This unannounced inspection was carried out on 11, 12 and 13 April 2018 by one social care inspector and an assistant inspector. The first two days of the inspection were spent at the service’s office and visiting some of the people supported by the service. On the third day of the inspection we contacted more of the people supported by the service by telephone.

Crossroads Care Liverpool Knowsley Sefton & Warrington provides care and support to adults and children in their own homes. The service also provides a STARS (Support, Talk, Act, Review, Share) service for end of life care in partnership with Marie Curie and Homecarers Liverpool Limited. At the time of our inspection the service was providing support for 59 people and employed 34 staff.

At our last inspection in November 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

The service had clear and effective policies and procedures to safeguard people from abuse. All staff we spoke with were able to tell us what they would do in these circumstances and they had confidence in both their own and management’s ability to deal with any issues.

We saw that staff were recruited safely following a thorough recruitment process. This process included carrying out the relevant checks, known as Disclosure and Barring Service (DBS) checks, to ensure staff were safe to work with vulnerable people.

Medication was stored, administered and recorded safely and people told us they received their medicines on time and with the support they needed. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required.

Staff were well-supported with regular and structured supervision and appraisal meetings. All new staff were supported to complete the Care Certificate as part of their induction and we saw that staff were up-to-date with the training they needed to support people safely and effectively. This included specialist training where necessary, such as stoma care, suctioning and tracheotomy care.

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

All of the people we spoke with told us that the staff were kind, caring and treated them with respect.

The care plans we reviewed were person-centred, detailed, regularly reviewed and contained appropriate risk assessments to help keep people safe and give staff the information they needed to effectively manage any risks.

We saw that the service used various methods to assess and monitor the quality of the service it was providing. These included regular audits, spot checks of staff performance and regular staff meetings to share learning points and gather feedback from staff.

Further information is in the detailed findings below.