Archived: Rochdale DCA

Updated 2 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 2 and 3 February 2016. The provider was given 24 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be available to provide us with the required information.

The inspection team consisted of one adult social care inspector and an adult social care inspection manager on the first day and one adult social care inspector on the second day.

Before our visit we asked the provider to complete a Provider Inspection Return (PIR) form and this was returned to us. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed all the information we held about the service including notifications the provider had made to us.

We contacted the local Healthwatch organisation and the local authority commissioning team to obtain their views about the provider. No concerns were raised about the service provided by Routes Healthcare Rochdale.

With their permission we visited and spoke with five people who used the service, four relatives of people supported by the service, seven members of staff, the registered manager two care co-ordinators, the staff branch recruitment team, the complex care assessor, the group Care Quality Assessor, the group Human Resources and Development manager, and the group Clinical Governance lead.

We looked at the care records for five people and the medication records for two people who used the service. We also looked at a range of records relating to how the service was managed including three staff personnel records, training records and policies and procedures.

Updated 2 April 2016

This was an announced inspection that took place on the 2 and 3 February 2016. The service was previously inspected in January 2014 and was found to be compliant with all regulations inspected.

Routes Healthcare – Rochdale works closely with healthcare commissioning teams in supporting children and adults who have complex healthcare needs or are at the end of their life. The hours of support vary depending on the assessed needs of people. The service provides 24 hour support for some people with complex needs.

The service currently supports 80 people. This number changes rapidly with people being referred to the service who choose to pass away in their own home. Services may be required the same day as the referral is received and may only continue for a few days.

The service had a registered manager in place. 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. At Routes Healthcare – Rochdale the registered manager was also the area manager for the Routes Healthcare group. They were at the Rochdale office three or four times each week and were available on the telephone at other times. A new manager had been appointed for the Rochdale office and they will apply to become the registered manager when they take up their post. An on call system was available outside of office hours.

All the people we spoke with told us that they felt safe being supported by staff from Routes Healthcare – Rochdale. One person told us, “I can’t speak highly enough of them (the staff); there’s not one that isn’t nice.” Staff had received training in safeguarding adults and knew the correct action to take to protect people from the risk of abuse. All staff said the registered manager and the care co-ordinators would listen to any concerns they raised.

Where Routes Healthcare – Rochdale had responsibility for administering medicines they were administered safely. Medication Administration Records (MAR) were audited weekly. Any errors were investigated. Staff training was provided for staff in the hand writing of medicines prescribing instructions on to the MAR sheets accurately and with two staff signing to state they were correct.

We saw that two families, where staff supported people through the night, would leave medicines out for staff to administer during the night if required. The details on when this would be required were not recorded and relied on the families informing the staff accurately. This meant that staff may be unsure of the prescribed instructions for people’s medicines where families took the lead in managing the medication.

Risk assessments were in place which provided guidance to staff about how to manage the identified risks. Care plans were in place which gave clear information and guidance to staff. The plans were regularly reviewed to ensure that the information reflected people’s current needs. This enabled the staff to support people effectively and safely.

People and relatives told us that support visits were not missed. Due to the nature of supporting people at the end of their lives the times of visits sometimes varied if people required additional support. Staff teams were organised on an area basis which enabled people to receive support from the same members of staff. Staff covered each other when one was ill or on annual leave. Agency staff were not used. This helped to ensure that staff knew the people they support well.

A business continuity plan was in place. Contingency plans were made in case of staff sickness or bad weather affecting staff being able to support people as planned.

The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA). Best interest meetings had taken place where a person who used the service did not have the capacity to make a particular decision.

A robust system for staff recruitment, induction and training was in place. Staff received an induction when they joined the service. They completed essential training before they were able to support people who used the service to help ensure that they could carry out their duties effectively. Additional training courses were also provided for staff who supported people who had specific needs such as epilepsy or percutaneous endoscopic gastrostomy (PEG) feeding. Staff received an annual appraisal and spoke with the care co-ordinators and registered manager weekly when they visited the office. The co-ordinators always asked them how they were and discussed the people they supported. This included any areas for staff development arising from the conversation. Staff would inform the co-ordinators of any concerns they had. Annual observations were completed by the Care Quality Assessor.

All staff told us that they felt very well supported by Routes Healthcare – Rochdale. They said that they could phone the office or on call at any time with any concerns or if they felt that people’s needs had changed. Staff told us that they enjoyed working in the service. One said, “This is the best job I’ve ever had” and another told us, “I love my job; I enjoy coming to work.”

We saw the service worked closely with the district nurses and specialist hospitals to ensure people’s health needs were met.

People who used the service and their relatives spoke extremely positively about the kindness and caring attitude of the staff. People had strong relationships with staff and they felt that staff went ‘the extra mile’ for them. Comments people made to us included, “The staff are absolutely superb; we class them as part of the family.” Staff would undertake additional tasks such as bringing milk or bread on their next visit to help the family. Staff we spoke with had a clear understanding of the people’s needs and knew them well.

Staff saw their role as supporting people’s family as well as the person who used the service as they came towards the end of their life.

Staff showed that they were determined to support one person with complex needs to partake in a holiday abroad. This would require considerable logistical planning to ensure that all the required medical equipment was taken with them.

We were told that the timings of the visits were flexible due to the nature of supporting people at the end of their lives. Staff told us that they would stay longer with people if they needed additional support. The staff told us that they would contact the office who would inform other people who used the service that the staff member would be delayed.

Staff could clearly explain the values of privacy, dignity and respect. We saw that these values were part of the interview questions for prospective employees. Annual observations of practice by the complex care assessor checked that these values were used in practice.

We were told that one person supported by the service chose to lead an unconventional lifestyle. Staff worked in a non-judgemental way, providing them with the care and support they required.

The service completed monthly phone calls to people or their relatives to gain feedback on the service provided. All comments made were passed on to the care co-ordinators. People we spoke with were very positive about the care co-ordinators and their responses to any feedback that had been given. A questionnaire was also sent to people every six months to gain their views. Systems had been introduced to reward staff. When a compliment was received by the service the staff member was sent a personal letter which was then used as part of their annual appraisal.

There was system in place to record, investigate and learn from complaints. Incidents and accidents were reviewed to reduce the likelihood of the incident re-occurring.

A robust system of audits was in place to monitor the quality of the service. A new role of Clinical Lead had been developed for the Routes Healthcare Group. Their role was to undertake audits across the whole of the organisation and also for each branch. This should help to drive continuous improvements in the service provided by Routes Healthcare – Rochdale.