Crossroads Care South East London

People’s experience of using this service:

• People spoke positively about the service. They said us they felt safe and their needs were being met.

• Care and support was personalised to people’s individual needs.

• Assessments were carried out to ensure people's needs could be met. Where risks were identified, management plans were in place to manage these safely.

• Medicines were managed safely and staff followed appropriate infection control practices.

• Appropriate numbers of suitably skilled staff were available to support people's needs.

• Staff had the knowledge and experience to support people's needs. They were supported through induction, training and supervision to ensure they performed their role effectively.

• People were supported to maintain good health and had access healthcare services.

• People were encouraged to eat healthy food for their wellbeing.

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

• People's privacy, dignity and independence was promoted.

• There were effective systems in place to assess and monitor the quality of the service provided.

• The service worked with healthcare services and professionals to plan and deliver an effective service.

Rating at last inspection: Requires Improvement (Report published 3 April 2018)

Why we inspected: This was a planned inspection based on previous rating. We saw improvements had been made since our last inspection and the service was rated good overall.

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

The service had 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.

At our comprehensive inspection on 28 October and 4 November 2016 we found breaches of legal requirements in respect of the monitoring of risks, management of medicines records keeping and with systems used to monitor the quality of the service. We undertook an announced focused inspection on 14 June 2017 and found that action had been taken but there was still room for improvement.

At this inspection we found that further improvements had been made to the management of medicines. There were safe medicines management systems in place and staff competencies had been assessed. Risk to people had been assessed, identified and with appropriate management plans in areas such as moving and handling, eating and drinking, medicines and behaviours that challenged. There were systems in place to continuously assess and monitor the quality of the service provided.

However, we found a breach of regulation in relation to the support staff received with training, supervision and appraisals. Staff training required updating in various courses including moving and handling and health and safety. Records we looked at showed that some staff had not received any training in these courses. The provider had a training planner which showed that training had been arranged for staff in the year 2018 to update their knowledge and skills. A supervision and appraisal record we looked at showed that supervisions and appraisals were not always carried out in line with the provider’s policy. Staff we spoke with were not sure when they last had an appraisal.

Staff involvement to actively improve the quality of the service required improvement as team meetings were not being organised in line with the provider’s policy. The provider had a staff zone on their website which was used to cascade important information to all staff. However feedback information we had prior to our inspection showed that two out of five staff felt their views were not taken into account and acted upon.

The provider had policies and procedures to protect both children and adults from abuse. There were arrangements in place to deal with foreseeable emergencies. Sufficient numbers of staff were deployed to support people and people told us their support staff were reliable, punctual and stayed for the full length of time. The provider had a recruitment system in place to ensure staff employed were vetted before working in social care. There were procedures in place to minimise the risk of infection. Staff told us they wore personal protective equipment when supporting people and we confirmed this with people and their family carers. Where accidents and incidents had occurred, the provider learnt from it and shared the learning with staff teams to prevent future occurrences.

People told us that staff knew them well, their preferences and what they needed support with. People’s physical, mental and social conditions were assessed to ensure the service could meet their needs. New staff were provided with training and shadowing opportunities to ensure they had the skills required to undertake the role in which they had been employed. People were supported to eat sufficient amounts for their well-being.

Where required, people were supported to have access to healthcare services such GP and district nurses. The provider worked with a range of health and social care professionals to plan and deliver care to people safely. The registered manager was aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the need to seek people’s consent before supporting them.

People said staff were compassionate, kind and thoughtful. They were involved in making decisions about their care and support to ensure that their needs were met. People said their privacy, dignity and independence was respected and promoted. They were provided with adequate information about the service to ensure they knew the standard of care and support to expect. Information was also presented in formats such as easy read to support people’s understanding. Each person had a care plan in place which covered areas in which they needed to be supported.

People were supported to participate in activities that stimulated them both at home and in the communities. The provider had a complaints policy in place and actions were taken to resolve complaints. At the time of our inspection, no one was being supported with end of life care; however, there were arrangements in place to ensure people's end of life wishes were respected.

The provider carried out audits in areas such as medicines management staff files and care records to identify issues and take action to improve on the service. People’s views were sought through home visits, telephone monitoring calls and annual questionnaires and the results were analysed to ensure that appropriate actions were taken to improve on the service provided.

