Coventry Crossroads is a domiciliary care agency registered to provide personal care to people in their own homes. At the time of this inspection the service supported 75 people with personal care and employed 45 care staff.

The office visit of this inspection took place on 10 and 11 October 2018 and was announced.

At our last comprehensive inspection of the service in December 2015 we rated the service as Good. At this inspection we found the service remained Good.

A requirement of the provider’s registration is that they have a registered manager. 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.

The registered manager in post at our last inspection had recently retired. They also had been the provider’s nominated individual for the service and the organisations Chief Executive Officer (CEO). The provider had appointed a nominated individual and a new manager, who was registered with us in August 2018. A new CEO had been appointed for the organisation.

People received care which protected them from avoidable harm and abuse. Staff understood people’s needs and knew how to protect them from the risk of abuse. Risks to people’s safety were identified and assessments were in place to manage identified risks. Where people required support to take prescribed medicines, staff had received training to assist people safely.

There were enough skilled and experienced staff to meet the needs of people who used the service. People had different experiences of the consistency of care staff and their call times. Some people received care around the time expected from staff they knew well. Others did not know which staff would be calling, and call times could be earlier or later than expected. The management team had identified consistency of calls to people needed improvement and action had been taken to improve this. Recruitment checks were completed on new staff to ensure they were suitable to support people who used the service.

The managers understood their responsibilities in relation to the Mental Capacity Act 2005. Staff asked for people’s consent before they provided care and people were involved in making decisions about how they wanted their care provided.

People received care from staff who they considered to be kind and caring, and who stayed long enough to provide the care and support people required. Staff promoted people’s privacy and dignity. People received care and support which was individual to them.

Support plans were personalised and provided guidance for staff about how to support each person in the way they preferred. People’s care and support needs were kept under review and staff responded when there were changes in these needs. Where required, people were supported to have sufficient to eat and drink and remain in good health.

The service continued to be well led. Staff said they received good support from the management team who were always available to give advice. Managers and staff told us there was good team work and that staff worked well together. The provider had effective and responsive processes for assessing and monitoring the quality of the service provided.

Coventry Crossroads is registered as a domiciliary care service which provides personal care and support to people in their own homes. At the time of our visit the agency supported 110 people with personal care and employed 66 care workers.

We visited the offices of Coventry Crossroads on 21 December 2015. We told the provider before the visit we were coming so they could arrange for staff to be available to talk with us about the service.

The service has 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 2008 and associated Regulations about how the service is run.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Care workers understood how to protect people from abuse and keep people safe. Care workers were properly checked during recruitment to make sure they were suitable to work with people who used the service.

The managers understood the principles of the Mental Capacity Act (MCA), and care workers respected people’s decisions and gained people’s consent before they provided personal care.

There were enough care workers to deliver the care and support people required. Most people said care workers arrived around the time expected and stayed long enough to complete the care people required. People told us care workers were kind and knew how they liked to receive their care.

Care workers received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us care workers had the right skills to provide the care and support they required. Support plans and risk assessments contained relevant information for staff to help them provide the care people needed in a way they preferred.

People knew how to complain and information about making a complaint was available for people. Care workers said they could raise any concerns or issues with the managers, knowing they would be listened to and acted on.

Staff felt supported to do their work and people felt able to contact the office and management at any time. There were systems to monitor and review the quality of service people received and understand the experiences of people who used the service. This was through regular communication with people and staff, returned surveys, spot checks on care workers and a programme of other checks and audits.

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with people who used the service and relatives. We also spoke with the registered manager, operations manager, three care staff and an independent trainer. We looked at some of the records held by the service including the care files for six people.

The focus of the inspection was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

We found that people's needs had been assessed and individual care plans completed that met people's needs. Risk assessments were in place to keep people safe. The provider carried out spot checks to ensure risk assessments and care plans were followed by staff.

There were arrangements in place to deal with foreseeable emergencies. We spoke with staff members who told us they were able to contact a manager when they needed to.

