Archived: Routes Healthcare (West Midlands)

We had previously inspected the service on 6 July 2015. We rated the service as good overall with no breaches of regulations. However the service required improvements in the auditing of medication records. At this inspection we found that improvements had been made.

This service is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older adults. At the time of our inspection 110 people were receiving a service.

There was a registered manager in post at the time of our inspection. 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.

There were some systems in place to gather the views of people and to monitor the quality of the service. However, some of the systems used to monitor the quality of the service were not sufficient to identify shortfalls and to take the actions when improvements were required. Staff did not always feel well supported.

People were safe because staff had received training and understood the different types of abuse and knew what actions they should take if they thought that someone was at risk of harm. Staff were knowledgeable about the actions to take in the event of emergencies and about how the risks to people in respect of their care should be managed.

People received a safe service because staff were trained and followed the procedures to ensure the risk of harm and abuse to people was reduced. Risks that were associated with people’s care were assessed and managed appropriately because staff had the information to support people safely. Where people received support from staff with taking prescribed medicines, this was done in a way that ensured people were supported with their medication safely.

People received care and support from staff that were trained to be effective in their role. People’s rights were protected and they had choices in their daily lives. People were supported to maintain their diet and health needs where required. Staff were caring and people’s privacy, dignity independence and individuality was respected and promoted by staff and the management.

People received care from staff that were suitably recruited in sufficient numbers to ensure people’s needs were met. This was because the provider had undertaken the relevant checks to ensure the staff they employed were suitable to work with people. There were sufficient numbers of safely recruited staff to provide people with regular staff to support them.

People told us that they felt supported by the registered manager and felt able to speak with him if they needed to. People had no complaints about the service but felt they could raise any complaints with the registered manager. The registered manager worked with other agencies to ensure that people's needs were met.

On the day of our inspection there were 125 people using the service and 37 care staff employed at the service. We talked with the manager and the nominated individual and looked in detail at the care records for five people. We talked with two care staff and telephoned three relatives. The service gave us six contact details for people and we spoke with four people who used the service.

During the last inspection we found that medication recording was not consistent. During this inspection we saw that this area had not improved.

During this inspection we also found that there was insufficient evidence in relation to checking and monitoring the service.

Below is a summary of what we found. The summary describes the records we looked at and what people using the service and staff told us.

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

Is the service safe?

Staff understood their role in safeguarding the people they supported. Staff we spoke with told us they had safeguarding training and would report any concerns. Staff had access to equipment that kept them and people who used the service safe and well. One member of staff told us, 'There are always lots of gloves. I get them from the office.' There were enough staff and emergency processes in place to make sure that calls were not missed. The manager had a good understanding of issues around safeguarding and their role in protecting people.

We found that medication recording was not consistent and that the agency did not give clear instructions to staff about how to support people to take their medication safely. The agency did not have a system to check that people had received their medication properly.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. Staff had been provided with up to date training in a range of topics including health and safety and manual handling. One person told us, 'They are good, they suit me down to the ground. The manager gets in touch and they deal with things quickly.'

Care plans were linked to people's individual needs. Staff had an understanding of people's care and support needs. One person told us, 'On the whole they are good.' All the people we spoke with told us that the service met their needs. Some people told us they would like to see improvements around time keeping of staff. One relative told us, 'The plan of care meets dad's needs and anytime I've had a concern they have responded really quickly.'

Is the service caring?

We saw that staff we spoke with cared about the wellbeing of people they visited. Staff knew what people wanted and how they liked their care to be given. People told us staff were mostly caring and kind. One person said, 'I think they are marvellous. Nothing is too much trouble for them.'

Is the service responsive?

We spoke with the manager who told us other professionals were involved in people's care when their needs changed. This was so people's care could continue to be provided safely and appropriately. Staff we spoke to said they were supported by the office and could phone for advice at any time. One relative said, 'The managers are pretty good.'

Is the service well-led?

Staff felt supported and records we reviewed confirmed that staff were appropriately trained to carry out their role safely.

We found that people could not be sure that they would get their prescribed medication safely. We also found that systems for checking and monitoring staff and paperwork were not robust.

At the time of our inspection the service provided personal care and support to 95 people. We spoke with seven people who used the service and seven of their relatives. We also spoke with the provider, the registered manager and five members of staff. To help us understand how people's care was delivered we undertook two home visits to observe how staff interacted with people. We did this with people's consent and did not observe any areas of care that would impact on people's privacy or dignity.

Care was planned and delivered in line with people's individual needs. One person told us, 'Staff always ask me what I would like for my meals'.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect people from the risk of harm.

Recruitment processes were in place which gave people who used the service some assurances that only suitable staff had been employed.

People were cared for by staff who were supported, supervised and trained to deliver care to an appropriate standard. One person told us, "The staff are very helpful ".

Systems were in place to regularly assess and monitor the quality of service that people received.

Inconsistencies and gaps in record keeping meant that people may not be protected from the risks of unsafe or inappropriate care.

All of the people using the service that we spoke with were generally happy with the standard of care that they were receiving. One person commented 'The care is good I get the help that I need". Another person that we spoke with told us 'The care is excellent I have no complaints".

People told us that they were afforded dignity and respect and their independence was promoted.

Care plans and risk assessment were in place to support people's needs however they were not always updated to reflect changes. There was also a lack of detail about people's care needs and information was not always person centred. This could mean that people do not always get the care that they need.

Safeguarding procedures were in place and staff were confident that they would recognise and report any allegations of abuse so that people were protected from the risk of harm.

Staff were supported, supervised and trained to provide safe and effective care.

Systems were in place for the ongoing monitoring of the quality of service but a lack of analysis meant that the provider was not identifying themes and trends in order to learn and improve from findings.