Rugby Crossroads is a domiciliary care agency registered to provide personal care to people in their own homes. At the time of this inspection the service supported 150 people with personal care and employed 43 care staff.

The office visit of this inspection took place on 28 November 2018 and was announced.

At our last comprehensive inspection of the service in April 2016 we rated the service as Good. At this inspection we found the service remained Good.

A requirement of the provider’s registration is that they have a registered manager. 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.

The registered manager in post at our last inspection had recently retired. They also had been the provider’s Chief Executive Officer (CEO). The provider had appointed a new manager, who was registered with us in August 2018. A new CEO had been appointed for the organisation.

People received care which protected them from avoidable harm and abuse. Staff understood people’s needs and knew how to protect them from the risk of abuse. Risks to people’s safety were identified and in most cases risk management plans were in place to manage identified risks. Staff received training to assist people safely to manage risks and take prescribed medicines.

There were enough skilled and experienced staff to meet the needs of people who used the service. People had different experiences of the consistency of care staff and their call times. Some people received care around the time they expected, from staff they knew well. Others did not know which staff would be calling, and call times could be earlier or later than expected. The management team had identified the consistency of calls to people needed improvement. Actions were being taken to make improvements at the time of our inspection visit.

Recruitment checks were completed on new staff to ensure they were suitable to support people who used the service.

The managers understood their responsibilities in relation to the Mental Capacity Act 2005. Staff asked for people’s consent before they provided care and people were involved in making decisions about how they wanted their care provided.

People received care from staff who they considered to be kind and caring, and who stayed long enough to provide the care and support people required. Staff promoted people’s privacy and dignity. People received care and support which was individual to them.

People’s care and support needs were kept under review and staff responded when there were changes in those needs. Where required, people were supported to have sufficient to eat and drink and remain in good health.

Staff said they received good support from the management team who were always available to give advice. Managers and staff told us there was good team work and staff worked well together.

The provider had effective and responsive processes for assessing and monitoring the quality of the service provided.

This inspection visit took place on 6 April 2016 and was announced. The provider was given two days’ notice of our inspection visit to ensure the manager and care staff were available when we visited the agency’s office.

The service was last inspected on 17 June 2014 when we found the provider was compliant with the essential standards described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Rugby Crossroads is a domiciliary care agency providing care for people in their own homes in the Rugby area. People received support through several visits each day. On the day of our inspection the agency had 55 care staff providing support to 155 people.

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. We refer to the registered manager as the manager in the body of this report. In addition to the registered manager the service was also managed on a day to day basis by a care manager.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care and for managing people’s medicines safely. Care staff understood how to protect people from abuse and keep people safe. The character and suitability of care staff was checked during recruitment procedures to make sure, as far as possible, they were safe to work with people who used the service.

There were enough care staff to deliver the care and support people required. Most people said care staff arrived around the time expected and stayed long enough to complete the care people required. People told us care staff were kind and knew how people liked to receive their care.

Care staff received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us care staff had the right skills to provide the care and support they required. Support plans and risk assessments contained relevant information for staff to help them provide the care people needed in a way they preferred.

Staff were supported by managers through regular meetings. There was an out of hours’ on call system in operation which ensured management support and advice was always available for staff. The managers understood the principles of the Mental Capacity Act (MCA), and care staff respected people’s decisions and gained people’s consent before they provided personal care.

Staff, people and their relatives felt the manager was approachable. Communication was encouraged and identified concerns were acted upon by the manager and provider. People knew how to complain and information about making a complaint was available for people. Care staff said they could raise any concerns or issues with the managers, knowing they would be listened to and acted on. The provider monitored complaints to identify any trends and patterns, and made changes to the service in response to complaints.

There were systems to monitor and review the quality of service people received and to understand the experiences of people who used the service. This was through regular communication with people and staff, returned surveys, spot checks on care staff and a programme of other checks and audits. Where issues had been identified, the provider acted to make improvements.

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with people who used the service and relatives. We also spoke with the registered manager, operations manager, two senior care staff and three care staff. We looked at some of the records held by the service including the care files for five people.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

The summary below describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People's needs had been assessed and individual care plans drawn up to meet people's needs. Risk assessments were in place to keep people safe. The provider carried out spot checks to ensure risk assessments and care plans were followed by staff.

