Newcross Healthcare Solutions Limited (Truro) is a domiciliary care service which provides complex care and support to people of all ages in their own homes. The service provides help with people's complex care and personal care needs in Cornwall. The packages of care that Newcross provide ranged from a minimum of four hours a day up to 24 hour care dependant on the person’s care needs.

Not everyone using Newcross receives regulated activity; 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. At the time of the inspection 26 people were receiving support with personal care needs.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 registered manager had been appointed ten weeks prior to this inspection and was therefore new to the Cornwall branch. The registered manager also oversaw two other locations and divided their time between the three Newcross offices. People, relatives and staff felt the registered manager spent sufficient time at the office and was available at all times.

We carried out this announced inspection on 29 and 31 January and 2 February 2018. At the last inspection, in November 2015, the service was rated Good. At this inspection we found the service remained Good.

People we spoke with told us they felt safe using the service and said they trusted the staff that supported them. People and their relatives were extremely satisfied with the quality of the service they received and the caring approach from staff. People said about the service, “Carers are excellent, I would be lost without them”, "They want to do their best, they want to be outstanding” and ”They (staff) genuinely care.”

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Risk assessments clearly identified any risk and gave staff guidance on how to minimise the risk. They were designed to keep people and staff safe while allowing people to develop and maintain their independence.

Staff were aware of the reporting process for any accidents or incidents that occurred and there was a system in place to record incidents. Where accidents, incidents or near misses had occurred these had been reported to the service’s managers and documented in the service’s accident book.

People were supported by dedicated teams who were employed to work specifically with each person using the service. Staff knew people well and had received training specific to their needs. Training records showed staff had been provided with all the necessary training which had been refreshed regularly. People told us they were never supported by someone they did not know.

Staff were recruited in a safe way and available in sufficient numbers to meet people’s needs. Staff were supported by a system of induction, training, one-to-one supervision and appraisals to ensure they were effective in their role.

The service had robust and effective procedures in place to ensure that all planned care visits were provided. The service’s visit schedules were well organised and there were a sufficient number of trained staff available to provide people’s care visits in accordance with their preferences. Newcross operated an on call system outside of office hours. Relatives and staff told us managers would respond promptly to any queries they might have.

Newcross Healthcare Solutions (Truro) is registered as a domiciliary care agency that provides personal and nursing care to people in their own homes. At the time of our inspection 28 people were receiving a service. Some people had short visits at key times of the day to help them get up in the morning, go to bed at night and give support with meals. Other people, who had complex nursing needs, received longer visits and overnight or 24 hour care. The service employed care staff and qualified nurses. Newcross Healthcare also operates as a nursing agency and this part of the business is not regulated by CQC as it provides staff to work into regulated services such as care homes and hospitals.

There was a registered manager in post. 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 carried out this inspection on 3 and 5 November 2015. The service was last inspected in December 2013 and was found to be meeting the Regulations.

People we spoke with told us they felt safe using the service and said they trusted the staff who supported them. People commented, “Good standard of care and good service” and “I have no complaints.”

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The service recruited staff to match the needs of people using the service and new care packages were only accepted if suitable staff were available.

People were supported to take their medicines by staff who had been appropriately trained. People received care from regular staff who knew them well, and had the knowledge and skills to meet their needs. They told us staff always treated them respectfully and asked them how they wanted their care and support to be provided. People and their relatives spoke well of staff, comments included, “I have regular staff”, “They [staff] don’t rush me”, “They [staff] are really good” and “Staff are kind to me.”

Before people started using the service a manager visited them to assess their needs and discuss how the service could meet their wishes and expectations. From these assessments care plans were developed, with the person, to agree how they would like their care and support to be provided. A relative told us, “The service completed a very thorough assessment and wrote a very good care plan.”

Care plans provided staff with clear direction and guidance about how to meet people’s individual needs and wishes. The service was flexible and responded to people’s needs. People told us about how well the service responded if they needed any changes to their hours. For example, the relative of one person told us the service always arranged additional visits when they went away on holiday.

The management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Where decisions had been made on a person’s behalf, the decision had been made in their best interest at a meeting involving professionals and family if appropriate.

People said they would not hesitate in speaking with staff if they had any concerns. People knew how to make a formal complaint if they needed to but felt that issues would usually be resolved informally. One person said, “If I had a concern I would be happy to speak with the manager or office staff.”

There was a management structure in the service which provided clear lines of responsibility and accountability. There was a positive culture in the service, the management team provided strong leadership and led by example. Staff said, “One of the best places I have ever worked”, “The clinical lead is very good, they respond quickly to any concerns raised”, “Newcross is very good” and “We have regular team meetings.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. Members of the management team were visible in the service and regularly visited people, in their homes, to seek their views of using the service. People told us, “I have a care plan and someone from the office comes out to review it with me about every 3 months” and “there is plenty of opportunity to share my views.”