This inspection took place on 25 January 2018 and was unannounced. This meant the staff and provider did not know we would be visiting.

Holy Cross is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Holy Cross accommodates 56 people in one adapted building. Accommodation is provided on two of the four floors. One of which provides accommodation for people with nursing care needs. On the day of our inspection there were 50 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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 last inspected the service in November 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration and storage of medicines.

The home was clean, spacious and suitable for the people who used the service, and appropriate health and safety checks had been carried out.

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 were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Holy Cross.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any care or support plans and their individual wishes, needs and choices are taken into account.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. Support plans were in place that recorded people’s plans and wishes for their end of life care.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

The provider had an effective complaints procedure in place and people who used the service and family members were aware of how to make a complaint.

The provider had an effective quality assurance process in place. Staff said they felt supported by the registered manager. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

The inspection took place on 2 and 9 November 2015 and was unannounced. We last inspected the service on 19 November 2013 and found it was meeting the requirements of the regulations we checked.

Holy Cross Care Home is registered to provide nursing and residential care for 56 older people. At the time of our inspection there were 52 people living at the home.

The home did not currently have a registered manager. The registered manager had left the home in September 2015. A new manager had recently been appointed. 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 told us they received good care from kind, caring and considerate staff. People told us the home was a good home to live in and the care was good. One person said, “I am content here”, and, “This is a good home.” People were supported to be as independent as possible by staff who knew their needs well.

People, family members and staff consistently told us the home was a safe place to live. One person said, “I love it here. Staff are so kind and helpful, nothing is a problem. Yes I feel perfectly safe here.” One family member said, “[My relative] has been in a couple of homes and this is by far the best, I have no concerns at all and would recommend it to people.” One staff member commented, “Safe, yes…We have everything in place.”

Staff had a good understanding of safeguarding adults and whistle blowing. This included how to report concerns. One staff member said, “Yes, [concerns] would be dealt with appropriately. In 18 years I have never thought about using it [whistle blowing procedure].” There had been no recent safeguarding concerns logged.

People were assessed to help protect them from a range of potential risks. Where risks had been identified action was taken to help keep people safe, such as high protein drinks and meals and monitoring people’s food and fluid intake where people were at risk of poor nutrition. Medicines were managed safely and people received their prescribed medicines on time.

There were usually enough staff to meet people’s needs quickly. The registered provider assessed staffing levels to ensure there were enough staff on duty. One staff member described staffing levels as, “Fine, we can see people quickly.” Recruitment checks were carried out before new staff started their employment.

The home was clean and tidy with no unpleasant odours. People had personalised their rooms. Regular health and safety checks were carried out. There were procedures in place to deal with emergency situations, including an ‘Emergency Plan’ and Personal Emergency Evacuation Plans (PEEPs). There was an electronic reporting system for incidents and accidents which automatically alerted senior staff that there had been an incident.

Staff told us they were well supported and received the training they needed. One staff member commented, “Very supported, [senior manager’s name] is always there for support if I ever need it. I have never felt unsupported.” Records showed that staff supervisions, appraisals and training were up to date.

People were asked for their permission before receiving care. Staff confirmed they would respect a person’s decision. One staff member said, “It’s their choice. We always ask first. If they refused we would offer another alternative such as a full body wash for example.”

The registered provider followed the requirements of The Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). DoLS authorisations were in place for 20 out of 52 people. MCA assessments and best interest decisions had been made on behalf of people who had been assessed as not having capacity.

Although most people had a

People and their relatives told us they were happy with the service. One person said “The staff are really good. They make you feel comfortable and work very hard”. Another person told us “The food is really good”.

One relative said “The care is phenomenal; the staff are experienced and understand my relative’s needs”. Another relative said “Brilliant, the care is 100%, I cannot fault it, the staff are lovely.” One relative said there were plenty of activities “They make seasonal decorations, play carpet games and there is a good atmosphere and activities every day”.

We saw that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard and the provider had systems in place to identify risks and monitor the quality of service provided. There was an effective complaints system in operation.

We carried out this inspection because we received an anonymous concern from a person telling us their relative had developed a pressure sore since they had been admitted to Holy Cross Care Home. They said people were left in the dining room for long periods of time after their meals and also people remained in their rooms as there was not enough staff on duty to assist them.

We spoke with people about the care they received at Holy Cross Care Home. They told us they received regular medical care from their GP, and also from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required. One person told us, “The girls are wonderful. They go beyond the call of duty in making sure we are okay”.

People told us there was always staff around and that they had chosen to stay in their room. One person told us, “I like staying in my room. I am not a good mixer and always preferred my own company”. Another person we spoke with told us “I stay in my room when I want and join others in the lounge when I want. It has nothing to do with staffing”.

The activities coordinator had detailed records of activities that individuals had been involved with, including one to one activities with people who were not able to join in group activities. The information board gave details of forthcoming activities such as manicure and polish, indoor bowls, decorate you own cake, pamper session (hand and feet) and Easter activities.

People we spoke with told us the home supported them when they were planning to move to Holy Cross Care Home. They told us they were offered the opportunity to visit the home personally to see the facilities in the home before making their decision to move there. One person told us they had the opportunity to look at other homes in the area before they decided to move to Holy Cross. Another person told us their daughter suggested Holy Cross to them and they said, “I have never regretted coming here”.

People told us they received regular medical care from their GP, and also from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required.

We spoke with three relatives who were visiting at the time of the inspection. Relatives told us they had no concerns and felt the people who used the service were protected from harm. One relative told us, “The Sisters are a hard act to follow but so far I feel confident about the present owners. They are a religious organisation as well so I feel confident”. Relatives and people who used the service told us they would know what to do if they had any concerns about the service they received.

We asked the people who used the service and relatives whether they thought there was enough staff in the home to meet their needs. All the people we spoke with told us there was always enough staff to support people with their care.