This inspection took place on 20 July 2018 and 27 July 2018 and was unannounced.

Crossways nursing home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a registered manager. A registered manager is a person who has registered with the 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.

Crossways Nursing Home provides nursing and residential care for up to 18 people with various needs including people living with dementia, diabetes and other health conditions. At the time of the inspection the provider was caring for 13 people.

The home comprised two floors and a large garden in a village near Basingstoke. There are 10 single rooms and four double rooms for residents, some with en-suite bathroom facilities. There is a lift for people to access both floors, as well as a communal lounge and dining room. There is also a large garden at the rear of the property which is used by residents and relatives.

Crossways was last inspected in August 2017 and was rated requires improvement. We found breaches of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, related to person-centred care, the need for consent and good governance. Following the last inspection, we asked the provider to make the necessary improvements to ensure they became compliant with the regulations.

At this inspection we found the provider had made the necessary improvements to meet the requirements of regulation 9 of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

At this inspection we found there were three breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014, two continued breaches in the need for consent and good governance and one breach of safe care and treatment.

People's care plans contained assessments of their needs and some information about their individual preferences. Some people’s care plans included details about their life histories and relationships. However, care plans were not always accurately completed, as care and support plans contained errors and inaccurate language which were not reflective of people’s needs. People were exposed to the risk of not receiving person-centred care as care plans did not contain sufficient information to support staff to provide individualised care which reflected people’s needs and choices. In addition, inaccurate language and unclear guidance in care plans also exposed people to the risk of receiving unsafe care.

The provider did not comply with all the requirements of the Mental Capacity Act 2005 (MCA) when delivering care and support to people. The provider had not always documented mental capacity assessments and best interest decisions to ensure MCA requirements were met at all times. Following the inspection, the provider sent us evidence that some actions had been taken to address these omissions. However, these were not sufficient to meet the requirements of the regulation.

The provider had not always ensured that effective systems were in place to assess and monitor the quality of the service provided to ensure appropriate action was taken to improve the quality and safety of the care people received. The provider's service improvement plan and quality assurance audits had identified a number of required improvements. However audits carried out were not always effective in ensuring improvements were sustained or embedded and had failed to identify risks to people’s safety, including unlocked gates in the garden.

Systems and processes were effective in ensuring people w

This inspection was unannounced and took place on the 5 and 6 June 2017.

Crossways Nursing Home (to be referred to as ‘the home’ throughout this report) is a home which provides nursing and residential care for up to 18 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. At the time of our inspection 14 people were living in the home.

Crossways is a two storey building set in secure grounds in a village on the outskirts of Basingstoke. The home comprises of 10 single rooms and 4 double rooms for residents, some with ensuite bathroom facilities. There is a communal lounge and dining room on the ground floor with a lift that offers people access to both floors. There is a secure garden to the rear of the home which houses a marquee allowing people to enjoy sitting in the garden in all weather conditions. However this was being used to store equipment such as wheelchairs at the time of this inspection.

At our last inspection on 28 and 29 June 2016 we made a recommendation that the provider sought guidance on the environmental factors in the home to ensure they could be adapted to meet the needs of those living with dementia. Additional work was also planned to ensure the home's environment was developed further in order to continue to meet people's needs. At our last inspection we also made a recommendation that the provider actively promoted activities identified as appropriate for those living with dementia.

At this inspection we saw improvements had been made to ensure the environment met the needs of those living with dementia. However more work was required to fully engage people in personalised activities enabling them to live a socially active and enjoyable life.

The home has a registered manager in post. 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.

People were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 (MCA) when supporting people to make decisions. However the provider had not always completed mental capacity assessments and best interest decisions where required, to ensure those requirements of the MCA were met at all times.

People’s needs were assessed and care plans were in place to address their needs. However care plans were not always person centred ensuring each person’s individual needs were met appropriately.

People, relatives and staff were not always encouraged to provide feedback on the quality of the service they received. Quality assurance processes were not in place to enable people to provide feedback identifying where improvements in service provision could be made.

The provider had not effectively implemented quality assurance systems to assess, monitor and improve the quality of the service people experienced.

People using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people. People's safety was promoted because risks that may cause them harm had been identified and guidance provided to staff to help manage these appropriately.

People told us they there were sufficient numbers of staff deployed in order to meet their needs. The provider was able to adapt their staffing levels appropriately when required, in order to meet changes in people’s needs.

Recruitment procedures were fully completed to ensure people were protected from the employment of unsuitable staff.

People received their medicines safely. Nurses received the appropriate training and guidance to enable them to complete their role in relation to

This inspection was unannounced and took place on the 28 and 29 June 2016.

Crossways Nursing Home is a home which provides nursing and residential care for up to 18 people who have a range of needs, including those living with dementia, epilepsy and diabetes and those receiving end of life care. At the time of our inspection 16 people were living in the home.

