Archived: Routes Healthcare Manchester

Updated 14 July 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 inspectors, a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience made telephone calls to people and their relatives.

Service and service type

This service is a domiciliary care agency. It provides personal care to older people living in their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection.

Inspection activity started on 1 June 2023 and ended on 14 June 2023. We visited the location’s office on 1 June 2023.

What we did before the inspection

We reviewed information we had received about the service since it had registered with us, including notifications the provider had sent to us. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During our inspection we spoke with 7 people, 10 relatives and 1 professional. We also spoke with the peripatetic manager, quality director, operations director and 26 care staff completed a questionnaire we sent them. We looked at the care records for 10 people and various medicines records. We checked that the care they received matched the information in their records. We looked at records relating to the management of the service, including audits carried out within the service.

Updated 14 July 2023

About the service

Routes Healthcare Manchester is a domiciliary care agency providing personal care to people in their own homes. The service also provides a reablement service and bespoke service to people with physical health needs. The service was supporting 130 people at the time of the inspection, including older people, those living with dementia, people with a physical disability and younger adults.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

At this inspection we found the service had taken positive steps and implemented systems to improve the quality and safety of the service provided. However, further work was still required to ensure people received their medicines as prescribed.

Call monitoring of people's support had vastly improved, with better oversight and scheduling of calls taking place. Further improvements in this area were taking place to ensure people's call times lasted the allocated time they were commissioned for.

The management team had started the process of re-assessing people's care planning documentation in order to ensure this fully captured people's needs. Work in this area was ongoing to ensure records were person-centred and people’s care tasks were clearly recorded.

When incidents took place, the management team reflected on the events to ensure learning was embedded for future practice. This included sharing experiences in staff meetings and during supervision of staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. A formal process of accessing people’s mental capacity was introduced when concerns were identified in regards to people did not have the capacity to consent.

Oversight of complaints had improved, with a clear auditable framework in place. People and their relatives told us they were aware of how to make a complaint and were confident they could express any concerns which would be addressed.

Following our last inspection, the provider completed a full-service review of their training resources provided to staff, in order to improve the quality of training and deliver more face-to-face training. Feedback from staff during the inspection indicated the training on offer was much improved.

People benefited from an improved quality assurance system being in place. This meant the management team and provider had oversight of all the service's functions, including recruitment, training, complaints, and care planning was now more robust. However, these systems needed to be strengthened further to ensure medicines anomalies could be addressed in a timelier manner to drive service improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 25 January 2023).

This service has been in Special Measures since 4 January 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an announced comprehensive inspection of this service on 21 November 2022. Breaches of legal requirements were found. We issued two warning notices, and the provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements.

Enforcement and Recommendations

We have identified a continued breach in relation to medicines.

We have made recommendations for the provider to improve their governance processes.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.