Archived: Routes Healthcare Manchester

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.

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 218 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. 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

The risks associated with people's care were not always managed in a safe way. This included the provider not knowing whether staff had attended calls and poor management of medicines. This meant people were at risk of avoidable harm.

People, their families and other people that mattered were sometimes involved in the planning of their care. However, the care plans did not contain information specific to people's needs and how to manage any conditions they had.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Safeguarding incidents were documented, and records showed that some action had been taken to address concerns. However, following a recent substantiated safeguarding concern we found the previous manager had not followed up on their assurances provided to the safeguarding team. This meant poor staff practice had not been addressed.

Feedback and oversight of the reablement service and bespoke service provided to people with physical health needs was positive. They operated separate governance systems and had access to a workforce that’s was not connected to the care at home service.

There was a lack of robust systems in place to monitor the delivery of care and this impacted on the care that people received. The provider had failed to ensure there were robust systems in place where staff either arrived late for a call or and there had been a small number of instances where staff failed to attend a call. Audits taking place were not identifying or preventing issues occurring or continuing at the service.

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 good (published 13 September 2018).

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

The inspection was prompted in part due to concerns received about the management of people's care, missed and late visits, medicine management, quality of care and management of the service. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person centred care not always being delivered, the management of medicines, need for consent and ineffective governance systems.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.