This inspection took place on 15 February 2017 and was unannounced. This meant the staff and registered provider did not know we would be visiting.

Crosshill Nursing Home provides care and accommodation for up to 30 people with residential and nursing care needs. On the day of our inspection there were 29 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 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.

We last inspected the service in October 2014 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

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 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.

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

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA) and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

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

People who used the service and family members were complimentary about the standard of care at Crosshill Nursing Home.

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

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.

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

The registered 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.

Staff felt supported by the management team and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service.

The inspection took place on 27 October 2014 and was unannounced. Crosshill Nursing Home provides care and accommodation for up to 25 people. The home provides care for the elderly, people with physical disabilities and those who require nursing care.

At the time of our inspection there were 22 people living at the home.

The home had a registered manager in place. 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.

On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a very friendly and respectful manner. One person told us, “It’s a lovely place to live.” Another said, “I’m happy here and I’m well looked after.”

Care staff were appropriately trained to carry out their roles and additional training was provided if staff requested it. The provider actively encouraged staff to take part in training and to request training for any particular areas of interest.

The provider had policies in place to ensure people who used the service were kept safe.

Medicines were stored and administered appropriately with accurate records kept of medicines in stock.

An infection control lead had been appointed and staff were regularly assessed and monitored to ensure they followed the necessary requirements to prevent the spread of infection.

Further audits were carried out for housekeeping, mattresses, bed rails and cushions which helped to protect people from pressure sores. In addition regular checks were carried out to ensure running water in the home was kept to a safe temperature.

Recommendations regarding the health needs of people who lived at the home were recorded in care plans, along with the letters from the relevant professionals. Care plans showed, where recommendations had been made, this advice was followed and care and support were amended to take account of these needs. This meant people received care that was most appropriate to their needs.

Everybody who used the service had care plans to detail the help they required and how they would like it to be provided. Risks to people who used the service were identified and appropriately managed.

The home provided an environment and facilities that were welcoming to people who used the service, their friends and relatives.

People who used the service, their friends and relatives told us the registered manager was friendly and approachable. We were told that if they had any concerns they would tell the manager and they were confident they would be appropriately investigated and dealt with.

We spoke with four people who used the service and the relatives of three. They told us, they thought the service was very good, and they or their relatives were well cared for. One person who used the service said, "The overall thing I would want to say about this home, is that I highly recommend it. The staff are really good, and they listen to what you want."

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. Where people did not have the capacity to consent to care and treatment, the provider acted in accordance with legal requirements.

We found people's needs were assessed. Care was planned and delivered in line with their individual needs. Staff personalised their approach when supporting people, to ensure they were meeting individual needs.

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. At the time of our visit, work was ongoing to redecorate the home, and improve the layout of bedrooms. Improvements were also being made to staff areas within the home.

We found there were effective recruitment and selection processes in place.

Comments and complaints people made were responded to appropriately.

We spoke with many of the people living in the home. They told us they really liked living in the home. They said that staff encouraged them to maintain their independence by supporting them to “wash the pots” or to walk short distances and to do what they could for themselves.

They said that the staff looked after them well and that “it’s not like the ones, (meaning care homes), I’ve seen on the television”. They told us that staff were always around and that they would have no hesitation making a complaint if they were unhappy.

They told us that they liked their bedrooms, that the “food was lovely” and that the staff were “very nice”. Some people told us they had been away to holiday resorts with the staff, for example, Morecambe and Haggerstone Castle.

A high proportion of people who used the service were unable to express their views to us due to their general medical conditions. In order to determine how care and treatment was provided we spoke with staff, observed their practices and looked at some people's care records. We also spoke to relatives of people who used the service. One person told us "They're very respectful, very caring.” Another person told us “They're all great here.”

Our previous inspection had resulted in a compliance action due to the way in which people's care plans were written. Following this the provider had implemented a new care plan system which ensured people's care plans had more information in relation to the level of care required.