CQC report explained · a residential care home
What the CQC found at Cross Way House Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People told inspectors they felt safe. There were enough staff, recruitment checks were completed, risks were managed and medicines records were accurate and up to date.
- Effective?
- Good
- Staff were trained and supported people's health, nutrition and healthcare needs. Records of best interest decisions were not always individualised, and inspectors recommended improving this.
- Caring?
- Good
- Staff treated people with kindness, dignity and respect. People and families said they were involved in care decisions and could maintain their independence and relationships.
- Responsive?
- Good
- Care plans reflected people's preferences and support needs. People had choices about meals, activities and where they spent their time, and knew how to raise concerns.
- Well-led?
- Requires improvement
- The management structure was clear and staff felt supported, but quality systems were not always robust. Audits did not consistently identify areas needing improvement, and some policies did not reflect current best practice.
What inspectors found, July 2019
Cross Way House Care Home was rated Good overall; inspectors found safe, kind and personalised care, but leadership and quality checks still required improvement.
Inspectors made an unannounced visit on 23 May 2019. They spoke with eight people living at the home, four family members, 11 staff and seven health and care professionals. They also reviewed care, medicines, incident, complaint and management records.
The home was rated Good for Safe, Effective, Caring and Responsive. People were described as safe, treated kindly and supported by staff who understood their needs. There were enough staff, medicines records were complete, and care plans were generally personalised.
Well-led was rated Requires Improvement. Quality checks did not always identify worn furniture, gaps in some care plans and risk assessments, or staff practice that did not follow best practice. Records of some best interest decisions were also too general.
The overall rating improved from Requires Improvement at the previous inspection. The two previous breaches had been resolved, and the home was no longer in breach of regulations at this inspection.
Enough staff
Inspectors found enough suitable staff to meet people's needs safely. People and families also said staffing levels were good.
“There were sufficient numbers of suitable staff to support people safely according to their needs.” from the report
Kind and respectful care
Staff were observed treating people with patience, kindness and compassion. They respected privacy, dignity, choices and independence.
“We observed people were treated with kindness and compassion.” from the report
Personalised care
Care plans gave staff information about people's likes, dislikes, preferences and complex health needs. Daily records showed care was delivered as planned.
“Care plans informed staff how they should support people in a way that met their likes, dislikes and preferences and of the things that were important to them.” from the report
Safe medicines practice
Medicines were given by trained staff, and the records checked by inspectors were complete and up to date.
“All the MAR charts we looked at were accurate, complete and up to date.” from the report
Improvement since the last inspection
The home improved from Requires Improvement overall. The previous concerns about governance, nutrition records and personalised care had been addressed sufficiently for the home to be out of breach.
“At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.” from the report
Quality checks missed problems
needs fixingAudits did not always identify issues with furniture, care plans, risk assessments or staff practice. The home agreed to widen its auditing processes.
“However, these systems were not always robust and did not always identify opportunities for improvement.” from the report
Best interest records
needs fixingSome records did not show the individual decisions made for people who could not make certain decisions themselves. Inspectors recommended seeking advice on better recording.
“However, the documents did not always reflect individual best interest decisions.” from the report
Worn lounge furniture
minorSome lounge furniture had exposed foam and could not be cleaned effectively. The manager replaced it immediately and updated the infection control audit.
“This meant they could not be cleaned effectively.” from the report
Policies needed updating
needs fixingThe provider did not always have consistent systems to check that policies and related processes reflected current best practice and regulatory requirements.
“However, they did not always have consistent systems in place for reviewing all of their policies and associated processes, such as staff recruitment, to ensure they always reflected current best practice and aligned to the regulatory requirements.” from the report
- 01How have you strengthened audits so they identify problems with care plans, risk assessments, furniture and staff practice?
- 02How do you now record each person's mental capacity assessment and best interest decision?
- 03Which policies and recruitment processes have been reviewed since this inspection, and when will the remaining reviews be completed?
- 04How do you check that improvements identified in action plans remain in place over time?
- 05How will you make sure care plans continue to reflect each person's changing needs and preferences?