Arrangements were in place to deal with foreseeable emergencies. We were told by staff members we spoke with that they were able to contact a manager when needed.

The local Safeguarding policy and procedure was in place and available to staff. We looked at staff training records and saw staff had received training on safeguarding and on the Mental Capacity Act 2005. Staff we spoke with told us what they would do in the event of abuse being witnessed, suspected or alleged. We found the provider had taken appropriate action when abuse had been alleged.

There were enough staff to meet the needs of the people cared for by Rugby Crossroads. One person told us, “They go above and beyond, I’m really happy with them”.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. One person told us, “They’ve made a difference to my life”.

We found staff received training to meet the needs of people.

Is the service caring?

We found people who used the service understood the care and treatment choices available to them. We saw people had been involved in agreeing to the levels of care and support they needed. We spoke with people who told us they had agreed how they would be cared for.

Staff we spoke with told us they considered meeting people’s needs to be the most important part of their role. One staff members said, “People’s needs come first”. A relative we spoke with said, “Staff are polite, courteous and caring”.

Is the service responsive?

We found the provider had listened to people's views and made changes to the service provided as a result. People told us the provider had altered the times of their care and support when requested.

People using the service and relatives told us they felt the provider responded to issues they raised regarding the care and support provided. A relative told us, “When we had a problem, they put it right”.

Is the service well-led?

Staff we spoke with told us they had received training to carry out their roles effectively. We looked at staff training records and saw that training was planned and provided. One staff member told us, "Crossroads give us good training”.

We found the provider monitored the health and safety of people using the service, staff and others. We were told by care staff that health and safety was seen as important by the provider.

We spoke with four people who used Rugby Crossroads about their experiences of the service. We also spoke with two relatives about the care their family members received. We spoke with five members of staff and manager. On the day of our inspection we were told the registered manager listed in this report and recently left the service. A new manager was in post and was currently in the process of being registered.

People and relatives we spoke with told us that the care planning was discussed with them regularly. We saw they were involved with providing their consent regarding the planning of care for people using the service.

We found that the care plans were person centred and reflected people’s individual needs. People and relatives we spoke with told us that staff supported people as detailed within their care plans. They told us staff were compassionate and caring when supporting people.

People and relatives we spoke with told us that staff were friendly and supportive. We spoke with staff who knew what people's care needs were and how they needed to be supported.

We spoke with members of staff about what they thought abuse was and they showed they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

We found the service was well led and the provider monitored the quality of service being provided.

We reviewed the service’s compliance with a number of essential standards in August 2011. When we visited in August 2011, we found minor concerns with the recording and monitoring of medication being administered to people who use the service.

On this inspection we saw that medication had been recorded when it was administered. We saw that medication was listed within the care plans and signed by people who use the service. We saw that checks were completed on the medication sheets. This meant that any concerns could easily be identified and corrected.

We spoke to one person who used the service about their experiences of Rugby Crossroads. We also gathered evidence of people’s experiences through speaking with two relatives of people who use the service. We spoke with three members of staff for Rugby Crossroads.

People and relatives we spoke with told us that the care received matched the care that was discussed with them. They told us that they were involved in planning the care and that reviews were held to reassess people’s needs. We saw that people or relatives had signed the care plans and reviews which showed their involvement.

We saw that the care plans were person centred and reflected people’s needs. This meant that the care plan was based on the needs of the person. We saw that people’s needs were reassessed and where necessary the care plan was updated.

People and family members we spoke with told us that staff were polite and friendly. People told us that it was usually the same members of care staff who provided their personal care. Continuity of staff should mean that people receive their care consistently as staff have an increased understanding of people's needs.

A safeguarding policy was available. Staff had signed to confirm they had received contact details on how to report any safeguarding concerns. We spoke with staff about what they thought abuse was. They showed us they had a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding abuse.

We saw that staff were supported through training and supervision sessions. Staff we spoke with told us there was training offered on a regular basis and felt ‘very’ supported. We saw that newsletters were sent to staff on a weekly basis which outlined any changes to people’s support needs.

