About the service:

Crossroads Cheshire East is a domiciliary care agency. It provides personal care to adults and children living in their own houses and flats in the community. At the time of the inspection it was providing personal care to 41 people.

Not everyone using Crossroads Cheshire East receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

People’s experience of using this service:

Overall people were positive about the service. People felt safe and well supported. They told us they received reliable care from familiar staff who understood their needs. Staff treated people with dignity and respect and took account of their individual needs when providing care and support.

People were supported by well trained staff who had their competency checked by the management team on a regular basis. Staff supervision sessions had taken place; however, the provider had identified some of these needed to be carried out more frequently.

The service was responsive to people’s changing needs and staff promoted choices. Care and support plans were in place and included details about people’s likes and preferences. However, some records needed to include further details. The provider was aware and addressing this.

People were involved in decisions about their care and were able to provide feedback. Reviews were held with people and their relatives. The provider had identified that some reviews had not been held as often as they should and was addressing this.

People said that communication with the office had deteriorated due to the number of staff changes. However, everyone felt able to raise any concerns should they need to and had appropriate information about the complaints procedure.

The provider had systems in place to monitor the service and the quality of the care. They were restructuring the management team and were advertising for some new staff. Monitoring of the service had identified some areas where they could improve, such as records and systems and action was being taken to address these areas.

Rating at last inspection: Good (Published 20 July 2016)

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner

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

We inspected Crossroads Care Cheshire East on 20, 23 and 25 May 2016. As this was a domiciliary care agency service, we contacted the manager 48 hours’ before the inspection. This was so that we could ensure that staff were available at the office. At the last inspection in February 2014 we found the service met all the regulations we looked at.

Crossroads Care Cheshire East is registered to provide personal care to children and adults who live in their own homes. They provide staff to support carers of all ages who care for someone with any disability or long-term illness. The offices for the service are located in Congleton and are within walking distance of the town centre. At the time of the inspection, there were 209 adults and 4 children in receipt of personal care.

The service did not have a registered manager in place. 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 service had a newly appointed manager, who confirmed following the inspection that she had made an application with CQC to become registered.

We identified one breach of the relevant legislation, relating to safeguarding. You can see what action we told the provider to take at the back of the full version of the report.

We found that people were positive and complimentary about the service that they received. They told us that they felt very well supported by the service. People said that they felt safe whilst being supported by staff from the service. We found that staff understood their responsibilities to report safeguarding concerns and to protect people from abuse or harm. Staff had received appropriate training and knew how to report concerns appropriately. However, we found evidence that the service had not reported a safeguarding concern to the local authority, as required by the local Adult Safeguarding Policy and Procedures. The previous manager had dealt with some aspects of the concerns but we could not evidence that the person had been fully protected from future harm.

There were sufficient staff to meet the needs of people receiving a service. There had been a period of time when the service had been short staffed and the service continued to recruit new staff. People told us that their calls had very occasionally been cancelled, but we found that this had improved. People were satisfied with the support that they received and told us that the carer support workers were usually on time. We found that people received consistent staff.

Medicines were administered safely. People were supported to take their medicines by staff as prescribed. We recommend that the service implements a more robust audit process for medicines.

Staff were skilled and knowledgeable. We found that staff completed a robust induction prior to starting work in the service. Staff received regular and ongoing training. People told us that they felt that the staff were well trained. Staff were encouraged to develop their skills and were supported by regular supervision meetings.

Staff had a good understanding of the Mental Capacity Act(MCA) . We saw that the service recorded when best interest decision had been taken when people did not have the capacity to do so themselves. Staff ensured that they obtained consent from people prior to carrying out any support tasks.

People told us that staff were caring and treated them with kindness. We found that people and their relatives were very happy with the support that they received and told us that staff treated them with dignity and respect.

Staff had a good understanding of risks associated with people's care needs and knew how to support them to be as independent as possible.

Assessments and care plans were in place. They p

We looked at a sample of six people’s support plans. We saw they contained an assessment of need, support plan, risk assessments and a record of each visit.

We saw there were forums in place for people to express their views about the service they received. Comments included: “Given us peace of mind.” “Provides vital friendship.” “Made an immense difference.” “Two hours free of worry and concern.” “They just make things easier.”

We spoke with two people who used the service and the relatives of six people who used the service. Comments included: “I find them very, very good. I truly don’t know what I would have done without them.”

We saw the agency worked closely with the local social services department, community nurses and hospice networks. We saw information sharing policies and procedures were in place.

There was a palliative care coordinator who worked closely with hospice staff, district nurses and or Macmillan nurses.

During our inspection we visited people who used the service and their carers. They told us that they were fully involved in making decisions about their care and how they wish to be supported.

People told us they received information about the service including how to express their views, make complain and raise issues of concern.

The people who used the service, their carers and the health and social care professionals we spoke with during our inspection were very positive about the care and support offered.

The carers we spoke with told us that they had “no concerns” about the staff and how they supported their family members. They told us staff from Crossroads had visited them and had carried out an assessment to determine how they would support their family members.

The carers and family members spoken with during our inspection told us that they had no concerns about the safety or well-being of people who used the service. They told us that they had “confidence” in the staff and “were very satisfied with the help and support” provided by the carer support workers.

The carers and their family members spoken with were very positive about the staff. They told us staff were kind, caring and provided a service which took pressure of them, even if only for a short time. They told us they had “absolutely” no concerns or worries about the way their family members were supported and cared for by the staff.

One person told us that the member of staff who came to their home was

“more like family”. Another person told us “having staff from Crossroads means I can keep (family member) at home without them having to go in a care home”

The home based carers and their family members told us they were asked, by carer support workers and senior staff, for their views on the service offered. They were all very positive about the manner in which any concerns or issues were quickly resolved. They also told us they had “every confidence in the organisation” and how they monitor and continually improve the service offered.

Carers told us that they would find things more difficult “if it wasn’t for the staff and the support they offered”.