This inspection took place on 25 October and 1 November 2016 and was announced. This was to ensure someone would be available to speak with us and show us records. We visited the registered provider’s office on 25 October 2016, and spoke with people who used the service, family members and staff on 1 November 2016.

Crossroads Care Cheshire, Manchester and Merseyside Limited provides care to people living in their own homes. On the day of our inspection there were 67 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Crossroads Care Cheshire, Manchester and Merseyside Limited was last inspected by CQC on 9 January 2014 and was compliant with four of the regulations inspected at that time, but was non-compliant with Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010 Supporting workers.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and staff and described potential risks and the safeguards in place. Staff had been trained in safeguarding vulnerable adults. Appropriate procedures were in place to ensure people received medicines as prescribed.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The registered provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The registered provider was working within the principles of the Mental Capacity Act 2005 (MCA).

Staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service, and family members, were complimentary about the standard of care at Crossroads Care Cheshire, Manchester and Merseyside Limited. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and care plans were written in a person centred way. Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs.

People who used the service, and family members, were aware of how to make a complaint and there was an effective complaints procedure in place.

Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service, family members and staff were regularly consulted about the quality of the service. People who used the service, and family members, told us the management were approachable and understanding.

As part of our inspection we contacted 20 people by telephone. These were either people who received care from Crossroads or were family members who cared for their relatives. One stated purpose of Crossroads was to provide relief or breaks for such carers.

One person said: "They are all very good in my house and speak to me in an appropriate manner and treat me with respect and dignity at all times."

Another person said: "The agency have a high calibre of staff who know what they are doing with my husband’s complex needs."

Someone else described Crossroads staff as "absolutely excellent carers". Another comment was: "First class, very nice people. Some have become friends they have been with me so long."

We found that Crossroads treated people with respect and maintained their dignity. We found that the care plans were thorough and updated, which encouraged high standards of care.

We found that staff were trained in safeguarding and knew what to do if they witnessed or suspected abuse of any kind.

We found that staff were well supported in some ways but that spot checks had not taken place recently. We considered this meant that the service was not supporting staff with adequate supervision and was not compliant with the relevant regulation.

Crossroads had a good policy to assure the quality of the service. We considered that the high quality reported by people using the service showed that the policy was being implemented on the whole.

We spoke with three people who used the service. They told us, "I am very satisfied with the service. I tell them what I want and they provide it." Also, "I am very satisfied with the service they provide".

People who used the service gave consent to the care they were to receive. They also gave consent to the way confidential information may be shared with other agencies, on a need to know basis only. One person said, “I gave consent for my care. I remember we discussed it at some length”. Also, “I am aware that some of my information could be looked at. I know it’s for my benefit”.

People told us they had received a visit from a representative from the agency before the service commenced. They told us their needs had been discussed and they had agreed to the support to be provided. People we spoke with told us their carers provided sensitive and flexible personal care and they felt well cared for.

People told us they could contact the head office whenever they felt it was necessary and voice their concerns if they had any. At the time of the inspection the three people we spoke with did not have any concerns. One person told us, “I know how to make a complaint if I need to".

We saw there were recruitment systems in place to make sure staff were suitable to work with people using the agency. One person told us, “I went through all the checks before I could start to work for Crossroads. That makes sure they take it seriously”.

People using the service told us that the agency was meeting their care and support needs properly. They also said that they were involved and consulted about how they were cared for and supported and that care staff treated them with respect and maintained their dignity.