The inspection was announced and took place on 7and 26 February 2018. We carried out follow up visits to the service on 14 and 17 September 2018. The reason for the later visits is outlined in the background section of this report. Crossroads Braintree & Chelmsford is a domiciliary care agency. They offer a respite break service for carers by providing care and support to family members in their homes. At the time of the inspection, 76 people were using the service, nine of whom were in receipt of the regulated activity of personal care. CQC only inspects the service being received by people provided with personal care; such as help with tasks related to personal hygiene and eating, and so did not look at the support being provided to the other people in the service.

The last inspection of the service took place on 22 November 2016. It was a focused inspection to follow up on concerns found during a comprehensive inspection on 12 September 2016. During both inspections, we had found the service was not maintaining a complete and contemporaneous record in respect of each service user and effective quality control and auditing systems were not in place. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of the service to at least good.

At this inspection, we looked to see whether the provider had implemented the action plan. We found the provider had made the required improvements to improve the standard of care and they were no longer in breach of any regulations.

A registered manager was 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.

A business manager had been appointed since our last visit. They had supported the registered manager to address the concerns we had around the management and systems within the service. The registered manager and business manager are referred to as ‘the management team’ in this report. The management team was visible and supportive and their presence ensured effective leadership within the organisation.

Following the previous inspection, the service had made improvements to how staff recorded people’s care plans. Individual risk assessments were in place to mitigate the risk of harm. Staff were aware of the need to promote and maintain people's safety whilst taking a person-centred approach to risk. This enabled people to take calculated risks, which enhanced their well-being and enabled them to live as they chose within their home.

The management team had implemented effective quality assurance systems to monitor people’s care plans and ensure regular reviews were completed. This ensured they were up to date and reflected people’s current needs.

Staff knew how to recognise signs of abuse and were confident about what action to take if any concerns arose.

The service had a robust recruitment process in place to ensure that staff had the necessary skills and attributes to support people using the service. New members of staff completed an induction programme during which they completed training sessions and were introduced to, and spent time with, the people that they would be supporting.

Staff had completed a variety of training sessions. This meant people received care from skilled staff who were able to meet their needs. Staff received supervision and annual appraisals to support them in their role and identify any learning needs and opportunities for professional development.

People using the service, and their relatives, consistently spoke highly of the staff who visited them and the

During our comprehensive announced inspection on 12 September 2016, a breach of legal requirements was found. We found that a complete and contemporaneous record in respect of each service user was not being kept. This was caused by quality control and auditing systems not being in place. This was a breach of regulation 17 (2) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check whether improvements had been made and legal requirements were being met. This report only covers our findings in relation to the outstanding breach of regulation. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Crossroads Care Braintree District and Chelmsford Limited on our website at www.cqc.org.uk.

Crossroads Care Braintree District and Chelmsford provides a choice of sit in respite care and personal care to people who live in their own homes. This is in order for people to have company and remain safe whilst their family members have a break from being main carer, as well as supporting people with personal care and to maintain their independence.

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.

This inspection was announced and took place on 22 November 2016.

During this inspection, we found that improvements had been made to the systems in place within the service. Quality control and audit systems had been implemented to keep care plans and risk assessments up to date and relevant to people’s needs.

While improvements had been made we have not revised the rating for the key questions; to improve the rating to 'Good' would require a longer term track record of consistent good practice. We will review our rating at the next comprehensive inspection.

This inspection took place on 12 and 13 September 2016 and was announced.

Crossroads Care Braintree District and Chelmsford provides a choice of sit in respite care and personal care to people who live in their own homes. This is in order for people to have company and remain safe whilst their family members have a break from being main carer, as well as supporting people with personal care and to maintain their independence.

At the time of our inspection the provider confirmed they were providing support to 90 people. Of these, only four people received personal care, as regulated by us, the Care Quality Commission (CQC). Information relating to other people could not be included in this report.

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.

People had risk assessments in place, but they were not always up to date and did not always reflect their current support needs.

People’s care plans were not always up to date, and did not always reflect their current support needs. A relative told us that they had not been able to have a review of their family member‘s care needs within the timescale that the service had said they would..

Quality assurance systems and audits were not being used. This meant that the service was not always aware that care plans were out of date and not reflective of people’s current needs.

The staff we spoke with had an understanding of abuse and the safeguarding procedures that should be followed to report abuse. The staff we spoke with were able to demonstrate what they would do should they have any concern that abuse was taking place.

Staffing levels were adequate to meet people's current needs. The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. Staff induction and on-going training was provided to ensure they had the skills, knowledge and support they needed to perform their roles.

The service was not currently supporting people with the administration of medication. Systems were in place to appropriately record medication administration should it need to be, and staff were trained to do so.

Staff were well supported by the registered manager and senior team, and had regular one to one

supervisions. The staff we spoke with were confident that the support they received enabled them to do their jobs effectively.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Everyone we spoke with told us that staff members always gained their consent before carrying out any care tasks.

People were able to choose the food and drink they wanted and staff supported people with this, and people were supported to access health appointments when necessary.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People were involved in their own care planning and were able to contribute to the way in which they were supported.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required. The people we spoke with knew how to use it

During our inspection of the service on 19 November 2013, people told us they had been involved in decisions made about the levels of care and support provided to them. One person said, “We told them [the provider] what we needed and they deliver just that….it’s a wonderful service.”

We looked at records which showed that people’s care and support needs had been assessed, documented and reviewed. They were personalised and gave staff clear guidance on how to meet people’s individual needs and requirements. A relative of a person who received a service told us, “They [staff] are extremely kind, caring and professional. I feel confident that my [family member] is well looked after and cared for.”

People who used the service had been protected from the risk of abuse. We saw that a policy and procedure about safeguarding vulnerable people had been put in place. A relative commented, “I trust them [staff] totally and always feel that [family member] is very safe and secure.”

At a previous inspection carried out in February 2013 we found that the provider had not put suitable arrangements in place to manage people’s medications safely. We judged that this had a minor impact on people who received a service at the time. During our recent inspection we found that necessary improvements had been made.

The provider had taken appropriate steps to ensure there were sufficient numbers of suitable staff to meet people’s needs. One person told us, “We get the same carers who are always on time. They work at our pace and never rush.”

We looked at records which showed that systems were in place to regularly assess and monitor the quality of services provided.

We visited three people who were using this service in their own homes. We also spoke with the relatives of four people. One person told us, "Crossroads carers have been visiting for years now. They are my lifeline. It is such a relief to know that my spouse can have some time to themselves, safe in the knowledge that I am being well cared for. I look forward to the company and stimulation." A family member explained, "Care staff are always prompt and I do not feel that they are in a rush. They provide a very good service." We sat with someone using the service who did not use verbal communication. A Crossroads carer spoke with them throughout their visit, offering company and stimulation. The staff member knew the person's life history, interests and preferences well. We later spoke with their relative who was "extremely pleased with the standard of care."

We found that the service was meeting the needs of people. Staff had received a wide range of training and most had benefitted from completing national vocational qualifications in health and social care. Staff spoke respectfully and knowledgably about the people they visited. Staff sometimes helped people to take their medication and we noted that there was scope to improve the way in which instruction for staff was given and administration was recorded in order to ensure the safety of people using the service. Relatives and people using the service were able to influence the way that the service was run.

We visited three houses in the community where people were receiving care and support in their own home. Those people with whom we spoke confirmed that they were happy with the support and care provided by this service. They also reported that they were happy with how the service meets their individual care and welfare needs.