The inspection was unannounced and took place on the 8 September 2016.

Crossways Nursing Home provides nursing care and support for up to 30 people, some of whom maybe living with dementia.

At the time of our inspection 24 people were using the service.

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

People felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and minimise any unnecessary restrictions on their liberty.

There were sufficient staff with the appropriate skill mix available to support people with their needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service.

Systems were in place to ensure that medicines were managed safely. This ensured that people received their medicines at the prescribed times.

Staff received appropriate training, supervision and support to enable them to carry out their roles and responsibilities effectively. People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were able to make choices about the food and drink they had and to maintain a healthy and balanced diet. If required, staff supported people to access a variety of health professionals including the dentist, optician, chiropodist, dietician and the speech and language therapist.

People and their relatives commented positively about the standard of the care provided. Staff provided care and support in a meaningful manner; and knew about people’s preferences and personal histories.

People’s views were listened to and they were actively encouraged to be involved in their care and support. Staff ensured that people’s privacy and dignity was upheld. Any information about people was respected and treated confidentially.

People’s needs were assessed before coming to live at the service and the care plans reflected how their needs were to be met. There was a complaints procedure to enable people to raise complaints.

There was a culture of openness and inclusion at the service amongst staff and people who used the service. A variety of audits were carried out, which were used to drive continuous improvement.

The inspection was unannounced and took place on the 15 October 2015.

Crossways Nursing Home provides nursing care and support for up to 30 people, some of whom were living with dementia.

At the time of our inspection 22 people were using the service.

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

We responded to information of concerns that had been raised regarding the safety of people using the service; and found improvements were needed to ensure the day-to-day culture of the service including the attitude and behaviour of staff was kept under regular review.

Improvements were needed in relation to staff deployment at specific times of the day when more intervention was required to support people and the well-being of people living with dementia.

We saw evidence which confirmed that not all staff was consistently ensuring that people were protected from abuse and avoidable harm.

We found there were risk management plans in place to protect and promote people’s safety.

There were recruitment procedures in place which were being followed to ensure suitable staff were employed to work with people.

Staff received appropriate training and support to enable them to carry out their roles and responsibilities effectively.

People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act (MCA) 2005 legislation.

People were supported to have food and drink of their choice. If required, staff supported people to access healthcare services.

Staff ensured confidentiality was maintained to promote people’s privacy.

People and relatives spoken with commented positively overall about the standard of care provided.

People were supported to take part in a range of activities in the service.

The service had a complaints procedure, which enabled people to raise complaints.

There was a culture of openness and inclusion at the service amongst staff and people who used the service.

We gathered evidence against the outcomes we inspected to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

People told us they felt safe. People's needs had been assessed, and risk assessments described how any identified risks to people were minimised. The provider's robust recruitment processes ensured that people were supported by adequately trained and experienced staff, who also administered people's medicines safely. People were also protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Is the service effective?

Detailed care plans were in place, and people told us their needs were being met. Staff received training to support people with various care needs. They also sought additional support from other health and social care professionals, to ensure positive care outcomes for people using the service. We found people were provided with nutritious food that enabled them to maintain their health and wellbeing.

Is the service caring?

People were supported by kind and attentive staff. It was clear from our observations and from speaking with the staff, that they had a good understanding of the needs of the people they supported. People told us the staff were caring. One person said, "The staff are really nice. If I ask for something, they get it for me."

Is the service responsive to people's needs?

We observed that staff responded promptly to people's needs. We saw that care plans had been updated when people's needs changed, and that referrals had been made to other health and social care professionals when required. The service took account of individual preferences, and people were supported to engage in a variety of activities of their choice.

Is the service well-led?

The service had a registered manager in post. We saw that the provider had effective systems to assess and monitor the quality of the service they provided. They regularly sought the views of people using the service and their relatives, staff, and other professionals. We found that they took account of the comments to improve the service.

When we visited Crossways Nursing Home on 8 May 2013, we spoke with four people living at the service, one relative and observed six people to help us understand their experiences. Some people had complex needs which meant they were not able to easily communicate verbally with us.

We observed that staff interacted well with the people using the service and made sure they were fully involved in making decisions about their care and support. We found that people's capacity to consent was recognised and where appropriate, they

were able to exercise consent in most daily activities.

One person told us, "I am happy living here and the staff are really kind." Another person told us, "The care is second to none. Staff know me and my needs and really care for me." One relative said, "They look after her really well. If I have a concern I can talk to people straight away and it is dealt with."

We observed that care plans were person centred, with risk factors being appropriately assessed.

Staff felt well supported at work and said they found the home manager to be approachable. They received supervision and were supported with appropriate training and development to assist them in their roles.

We observed a robust complaints policy prominently displayed. Both staff and people told us they would feel able to raise any concerns or issues that they had.

We visited Crossways Nursing Home on 17th May 2012 and spoke with three people living in the home, and relatives of four other people. All those we spoke with said they were very happy with the care provided and told us they found the staff to be caring and kind. People said they felt the needs of those living in the home were supported and staff treated them with respect and dignity. People told us that they felt staff listened to them and they were involved in decisions about their care.

During our visit on 12 July 2001 we spoke with four people who receive service at Crossways. They all told us they were happy with the care provided.

Not everyone receiving a service at Crossways was able to tell us about the care they received. We found that the manager was aware of the need to carry out assessments to support decisions made for people who are not able to make decisions for themselves. Clear processes were in place to protect people who did not have capacity to consent to their care and treatment. This included the use of advocates.

We saw that people who were unable to tell us about their care were well groomed and appropriately dressed.

We found that the majority of staff treated people with respect and encouraged them to be involved in their care. For instance we heard some staff asking people if they would like assistance and explaining what was going to happen before care and support was provided. We saw a member of staff enter a lounge and turn the television off without consulting any of the people sitting there. We saw a member of staff standing up and having very little interaction with a person they were supporting to take a drink.

The people we spoke with told us they were happy with their meals and the choices available to them. One person told us that if they didn’t like what was on the menu they were offered an alternative. Jugs of drinks were available in the lounge and in people bedrooms. We saw staff regularly offering a choice of hot and cold drinks to people.