The inspection of this service took place on 13, 14 and 15 June 2018 and was announced.

Routes Healthcare Rochdale is a domiciliary care agency providing personal care to people across the north of Greater Manchester in their own homes. It is registered to provide personal care and treatment for disease, disorder and illness. The service provides excellent services to children and adults with complex health and social care needs. Services include 24 hour support; up to five domiciliary visits a day, a night sitting service and carer breaks. When we inspected, the service was supporting 131 people. However, this figure could change on a daily basis, as they supported a large number of people who were on an end of life care pathway. The service provides an extremely efficient and speedy response to requests to ‘fast track’ people at the end of their lives to return home from hospital so they could spend their last hours and days in the comfort and familiarity of their own homes and allowing them respect and dignity in their final days.

This was the first inspection of Routes Healthcare Rochdale since they moved to their current premises. At a previous address the service was last inspected in February 2016 when it achieved a rating of good overall, with outstanding in care. At this inspection we found the service continues to maintain and improve standards.

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. The service did not have a registered manager at the time of our inspection. Services without a registered manager cannot be rated as ‘Good’ in the well led section of our inspection. We were told that a new manager had been appointed and started the registration process. An area manager had taken responsibility for the day to day management of the service and to ensure a smooth transition to the newly appointed manager. This person was supported by a Deputy Manager who was on leave on the days of our inspection. Both the area manager and the nominated individual were present during the inspection. They told us that they were keen to ensure that the service recruited a registered manager who had the appropriate managerial know-how and the clinical knowledge and understanding to meet the complex needs of the people supported by Routes Healthcare, and wanted to ensure the right person was recruited.

Training opportunities for staff were exceptional, with consistently high-quality training provided to all staff. Bespoke training was delivered face to face by people who knew the issues and risks involved in supporting people with diverse and complex social care needs, and specialist training was provided for staff who were working with people who had complex or life limiting illnesses, so that they were able to use specialist equipment and monitor, manage and minimise any risk to the individual.

Care staff demonstrated an exceptionally caring and enthusiastic approach to meeting the needs of the people they supported. They were kind and considerate of people’s needs and abilities and were prepared to go the extra mile to ensure needs were met, and that the people they supported were comfortable. There were many examples of how their caring outlook had a positive impact on people’s lives.

Care plans showed really good attention to detail and were flexible to meet day to day changes and changing needs. This meant that care staff could arrange with the people they supported to spend less or more time with each person they supported, depending on their needs on the day.

Care records contained important information about people and daily records were clearly written and gave detailed and factual accounts of each intervention.

To ensure staff mai