Archived: Routes Healthcare Rochdale

Updated 30 August 2018

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 13, 14 and 15 June 2018 and was announced. We gave the service 24 hours' notice of the inspection because it is a domiciliary care service and we needed to be sure that someone would be in the office.

The inspection team consisted of one inspector and an assistant inspector. Before this inspection, we reviewed notifications that we had received from and about the service. This included statutory notifications, which are notifications the provider must send us to inform us of certain events. We had received a Provider Information Return (PIR). 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 contacted the local authority and health commissioning teams who were responsible for organising and commissioning the services on behalf of individuals and their families. This was to seek their views on how they felt the service operated. All provided positive feedback.

During this inspection we visited and spoke with four people who used the service and contacted five by telephone. We also spoke with six relatives. At the main office we spoke with the area manager and nominated individual, two nurse leads, two team leaders, a healthcare assessor and five care assistants. We reviewed eight people’s care records, nine staff records, and four medicine administration sheets. We also looked at other documents and records about the service, such as audits, quality assurance questionnaires and training records.

Updated 30 August 2018

The inspection of this service took place on 13, 14 and 15 June 2018 and was announced.

Routes Healthcare Rochdale is a domiciliary care agency providing personal care to people across the north of Greater Manchester in their own homes. It is registered to provide personal care and treatment for disease, disorder and illness. The service provides excellent services to children and adults with complex health and social care needs. Services include 24 hour support; up to five domiciliary visits a day, a night sitting service and carer breaks. When we inspected, the service was supporting 131 people. However, this figure could change on a daily basis, as they supported a large number of people who were on an end of life care pathway. The service provides an extremely efficient and speedy response to requests to ‘fast track’ people at the end of their lives to return home from hospital so they could spend their last hours and days in the comfort and familiarity of their own homes and allowing them respect and dignity in their final days.

This was the first inspection of Routes Healthcare Rochdale since they moved to their current premises. At a previous address the service was last inspected in February 2016 when it achieved a rating of good overall, with outstanding in care. At this inspection we found the service continues to maintain and improve standards.

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 service did not have a registered manager at the time of our inspection. Services without a registered manager cannot be rated as ‘Good’ in the well led section of our inspection. We were told that a new manager had been appointed and started the registration process. An area manager had taken responsibility for the day to day management of the service and to ensure a smooth transition to the newly appointed manager. This person was supported by a Deputy Manager who was on leave on the days of our inspection. Both the area manager and the nominated individual were present during the inspection. They told us that they were keen to ensure that the service recruited a registered manager who had the appropriate managerial know-how and the clinical knowledge and understanding to meet the complex needs of the people supported by Routes Healthcare, and wanted to ensure the right person was recruited.

Training opportunities for staff were exceptional, with consistently high-quality training provided to all staff. Bespoke training was delivered face to face by people who knew the issues and risks involved in supporting people with diverse and complex social care needs, and specialist training was provided for staff who were working with people who had complex or life limiting illnesses, so that they were able to use specialist equipment and monitor, manage and minimise any risk to the individual.

Care staff demonstrated an exceptionally caring and enthusiastic approach to meeting the needs of the people they supported. They were kind and considerate of people’s needs and abilities and were prepared to go the extra mile to ensure needs were met, and that the people they supported were comfortable. There were many examples of how their caring outlook had a positive impact on people’s lives.

Care plans showed really good attention to detail and were flexible to meet day to day changes and changing needs. This meant that care staff could arrange with the people they supported to spend less or more time with each person they supported, depending on their needs on the day.

Care records contained important information about people and daily records were clearly written and gave detailed and factual accounts of each intervention.

To ensure staff maintained high standards when delivering care, regular spot checks were undertaken, and staff received regular supervision. They told us that they found supervision informative and instructive. They told us that their managers and supervisors were helpful and always available to speak to if they had any concerns. The service operated an on-call system to allow staff to contact a member of the management team in case of any emergencies.

Staff were supplied with appropriate equipment to prevent the spread of infection, including disposable gloves, aprons, and facemasks to minimise the risk of airborne germs. Good systems were in place to manage and administer medicines and reduce the risk of errors occurring.

All the staff were aware of how to protect people from abuse, and well trained to ensure their safety. We saw that where a risk or potential risk was identified, comprehensive care plans were designed to minimise the risk as they applied to the person who was being supported. They were personalised to each individual and recognised their right to take personal risks. All the staff we spoke to understood issues around mental capacity and people were offered choices in how their care was delivered.

Staff were safely recruited. People who used the service were involved in selecting staff, and the service considered people’s needs and wishes, looking to recruit people who shared similar backgrounds and culture People told us that they were supported by regular and consistent staff, and that they liked that the staff who supported them always worked in pairs, as this allowed the staff time to talk and listen to them.

We saw that the service had developed good systems of communication, including regular team meetings. Staff could access a Routes Healthcare app on their mobile phones so they could access up to the minute information about the service and receive text messages relating to their work. They had set up their own ‘Routes TV’ channel on the internet to provide guidance and advice to staff working in the field and to access any information they might require.

The provider had up to date complaints and whistleblowing policies and procedures which gave information for staff to follow and time scales to adhere to. This helped to assure people and caregivers that their concerns were taken seriously and addressed quickly. Quality assurance systems were in place and used to monitor the quality of service people received, and good systems were in place to monitor day to day management of the service. The management team had adopted an inclusive management style that supported staff and increased their confidence in working with people who had complex health and social care needs. Staff felt well supported. Staff turnover was low which meant that people who used the service were supported by people who knew them well. Where they had identified risks with the recording of medicines they used this as a positive opportunity to revise their medicines procedures to ensure that the risk of medicine errors was minimised.