What life is like for people using this service:

Without exception all the people and relatives we spoke with praised the home. People’s felt safe and well cared for. People’s preferences were respected and staff were sensitive and attentive to people’s needs. Staff were seen to be kind, caring and friendly and it was clear staff knew people and their relatives well. The management of the home was described as “good” and “exceptional”.

There were sufficient numbers of staff employed to ensure people’s needs were met. Staff had time to sit and engage people in conversation and to support people’s involvement in social activities. Recruitment practices were safe and staff were well-trained.

Risks to people’s health, safety and well-being were assessed and management plans were in place to ensure risks were mitigated as much as possible. Staff were aware of their responsibilities to safeguard people.

People received their medicines safely and as prescribed. Medicine management practices were safe.

Décor and signage supported people living with dementia to orientate around the home. The environment was safe and equipment regularly serviced to ensure it remained in safe working order.

Consideration was given to providing a variety of leisure and social activities for people to enjoy. The home maintained links with the local community by providing trips to local places of interest and inviting local community groups to visit the home.

Quality assurance processes undertaken by the registered manager and the registered providers ensured people received high quality care that met their needs and respected their preferences. People and their relatives were involved in making decisions about their care.

More information is in the Detailed Findings below.

Rating at last inspection: Good (report published 13 May 2016)

About the service: Cross Park House is a residential care home that is providing personal care to 23 older people. The service is designed for people who have a dementia or other physical health needs. At the time of the inspection, 21 people were living at the home.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The home 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.

Cross Park House is a care home which provides accommodation and personal care for up to 23 people living with dementia and other physical health needs. People who live at the home receive nursing care from the local community health teams.

The home had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This inspection took place on 25 and 26 February 2016 and was unannounced. At the time of our inspection there were 21 people using the service. People had a range of needs with some people being more independent and others requiring more support with their mobility and care needs. The majority of the people who lived in Cross Park House were living with dementia.

We carried out a previous inspection on 17 June 2014 and identified concerns with the systems for managing medicines in the home. At this inspection we found sufficient action had been taken in relation to the management of medicines.

People, relatives, staff and healthcare professionals expressed confidence in the care provided at the home and the home’s management. Relatives felt their loved ones were safe and well looked after. Staff had received training in safeguarding people and knew how to raise concerns if they were worried about anybody being harmed or neglected. Staff had received information about whistleblowing and felt confident about doing this if they needed to. Staff knew how to raise concerns and contact details for external bodies were available. Relatives and staff felt confident that any concerns they raised would be acted upon quickly and effectively by the management.

Following our previous inspection the registered manager had taken steps to improve the home’s medicines management. They had sought advice from professionals and had implemented new systems and audits. On our inspection we found some small discrepancies in the medicine records but we were assured that people were receiving their medicines as prescribed. Immediate action was taken to implement further spot checks and reminders for staff.

People, their relatives and healthcare professionals spoke very highly of the staff and the care people received. People’s care was person centred and took into account their social and wellbeing needs. Staff told us they had enough time to meet people’s needs and throughout our inspection we saw staff care for people in a personalised and unhurried manner. Staff had time to sit and talk with people and engage people in activities.

Activities were provided every afternoon and responded to people’s interests and preferences. People were encouraged to engage in activities and were given high praise for participating. Where people did not want to participate or were unable to, staff spent time with them individually to ensure they did not get lonely.

Staff received sufficient training to meet people’s needs well and further training was available to those who wanted it. Staff were encouraged to become champions in some areas and were provided with specific training in those areas. Learning from this was shared amongst the staff team and helped ensure people received care which reflected current best practice. Staff received supervision and appraisals and were encouraged to share their views and ideas.

There were robust recruitment processes in place to ensure that suitable staff were employed. Staff performance was monitored with supervisions and spot check observations and poor practice was picked up and acted upon.

Staff were knowledgeable and confident when they spoke about people’s care needs. Staff had received training in, and understood the principles of the Mental Capacity Act 2005 and the presumption that people could mak

One adult social care inspector and one pharmacist carried out this inspection. An expert by experience also attended this inspection. The focus of the inspection was to answer five key questions (Is the service safe, effective, caring, responsive and well-led?) and to respond to concerns that had been raised relating to pressure ulcer awareness, people not being repositioned when needed, poor hygiene practices and poor medicines practices.

There were 21 people living at the home at the time of the inspection. As part of this inspection we spoke with four people who used the service, the Registered Manager, three members of staff and six visitors including five relatives. We also reviewed records relating to the management of the home which included four people’s care plans, daily notes, people’s turning charts, medicine records, four staff files, the home’s policies and procedures and quality assurance folder.

Below is a summary of what we found. The summary describes what people who used the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People’s needs had been assessed and regularly reviewed. There were plans in place to ensure people’s care was delivered in a way that ensured their safety and welfare. There were clear policies and procedures relating to infection control. There were not suitable arrangements for the recording of medicines or the auditing of medicines.

Is the service effective?

People told us they were satisfied with the care they received. We saw from care records that people’s care needs had been appropriately assessed and care plans reflected these needs. Where people’s needs had changed, care plans had been updated to reflect these changes.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed understanding and gave encouragement when supporting people. Staff communicated clearly and at an appropriate pace with the people they were supporting. People’s preferences had been obtained by the home and were included in people’s care plans.

Is the service responsive?

