East Sussex, Brighton & Hove Crossroads Care

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. The service supports a high number of people across East Sussex, but many of these visits do not include provision of personal care. On the day of the inspection, the service was supporting 14 adults and children with a range of health and social care needs, including emotional and physical disability and people living with dementia. Support was tailored according to people’s assessed needs, considering people’s individual preferences and lifestyles to help people to live and maintain independent lives and remain in their homes.

People’s experience of using this service and what we found

Care and support visits provided by Crossroads Care may be a one off visit or a regular planned visit. They may even be support to meet people’s needs in an emergency for example if a family carer was taken into hospital or became unwell. During visits care support workers provided the care to people they would normally receive from their relative or carer. This was to enable the family carer to have a period of respite or to attend health appointments.

We were unable to speak with people using the service due to their health or communication needs. We spoke to parents and relatives who cared for people at home to gain feedback on the service.

Care was provided in a person centred way. Robust systems of reviewing and monitoring care provision and staffing ensured that people received effective care that met their current and changing needs.

The registered manager was in day to day charge of the service. Supported by a dedicated team of administration and care support staff. A high level of care meant peoples independence and welfare was supported. Respite visits enabled people’s relatives/carers to have time to do things that were important to them, reassured that care was being provided that met the persons need. The service also provided ‘Your Health Matters’ visits, where they took over a person’s care for a short time to enable their relative/carer to attend a health appointment.

Relatives/carers spoke positively about the care and support provided by Crossroads Care. Everyone spoke highly of the management and staff providing care and felt people were treated with kindness and respect. This in turn ensured they felt safe and well supported. The service worked closely with people’s families and other healthcare professionals involved in people’s care provision.

Relatives/carers told us, “He is safe in their care. He has had the same support worker over a year now and when she hasn’t been able to come, there has been cover from [staff name], who is equally competent. He wears a special hearing aid and has communication difficulties, which they have to manage. And they do this well.”

Sufficient staff were available to ensure people's wellbeing and safety was protected. The registered manager and office staff were trained to provide care and were able to carry out visits in the event of a member of care support staff going off sick or in an emergency.

A robust recruitment and selection process was also in place. Staff completed a full induction which included mandatory training and support. Staff told us they received all the training they needed to meet peoples care needs. Staff felt supported and received regular spot checks, supervision and appraisals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; policies and systems in the service supported this practice. Relatives/carers felt people were offered choice in the way their care was delivered and that they had no concerns around their dignity and privacy in their own homes being respected. One said, “They are very watchful of the safety of the environment. I have no concerns about their respect for our home in my absence, I trust them absolutely.”

The provider had robust of quality assurance systems in place to measure and monitor the standard of the service. This included a number of audits and reviews. Systems supported people to stay safe by assessing and mitigating risks, ensuring that people were cared for in a person-centred way. Actions were identified and taken forward to ensure continued learning and improvement.

Relatives/carers told us they thought the service was well managed and they received good quality care that met people’s needs and improved their wellbeing from caring and compassionate staff. One told us, “The care support worker is totally competent, she can deal with anything that arises, never panics. She says if she thinks there is anything I need to attend to, and texts me if she needs to double check anything during a visit.”

The registered manager and staff attended forums and worked with other care agencies. This meant that best practice could be shared, and on-going learning was facilitated.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection.

The last rating for this service was Good (published 13 September 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

East Sussex, Brighton & Hove Crossroads Care is a charity providing home and respite care services for carers in East Sussex, Brighton & Hove. This included children and adults with various conditions including older people living with dementia, people with a learning disability or autism and people with a physical disability. The focus of the service is to, ‘Provide support to carers in their own home, and give carers ‘time’ to be themselves.’ At the time of our inspection around 160 people were receiving a care service.

The service had a registered manager. 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 spoke of a difficult last year with a number of changes in office staff. This had resulted in some slippage in systems in place such as reviews. However, new staff had been recruited and the registered manager demonstrated this had been addressed with a robust plan in place for staff to follow and the registered manager monitoring the completion of this.

