Routes Healthcare is registered as a domiciliary care agency and provides a range of services including personal care and end of life care to people living in Bradford and Calderdale areas of West Yorkshire. At the time of inspection the agency was providing care and support to approximately 43 people.

We inspected Routes Healthcare on the 17 February and 2 March 2017. We announced the inspection 48 hours prior to our arrival to make sure the registered manager would be available.

Our last inspection took place 11 and 15 February 2016 and at that time we found the service was not meeting three of the regulations we looked at. These related to safe care and treatment, person centred care and good governance. This inspection was therefore carried out to see what improvements had been made since the last inspection.

At the time of inspection there was a registered manager in post. 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.

We found staff received training to protect people from harm and they were knowledgeable about reporting any suspected harm. Staff told us the training provided by the agency was very good and they received the training and support required to carry out their roles effectively.

Where risks to people’s health, safety and welfare had been identified appropriate risk assessments were in place which showed what action had been taken to mitigate the risk.

The feedback we received from people who used the service or their relatives about the standard of care provided was consistently good and people told us staff were reliable and conscientious.

The support plans we looked at were person centred and were reviewed on a regular basis to make sure they provided accurate and up to date information. The staff we spoke with told us they used the support plans as working documents and they provided sufficient information to enable them to carry out their role effectively and in people's best interest.

If people required staff to assist or support them to prepare food and drink information was present within their support plan and staff told us they encouraged people to eat a healthy diet. However, this was not always reflected in the daily logs they completed.

There were a sufficient number of staff employed for operational purposes and the staff recruitment process ensured only people suitable to work in the caring profession were employed. Staff were able to describe how individual people preferred their care and support delivered and the importance of treating people with respect in their own homes.

The registered manager demonstrated a good understanding of their responsibilities under the Mental Capacity Act 2005 (MCA) and staff demonstrated good knowledge of the people they supported and their capacity to make decisions.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received. People told us they felt able to raise any concerns with the registered manager and felt these would be listened to and responded to effectively and in a timely manner.

There was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in service provision. People who used the service and staff spoke highly of the registered manager and we found there was an open and honest culture within the service.

On this inspection we found no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 dail