What life is like for people using this service:

People were safe at the home and there were enough staff on duty.

People received the medicines they needed safely.

Staff understood their responsibilities about keeping people safe.

Risks were identified and managed well. Incidents and accidents were monitored to inform practice and make improvements to the service.

The home was clean and hygienic. Staff understood their responsibilities regarding prevention of the spread of infection.

Staff had received the training and support they needed to carry out their roles effectively. People had confidence in the staff and were content with the care they received.

Risks associated with nutritional needs were identified and managed and people received the support they needed to have a healthy diet.

People were supported to access health care services when they needed to. Staff described positive working relationships with health care professionals.

Staff supported people to remain independent and promoted their dignity. People's privacy was respected and their personal information was kept securely.

There was a clear management structure at the home and staff understood their roles and responsibilities. Staff had a firm understanding of the ethos of the home to provide care and support in line with the values of the provider.

Governance arrangements were embedded within practice and regular audits identified any shortfalls in standards of care.

More information is in Detailed Findings below

Rating at last inspection: Good (report published 2 November 2015)

About the service: Holy Cross is a residential care home that was providing personal care to 51 people at the time of the inspection, some of whom were living with dementia. It is registered for a total of 57 beds.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 22 September 2015 and was unannounced.

Holy Cross Care Homes Limited is registered to provide accommodation and personal care and support to a maximum of 57 older people. There were 53 people living at the home on the day of our inspection.

A registered manager was in post and was present during our inspection. 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 we had rated the provider as requires improvement. At this inspection we saw that improvements had been made.

Staff had received training and understood their responsibilities in keeping people safe at the home. They understood the procedures they needed to follow if they suspected people were at risk of danger, harm or abuse.

People’s medicines were managed safely by staff and people received their medicines as prescribed. People were supported by sufficient staff and were not kept waiting when they needed assistance. The provider had recruitment processes in place to make sure staff were suitable to work at the home.

People’s right to make their own decisions and choices were supported by staff. When people could not make their own decisions these were made on their behalf and in their best interests by people who knew them.

People were supported to maintain good health by having access to regular healthcare services when they needed it. Staff supported people to eat and drink enough and monitored any risks that were associated with this.

People were supported by staff who knew them well and had good relationships with them. Staff made sure people were involved in their own care and made sure information was given to them in a way they could understand.

People were encouraged to maintain their independence and staff supported this. Staff treated people with kindness and respected people’s right to privacy and dignity.

People were involved in agreeing how they wanted their care delivered and this information was used to personalise people’s care and support. People’s opinions were sought and listened to and improvements made for the benefit of the people of who lived at the home.

Staff at the home worked for the benefit of the people that lived there. The home had a positive and homely atmosphere and staff spoke about the people they supported with warmth and consideration.

Regular checks were completed by the provider and registered manager to monitor the quality of service that staff delivered at the home and improvements were made where needed.

This inspection took place on 06 October 2014 and was unannounced. At our previous inspection no improvements were identified as needed.

Holy Cross care home provides accommodation with personal care and support to older people. It is registered to accommodate a maximum of 57 people.

The home had a registered manager in post who was present for our inspection. 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.

We found the provider needed to improve their system for recording medicines received from pharmacy. The recording process for medicines received from pharmacy meant there was no accurate information about the number of some medicines held in the home.

Staff knew how to protect people against the risk of abuse and discrimination and how to report concerns they may have. They understood how to help keep people safe and followed instructions to reduce risks that had been identified.

People were supported by sufficient numbers of staff. However, we found that the allocation of staff over lunchtime needed to be improved to ensure people received the same level of care other times during the day.

Staff’s understanding needed to be improved on how the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) affected their practice. The MCA sets out how to support people who do not have capacity to make a specific decision. DoLS are safeguards used to protect people where their liberty to undertake specific activities is restricted. The registered manager had made appropriate applications to the local authority in accordance with DoLS and was following legal requirements.

People living in the home were supported by health professionals such as district nurses and doctors, to ensure their needs were fully met. The provider ensured there was a joined up approach to meeting people’s care needs to allow them to stay at the home as long as they needed and wanted to.

Staff were caring in their approach with people. Although we found that in one dining room over lunchtime the allocation of staff meant people were not always given the time and support they needed to express themselves and make choices.

People were involved in their own care and in what was happening within the home. Staff understood people’s needs and preferences and respected their privacy and dignity when supporting them.

The registered manager actively asked for people’s and staff’s opinions and gave them opportunities to talk about any concerns or complaints they had. People, their relatives and staff felt listened to and told us any concerns they had were dealt with promptly by the manager. They also felt involved in what was happening within the home and in helping to make improvements.

The home’s positive values and culture were seen during our inspection. Staff created a homely environment and spoke about the people they supported with warmth and affection. People were happy living at Holy Cross and told us their views and preferences were listened to and respected.

People shared their experience of the care and support they received. Comments included, "I am well looked after and the staff do everything they can for me, they are so cheerful, they help me do what I can for myself which is very respectful of my wishes".

We spent time in various parts of the building so that we could see how people spent their time and how the staff supported them. People considered the staff met their current needs and felt assured that if they became unwell that staff would respond.

People were supported to look their best and staff made sure people's health care needs were met. We saw that people took part in social activities at the home and in the local community. Careful attention was given to people having a suitable diet and sufficient amounts to drink.

The service did the expected checks on new staff to make sure they were suitable people to work in care.

People believed staff were well trained to do their job and one person said, "They are very good at knowing what to do to help me". They thought that staff were caring.

People told us they were regularly asked if their service was satisfactory. People knew how to complain and considered the level of communication with the management was good. This meant that the service was effective and well led.

People were pleased with the care and support they received. Many comments were made about staff being helpful and attentive.

People who used the service said they had received information before they agreed to the service. They had been able to visit the home and look around. They said they had talked to the manager about their needs and were told whether they could be met at the home. People commented that they were asked about how they would like their care to be delivered.

People who used the service said they felt able to raise any issues they had with the staff. People told us that they felt able to complain. One person said, “Staff would put things right if I wasn’t happy”.

People told us that the home was clean and comfortable. The service had systems in place to manage the prevention and control of infection within the home.

We spoke with staff who had different roles in the home. They told us they enjoyed their work and were well supported. They said they were provided with training opportunities to meet the specific needs of the people who used the service and to keep them safe.

We carried out this review to check on the care and welfare of people who used this service.

We did not review every outcome for this provider. We were proportionate in our approach and focused on outcomes four and 16.

We met with people who used the service, staff and the manager/owner. People we spoke with shared their experiences of the service that they received. We observed people who used the service and staff interaction in the lounge and around the home.

People told us that they had been involved in discussions about their needs and development of their care records. One person said “I feel safe living here, enjoy the activities available and I can choose whether to participate in them or not. Staff ask me questions about my care and are very kind to me”.

People told us that the staff were available to speak with whenever they needed them, day or night. Comments included, “The staff are good to me, this is a nice home and they are always willing to have a chat if something is bothering me”.

People who used the service told us that they were happy with the meals provided and said the service was able to meet their dietary needs. One person said, “There is a very good choice of food and alternative meals are always made available if you do not like the main option”. People told us their rooms were comfortable and that staff respected their privacy and dignity.

We spoke with staff who had different roles in the home. They told us they enjoyed their work and were well supported. They said they were provided with training opportunities to meet the specific needs of the people who used the service and to keep them safe.