Crossways is a two storey building set in secure grounds in a village on the outskirts of Basingstoke town centre. The home comprises of 10 single rooms and 4 double rooms for residents, some with ensuite bathroom facilities. There is a secure garden to the rear of the home which houses a marquee allowing people to enjoy sitting in the garden in all weather conditions.

The home has a registered manager in post. 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.

Staff provided care to those living with dementia however the environment did not always support people to move around the home safely and to remain independent. Corridors were not often well lit and flooring was not always appropriate to support those with limited eyesight. This would not assist those with limited vision as a result of their condition to be able to move effectively around the home.

We have made a recommendation that the provider seeks further guidance on the environmental factors which can be adapted to meet the needs of those living with dementia.

The provider was not always able to provide person centred activities for all persons to ensure they lead full and meaningful lives.

We have made a recommendation that the provider promotes activities identified as appropriate for people living with dementia to those living in the home.

Relatives of people using the service told us they felt their family members were cared for safely. Staff understood and followed the provider’s guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm had been identified and guidance provided to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Detailed recruitment procedures were in place to protect people from unsuitable staff.

Contingency plans were in place to ensure the safe delivery of care in the event of adverse situations such as a loss of accommodation as a result of fire or flooding. Fire drills were documented, known by staff and practiced to ensure people were kept safe.

People were protected from the unsafe administration of medicines. Nurses responsible for administering medicines had received additional training and were subject to competency assessments to ensure people’s medicines were administered, stored and disposed of correctly.

People received sufficient food and drink to maintain their health and wellbeing. Snacks and drinks were encouraged between meals to ensure people remained hydrated. People assessed as requiring a specialised diet, for example a pureed and diabetic diet, received these and the food was pleasantly presented.

People were supported by staff who had received an effective induction and period of support from more experienced members of staff. This enabled them to acquire the skills and confidence to deliver safe effective care. Regular supervisions ensured that staff were able to express concerns and they felt supported as a result.

People were supported by staff to make their own decisions. Staff were able to demonstrate that they complied with the requirements of the Mental Capacity Act 2005 when supporting people. This involved making decisions on behalf

At the time of our inspection there were twelve people living at Crossways.

During our inspection we spoke with 6 people who used the service and two visiting relatives. We also spoke with four staff including the home manager. One person we spoke with told us “I have no fault to find, everyone is perfectly lovely.” A family member told us “they are very supportive of my relative, staff make sure they encourage her not to always stay in her room.”

We observed staff talking to people in a respectful manner. Staff called people by their preferred name. We saw that people appeared relaxed and happy sitting in the communal area. People we spoke with told us that they would sometimes sit in the garden and that they also had a summer house they could use.

We found that the home trained staff correctly before they undertook any responsibility for administering medication. Staff we spoke with confirmed that only the trained nurses would administer medication.

Staff we spoke with told us that they felt supported by the home manager and other team members. They said that there were always adequate numbers of staff available on each shift. They also told us that cover would be sought for any staff absences. Records we reviewed showed that staff had access to training relevant to their roles.

People were provided with a choice of suitable and nutritious food and drink. People’s dietary requirements, such as likes and dislikes, were detailed in their care plan. We spoke with the cook who explained that they used this information to support their menu planning.

The provider had systems in place to monitor and evaluate the quality of services provided. People living in the home, their relatives and staff were able to express their views and opinions.

At the time of our visit there were 11 people living in Crossways nursing home. We observed people being treated with dignity and respect. Those who were in the lounge area were well dressed and groomed. They appeared content and were observed to get along with staff well.

Several residents were very frail so chose to remain in their rooms for much of the time. Most of the residents living at Crossways suffered with dementia and as such were not able to talk with us about all aspects of their care. We spoke with a relative who was very complimentary about the care their relative received. They told us that “this home gives the best care of the four my mother has been in”. They told us that they could see there were areas of the home that were in need of updating but that this was in progress. They said “care is more important than the fabric of the building”.

Staff received appropriate training and support. Training files and supervision records were up to date. We spoke with three staff who told us that despite there not being a registered manager at the time of our visit they felt supported by management and could raise issues or concerns. Staff members told us they thought they worked in a positive team that worked well together. They said their focus was on the residents, ensuring they had the correct support.

The provider had a system in place to monitor and assess the service provided and staff and residents were able to express their opinions.

The people who use this service preferred to be referred to as residents. This preference is respected within this report.

Residents we spoke with told us they felt safe living at the home and that they would tell the manager or another staff member if they had any concerns. They felt that the staff had the skills they needed when providing their care and working with them.

Residents we spoke with told us that, before she left, the acting manager had often sought their views about the home and the way things were run and felt that their opinions had been listened to and taken into account.

Residents thought the home and their rooms were kept clean and one resident explained how the staff worked together to keep the home clean since the cleaner had left.

On this occasion we did not speak with people who use the service about the outcomes we were looking at.