Routes Healthcare Tameside

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to staffing as we were not assured staff had the right skills, knowledge and competencies to provide care and support to people.

This service scored 56 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events.

People and their families told us there were frequent changes within the management and staff structure which at times impacted on people’s outcomes. People did not always feel they could speak to the leaders of the service and their concerns would be acted upon. One person told us, “We had given up trying to talk to with managers. Nothing gets sorted.”

We received mixed feedback from staff regarding raising concerns. One staff member told us, “Yes, I feel I can raise concerns.” Another staff member told us, “When I raise things of concern with the office, it never gets looked into. Nothing gets done and it feels like it is a piece of paper to put in a file.”

There were processes and policies to support a learning culture. We saw some evidence of learning identified, for example the provider developed an internal action plan to support improvements and address any shortfalls in care operations. Additionally, we saw the provider started to address some historical complaints raised by people. Following our feedback, the provider had also taken action to improve some of its internal recruitment processes and checking staff competencies. These improvements also included addressing issues with effective communication with both people and staff.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

People told us they did not always feel safe due to staff not having relevant skills, knowledge and training. One relative told us, “We got used to a carer, they got used to us, understood our needs, did a good job, then got moved and we never saw them again. New carers turn up who do not have a clue about care, or what is needed.” Another relative told us, “There was no specific training for my loved one’s needs. They feel at risk and unsafe.”

There was evidence of risks being identified for example people with complex needs such as those requiring special assistance with their diet using a percutaneous endoscopic gastrostomy (PEG) tube which is a feeding tube placed directly into the stomach to provide nutrition. However, actions to reduce some identified risks were not always comprehensive which could impact on the safe delivery of care to a person. For example, one person had a risk assessment in place regarding their skin integrity. However, there were very few details regarding what action was taken to mitigate risk of changes to their skin such as skin ulcers, especially as the person was immobile.

We received mixed feedback from people regarding their involvement in care planning. One person told us, “Yes, I do get involved.” Another person told us, “We did have a care plan, but this was taken to the office, and we have not seen it since, there are no reviews.” We did not receive any feedback from professionals or other stakeholders who worked with the provider. However, we saw some evidence of the provider working with professionals such as commissioners, general practitioner or physiotherapist. The provider used hospital passports and one-page profiles to ensure continuity of care during transitions.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff received appropriate safeguarding training. One staff member told us, “We do e-learning, once it’s expired, we need to do it again. We also do some training in the office. The training tells us what we need to do and how to report things. If you don’t pass, they will tell you to do it properly or we can’t work.”

Staff who we spoke with had a good understanding of how to keep people safe. One staff member told us, “Once I spot something I report it to make sure my client is ok.” Another staff member told us, “I would raise concerns to my manager, and I would send an e-mail and write a statement. My manager would action the safeguarding.”

There were systems, processes and policies in place to make sure people were protected from abuse and avoidable harm. Provider reported safeguarding issues to the local authority in line with local guidance.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do things that mattered to them.

We received mixed feedback from people regarding their involvement in their own care to support their independence and to include them in decision making. However, both people and staff told us not all the staff had the right skills, knowledge and training which could put people at risk of harm. One relative told us, “There are inexperienced carers making mistakes with my loved one’s care and not understanding their needs. Carers have hurt my loved one due to the moving and handling errors.” Another relative told us, “My loved one has dementia, and carers just don’t know how to help them.” We also received the following feedback, "There is a hoist here, but they[staff] don't have to us it very often .When they do, they are careful, and they know how to use it."

People’s risks were identified and reviewed. People’s care plans contained information about identified risks. Staff understood people’s risk and knew how to keep people safe. However, some care plans were more detailed regarding the mitigation of assessed risks than others, and we told the provider about this. The provider was in the process of reviewing people’s care plans and risk assessments were to be reviewed as a part of this process to ensure risk assessments and their mitigation were comprehensive and robust.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Provider completed risk assessments within people’s own homes where care was provided and outcome of these were communicated with staff.

