This comprehensive inspection took place on 23 October and 6 November 2018 and was announced.

Newcross Healthcare Solutions Limited (Barnstaple) is a domiciliary care agency. The agency provides staff to work in care homes and also provides personal care to people living in their own houses and flats. It provides a service to older adults, younger disabled adults and children.

Not everyone using Newcross receives regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. We did not inspect the part of the service which supplies staff to care homes as this was not a regulated activity.

There were 13 people adults and children using the service when we inspected. This was the first inspection since the service was registered in February 2016. Newcross only accepted complex care packages over a minimum of four hours care.

There was a registered manager in place who has registered with the 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. The current registered manager was also the registered manager for two other Newcross offices and shared their time between them. There was a trainee manager in post at Barnstaple full-time, who was training to take over the registered manager role.

They were supported by two clinical lead nurses, a team leader and a care co-ordinator who formed the management team. People spoke highly of the management team and the majority said there was good communication between them.

There was a positive culture at the service and people, relatives and staff were encouraged to give their views on the service and influence change.

People were assessed and had a care plan in place. However, these plans did not always contain all the information required to give care in an individualised and personalised way. This was discussed with the clinical lead nurse.

People had their individual risks assessed and plans were in place to manage the risks without restricting people. Staff had access to personal protective equipment and followed infection control practices.

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 asked for their consent before any care or support was given. Where the person was unable to give consent, for example a child, the service worked with the parents who had been authorised to make decisions on their behalf.

Staff were safely recruited and trained to do their jobs. They received supervision and had their competencies checked regularly. People spoke of kind and caring staff who had developed meaningful and trusting relationships with them. One person said, “… they allow me to be me.”

There were enough staff on duty to meet people’s needs and staff were carefully matched to people based on their skills, knowledge and personality. Staff enjoyed their jobs, felt motivated and listened to. They were trained to deal with emergency situations.

People were supported at the end of their lives to ensure they were cared for in a dignified and appropriate way.

Staff understood people’s communication needs and used alternative ways to communicate with people if not in a verbal way. Staff understood their responsibility to safeguard vulnerable adults and had received training on this. There were safe processes in place for the management of medicines.

Staff worked with other healthcare professionals to ensure the best outcomes for people. Staff encouraged people to eat a balanced and healthy diet.

There were ongoing systems in