This was an announced inspection which took place over two days on the 6 and 7 October 2016. Crossroads Care - Forest of Dean and Herefordshire provides support to people in their own homes and a range of additional services to support the needs of carers including respite care. It is a charitable organisation which provides practical help, support and social opportunities to carers and those they care for across all ages and disabilities. At the time of our inspection the provider was supporting 99 people with their personal care needs in the Forest of Dean and Herefordshire areas.

There was 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.

People did not benefit from robust recruitment procedures. Verification about why staff left former employment had not been obtained. Reference requests were changed during the inspection so this information would be requested from former employers. The registered manager had identified issues with the recording of medicines and new medicines administration forms had been introduced to rectify this. Training was being delivered to staff and work was in progress to resolve these recording issues and to make the administration of medicines more robust.

People received highly individualised care and support which reflected their personal wishes, needs and routines important to them. The needs of their carers were also recognised and support mechanisms were in place to help them as well as people being cared for and to reduce their social isolation. Excellent networks had been established to provide people being cared for and carers to have a presence in their local communities and to access partner organisations for support and advice. People living with dementia and people at the end of their lives could be confident staff had an excellent understanding of how to support them with dignity, respect and compassion. Staff had completed training to ensure they had the skills and knowledge necessary to meet people’s specialist requirements.

People’s rights were upheld. Staff understood how to recognise and report suspected abuse. They were confident any concerns would be followed up by management and the necessary action taken. People were safeguarded against the risks of accidents or injuries. When they were upset, anxious or distressed staff responded appropriately offering reassurance and support as needed. People were encouraged to be as independent as they could be. They liked to be supported by the same staff and had developed positive relationships with them. There were enough staff to meet people’s needs. New peripatetic staff (who were able to work in various places for short periods of time) had been employed to help out at times of emergency or staff shortages.

People’s experience of their care and support was encouraged. They were invited to give feedback each year in the annual survey and as part of the quality assurance process to assess the competency of staff during observations of their practice. A staff forum enabled staff to voice their views. Newsletters to staff and people using the service kept them up to date with improvements to the service. A quality committee monitored complaints, risks and people’s experience. They reported to the board of trustees.

The registered manager supported staff in their roles, enabling them to access training to develop their skills and knowledge and recognising and rewarding their performance and achievements. Crossroads Care - Forest of Dean and Herefordshire worked closely with social and health care professionals, local and national organisations, councils and partner organisations keeping abreast of changes in guidanc

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This inspection was completed by one inspector and an expert by experience. The inspector visited the office and three people in receipt of personal care and spoke with staff. The expert by experience conducted telephone interviews with people who used the service, or their representative

This is a summary of what we found based on our observations, speaking with 19 people who used the service, talking with 10 staff and looking at records.

Is the service safe?

People told us that they felt safe when supported by staff. An assessment had been carried out for each person who used the service and care was planned to meet their needs. Advice and assessments by external health and social care professionals had been sought when indicated and taken into account when providing care. Required employment checks had been completed before staff started work.

Is the service effective?

Care plans had been agreed with the person or their representative. Staff routinely checked what support the person wanted before beginning care. When planned care was refused, staff responded appropriately to ensure people’s needs were met and their rights were respected.

Staff received effective support and training to enable them to meet the needs of the people they supported. Further to our discussions with the registered manager, four senior members of staff were booked for training in mental capacity assessment.

Is the service caring?

During our conversations with staff they demonstrated a caring and professional approach toward the people they supported. Staff were described as, “Lovely and good with her, very respectful”, “Wonderful”, “Polite and professional” and one person’s representative said, “She really likes them”. When complaints had been raised about the attitude of a minority of staff members these had been promptly addressed.

Is the service responsive?

Some care reviews had not been carried out as planned and were overdue. One person told us that when they complained about this, a review was carried out. The majority of people told us that their care plans in place reflected their needs. One said, “There are two main carers (staff members), some of the care has changed but they know what to do. They are very good, spot on.” Another person’s representative said, “They always ring me if there is a problem. Once they rang the paramedics and rang to tell me straight away.”

Complaints were investigated and responded to in a timely manner.

Is the service well led?

The systems in place for monitoring the quality of the service were effective. Managers and the executive team were aware of areas that people who used the service were less satisfied with and told us about the action they had taken in these areas. Similarly, some staff told us about difficulties they had experienced with travelling times between visits on their rotas. We found these were being monitored and checked by senior staff.