This inspection took place on 18, 20 and 24 September 2018. We previously inspected the service on November 2015 and it was rated ‘Good’. At this inspection the rating has been changed to ‘Outstanding’.

Crossroads Care Central & East Gloucestershire provides domiciliary care services to a range of people who live in their own home. In addition to providing support directly to individuals, Crossroads specialises in offering respite breaks for family carers and a carers emergency scheme. This may be provided as two to three hours supporting the person they care for whilst the carer has some “me” time or time to do those important tasks which are difficult to weave between a fulltime caring role. The service will be described as Crossroads throughout the 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 and associated Regulations about how the service is run.

The service was Outstandingly well led. The provider had a holistic approach to service provision and had developed their services innovatively around the needs of the people. They had developed a variety of support services which allowed people to live their lives to the fullest in situations where they otherwise might not have been able to remain living at home. As well as the regular domiciliary care services, Crossroads also has several innovative services that improved the experience of people and their relatives.

These services include the Carers’ Emergency Scheme which in the event of an emergency offers total replacement care for up to 48 hours. This ensures that the person cared for is supported with all their personal care requirements in their own home by a support worker from Crossroads who will remain in the home 24 hours a day if the person cannot be left alone. This gives peace of mind to the carer and continuity of care for the person they care for, preventing further distress that can be caused if a person cannot remain at home without their carer. The scheme is only available for people who have been assessed and registered in advance with the scheme. The cared for had a care plan and risk assessment developed at point of registration which was reviewed in the home at point of activation by a manager if ongoing support is required Crossroads help make ongoing arrangements.

The Out and About service offers an opportunity for people that cannot access the community without support to join others in activities such as theatre, bowling and meals out. Wheelchair accessible transport from door to door is provided. The Azalea Clubs are available in four areas throughout Gloucestershire. These are interactive, person centred clubs for people of all abilities offering an opportunity to interact in new activities and to provide family carers a day of respite.

The provider worked creatively to ensure the values and objectives of the service were shared and implemented by all. This was evident in the outstandingly caring nature of the service.

People and their relatives were extremely positive about the care and support they received. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and could describe what they liked to do and how they liked to be supported. The service often went above and beyond their contractual obligations to ensure people had good quality care. People were placed at the centre of their care and were supported to develop their independence, meet their individual desires and live their lives to the fullest.

In addition, the service often “went the extra mile” outside of care hours to ensure people’s needs were met. For example; taking a person to a GP or hospital appointment that is not at the time of their regular c

This inspection took place on 11 and 18 November 2015 and was announced. The Gloucester branch of Crossroads Care provides a domiciliary care services which provides regular short breaks to carers/relatives who care for a person with physical needs or memory loss. They provide a service across Gloucestershire, including Gloucester, Cheltenham, Stroud and Tewkesbury. Crossroads Care is part of the Carers Trust. The Carers Trust works to improve support, services and recognition for anyone living with the challenges of caring. At the time of our inspection there were 189 people and their carers using this 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 and associated Regulations about how the service is run.

Due to the nature of the service, we spoke with people’s main carers (people’s relatives); throughout the report we will refer to people’s main carer as carers. Staff employed by Crossroads Care were called Care Support Workers.

Everyone we spoke with spoke positively about the service. People spoke highly about the care support workers and valued the positive caring relationships they had by having regular care support workers. People and their carers spoke positively about the care managers of the service, telling us they were always approachable.

There was a positive caring culture, promoted by the registered manager, care managers and chief executive officer. Care support workers were passionate about providing high quality personalised care and support. They spoke confidently and positively about people and their preferences. Care support workers felt supported by the care managers, registered manager describing them as approachable and supportive both personally and professionally.

Care support workers were knowledgeable about the people and carers they supported. They had access to development opportunities to improve their skills and the service people received. Care support workers received the training they required to support people with individual needs and had access to effective supervision (one to one meetings with their manager).

People's needs were assessed. Where any risks were identified, management plans were in place. People were supported in a way that recognised their rights to take risks. The care and support people received was personalised to their needs.

Where people’s needs changed, senior care support workers had taken action and made referrals to healthcare professionals where necessary. Carers spoke positively about the responsiveness and flexibility of the service.

People and their carers view on the service were continuously sought. Care managers and the registered manager made every effort to ensure people and their carer’s views mattered. People and their carers felt the management was approachable and felt confident in their ability to complain.

Quality assurance systems were in place to enable the service to identify areas for improvement and ensure people and their carers received a good quality service. The registered manager was supported by a chief executive officer who answered to a board of Trustees. The service ensured people and their carers had the information they needed.

The organisation was looking at creative and innovative ways to improve the amount and quality of support people and their carers could receive. This included community events aimed to support people who wanted more support.