This inspection took place on 1 March 2017 and was announced. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because Crossroads provides personal care for people who live in their own homes and we needed to be sure that someone would be available at the office.

At the time of our inspection 121 people received personal care in their own homes.

At the last inspection on the 6 August 2014 the service was rated as good. There was 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.

Staff we spoke with knew how to protect people from harm. We found staff recognised the signs of abuse and knew how to report this. Staff made sure risk assessments were in place and took actions to minimise risks without taking away people’s right to make decisions.

People told us there were enough staff to help them when needed. Staff told us there were enough staff to provide safe care and support to people. Advanced planning meant that staffing levels were reviewed and reflected the needs of people who used the service. People’s medicines were checked and managed in a safe way.

People received care and support which met their needs and preferences and in line with their consent and agreement. Staff understood and recognised the importance of this. We found people were supported to eat a healthy balanced diet and were supported with enough fluids to keep them healthy. We found staff supported people with access to healthcare professionals, such as their doctor or hospital appointments.

People told us they were involved in planning their care. People’s views and decisions they had made about their care were listened and acted upon. People told us that staff treated them kindly, with dignity and their privacy was respected.

We found people knew how to make a complaint and felt comfortable to do this should they feel they needed to. Where the provider had received complaints, these had been responded to. Learning had been taken from complaints received and actions were put into place to address these.

Staff felt supported by the registered manager to carry out their roles and responsibilities effectively, through training and staff meetings. We found checks the registered manager completed on the service provided focused upon the experiences of people. Where areas for improvement were identified, systems were in place to ensure lessons were learnt and used to improve staff practice.

During this inspection we spoke with six people who used the service about their experiences of the support they had received. We also spoke with four of the staff and with the registered manager.

All the people we spoke with who used the service spoke positively about the care they received. One person told us that the staff were: “Very good, I have never had a cause for concern”. All the people we spoke with told us that the care workers who supported them understood their care needs. People told us that their wishes were always listened to and we found that the provider made sure people consented to any care.

We found that the provider had not taken the necessary actions to ensure that people who used the service were safeguarded against abuse.

Staff employed at the service had access to further training. One staff member told us: “I always feel that there are opportunities for further training”. However we found that staff did not receive regular supervision even if they had indicated that they had experienced difficulties with the work they had done.

We saw that the provider had systems in place to monitor and assess the quality of services provided. Feedback was regularly sought from the people who used the service, families and staff. The provider and managers held regular quality report meetings that identified actions for improvement.

We inspected the agency office and spoke on the telephone with five people who used the agency and their relatives. We also spoke with four members of staff who provided care to people. We found that people were able to express their views and had been involved in making decisions about their care and treatment.

People were complimentary about the care and support that they received. One person told us, “They’re very good. They always try and accommodate me. I’ve always been very pleased with them.” Another person said, “I find them very helpful. They do the best they can. They always do their best for me.” Another person said, “I can’t think of anything they could do better. I’m very fortunate.” This meant that people felt the agency was meeting their individual needs.

We found that people who used the agency were protected from the risk of abuse.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had systems in place to regularly assess and monitor the quality of service that people received

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was announced. We called the provider 48 hours before our inspection to ensure that we could speak with staff and look at the relevant records.  We undertook the inspection over a two day period, on the 29 July and 6 August 2014. We carried out an inspection on 17 September 2013 and found the provider to be in breach of two regulations, safeguarding people who use the service and supporting workers. We asked the provider to send us a report of the changes they would make to comply with the standards they were not meeting. In March 2014 we followed up to make sure that the necessary changes had been made and found the provider was now meeting the regulations.

Crossroads Caring for Carers is a service that provides care to people in their own home. At the time of our inspection there was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Our findings from our inspection meant that the provider was not in breach of any regulations. We found that people were kept safe by trained staff who knew how to protect people. There were sufficient staff to meet people’s needs.

People confirmed that staff knew them well, knew what their preferences were and how they wanted their care to be delivered. People we spoke told us they mainly had the same staff visit them regularly and knew their needs well.

People told us that all the staff were caring and that staff were respectful and talked to them calmly and respectfully. People that we spoke with gave many examples of how staff maintained their dignity when providing assistance and respected their privacy. People told us they were supported to remain independent and received assistance when they needed it.

We found that the provider was responsive towards people’s health needs. People told us that if they had a hospital appointment and requested a staff member to come earlier then the provider accommodated this.

All of the people we spoke with told us that they often met the team leaders and discussed concerns they may have with them. People told us that they felt the service was well-led, they had not had any concerns however if they did they had the information available to them to know who to contact. We found that when staff had raised concerns to the registered manager, they had acted promptly and appropriately.

We found the registered manager had systems in place to ensure that the quality of the care was monitored.  Annual questionnaires were sent out, which people confirmed they received. Audits such as incidents and accidents, record keeping and staff training were monitored. Where there were any actions following these audits they were followed up and improvements had been made. This meant there were systems in place to continually monitor the quality of the service provided to better achieve safe and effective care.