The inspection took place on 10 April 2018. The inspection was announced. This is because the service provides care to people in their own homes and we needed to be sure that someone would be available in the office to support our inspection. At our last inspection, the service was rated Good with no breaches of regulation. At this inspection we found one breach of regulation and the service was rated as Requires Improvement.

The service provides care for people with complex care needs. The service provides care to both adults and children. At the time of our inspection the service was providing 28 packages of care.

There was a registered manager in place, although they were shortly to be going on long term leave. A manager had been found to cover whilst the registered manager was absent. 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.

We found that the service required improvement. People were not consistently kept safe because there weren’t sufficient numbers of suitably qualified staff to meet the demands of people’s care packages. This had led to a significant number of calls being cancelled by the agency because they weren’t able to provide cover. People using the service were supported by family and so their immediate safety was not put at risk by the calls being cancelled, however it was clear from feedback provided that the situation was impacting negatively on people and causing them distress. The service was reviewing their recruitment procedures to try and improve the situation.

The service had not been well led in all aspects. Historically, the management of acquiring new care packages had not been well managed and this was impacting on the service’s current performance.

We received positive comments about the care staff and people had clearly built up good, strong relationships them. It was clear that regular staff understood and met the needs of the people they supported. However frustrations arose when visits were cancelled by the service. This was reflected in both feedback from people and professionals involved with the service.

There were systems in place to manage complaints, however there was a lack of confidence amongst service users and professionals about how their concerns would be responded to. Feedback was inconsistent, some people were satisfied about how the service managed their complaint, others expressed frustration and concern about the process.

Staff were required to have the skills to support complex health needs and conditions. It was clear from staff records that their skills and abilities were monitored closely. There were lead registered nurses in place overseeing care packages and reviewing them regularly.

Staff understood their responsibility to safeguard vulnerable adults and had received training in this. There were safe processes in place to support people with their medicines where this was part of their agreed care package. Medicine Administration Records (MAR) were reviewed and checked regularly to monitor for any errors or omissions.

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We undertook an inspection of Newcross Healthcare Solutions Limited (Bristol) on 1 December 2015. The inspection was announced, which meant that the provider knew we would be visiting. This is because we wanted to ensure that the provider, or someone who could act on their behalf, would be available to support the inspection. The service was registered with the Commission in November 2013 and this was the first inspection.

Newcross Healthcare Solutions Limited (Bristol) provides nursing and personal care to people in their own homes in Bristol and South Gloucestershire. At the time of our inspection there were 13 people receiving personal and nursing care.

A registered manager was in post at the time of our inspection. 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.

People felt safe and spoke highly of the care they received. Staff knew how to identify and respond to abuse. Staff received training in safeguarding and demonstrated knowledge of the provider’s policies.

Recruitment procedures were thorough and ensured all the correct pre-employment checks were carried out before staff began work. Staff received an induction and on-going training.

Risks were identified and managed through comprehensive assessments. Staff were competent in the administration of medicines. The service had an auditing system to check people’s medicines were being managed safely.

People were provided with care by well trained and knowledgeable staff. Staff felt well supported and had regular supervision.

Staff understood the principles of the Mental Capacity Act (2005) and delivered care in the way that people wished. Staff promoted choice and understood how people were able to communicate.

People and relatives spoke highly of the kindness of staff and the care they provided. People and relatives told us they had trusting relationships with staff.

People told us the service was flexible and adapted to people’s changing needs. People’s needs were assessed and their care records were informative and up to date.

The service had a complaints procedure and people had been given information about how to make a complaint. People told us they felt able to make a complaint and that it would be dealt with thoroughly and openly.

People told us they felt the service was well organised and managed. People felt the registered manager was approachable and effective. The registered manager communicated effectively with staff ensuring they had the necessary information to perform their roles well.

The service had systems to monitor performance and the quality of care provided by staff.  People were asked for their feedback on the service they received.