We carried out a review of the data available to us about Crossley House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Crossley House, you can give feedback on this service.
About the service
Crossley House is a residential care home providing accommodation and personal care for up to 17 people. The service provides support to older people and those who are living with dementia. At the time of our inspection there were 15 people using the service.
People’s experience of using this service and what we found
People were kept safe from avoidable harm because staff knew them and understood what actions they should take to protect people from abuse. The service worked with other agencies to do this.
People's medicines were administered as prescribed and generally managed safely by competent staff. We have made a recommendation about the management of creams and ointments.
Staff assessed, monitored and managed safety. Care records contained individual risk assessments which reflected people’s needs and supported staff to provide safe care for people. We were assured that people were protected by the prevention and control of infection.
New staff had recently been recruited and most shifts were now covered by permanent staff. The provider recruited staff safely, although paper records could be streamlined. We highlighted this to the management team.
Staff completed an induction programme and were supervised when they started in post. The provider was committed to providing staff with training, but this was not always up to date or in line with best practice. We have made a recommendation about staff training.
People’s needs and choices were assessed, and care and support delivered in line with current standards to achieve effective outcomes. Care plans reflected a good understanding of people’s needs, were up to date and regularly reviewed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
A wider range of activities and events were restarting as the restrictions of the pandemic eased.
Staff provided respectful support with personal care and daily routines. People were supported to maintain their health and wellbeing, and to eat and drink enough to have a balanced diet. Referrals were made to specialist services as required.
The management team had a clear vision about the quality of care and service they aimed to provide. They worked in partnership with other organisations to develop the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 09 July 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service in June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, notifications of other incidents, need for consent and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective, responsive and well led which contain those requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Crossley House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Crossley House is a care home which provides personal and nursing care for up to 17 people who are living with dementia. At the time of the inspection, 11 people were living at the home.
We found the following examples of good practice.
Clear signage and procedures were in place on arrival at the service to keep people safe. This included screening visitors for coronavirus symptoms, carrying out a temperature check, and wearing personal protective equipment (PPE). Visits were planned and personalised, and staff supported people to make telephone and video calls to maintain social contact when visits could not take place.
Staff made efforts to ensure relatives were kept informed about the activities and wellbeing of their family member. This included sending regular photos and videos and sharing events and celebrations on the provider’s Facebook page. This included summer and Christmas parties, online sessions with an entertainer, charity fundraising and celebrating seasons.
One person had been able to celebrate their 100th birthday with staff and people at the service, as well as members of their family. The visitors to the service were outside in the garden, while the person who lived at the service was indoors in the conservatory. The event was important to and appreciated by the person and their family and was carefully planned and risk assessed to keep everyone safe.
The provider had carried out surveys with people who lived at the service and their relatives. They had received positive feedback about how relatives felt the service had managed during the pandemic, and how they had been able to keep in touch with their family members.
The service was clean and well maintained and procedures throughout the building helped control the risk of cross infection. Staff had access to sufficient PPE, and received training in infection prevention and control measures to keep people safe. During our inspection we noted windows were open and rooms were well ventilated. This can help to reduce the spread of coronavirus.
The management team spoke highly of the staff and noted many had ‘gone the extra mile’ to keep people safe when there was a coronavirus outbreak at the service. Staff were well supported and received training to help them carry out their role to a high standard. Staff and people living at the service could access regular Covid-19 tests.
People who did not have the capacity to consent to a Covid-19 test or vaccination had been appropriately assessed and decisions were made in their best interests and in consultation with others.
People’s experience of using this service:
People were not always involved in decisions about their care and support. When people lacked the mental capacity to make decisions, records did not always demonstrate current statutory guidance had been followed. This was to ensure people were not restricted any more than necessary and decisions made on their behalf were in their best interest.
Care records were not always accurate and up to date, and people’s end of life care needs were not clearly documented.
Information about risks to people’s safety was not consistently identified and recorded. Medicine practices did not ensure the service followed relevant national guidelines. People did not always receive their medicines such as creams as prescribed.
People and their relatives said staffing was not consistent at the weekends and felt there were less staff to support them. Staff said periods of the day was busier than others, but people received the care they needed and were safe. We recommend the provider finds out more about calculating staff based on current best practice, in relation to the specialist needs of people living with dementia.