There was a registered manager in post who was supported by a board of trustees and an operations manager. The provider operated an open culture and work with key organisations such as Carers Trust, the local authority and clinical commissioning groups to plan and provide quality service. Where issues were identified, lessons were learnt to improve on the quality of the service.

Crossroads Care South East London is a voluntary organisation and registered charity that provides a diverse range of support services throughout the year to family carers and people with support needs in their own home or on activities in the community. The service aims to encourage people’s well- being, independence and involvement in their community as much as possible, as well as providing a respite service for some families. For some people and their family carers, this support includes the regulated activity of personal care which is regulated by the Care Quality Commission. At the time of the inspection there were approximately 60 adults, children and their families who received personal care and support from the service.

There was a registered manager in post who had been the registered manager at the service for several years. 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.

We found improvements had been made to the management of medicines. Care plans recorded whether the responsibility to administer medicines was with the family carer, or, the service, or, a combination of the two. Medicines records were completed accurately. Improvements had been made to the assessment and monitoring of risks. There was guidance for staff on how to manage risks to reduce the likelihood of them re-occurring. However some improvement was still needed to ensure these processes were applied consistently across all risks.

There had been improvements to the quality monitoring processes at the service and there were now effective systems to monitor quality across the service. Audits had been completed of staff files and action taken to address missing records. Care plan audits and medicines audits had been completed and action taken in relation to issues identified from external audits.

There was still room for improvement with the frequency of medicines audits to ensure any issues were identified in a timely way and medicines competencies had yet to be completed to verify staff competence in administering medicines. We will check on these issues at our next comprehensive inspection.

Although improvements have been made, the rating for the key questions and the overall rating for the home remains Requires Improvement in line with our characteristics for ratings.

Crossroads Care South East London is a specialist voluntary organisation and registered charity, providing a diverse range of support services throughout the year to family carers and people with support needs within their own home or on outside activities. The aim of the service is on encouraging people’s well- being, independence and involvement in their community as much as possible, as well as providing some respite for families. For some people and their family carers, this support includes the regulated activity of personal care which is regulated by The Care Quality Commission. At the time of the inspection there were approximately 46 adults and children and their families who received personal care and support from the service.

There was a registered manager in post, who had been registered manager at the service, for several years. 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.

At this inspection we found that people received good quality personalised care and support from the same consistent staff but there were three breaches of regulations in respect of records. Records related to possible risks to people were not always completed which could pose a possible risk to any staff that might be unfamiliar with people’s needs. Medicines records were not always accurately maintained or audited and staff recruitment records were not adequately maintained or audited. There was no system to audit support plans on a regular basis. We did not find these issues impacted people’s care but there were possible risks to people as a result. The registered manager told us they had lost some key staff members earlier in the year and some systems had suffered as a result. However they were now able to address these issues.

People, family carers and staff told us the service was well led and all the staff were approachable, flexible and supportive. We found there was room for improvement in the management of the service as some aspects had not been consistently monitored. The new head of operations had identified these issues prior to our inspection and had produced an action plan to address them which the staff team had started to work on.

People and their relatives told us they felt safe and well cared for using the service. They said staff were reliable and did not rush their care. Staff had received training on safeguarding adults. They knew the signs of possible abuse and were aware of how to raise any concerns. Risks to people were identified and there were some plans recorded to reduce risk. There were arrangements to deal with emergencies and there were enough staff to meet people’s needs.

People and their relatives were complimentary about the service. People told us that staff were warm, caring and reliable and that their dignity and individuality were respected. Care was taken to match staff to the people and family carers they supported to build supportive relationships. This enabled staff to get to know people’s needs fully and for people to feel relaxed with them. People and their family carers told us the service was flexible and responsive to their needs. Staff knew people and their family carers very well and this maintained consistency in the support provided. Staff received training to meet people’s needs and told us they were well supported to carry out their work.

People were asked for their consent before care was provided. They were involved in making decisions about their care wherever possible and were supported to be as independent as they could. Where people were supported to eat and drink they were consulted about their food and drink choices and any cultural or health needs were addressed. Health care professionals were consulted when needed. Care plans reflected people’s individual needs and wishes, and guided staff on the care and support to be provided. People and their relatives knew how to make a complaint if they needed to.

The provider sought the views of people about the service through frequent contact. People and their family carers told us any issues they raised were acted on to improve the quality of the care provided.

People received a safe care that met their needs. The provider followed appropriate recruitment processes and care plans and staff files were stored securely.