Routes Healthcare (Yorkshire) is a domiciliary care agency which provides personal care to people living in their own homes. The service currently provides care in the Halifax area of West Yorkshire with its office base located in Bradford. Referrals to the service are usually from the local clinical commissioning group (CCG). At the time of the inspection 19 people were using the service. A registered manager was 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.
People and their relatives provided mixed feedback about the quality of the service. Most people said they were happy with the care and support package provided by the service. However
three relatives raised concerns over the timeliness of calls stating that due to erratic call times people were not receiving appropriate care and support. A further two relatives raised the timeliness of calls as a more minor issue. We looked at six people’s care records and saw care and support was not arranged to ensure people received visits at consistent times. This posed a risk to people particularly where they required regular pressure relief or medicines at specific times.
A range of risk assessments were in place to help support safe care and support. For example detailed manual handling risk assessments to aid staff in the safe transferring of people.
Safe recruitment procedures were in place to ensure staff were of suitable character to work with vulnerable people.
People and relatives we spoke with said they felt safe from abuse in the company of staff. The registered manager followed local safeguarding procedures and where incidents had occurred preventative measures had been put in place to prevent a re-occurrence.
People and their relatives generally said staff had a good level of skill and knowledge and conducted all required tasks in a competent manner at each visit. The service had a strong focus on ensuring it employed experienced staff who then undertook extensive training. Training was kept up-to-date and staff praised its effectiveness in Giving them the skills they needed to carry out their duties. Staff were supported with periodic observations, supervision and appraisal.
The service was acting within the legal framework of the Mental Capacity Act. People were given sufficient choices in relation to their care and support.
People and their relatives described staff as kind and caring and said they had the right personal attributes to ensure dignified care. The attitude of staff was regularly monitored and dignity and respect promoted with staff to help ensure a caring culture within the service.
People’s needs were assessed when they started using the service and plans of care put in place. We found some care plans required further detail, for example regarding pressure area care and nutrition.
Call times did not meet people’s individual needs and preferences. This meant people were not always receiving appropriate care as calls to provide food, continence care and assistance getting in and out of bed were occurring at irregular times.
A system was in place to record and respond to complaints. Most people told us they were satisfied with the service and where they had complained the service had offered to meet with them.
The service had access to a range of staff with specialist skills and knowledge to help continually improve the quality of care for example to improve clinical awareness. The provider was committed to further improvement of the service and had action plans in place to drive this improvement.
A range of audits and checks was undertaken by the provider. We saw some of these for example medication chart audits and daily record audits had been effective in addressing inconsistencies in documentation. However there was a lack of audits and monitoring to check t staff arrived consistently, and at an appropriate time each day.
We found three breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of this report.