People’s healthcare needs were monitored, and they had access to suitable healthcare services. Regular social activities were organised for the enjoyment of the people living at the home. These were kept under review. People were provided with sufficient home cooked food and drink to maintain their health and wellbeing.
People were supported and treated with dignity and respect. Staff knew people well and were kind and patient.
People, relatives and staff said they felt the service was now well managed since the new manager commenced in post. There had been improvements into how staff worked together in providing care that was person centred.
Over the last 12 months, there had been a high staff turnover, a change of manager and high agency usage. This has had an impact on the morale of staff and care delivery. It was evident this was changing with the new manager actively recruiting staff and agency usage being reduced.
Governance arrangements were not always effective and used consistently to monitor the service. The provider had failed to notify CQC about some incidents, which had taken place at the service. They are legally obliged to do this.
Rating at last inspection: Rating at last inspection: Good (report published January 2017).
Why we inspected: This was a planned inspection based on the rating at the last inspection.
Enforcement
Please see the 'action we have told the provider to take' section towards the end of the report.
Follow up: We will continue to monitor intelligence we receive about the home until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Crossley house provides care and accommodation for people living with dementia. There were 13 people living in the home at the time of our inspection; however two of these were in hospital.
There was a registered manager in place, however they were on leave at the time of 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. There was a deputy manager in charge and also the quality and training manager supported the inspection.
People in the home were protected in line with the Mental Capacity Act 2005 (MCA). This is legislation that protects the rights of people who are unable to make decisions about their own care and treatment. There was evidence of mental capacity assessment relating to various decisions and a best interest decision made. Where people had LPA's in place, information about this was available in their file and they were asked to consent to people's care arrangements.
Medicines were stored and administered safely. However we found that there weren’t clear instructions in place for all PRN (‘as required’) medicines. Clear instructions are important to set out exactly when PRN medicine should be given and what dose should be administered.
People in the home experienced happy and positive relationships with staff. Staff were responsive to people’s needs, offering support and reassurance when people were upset and at other times sharing smiles and laughter. Activities that engaged people and which they clearly enjoyed were provided. Staff spent 1-1 time with people outside of care tasks; for example we saw one person clearly enjoying have their nails painted by staff and being encouraged to participate by choosing the colour of varnish.
Staff were supported in their role with training and supervision. New staff followed the Care Certificate which is a set of standards that all care workers are expected to achieve. Of the staff files we checked not all had received formal 1-1 supervision with their line managers; however staff were positive about their training and support and felt able to approach the registered manager at any time.
The home was well led by the registered manager and supported by other senior staff within the organisation. There were systems in place to monitor the quality of the service provided and this included gathering feedback from people and their relatives.
This inspection was unannounced and took place on 24 and 25 June 2015. A previous inspection on 30 November and 1 December 2014 had found six breaches of regulation. At this inspection we found that action had been taken in response to these breaches; however further improvements were required in two areas relating to audits and record keeping.
The home provides care for older people, some of whom are living with dementia. At the time of our inspection there were 14 people living at Crossley house.
There was a manager in post at the home, although at the time of our inspection they had not yet begun the registration process with the Commission. The previous manager had deregistered with the Commission in May 2015.
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 previous inspection on 30 November and 1 December 2014, we found six breaches of regulation. These included concerns relating to record keeping and auditing of medicines. Although action had been taken to improve in these areas, further improvements were required.
Errors had been made in stock taking of medicines which meant there was a risk that concerns would not be identified through the audit process. Records relating to food and fluid intake showed significant improvement; however gaps in recording were still found. The manager was aware of the importance of clear record keeping and was taking action to address issues, including providing training for staff.
People in the home benefitted from kind and caring relationships with staff. This was evident in interactions where people shared laughter with staff and received reassurance when it was needed. Friends, relatives and staff alike were positive about the home and the changes that had occurred in recent weeks, since the findings of the previous inspection.
Staffing levels had increased since the last inspection and this meant people’s needs were met effectively. Staff reported that the increased staffing levels allowed them to spend more time with people on care tasks not directly related to their personal care.
Staff understood people as individuals. Their needs were well described in their care plans and we observed staff supporting people in accordance with their plans. Friends and relatives were able to be involved in planning people’s care where appropriate.
