This inspection took place on 18, 20 and 24 September 2018. We previously inspected the service on November 2015 and it was rated ‘Good’. At this inspection the rating has been changed to ‘Outstanding’. Crossroads Care Central & East Gloucestershire provides domiciliary care services to a range of people who live in their own home. In addition to providing support directly to individuals, Crossroads specialises in offering respite breaks for family carers and a carers emergency scheme. This may be provided as two to three hours supporting the person they care for whilst the carer has some “me” time or time to do those important tasks which are difficult to weave between a fulltime caring role. The service will be described as Crossroads throughout the report.
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 and associated Regulations about how the service is run.
The service was Outstandingly well led. The provider had a holistic approach to service provision and had developed their services innovatively around the needs of the people. They had developed a variety of support services which allowed people to live their lives to the fullest in situations where they otherwise might not have been able to remain living at home. As well as the regular domiciliary care services, Crossroads also has several innovative services that improved the experience of people and their relatives.
These services include the Carers’ Emergency Scheme which in the event of an emergency offers total replacement care for up to 48 hours. This ensures that the person cared for is supported with all their personal care requirements in their own home by a support worker from Crossroads who will remain in the home 24 hours a day if the person cannot be left alone. This gives peace of mind to the carer and continuity of care for the person they care for, preventing further distress that can be caused if a person cannot remain at home without their carer. The scheme is only available for people who have been assessed and registered in advance with the scheme. The cared for had a care plan and risk assessment developed at point of registration which was reviewed in the home at point of activation by a manager if ongoing support is required Crossroads help make ongoing arrangements.
The Out and About service offers an opportunity for people that cannot access the community without support to join others in activities such as theatre, bowling and meals out. Wheelchair accessible transport from door to door is provided. The Azalea Clubs are available in four areas throughout Gloucestershire. These are interactive, person centred clubs for people of all abilities offering an opportunity to interact in new activities and to provide family carers a day of respite.
The provider worked creatively to ensure the values and objectives of the service were shared and implemented by all. This was evident in the outstandingly caring nature of the service.
People and their relatives were extremely positive about the care and support they received. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and could describe what they liked to do and how they liked to be supported. The service often went above and beyond their contractual obligations to ensure people had good quality care. People were placed at the centre of their care and were supported to develop their independence, meet their individual desires and live their lives to the fullest.
In addition, the service often “went the extra mile” outside of care hours to ensure people’s needs were met. For example; taking a person to a GP or hospital appointment that is not at the time of their regular care and getting shopping in for people whose arrangements have broken down the day before a bank holiday.
Quality assurance checks were in place and identified actions to improve the service. Staff and relatives spoke positively about the management team. People’s feedback and the views of relatives and staff were sought to make improvements to their experience of the service. People were actively involved in striving to improve the service.
The service had suitable systems for identifying and responding to allegations of abuse. Recruitment processes ensured that new staff were of good character and suitable to work with people.
Staff had received training appropriate to their role including around safeguarding and were confident to raise any concerns relating to potential abuse or neglect. Staff received regular supervision from the management team.
Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, action had been taken to ensure the ongoing safety of the person.
Staff had received training appropriate to their role. The administration and management of medicines were safe.
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 were encouraged to make choices about their day to day lives.