Crossroads Caring for Carers

People’s experience of using this service: People were happy with the care provided and spoke positively about their experiences with staff. Staff were described as “nice, friendly and competent.”

People were kept safe from avoidable harm and abuse and there were enough staff to safely meet people’s care and support needs. People’s needs were assessed and risks to people’s safety were identified but risks associated with people’s healthcare needs were not always recorded. We made a recommendation about the management of some risks.

Staff told us they felt well supported by the management team and received regular supervision and appraisals. Staff received appropriate training and were supported to undertake specialist training to meet people’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were trained in mental capacity legislation and understood their responsibilities. They gained consent before providing care and supported people to make their own decisions and choices.

Staff were respectful and built trusting relationships with people. They supported people to maintain their dignity and independence. Equality and diversity were respected and people were recognised as individuals. People were supported to access services and activities in the local community.

People were supported to access healthcare services in a timely manner. Staff were compassionate when providing end of life care and supported people to have pain-free, dignified deaths.

The registered manager had an open and honest approach and supported staff professionally and personally. They were keen to develop the service and worked with other organisations to develop services that benefitted the local community. The management team listened to people’s feedback and responded to issues and concerns to continually improve the service. Governance processes were not always recorded and did not always identify or address shortfalls.

Rating at last inspection: Good (The last report was published 28 July 2016).

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

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

The inspection took place on 19 May 2016 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because the service provides a domiciliary service and we wanted to make sure that staff would be available. The last inspection of the service was in May 2014 and the provider was compliant in all areas looked at.

There was a registered manager in post. 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.

Staff were aware of the types of abuse people may be at risk of and knew the actions to take if they suspected someone was at risk of harm.

People received their care on time from a regular team of staff to ensure consistency. Recruitment processes were in place to reduce the risk of unsuitable staff being employed by the service and staff received appropriate training and supervision to carry out their role.

Medication was given in a safe way by staff who had received training in how to do this. People were supported with meals where required and staff had a detailed knowledge of people’s dietary requirements.

People told us that staff sought their consent before providing their care. Staff had an awareness of the Mental Capacity Act (2005) and knew how to support people to make their own decisions.

Staff worked alongside health professionals to promote the health and wellbeing of people and knew the action to take if someone became unwell.

People told us that staff were kind and treated them with dignity. People and their relatives were involved in planning for their care and took part in reviews to ensure that support continued to meet their needs. Where complaints had been made, these had been investigated fully by the registered manager.

People positively about the registered manager and the leadership of the service. There was an open culture at the service. Staff were confident to raise concerns and whistle blow if required.

Audits had not always been recorded to monitor the quality of the service. There was no analysis of complaints with a view to identify patterns and the registered manager had not identified issues with the maintenance of accurate care records.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

All the people we spoke with told us that they felt safe with the staff that supported them. One person told us, 'They (staff) are very good always polite and helpful nothing is too much trouble.' Another person told us, staff know what they are doing I am very happy.'

All the staff that we spoke with confirmed that they had received training on how to protect people and understood what safeguarding people meant. In addition they received updated training when required.

We saw that people had an assessment of their needs and associated risks. A plan of care was completed which enabled staff to offer care and support to people in a safe way. Staff told us and records sampled showed that they had received training and support to enable them to deliver care safely.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes. This is a domiciliary service. No one using this service was subjected to an application to deprive them of their liberty.

Records sampled showed that the provider had systems in place to establish whether people had capacity to give their consent to receiving care and were able to make informed decisions. Staff spoken with understood about people making decisions and how to respect rights. For example, supporting people to make choices about their care.

All the people we spoke with told us, they were happy with the care they received and would speak with the office staff if they had any concerns. All of the staff spoken with were able to tell us about the needs of the people they were supporting. One staff member told us, 'I have been with the same person for years so I know them really well.'

Is the care effective?

People spoken with told us and records sampled showed that they had been involved in an assessment of their needs and were able to tell staff what support they needed. This meant that people were able influence the care they received.

All staff spoken with were able to tell how they supported people and gave them choices about their care. All staff told us they asked people what they wanted at each call. People confirmed that staff always asked them what they wanted. All the people spoken with told us that they were supported by the same staff on most care calls which meant people received continuity of care from staff they felt comfortable with.

Is the service caring?

People told us they were happy with the care they received. We saw from daily records sampled that where staff had concerns about people's health, additional support was provided or other health care professionals were made aware and advice sought. One person told us, I think I get a good service I have had other agency but these are the best.' We saw that reviews of peoples care needs were completed to ensure that the service provided to them met their needs. All the people we spoken with gave positive comments about care. One person told us, 'the girls are like family I have had them so long.' Another person told us staff are very caring and very supportive.'

Is the service responsive?

All of the people told us that staff did what they wanted them to do. They told us that if their care workers were going to be late they were kept informed either by the care staff or the office. One person told us, 'Staff only change when my regular staff are on holiday and then they send someone I know.'

Records sampled showed that there were systems in place to gather the views of people so that the service was developed taking into consideration the views of staff and people who received a service. All people that we spoke with told us they were happy with the service and had not needed to make any complaints.

Is the service well led?

We saw that the service had a staffing structure that enabled the service to be managed appropriately. This included a manager that had been registered with us and was responsible for the running of the service. There was a deputy manager and team leaders. This meant that people could always contact a senior member of staff if they had any concerns. People were consulted about the quality of service they received. Comments and suggestions were analysed to identify where improvements were needed.

Staff told us they were clear about their roles and responsibilities and received regular newsletters or had frequent staff meetings. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

Records showed that regular spot checks on staff practices were carried out by senior staff . This involved supervising staff to ensure safe care practices. Records showed that training was regular and up to date. This ensured that people received care from staff that were suitably skilled to deliver care and feedback was continuously given on their performance.

We saw that the provider sought feedback from people who used the service regularly by telephoning people or visiting them. A senior member of staff told us, 'If concerns are identified then action is taken immediately.' This meant people were listened to and actions taken to address the issues raised.

People's care and health needs were planned and met in a personalised way. All staff spoken with told us they had the information they needed to care for people safely. All the people spoken with told us staff respected their privacy and ensured that they are consulted about their care.

All six people and a relative told us they felt secure and knew who they could contact if they had any concerns. During our inspection a safeguarding referral was made at our request because the manager had failed to notify the relevant agencies at the time of an allegation. This meant that the appropriate actions were not always taken to protect people.

All staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

There were systems in place to monitor the service provided to people. We looked at thirty two questionnaires that people had recently completed. Suggestions for improvements had been made. We saw that the provider had listened and taken the appropriate action to improve the quality of the service in response to these comments..

People spoken with told us the staff were friendly, treated them with respect and always asked their opinion. Staff spoken with were able to tell us about people's needs and told us that they had received a range of training so they could look after people safely.

We saw that systems were in place to keep people safe from harm. One person using the service told us,'staff make sure my door is locked when they leave I feel safe and secure'.

There were systems in place to monitor how the service was provided. Improvements were made to the service by listening to the views of people using the service, their relatives and taking the appropriate actions to address issues. This meant the provider continuously monitored the service provided to protect people who used the service.