People told us they felt safe, and the care they received was good. One person told us, “They do all I require. Absolutely safe.” Another person told us,” Have always felt safe. They are friendly and professional.” There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. One member of staff told us,“ You have to use you practical skills. We went on an all-day course. If I thought someone was being physically or mentally abused I would report it. There’s also things in the home that could cause an accident, we have to make sure their home is safe.” Another member of staff told us, “Yes, we have our own clients. They fit the right person to the right client and this is also done with holiday and sickness cover. Crossroads are good at matching people to their clients.”

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. Care staff had received medicines training. One member of staff told us, “I’ve had medication training. I occasionally give meds. The carer will leave the tablets in a blister pack, we record it in the meds sheet in the daily record.”

Staff considered people’s capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. One member of staff told us,“ A person is assumed to have mental capacity unless deemed otherwise by a health professional. Everyone should be given the opportunity to express themselves. Mental capacity can fluctuate from one day to the next.” Another member of staff told us, “People have consent form in their care plan. Other than that it would depend on the context of what you are asking but yes we ask for consent.” A third member of staff said,“ We know what’s right and wrong for them and we make the appropriate decisions. We explain what we’re doing and make the appropriate decisions. We make it light hearted.”

People told us they were involved in the planning and review of their care. People’s needs were assessed and regularly reviewed and they received support based upon their needs and preferences. One member of staff told us, “The manager goes in to do a review when things change. A gentleman who recently had a bad fall. The manager went in and did a re-assessment.” Staff were proactive in recognising and supporting changes in people’s needs. We found the support plans to be person centred and details recorded were consistent.

Robust recruitment procedures were in place. There were a number of staff who had worked in the service for many years. One member of staff told us, “We have got a fantastic team who have been with us a long time. We keep the staff and support the staff. I would not want to work anywhere else.”

Staff felt fully supported by the registered manager to undertake their roles. New care staff undertook and induction. New staff trained alongside experienced staff on support calls They were given training updates, supervision and development opportunities. One member of staff told us, “Last year I did stack and stacks of training. I did an all-day moving and handling course, first aid, infection control, food hygiene, safeguarding, and Parkinson’s. I think I did dementia training. Meds training was a half day course.” Another member of staff told us, “I’ve just done safeguarding children last week, I’ve also done first aid and every year we do manual handling. We have someone who tells us when we need to do our training. We do a refresher if we have done something recently or a full day if it’s been a while. I did safeguarding online and also some of the others. I did mine in the office as I needed help to log on. We do infection control every two or three years. If we go to someone with dementia, we do dementia training.”

Staff received supervision and appraisal. One member of staff told us “I had supervision a couple of months ago. We have them quarterly. We had a staff meeting last Thursday. The next one is due 10th/11th of August. We have them at the day centre once a month.” Another member of staff told us,” Yes, we can say what we like at the meetings.” Another member of staff told us, “I’ve had supervision in the last month, it was three or four weeks ago. We have a main staff meeting once a month and an office meeting once per week.”

People told us staff were kind and caring. Care staff were able to tell us about the people they supported, for example their likes and dislikes and their interests. People told us they always got their care visit, that they were happy with the care and the care staff that supported them. Comments received included,” Very kind and caring. Their whole attitude, the way they talk and interact.” Another person told us,” He is not conversant. They talk and listen. Very kind and caring. They want to please him and try hard.” A third person said, “Very kind and caring. Yes very respectful.” People confirmed staff respected their privacy and dignity. Staff had an understanding of respecting people within their own home and providing them with choice and control.

People were supported at mealtimes to access food and drink of their choice if required. One member of staff told us they supported one person by,“ I look after a person with severe dementia. He puts too much food on his fork or spoon and misses his mouth sometimes. I support him gently without actually feeding him directly just by guiding the spoon or fork into his mouth. You have to be careful not to take their dignity away.”

People said they were happy with the management of the service. There were clear lines of accountability. The service had good leadership and direction from the registered manager and the provider. Staff felt supported in their roles and felt the management team were approachable. When asked if staff felt supported one member of staff told us, “Yes, 100%.” The registered manager monitored the quality of the service by the use of regular checks and internal quality audits to drive improvements. Feedback was sought through surveys which were sent to people and their carers. Survey results were positive and any issues identified acted upon. People we spoke with had not made any formal complaints, but were aware of how to make a complaint and felt they would have no problem raising any issues.