A copy of the local Safeguarding policy and procedures was in place and available to staff. We looked at staff training records and saw staff had received training on safeguarding and on the Mental Capacity Act. Staff we spoke with told us what they would do in the event of abuse being witnessed, suspected or alleged. We found the provider had taken appropriate action when abuse had been alleged.

There were enough staff to meet the needs of the people cared for by Coventry Crossroads. People told us staff were, "Excellent, I couldn’t fault them, they do a wonderful job" and, "I’ve got to know some of them very well". Staff told us the provider tried to ensure consistent staff worked with people. One staff member said, “I know it’s difficult, but they try to keep you with the same people”.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. One person told us, “I was told I wouldn’t walk again but with their help I can”.

We found staff received training to meet the needs of people. An independent trainer we spoke with told us, “Training seems integral to this organisation. I feel honoured to work with great staff and a great management team”. We found that care qualifications were held by 80% of the provider’s care staff.

Is the service caring?

We found people who used the service understood the care and treatment choices available to them. We saw people had been involved in agreeing to the levels of care and support they needed. We spoke with people who told us they had agreed how they would be cared for

Staff we spoke with told us they felt it was important to provide care in a kind, considerate manner. A relative we spoke with said, “They employ caring staff”.

Is the service responsive?

We found the provider had listened to people's views and made changes to the service provided as a result. We saw the provider had made changes to the staff supporting people as a result of comments received from people and their families.

People using the service and relatives told us they felt the provider responded to issues raised regarding the care and support provided.

We found the provider took steps to provide care and support in people’s preferred language by ensuring staff who spoke the language preferred were available.

Is the service well-led?

Staff we spoke with told us they had received sufficient training and supervision to carry out their roles effectively. We looked at staff training records and saw that training was planned and provided. One staff member told us, "They provide plenty of training".

The service had been monitored by the City Council in April 2014. The Council had stated there were no concerns or actions they required from the provider.

We found the provider monitored the health and safety of people using the service, staff and others. We were told by care staff that health and safety is seen as a priority by the provider.

At the time of our visit the agency supported approximately 800 people and employed around 100 care workers.

We spoke with the registered manager, operations manager, care manager, some of the staff working in the office and three care workers during our visit. We spoke with 13 people who used the service, or their relatives, and sent surveys to people to find out their views about Coventry Crossroads.

People who used the service told us their care and support needs had been agreed with them when the service started. People who were unable to make their own decisions had a family member who acted on their behalf.

We saw people's care needs had been assessed and were regularly reviewed to make sure people received the care they required. Risks associated with people’s care had been identified and were managed appropriately by the service. The care plans we looked at provided staff with sufficient information about the care and support people required to meet their needs and maintain their safety.

We found there was a safe procedure for assisting people with medication and people received their medicines as prescribed.

People we spoke with said their care workers were friendly and polite. We asked people if they had consistent care workers. People we spoke with had different experiences. People told us, “The afternoon care workers are not consistent and are often late.” Another said, “I am quite content, safe and pleased about the service as the carers are the same and on time.”

We were satisfied care workers had been recruited safely and had the necessary skills and experience to work with people using the service.

Records showed the agency had systems in place to monitor the care provided. Everyone we spoke with told us they were happy with the care they received. People said, “Overall the service is excellent and the care workers do a grand job.”

People told us that their care and support needs had been agreed with them when the service started. We were told copies of care plans were available in people’s homes. People told us that the care staff respected their privacy during personal care routines. One person told us, “My carer is an absolute star; she always makes sure my privacy is maintained. I never feel embarrassed with her at all.” The files we looked at contained care plans that were personalised and included people’s preferences. Although people said staff checked their pressure areas there was no record to show that this was happening.

People told us care staff stayed long enough to do everything they needed. They also said staff took their time and did not rush. One person said, “They always stay long enough to do everything, sometimes a bit longer if needed.” People said that care staff did things in the way they preferred and respected their opinions.

Records showed the agency had systems in place to monitor the care provided and for managing identified risks. People said they were happy with the care they received. One person told us “I am very impressed, I can’t fault them. My carer seems to understand dementia so is able to relate really well with my wife.”