Background to this inspection
Updated
11 April 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 14 March 2017. The inspection was carried out by one adult social care inspector.
Before the inspection we reviewed information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.
We spoke with two people living at the service. Not everyone we met who was living at Crossroads was able to give us their verbal views of the care and support they received due to their health needs. We looked around the premises and observed care practices. We spoke with seven staff and the registered manager, the head of care, the operational lead and the provider.
We looked at care documentation for four people, medicine records, six staff files, training records and other records relating to the management of the service.
Following the inspection we spoke with one family member and one person who had experience of the service.
Updated
11 April 2017
This unannounced comprehensive inspection took place on 14 March 2017. The last inspection took place on 21 May 2015. The service was meeting the requirements of the regulations at that time.
Crossroads is a care home which offers care and support for up to 47 predominantly older people. At the time of the inspection there were 42 people living at the service. The majority of these people were living with dementia. The service uses a detached house over three floors. There is a passenger lift for people to access the upper floors.
The service is required to have a registered manager. 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. The service had a registered manager in post.
Most staff had received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being provided. However, one member of staff who was new to the role and had been working at the service since January 2017 had not been provided with moving and handling training. This member of staff was supporting people to move and transfer. The registered manager addressed this issue immediately and we were told following the inspection that this member of staff had now received this training.
The service had a process for recruiting new staff where necessary checks were made before a person began working with vulnerable people. Staff files contained Disclosure and Barring checks and references. However, one staff file contained no references. The registered manager told us that these had been obtained over the phone. This information was not recorded in their file. Two further staff files only contained one reference. The registered manager assured us this would be addressed immediately.
The service held money on behalf of three people living at the service. This money was held in individual zip bags for each person. We checked the records of the money held against what cash was present at the service. Two people’s records did not tally with the money held. This was discussed with the registered manager and the head of care who were the only two people to have access to this money. Following the inspection we were advised by the registered manager that the money had been found in the safe and had been placed correctly in each person’s zip bag.
Risks in relation to people’s daily life were assessed and planned for to minimise the risk of harm. Such risks were reviewed as people’s needs changed.
Staff were supported by a system of induction, training, and supervision. Care staff had not received annual appraisals. The registered manager assured us this was being commenced.
People were supported by staff who knew how to recognise abuse and how to respond to concerns. The service displayed information for staff and visitors regarding how to raise any safeguarding concerns they may have.
The service was warm and comfortable with bedrooms personalised to reflect people’s individual tastes. People were able to move freely around the various areas of the service as they wished. Electronic fobs were worn by some people to facilitate their access through specific doors which were locked to other people. This helped ensure people’s independence was supported whilst keeping them safe. There were no unpleasant odours throughout the service. The housekeeping team worked hard to ensure that the service was kept clean and in good condition. Bedrooms and communal areas were regularly deep cleaned.
People were treated with kindness, compassion and respect. There were many positive interactions seen between people and staff with people showing great fondness for the staff, approaching them for support and guidance in a relaxed manner.
The service used an electronic medicines management system. The management and system for the administration of medicines was robust. People had received their medicines as prescribed. Regular medicines audits were consistently identifyied if any errors occurred.
Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service. Staff told us they felt well supported by the approachable management team.
The service had identified the minimum number of staff required to meet people’s needs and these were being met. The service was fully staffed at the time of this inspection.
People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards were understood and applied correctly.
Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.
The premises were well maintained. The service had provided orientation around the service to meet the needs of people living with dementia. For example, each person had a different bedroom door design and colour to help people to recognise their own bedroom.
Care plans were held on an electronic system. Information was easily accessible and contained accurate and up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews although this was not clearly recorded on the system.
People had access to meaningful activities. An activity co-ordinator was in post who arranged meaningful activities for people. These included housework chores such a pairing socks, arts and crafts, music, games and events that involved families and friends.
The registered manager was supported by a head of care on a day to day basis, along with regular contact with the operations manager and the provider.