriate for their role. Staff received annual appraisals and had regular group supervision with their line managers. Staff told us they felt supported to deliver safe and effective care.

People were encouraged or supported to make their own decisions about their food. We saw there was a weekly menu which gave people choice. People who did not like the choice on the menu could ask for an alternative. The feedback from people was positive about the choice and quality of the food provided. People were cared for by very kind and caring staff. Staff demonstrated they knew people well. One person told us, “They are kind, so very kind.” Another said, “Just wonderful, everything I could want is here.” Everyone we spoke with told us they felt staff treated them with respect and dignity and that they could have privacy whenever they needed it.

One person who told us that they were involved in reviewing the care and treatment they received. They told us, “The nurse asks me about how I feel and if I am happy with the care.” The staff we spoke with said, “We always ask people for their input, thoughts and agreement.” The service clearly involved people in designing their own care.

Care plans showed us that people had access to other health care professionals as and when required. Staff followed guidance from health professionals. However for one person who had declined to follow professional advice there was little documented about the risks of ignoring the advice. There was also no evidence of communication with the health professional that informed them their advice was not being followed. This was an area identified as requiring improvement.

There was an activity co-ordinator and an assistant co-ordinator who visited people individually. Events such as ‘bowls’ always took place each week, with an afternoon cream tea, weather permitting. From our observation and feedback, individualised activities was an area that needed improvement. People told us that some of the group activities were not to their taste and therefore did not attend them. Only two people attended the art session on the day of the inspection. No other activity was offered and people retired to their room. There was little documented about people’s personal preferences for life choices and how staff could support them to achieve them. This was an area identified as requiring improvement.

People were given information on how to make a complaint on admission to the home. We also saw the complaint procedure displayed on notice boards in the corridors. The manager told us that there had been one complaint received in the last 12 months which had been fully investigated. 

There was a central code of ‘care’ which staff had contributed ideas to. This included to maintaining people’s self-respect and dignity, treat people how they’d like to be treated themselves, show compassion and treat people all in the same way.

The people told us that the registered manager was approachable and supportive. One person we spoke with told us, “If I had any concerns I would go straight to the manager.” Another told us, “I go to the office or speak to a sister.”

Staff carried out regular audits of the service which included a monthly provider’s visit. The monthly providers visit is part of the quality assurance system used by the service. This showed us that the provider checked that the service provided the care and treatment in an appropriate and safe way and that where necessary, improvements were made.

The service held an accident and incident log which recorded details of the incident, together with the outcome and action taken.

We spoke with three people living at Holy Cross. They told us “The staff are lovely. I genuinely see that they care about us”, “I wasn’t sure about coming to a home but I’ve nothing but praise”, “It’s really well run and we’re able to do the things we want to do... things that we’ve always done. I like to tend the flowers outside, but other like to play bowls, go to the village. The staff always ask me what I’d like to do”.

In our discussions with staff they demonstrated a thorough knowledge of the people living at the service. There was also strong evidence on people’s records that people’s care was planned alongside the individual and that people were encouraged to be as independent as was safe to do. We saw the home involved outside agencies as required.

Care records showed that people were involved in the planning and delivery of their care. People told us that they were encouraged to make their own choices. We could see from the records that care was planned and information from family and outside agencies helped plan this care.

We saw that medication was stored correctly and there was a good procedure in place. Storage areas were clean and medication records were up to date. There was a system in place for checking medication.

We could see from observing and looking at records that there were sufficient staff on duty, who were suitably qualified and trained. Records relating to staff were well kept and staff received training on a regular basis.

During our visit we spoke with six people who live in the home. We spoke with four members of staff, including the manager. We looked at the records of three people. We also looked at the responses to monthly surveys of people who live in the home, their families and friends, and staff.

The people we spoke to were very happy living at the home. One person we spoke to said "I'm very happy here"; another said "It's excellent". One person told us "I couldn't think of anything that could be better. It's a home from home - only I don't have to do the hard work!".

The staff we spoke to had a good understanding of the needs of people who lived at the home, and gave high priority to respecting people's privacy and dignity. They received all the training they needed and were well supported. Some of the staff said that they had worked there for a long time because they liked it so much. They told us that there were enough staff and that they were able to have the training they needed. One staff member told us that "staff unconsciously respect people" and that "everybody's happy".

We spent time observing the care that people received. We saw that people's needs were responded to quickly, and that staff knew how to give the right care to each person. We saw that people were given choices and were treated with dignity and respect. Staff spoke to people in a friendly way and took time to listen and communicate with them. The home had a friendly and happy atmosphere.