Routes Healthcare Rochdale was rated Requires Improvement overall following an October–November 2023 inspection, with a regulatory breach (Regulation 12) identified for failing to have care plans and risk assessments in place at the start of care packages, and for unsafe medicines management. Caring and responsive practice was rated Good, reflecting staff who treated people with dignity and responded well to individual needs.
Concerns (10)
criticalCare planning: “Care plans were not in place when people started receiving support from the service. The provider was reliant on staff using the local authority assessments when delivering care”
criticalCare planning: “Sometimes we go in blind, we have to use our own initiative and common sense [to deliver care].”
criticalMedication management: “One person did not have a prescribed medicine administered for 17 consecutive days as the medicine had ran out. There was no evidence that this had been reported”
moderateMedication management: “MARs were not always complete, recording of prescribed creams was not done consistently, PRN records were not always available”
moderateGovernance: “Governance systems did not always address immediate risks when identified through auditing processes.”
moderateGovernance: “Some of the audits completed by the service did not contain clear information about the action taken when concerns were identified.”
moderateRecord keeping: “Reviews of people's care were not recorded. The service updated care plans annually...however, the reviews undertaken and the conversations held...were not recorded.”
minorInfection control: “We received mixed feedback from people and their relatives about staff cleaning up after themselves and about staff wearing PPE during care visits.”
minorMissed or late visits: “We received mixed feedback from people and their relatives in relation to staff arriving on time for visits, being notified if staff were delayed”
minorStaff competency: “We received mixed feedback from people and their relatives about how skilled staff were to deliver care. People told us some staff were better in delivering care than others.”
Strengths
· Recruitment checks were robust to ensure staff were suitable to work with vulnerable people, with necessary safety checks in place before starting work.
· Staff had received training in safeguarding and were confident in how to report concerns; people felt safe.
· Staff knew people well, treated them with dignity, privacy and respect, and encouraged independence.
· Care plans reflected people's diverse needs, culture, lifestyle choices and daily routines.
· Complaints were responded to in line with the provider's policy and people knew how to raise concerns.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safely; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candour; Working in partnership with othersGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement