Crossroads Care North Nottinghamshire is a domiciliary care agency. It provides personal care to people living in their own houses. At the time of our inspection there were 190 people receiving personal care.

At our last inspection on 13 July 2016 we found that the provider needed to make improvements to make the service safe, effective, responsive and well-led. We found at this inspection that improvements had been made.

The service had a registered manager. The registered manager was also the registered provider. 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.

People told us they felt safe when they were supported by care workers and that they trusted the care workers. All staff had training about safeguarding training to enable them to recognise signs and symptoms of abuse and knew how to report them. There were risk management plans in place to protect and promote people’s safety. People were advised about how to stay safe in their homes.

The service had recruitment procedures that ensured as far as possible that only suitable staff were employed. There were enough care workers to cover all the home care visits that were required.

People received the support they required to have their medicines.

Care workers followed safe practice to protect people from the risk of infection.

There were arrangements in place at the service to make sure that action was taken and lessons learned when things went wrong and to improve safety across the service.

The care people received was focused on their needs and preferences.

Care workers who supported people with preparing meals were trained in food hygiene. People received enough to eat and drink and staff gave support when required.

Staff were supported to develop the skills and knowledge they needed to provide the care people needed through training and supervision. Different staff teams communicated with each other and coordinated their efforts so that people consistently experienced good care. Staff worked together with other services who were involved in people’s health and social care.

People were supported to access health services when they needed them.

People were supported to have maximum choice and control of their lives and support workers supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

There was a strong culture within the service of treating people with dignity and respect. People’s views were sought and acted upon. People told us they were treated with dignity.

People’s care plans provided staff with detailed information and guidance about people's likes, dislikes, preferences and guidance from any professionals involved in their care. People and their relatives were involved in planning all aspects of their care and support and were able to make changes to how their care was provided. Care plans were regularly reviewed to ensure care met people's current needs.

People, relatives and staff knew how to raise concerns and make a complaint if they needed to and there was a complaints procedure in place to enable people to raise complaints about the service.

The registered manager and the staff team were knowledgeable about people's needs and key issues and challenges within the service. The registered manager had systems in place to monitor the quality of the care provided and to ensure the values, aims and objectives of the service were met. This included audits of key aspects of the service. The registered manager reported monthly to a board of trustees who scrutinized the service.

Staff felt supported and valued. Staff received one to one supervision which gave them an opportunity to share ideas,

This announced inspection was carried out on 14 July 2016. Crossroads Care North Nottinghamshire provides support and personal care in Nottinghamshire. On the day of the inspection there were approximately 219 people using the service who received personal care.

The service had a registered manager in place at the time of our inspection. 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 were supported by staff who understood the risks of potential abuse people could face and knew how to make people feel safe. People might not receive their care and support in the safest and least restrictive way possible due to a lack of robust risk management.

People were supported by a regular individual or group of staff who they knew. People did not always receive the support they required to take their medicines safely.

People were provided with the care and support they wanted by staff who were trained and supported to do so and they provided consent to their care when needed. People’s human and legal right to make decisions for themselves may be overlooked.

People were supported to consume a sufficient amount of food and fluids that promoted their wellbeing. People received support from staff who understood their health needs.

People were treated with respect by staff who demonstrated kindness and understanding. People were involved in determining their care and support. They were shown respect and treated with dignity in the way they wished to be.

People’s care plans did not contain all the required information to ensure their care and support was delivered as needed. People’s concerns may not be recognised and acted upon.

People who used the service and care workers were able to express their views about the service which were acted upon. The management team provided leadership that gained the respect of care workers and motivated them as a team.

Systems used to monitor the quality of the service did not always identify where improvements were needed.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke over the telephone with four relatives of people who used the service and asked them for their views. We also spoke with four care workers, the registered manager and the general manager. We also looked at some of the records held in the service including the care files for seven people who used the service.

A relative told us, “I have every bit of information I need about how the scheme is managed, including health and safety. I have everything I could expect.”

Relatives told us they felt care workers respected their relation’s privacy and dignity and encouraged them to be independent. One relative told us, “They encourage them to do all they can for themselves”, and said their privacy and dignity was respected, “at all times.”

The relatives we spoke with told us they had a copy of the care plan in their home which they had signed. They also told us the care plans were reviewed. One relative said, “They come out and make sure it (the care plan) is current and correct.”

Relatives told us their relations felt safe when care workers were in their home and did not feel they had ever been put at risk. Relatives told us care workers spoke with respect to their relations and treated them in an appropriate way.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and eleven relatives and asked them for their views. We also spoke with four community support workers (CSWs) two assessment officers, a training and assessment officer and the registered manager. We also looked at some of the records held in the service including the support files for eight people, which were copy files of the ones in people’s homes.

We found people gave consent to their support and received care and support that met their needs. A person who used the service told us, “They listen to what I want to do.” A relative told us, “We have got a support plan at home, it is accurate and clear, I was there when they prepared it.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A person who used the service told us, “They (staff) manage my medication for me.” A relative told us their relation, “Has assistance with medication, they get it out of the packet as she can’t do that, then they observe her to make sure she takes it.”

We found the staff team were supported through training and the provider assessed and monitored the quality of the service. A person who used the service told us, “They seem to be very well trained to me.” A relative told us they “definitely” felt able to raise anything the wished.