The home responded to people’s changing needs and sought advice and guidance from relevant healthcare professionals. Actions had been taken to respond to accidents and incidents. Staff told us the service encouraged feedback and responded to this appropriately.

Is the service well-led?

Quality assurance processes were in place in the home. We saw evidence of people and their relatives being asked for feedback and this being responded to and acted on. We saw that several audits and internal inspections had been carried out and that issues identified had been acted upon. Staff told us they were asked for their feedback and felt their opinions had been listened to and used to improve the home.

When we visited Cross Park we found there were 23 people living in the home. We spoke to the manager and four other members of staff who were on duty at the time. We reviewed the care records of the people living there, the staff files, including training files, audit and administration records. We also spoke to four relatives and friends of people living there.

We looked at the care records of seven people and recruitment records for three members of staff. We looked at records relating to training of staff, management and administration of the service.

People told us they enjoyed living in the home, the staff “were very caring and always happy to help”. Some people living there told us they preferred to stay in their room although they also visited the lounges for activities and meals and if they wanted company. People told us “If I want anything I just ask, the staff are all kind”

We saw that outings were arranged, with the use of the minibus, and a variety of people visited the home providing entertainment, as well as visiting animals, including a donkey.

People had quarterly meetings, with members of their family and friends invited to attend. People told us notices about the meetings were put up in the home inviting them to attend. Staff also had quarterly meetings.

We saw that various quality and assurance audits were in place and monitored weekly and monthly. We saw evidence that the correct procedures were followed when employing staff and that mandatory training was undertaken, with a high number of staff undertaking higher level qualifications.

People told us the home was very easy to contact, the manager or the deputy manager were always available and they would have no hesitation about passing on any concerns they may have.

This inspection was performed to follow up two compliance actions we made in August 2012. Following that inspection the provider sent us an action plan listing the improvements to be made. At this inspection was saw those improvements were in place or had been completed.

We saw improvements to record keeping at the home. Care records had been improved to show what care had been given. Kitchen records showed that kitchen hygiene management at the home was good. Additional training monitoring systems had been introduced to highlight when staff were due training updates and staff supervision.

We saw improvements had been made in decision making processes where bed rails were used on peoples’ beds.

Changes had been made to the environment. During our inspection in August we saw that two ground floor bedroom doors had key chains fixed to the outside of them. We judged at the time that these could be considered as restraint. On this visit we saw that the doors had been transformed into windows. A fire risk assessment had been performed to show that the doors had not been present for fire escape purposes.

At the inspection we spoke with three people, seven staff and the manager. We spent time observing care to see what people’s experiences were who could not tell us what it was like to live at the home. We found that overall people had positive experiences. People appreciated the care they received. One person said "I'm healthier now that I was before I moved here." People were able to make choices about their lifestyle.

People told us they had been asked about their religious beliefs and people enjoyed the activities organised. People told us they enjoyed the food provided at the home and told us the food was “Superb".

People spoken with said they felt safe and knew how to raise any concerns with the home. Three people being nursed in bed with bed rails in place and two ground floor bedrooms had chains fixed to the outside of the doors. These methods could be seen as restraint. There was no evidence to show these methods were an appropriate way of keeping people safe.

The Environmental Health team had inspected the home in July and found shortfalls in kitchen management. We observed that improvements had been made. The EHO have not reinspected.

There was a mandatory training programme in place. However some staff had not received updates in the last three years.

The standard of record keeping at the home varied. We saw examples where records had not reflected the care that had been provided.

People told us they were able to make choices as part of their daily lives and staff respected their wishes. Relatives told us they were involved and kept well informed. We spoke with a relative who was visiting the home during our inspection. They told us they had been involved in their relative’s care planning and decision making.

People told us they were happy with the care and support they received at the home. Their comments included “I’m very happy here” and “if you want anything, you only have to ask”.

A relative told us they were very happy with the home and found the manager and staff very good. They told us that the home had arranged for a healthcare professional to visit to look for ways to improve outcomes, in one area, for their relative.

We spoke with a healthcare professional who had visited the home. They told us the manager and staff were very good at giving them the information they needed. If they were visiting a person for the first time, the staff introduced them to the person and stayed with them to ensure they felt comfortable with the assessment. They told us that the staff were good at carrying out the recommended treatment. If they asked for anything, they knew it would always be done.

Another healthcare professional told us they found the management excellent, and the staff very good and very supportive. They felt they had dealt very well with some difficult situations. They confirmed that staff contacted them when appropriate to ensure the best outcomes were achieved for people.

People told us they had enjoyed their lunchtime meal on the day of our visit. Their comments included “this tastes lovely” and “smells good”. During the afternoon, people appeared to enjoy taking part in tossing pancakes and laughter was heard throughout the home.

We spoke with people who told us they felt safe at the home and they would feel able to speak to the manager or staff if they were unhappy about something. They felt confident that the staff would deal with any matters to their satisfaction.

People we spoke with us told us the staff were very good. One person also commented that the staff were very patient.

Staff and people who live in the home told us that the manager was approachable. People told us that their comments were listened to and acted upon. Staff told us that they were able to make suggestions at staff meetings, and as a result improvements had been made.

We saw comments from relatives about the home. Their comments included “very caring staff”; “residents are well looked after”; the staff and manager go out of their way to help residents”; “lots of celebration parties”; and “very friendly staff, family atmosphere”.