Routes Healthcare Tameside

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was consistent.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment was effective because they did not always check and discuss people’s health, care, well-being and communication with them.

People’s needs and the way they wished to be supported, were not always assessed by the provider prior to them accessing the service. For example, we saw one person had their needs assessed by the local authority but not the provider. People’s needs were periodically reviewed and their care plans updated as a result. This included assessing and reviewing identified risks. One person told us, “My care plan has been updated, and I communicate regularly with the office through e-mail and phone calls.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

People told us they were not always involved in their care planning. Some people did not always have access to their care plans which was caused by difficulties accessing electronic copies.. One relative told us, “We did have a care plan, but it’s been taken to the office, and we haven’t seen it again.” People’s care and support was recorded by staff using electronic care notes. However, we found notes were task based, lacked detail and did not record people’s choices or preferences. Oner staff member told us about difficulties they experienced in completing care notes due to time pressures and the number of visits they had assigned. They told us, “Sometimes we have to write notes in the car, when our other colleague is driving as we have no time do it in the call.”

This issue had been identified by the provider and was included on their improvement plan. The importance of good note taking was discussed with staff in their supervisions and during staff meetings.

Staff had a good understanding of meeting people’s diet and hydration needs and received adequate training when people required additional support or specialist equipment. People received support and advice from relevant professionals when needed for example, their GP ora dietician. The provider had also drawn on support from internally employed nurses in supporting people with more complex needs.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Staff did not always work well together to ensure people received good care. We received mixed feedback from staff regarding collaborative working. Some staff told us their colleagues lacked appropriate skills and training which made working together and supporting people difficult and at times unsafe. One staff member told us, “During one shift, the office sent somebody who was on their first ever shift. They had no training; no competency checks no training for this client. This is a regular occurrence.” Another staff member told us, “We communicate well together and support each other where we can. I can contact my client’s medical professionals, and they will respond appropriately. They are very good.”

Staff told us they did not always feel they could raise concerns, and if they did these would not be followed up. One staff member told us, “I don’t feel listened to by the office staff, when we raise concerns that new staff can’t do basics they don’t do anything.” Another staff member told us, “I would like to think concerns would be looked into.”

Staff had some opportunities to provide feedback for example in the form of supervision. Staff were provided with opportunities to attend internal meetings. However, we received mixed feedback from staff regarding their frequency. One staff member told us, “To be honest I have not had a meeting with the office in 12 months. I can’t even remember the last meeting I have had with the new manager because we have had so many.” Another staff member told us, “Yes, we have meetings, every 6 months. The manager will arrange a staff meeting to hear from us about the service including any changes or concerns.” Some staff told us they worked with other professionals to meet the needs of people they supported. One staff member told us,” If anything is needed for example if my client needs medicines, I ring the pharmacy and then go and collect medicines.”

The provider used hospital passports and one-note profiles to share information with other professionals. For example, when people were admitted to hospital.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff enabled people to receive advice and support from relevant professionals such as GP or physiotherapist. Staff actively assisted people in meeting their needs regarding adequate diet and hydration by cooking people’s meals and assisting them to eat. People told us, staff offered help in meeting their personal hygiene needs. One person told us, “They [staff]help me to have a wash and put a cream on.”

People’s individual preferences were captured in people’s care plans. Some of these care plans were more detailed and comprehensive than the others. This was identified through the provider’s internal improvement plan and action was taken to address any shortcomings. When updated care plans were comprehensive, detailed and reflective of people’s needs. Staff we spoke to understood how to meet peoples’ individual needs and supported them in meeting their health outcomes.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We saw people’s care plans were updated when people’s needs were changing. This included relevant risk assessments. The provider also used review tools such as case studies where the person’s individual needs were considered, reviewed and adjustments to the support if required were agreed. However, people told us they were not always involved in their care planning or had access to care plans. One relative told us, “The manager has called me, but I have no care plan.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff had a good understanding of the importance of seeking people’s consent prior to commencing any support. One staff member told us, “If I have to do something for my client I would always ask in a discreet way. I wouldn’t just go in and start doing things.” Another staff member told us, “I obviously talk to my clients about what I’m going to do and ask for their consent.”

Staff received training in the Mental Capacity Act. Staff had a good understanding of the Mental Capacity Act 2015, including what mental capacity meant.

We saw people’s care plans contained information regarding their mental capacity. Where people lacked mental capacity there was information recorded about who was acting in the person’s best interest and there were copies of Lasting Power of Attorneys in place to confirm this. However, this was not always noted in people’s care plans which meant staff were not always clear about whom to contact when decisions about people’s care needed to be made. We told the provider about this, and they were going to review this as a part of the ongoing improvement plan.