This was a planned, unannounced inspection covering all five key questions; the previous overall rating was Requires Improvement and the provider was no longer in breach at this inspection. This explanation was written from the published report of 16 July 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, April 2018
Rated Requires Improvement; inspectors found kind care and safe medicines, but concerns about records, night staffing and responding to changing needs.
This was an unannounced inspection on 6 February 2018. It was prompted partly by concerns about people's safety, care and how the home was managed. Inspectors spoke with people, visitors, staff and managers. They observed care and checked care, medicine, staff and management records.
People were treated kindly and respectfully. Staff were trained and supported, medicines were generally managed safely, and the home was clean. People had access to healthcare and enjoyed activities. Complaints were investigated and people and relatives said the manager listened to them.
However, some care plans and risk assessments were out of date, incomplete or conflicting. The home had not properly assessed how many staff were needed at night. Inspectors were also not always satisfied that concerns about weight loss and other changing needs led to appropriate action.
The overall rating was Requires Improvement. Safe, effective, responsive and well-led were also rated Requires Improvement. Caring was rated Good. The provider had improved since earlier inspections, but inspectors found two breaches of regulations and required further action.
Kind and respectful care
People felt staff were kind. Inspectors saw staff supporting people patiently and compassionately, while respecting privacy and independence.
“Staff were observed to support people in a discreet, patient and compassionate manner.” from the report
Medicines were generally safe
Medicine records showed no gaps, and staff followed arrangements for regular, as-needed and time-critical medicines. Errors were investigated and learning was shared.
“We looked at the Medicines Administration Records (MAR) for all people living at the service and found no gaps in these records indicating people received their medicines as prescribed.” from the report
Staff training and support
Staff received induction, supervision and training. Inspectors found this helped them carry out their roles effectively.
“Staff were supported through induction, supervision and training which enabled them to carry out their role effectively.” from the report
Clean environment
The home was clean and tidy, with suitable hand-washing facilities and regular infection control checks.
“Throughout our visit we saw the service was clean. We did not detect any malodours.” from the report
Activities and independence
People were supported to make choices, go out where appropriate and take part in activities such as music, skittles and arts and crafts.
“People told us there was always something to do.” from the report
Incomplete risk information
seriousSome people's risks, including diabetes, behaviour, swallowing and choking risks, were not covered by clear and consistent records. This could make it harder for agency staff to support people safely.
“People's risk assessments and care plans were not always up to date and reflective of risks associated with people needs.” from the report
Nutrition concerns were not clearly acted on
needs fixingRecords showed significant weight loss for some people, but did not clearly show referrals, supplements, fortified food or updated care plans. One incorrect weight had also not been properly documented.
“The person's food intake was being monitored but there was no evidence this was leading to action.” from the report
Care was not always personalised
needs fixingCare plans did not always include people's preferences or reflect their current needs. Some people were not clearly involved in their care planning, and accessible formats had not always been provided.
“At times care plans lacked personalised detail that would enable staff to meet their needs.” from the report
Quality checks missed problems
seriousThe home had several audits, but these did not always identify or resolve gaps in care plans, risk assessments and staffing reviews. Action plans did not always include deadlines or named responsibilities.
“Although the provider had multiple audits and systems to assess the quality and safety of the service, not all of these were effective in identifying concerns and taking action to make improvements.” from the report
- 01How do you now assess the number of staff needed at night, based on each resident's needs and the need to respond to emergencies?
- 02How do you make sure agency staff receive accurate, up-to-date information about residents' risks, including diabetes, swallowing difficulties, choking and behaviours that may cause harm?
- 03What process do you use when a resident loses weight, and how do you record referrals, supplements, fortified food and changes to their care plan?
- 04How are residents and relatives involved in reviewing care plans, including providing information in pictorial, braille or other accessible formats?
- 05How do your audits now identify problems and track who is responsible for fixing them and by when?
This was an unannounced inspection of the overall service and all five CQC questions, including care, safety, staffing, medicines, records and management systems. This explanation was written from the published report of 19 April 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Cross Way House Care Home
4 rated inspections over 3 years: the service has improved, from Inadequate to Good.
- July 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- December 2016Requires improvementup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2016InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- December 2013
Report published without a new overall rating.
- July 2013
Report published without a new overall rating.
- September 2012
Registered with the Care Quality Commission on 16 September 2012.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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