Staff reported feeling well supported and felt able to approach senior staff with any concerns or issues. Staff received regular supervision, which provided opportunity to discuss their performance and development needs. An induction programme for new staff had been introduced based on the Care Certificate. The Care Certificate is a nationally recognised set of standards that new staff are expected to meet in order to equip them fully for their role.
Overall summary This inspection took place on 30 November and 1 December 2014. The inspection was unannounced. The previous inspection was carried out 22 May 2013 and there had been no breaches of legal requirements at that time.
Crossley House is registered to provide accommodation for up to a maximum of 17 people. The service cares for older people, some of whom are living with dementia. At the time of our inspection there were 16 people living in the care home.
A registered manager was not in post at the time of 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 and associated Regulations about how the service is run. The home did have a registered manager in post.
People in the home were not always safe. We found errors in the recording and auditing of medicines. This was around the maintaining of stock levels, administration of medicines and lack of effective auditing process.
One person did not attend a medical appointment that should have taken place. The manager or staff had not noticed the appointment hadn’t taken place. This person was placed at risk of not receiving safe care.
Staffing levels were not always sufficient to meet the current needs of people living in the home. The majority of staff and some relatives told us that staffing levels were insufficient at peak times, especially during the evening.
Some people’s risk assessments lacked detailed guidance for staff to follow as they were not always comprehensively completed. This meant that staff did not have full information to ensure people were kept safe and protected from harm
Not all records were completed fully. Some people’s care files lacked recordings in relation to their care and treatment. This included nutritional recording charts. This posed a risk to people’s individual needs not being met effectively.
People were not always protected from the risks associated with Infection Control. The home did not follow the Department of Health infection control guidelines or similar guidance. Areas of the home were cluttered and the laundry and kitchen were not clean. Some staff did not use the correct procedures when handling used laundry.
Some people had not received food hygiene training and were involved in the meal preparation. Therefore people could be at risk of food borne illnesses.
People were happy with the food and drink they received in the home. However we observed a mealtime where some people’s needs were not being met effectively. We found that some people did not receive the support they required.
The provider had not ensured that staff had the knowledge and skills they needed to carry out their roles effectively to ensure people who used the service were safe. Some staff had not completed their safeguarding adults training to ensure their knowledge was current and in accordance with current guidance.
Staff had training and awareness of the Mental Capacity Act 2005. Documentation confirmed correct processes had been followed. Staff that we spoke with had a good understanding of the processes that needed to be followed.
There were positive and caring relationships between staff and people at the service. People praised the staff and told us they provided a good standard of care even when they were very busy. We observed people to be relaxed in the company of staff and engaged in conversations.
We received some positive feedback from relatives and visitors while they also acknowledged staffing levels appeared not always to be sufficient.
Some people’s care records demonstrated their involvement in care planning and decision making processes. Some people had signed their documentation. This was confirmed when we spoke with people living in the home and their relatives.
People received regular reviews of their care needs; however we did find the service had failed to ensure some people’s risk assessments were fully reflective of their current needs. We have made a recommendation that the provider reviews peoples risk assessments and ensure they are cross referenced against each element of their care plans.
Staff meetings and manager meetings were scheduled regularly and staff were encouraged to express their views. Meetings were held with people and their relatives to ensure that they could express their views and opinions about the service they received. People could also raise any complaints at these meetings.
Quality and safety in the home was monitored to support the manager in identifying any issues of concern. However they were not robust and had not identified all the shortfalls found during this inspection. This included medicines and infection control.
We found breaches of six regulations relating to medicines, staffing, care of people in the home, records, infection control and quality assurance systems. You can see what action we told the provider to take at the back of the full version of the report.
Not all people were able to verbally tell us about the care they received and if they were happy. Therefore we observed how staff interacted and supported people in the communal areas to enable us to make a judgement on how their needs were being met. People appeared happy and relaxed in the company of the staff and were seen to be engaged in activities and conversations during our inspection.
We looked at people's personal care files to see if their care assessment documentation met their needs. We spoke with six people who used the service, one relative and five staff during our inspection.
Overall people's comments were positive about living in the home. Comments included; 'I can't fault it I'm very happy, they can't do enough for you', 'there is always something going on, it's very comfortable there are lovely gardens to walk around'.
One relative told us' X is very happy here, we have no complaints but we would know how to make one if we did'.