People and staff did not raise any concerns with us regarding how environmental risks were identified and managed by the provider.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

People told us there was no consistency with staff and frequent changes impacted on the outcomes of their care. One person told us, “We have many carers who are completely new, and they are being moved around by the office, so there is no consistency for my loved one.” One relative told us, “Carers are changing all the time, that’s the problem, there is too much change.” Staff also commented that changes made to their teams impacted on the way care was being provided to people, adding additional barriers and challenges. One staff member told us, “They [office] are starting to put new people with us, but they have no skills, and it is hard work to be honest. It is like you are working on your own. We try to feedback to the office, but they are hiring people who when you ask them to make a sandwich they don’t know how. They [new staff] are struggling with the basics.”

People also told us staff did not always turn up on time, or on occasions at all. One person told us, “Some turn up early, some turn up late. They always have too much work on, and they are in a hurry to go. One day, we were told by the carers there were only 2 carers covering the whole area.” Another person told us, “Sometimes they send one carer instead of two.”

Staff were recruited safely. There was evidence of references being sought prior to staff commencing employment. The provider completed criminal checks for staff and ensured staff had a right to work. Gaps in employment were identified and when required these were followed up. We could not see probation reviews were conducted for staff upon completing their probationary period and we told the provider about this. The provider informed us, this was confirmed with staff verbally. However, following our feedback the provider was going to review their internal recruitment procedures to ensure this was recorded in writing.

Staff received training, which was a mixture of online, and some face to training delivered in a classroom setting. One staff member told us, “We do have regular online training.” New staff received induction training prior to starting and were offered shadowing shifts with more experienced colleagues. One staff member told us, “My induction was not just going to the office and getting my uniform, they also paired me with an experienced carer. I went in 2-3 times to show me the ropes.” Whilst an induction process was in place this required further development and improvement action taken to be taken by the provider to ensure staff have adequate knowledge to provide support to people. The provider had tools to monitor staff compliance. However, we were not always assured staff had an adequate level of skills, knowledge and

experience to support people in a safe and person-centred way. Both people and staff expressed their concerns in this area especially regarding new recruits. One person told us, “The carers are not trained to support my loved one. New carers are being taken on with absolutely no experience. We have total strangers walking in to provide care. There is no consistency.” One relative told us, “My loved one has very complex needs but there was no specific training to meet their needs, and they feel unsafe. “One staff member told us, “The staffing issues impact you so much. The office doesn’t seem to care as a competent member of staff you have to carry the load as long as the shift is covered by whoever.”

People and relatives also shared some concerns about staff’s ability to communicate effectively with people where English was not their first language. One person told us, “Sometimes it is difficult because we can’t understand them, and they can’t understand us.”

Staff received regular supervisions. One staff member told us, “Yes, we do have supervision. I think I have received this once or twice this year.” However, the provider’s policy was not clear on how often staff supervision should be taking place. We saw no evidence staff received appraisals. Staff were provided with opportunities to attend meetings where they were able to share their feedback. One of the managers told us communication and engagement with staff was one of their priorities and formed part of an internal action plan which was ongoing.

Staff were provided with opportunities for further professional development. One staff member told us they were currently completing a level 5 qualification in Health and Social Care.

The provider assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly.

There were appropriate policies and procedures in place to support infection prevention and control. Staff completed specific training and had a good understanding of safe infection control practices. Staff told us they had good access to PPE (personal protective equipment) and we observed the provider maintained a good stock of it. One staff member told us, “We have a good stock of everything and if we need anything they[office] send it.” The provider addressed any concerns regarding infection control and shared good practice with staff during staff meetings, supervisions and competency checks.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Saff did not always involve people in planning.

There were policies and procedures in place to support how medicines were administered to people. People’s care plans contained a good level good level of information regarding their medicines and the support they required in administering these. The provider used an eMAR to record when people’s medicines were administered. However, not all of the medicines were administered at the times they were prescribed at. There was a potential people’s well-being, and their health outcomes could be put at risk for example if they were prescribed time specific medicines. Staff received medicines training and their competency to administer medicines was assessed and reviewed. However, some of the competency checks were completed as a part of the training session rather than during the actual care task. We told the provider about this, and they agreed to review the existing procedures on how staff competencies were completed in the future.

Staff had good a understanding of how to support people with their medicines and knew when to seek support and advice. One staff member told us, “Medicines are quite important, and you need to know what time to give it to, who to give it, and what sort of medication it is. You don’t want to give something you are not supposed to. We do medicines training once a year.” When people required support with their PRN medicines (PRN medicines are medicines not required on a regular basis, such as paracetamol). There was guidance in place which informed staff of when and how to administer these medicines to people.