About the service:

Crossroads Care Tendring and Colchester is a domiciliary care agency. It provides personal care to people living in their own homes. The agency supports 280 people. Some of the people using the service had complex needs and the frequency of visits depended on people's individual requirements. Some elements of the service although provided by Crossroads Tendering and Colchester would not need to be registered with the Commission if this was their sole purpose. Because of this, we have focussed our inspection on the people in receipt of personal care only. At the time of our inspection, 46 people were receiving personal care.

People’s experience of using this service:

People told us they felt they received care in a safe way. Individual risks to people and the environment had been identified and assessed and measures put in place to manage them and minimise the risk of harm occurring. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm.

Medicines were managed safely by trained staff who ensured that people received medicines at the right time.

Sufficient numbers of suitably qualified and skilled staff were deployed to meet people's individual needs.

Staff had received a range of training and support to enable them to carry out their role safely. People told us they received the right care and support from staff who were well trained and competent at what they did.

Staff were motivated to deliver care in a person-centred way based on people's preferences and likes. Staff treated people with kindness, compassion and respect and ensured that people's dignity was maintained at all times.

People spoke positively about the care and support they received. People told us they received support from regular staff who knew them well. They told us staff always arrived on time and stayed the right amount of time.

People's needs and choices were assessed and planned for. Care plans identified intended outcomes for people and how they were to be met in a way they preferred. People received support to maintain good nutrition and hydration and their healthcare needs were understood and met.

Records relating to consent for care were accurately completed and people told us they were always offered choice and control over the care they received. Care was delivered in a personalised way which was in line with information recorded in people's care plans.

People and family members knew how to make a complaint and they were confident about raising concerns should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted person centred care and a positive culture within the staff team. People, family members and staff all described the registered manager as supportive and approachable. The registered manager displayed knowledge and understanding around the importance of working closely with other agencies and healthcare professionals where needed.

Rating at last inspection: Good (Inspection report published in November 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 re-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

This inspection took place over three days between the 20 and the 24 of October 2016 and was announced. Crossroads Care Tendering and Colchester provides a choice of respite and personal care to people who live in their own homes. With the aim of supporting people with personal care needs to maintain their independence.

On the day of our inspection, 251 people were using the service. Some of the people using the service had complex needs and the frequency of visits depended on people’s individual requirements. Some elements of the service although provided by Crossroads Tendering and Colchester would not need to be registered with the Commission if this was their sole purpose. Because of this, we have focussed our inspection on the people in receipt of personal care only.

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.

There were sufficient staff to meet people’s needs and to manage risk safely. Systems were in place so people could take their prescribed medicines safely. The provider had a robust recruitment process, which helped protect people from the risk of avoidable harm, and staff were supported to develop their skills and knowledge.

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 supported to consume food and drink of their choice. Staff worked well with people and health care professionals, to ensure people maximised their health and wellbeing.

Staff knew people well and had time to spend developing positive relationships with them. People received support that was personalised and staff responded flexibly to changes in their lives. Guidance was in place to enable staff to provide a consistent level of support. People and their relatives told us they were aware of how to make a complaint and felt that they were listened to by the registered manager.

Staff were enthusiastic about working for the service and worked well as a team. The provider supported best practice and there were systems in place to check the quality of the service.

Crossroads Care provided a respite service for family carers. They provided support, including personal care, to people so that their family carers were able to take a short break. As part of this inspection we spoke with five people who received direct support from the service and also to four family carers.

We looked at seven people’s support records. We looked at staff records, training and supervision. We also looked at the provider’s arrangements to safeguard people from abuse and to monitor the quality of the services provided.

During our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well-led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

People and carers who used the service all confirmed that they felt safe when Crossroads Care staff visited their home. People told us that they felt their rights and dignity were respected and they felt in control of decisions about their care and support. One person told us, “I feel safe when they visit. They make me feel at ease. I never feel awkward or embarrassed.” Another person said, “You’re always introduced to new staff. That reduces my stress.” A carer told us, “They give me peace of mind. They make sure my relative is safe.”

There were systems in place to protect people from poor practices or abuse. Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported.

Is the service effective?

Carers told us that the service enabled them to have regular much needed breaks from their caring role. People told us that the service met their needs. They told us that staff came on time and stayed the right time. People particularly appreciated that staff promoted their independence. This enabled them to remain in their own homes for as long as possible, which was what they wanted.

Is the service caring?

People and their family carers were very complimentary about the staff. They said that staff always respected their privacy and dignity. They appreciated the continuity of care and support provided. One person told us, “They make me feel as if I’m really important, that they are only there for me.” One carer told us, “The staff are very caring. They’re all first class.” Another said, “Staff are absolutely excellent. They go the extra mile. They are very caring.”

Is the service responsive?

People and their carers told us that the service was very responsive to their needs. One carer told us, “My relative had a fall and I asked for support. They sent someone round straight away and gave me extra support until they had recovered from their accident.” People and carers said that the management team provided another support worker if they were not happy with one of them for any reason. Another carer said, “They respond quickly if I want anything changed. My relative needed eye drops so they put on training to enable staff to give the drops.” A person receiving care told us, “They respond to my needs and wishes on the day. They are really accommodating.”

Is the service well-led?

Carers and people receiving a service all told us that the service was well managed. One carer told us, “The agency seems well organised and managed. I’ve never had any concerns. I’m absolutely satisfied with the service they provide.” Another carer said, “The agency seems well managed. I get a quick response to any query I have.” Another person was very complimentary about the service. They said, “They have a good group of care staff who stay with them a long time because the agency is so well run.” Staff we spoke with considered that the agency was well managed; they told us that they had excellent support from the management team.

The manager told us that the agency mainly provided support for carers and a ‘sitting service’ for the person receiving care. We spoke with two people receiving direct support from the agency and three carers receiving a service from the agency. Carers told us that the service enabled them to have some much needed respite from their caring role. They described the service as “absolutely brilliant” and “excellent”. One carer said that they had very good communication with the office staff and added that the manager was “excellent”. The people we spoke with were both very complimentary about the care and support they received. One said: “I’ve only got praise for them. They provide support, and care if I need it, depending on my needs.” Another person told us that they had been using the agency for a number of years and had never had any concerns.

The standard of support documentation had continued to improve. The support records were much more detailed and provided staff with good information about both the carer’s needs and the needs of the person being cared for. Staff received regular training and told us that they felt very well supported. The manager had systems in place to monitor standards in the service and was in the process of making the systems more robust.

We carried out this inspection in order to check on the standard that had not been met at our last inspection in May 2012. The area needing improvement was care records. We found that the manager had made improvements since our previous inspection and we found that this standard was now met.

Crossroads Care provided respite breaks for carers. However, we did not speak with any carers or people receiving support as part of this inspection.

As part of this inspection we had telephone conversations of various lengths with five carers receiving a service from the agency. The majority of carers were extremely happy with the service provided, had no concerns and told us that it allowed them much needed respite from their caring role. Two carers described the agency as providing a “fantastic service”. Carers told us that the service was “reliable”, that there was “good continuity” with the care support workers and that they had “excellent support” from staff at the office. One carer we spoke with did not consider that the agency was fully meeting their needs. The manager met the carer following our inspection and took prompt action to address their concerns.