We saw that people were asked for their views on the service every six months. We saw feedback from people which stated they thought the service was meeting their needs.

People we spoke to said they were consulted about the care provided and had given their consent for the agency to provide the support required. People we visited had a booklet in their home that contained good information about the services the agency offers.

All files we looked at contained care plans and risk assessments. People we visited had copies of care plans in their homes. Plans provided staff with sufficient information about the care support required and care staff we spoke with demonstrated a good understanding of peoples needs and gave examples of promoting independence and maintaining peoples’ privacy and dignity. One member of staff told us, “ I encourage x to do as much for herself as possible, she is able to wash her top half and I do the bottom end”. Assessments and support plans had been reviewed and were updated regularly. Care staff said they always had up to date information in the home. People we spoke to said carers stay the full amount of time and never rush in and out. There were no concerns about late or missed calls. Clients we visited told us that staff are always polite and treat them with respect. We were told carers are helpful and friendly one person said “My carers are very good they are more like friends really”. People said they had consistent carers who they know well. One person told us “My carer is excellent she has been coming for about two and a half years. It’s lovely having the same carer who knows what to do”.

People we spoke to said they are encouraged and supported to do things for themselves. One person we visited told us "I am able to do a lot for myself but the carer does the areas I can't reach". Care files we looked at showed that risks associated with the care of clients are assessed and reviewed. Manual handling assessments were in place and staff had completed moving and handling training including the use of a hoist.

People we visited needed assistance with moving and handling, they told us care staff were competent doing this and knew what to do. Files we looked showed some people are looked after in bed and the others sit for long periods of time. Although people told us care staff check their bottoms and heals regularly for redness, pressure area management was not clearly identified in their care plans. We discussed this with the manager and the procedure for pressure area management has been improved. Care staff we talked to knew how they monitor and manage pressure areas during personal care routines and what changes in the skin condition would prompt a referral to the district nurse.

The agency assists people to take medication if they are unable to do this for themselves. Although records confirmed staff complete medication training we found that medication was not being managed safely. Care plans did not include a record of the medication people were prescribed, and medication records were being disposed of when they should be retained with care records. We visited a person who was assisted with medication and found gaps in the medication record and an error on one of the medicines. We reported this to the agency office so they could look into this quickly. When we visited the office the next day the manager had taken prompt action to address the shortfalls. We were provided with a copy of an action plan that had been put into place to improve the current system. The action taken should make sure that any gaps and errors are promptly responded to by care staff so they can be quickly rectified.

We visited one person who was looked after in bed and had bedrails fitted. Although the use of bedrails had been identified on the moving and handling assessment there was no risk assessment for the safe use of bedrails. When we visited this person the bedrails were in place but no bumpers were being used. On our second visit to the agency office a risk assessment for the use of bedrails had been completed by the manager but this said rails can only be used with bumpers. We advised the manager bedrails were being used without bumpers. The manager discussed this with the staff in the office and we were told bumpers had been supplied with the bedrails but the family did not want them used. The manager will ensure all seniors and carers understand the importance of using bumpers this is to make sure people remain safe and are not injured or trapped.

People who use the service said staff were competent in their work and knew what they were doing. Staff we spoke to knew how to recognise signs of possible abuse and what they would do to keep people safe. Records confirmed staff had completed safeguarding training. Staff said they completelots of training on a regular basis and records show there is an extensive training programme in place. Staff we spoke to said Rugby Crossroads was a good organisation to work for and said they felt well trained and supported to do their job well.

People we visited told us they had information about making complaints but had never had cause to do so. We were told any concerns are dealt with quickly by care staff or staff in the office.

The agency has procedures in place for monitoring the service they provide but during this review we found some of the monitoring systems were not being implemented effectively. The manager has taken prompt action to address this.

The agency have a separate file full of thank you cards and letters of compliments. Comments recorded on cards included, ‘I want to tell you how much I appreciate the high level of care and commitment that you gave to mother during the last years of her life. It was a great comfort for me to know that mother was in the hands of such marvellous people’.

The agency sends satisfaction questionnaires to clients, carers and staff. Responses from the 2010 surveys were sent to us from the provider these show that people who responded were 100% happy with the care and support they received.