We undertook an unannounced focused inspection of Routes Health Care Burnley on 26 October 2018. This inspection was prompted by an incident which had an impact on a person using the service. This matter is subject to an investigation by another agency but indicated the potential for concerns about the management of risk in the service. The team inspected the service against two of the five questions we ask about services; is the service safe and is the service well led.

No risks or concerns were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

This service is a domiciliary care agency. It provided personal care to people living in their own houses and flats in the community. It provided a service to people who were considered to be at the end of their life.

The service had a registered manager 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.

All the staff we spoke with confirmed they had received safeguarding training and that safeguarding policies and procedures were in place to guide them in their roles. Training records we looked at showed that safeguarding adults was an annual, mandatory course [a course the provider had deemed necessary as part of people’s roles]. Other safeguarding records we looked at showed the registered manager had notified the appropriate authorities when a safeguarding concern had been raised.

The service had a recruitment policy in place to guide the manager on safe recruitment processes. We looked at four staff personnel files. There was excellent evidence of records to demonstrate adequate checks had been undertaken prior to making a decision to employ people.

Records we looked at also showed that continuous checks of staff competence and suitability was monitored through spot checks, direct observations, supervisions and appraisals. This meant the registered manager and provider were able to ensure any concerns or gaps in knowledge were addressed to ensure staff remained suitable and competent.

We saw where concerns or complaints had been highlighted about the conduct of any staff member, the registered manager and provider had acted accordingly through robust disciplinary procedures.

We looked at how risks to people’s individual safety and well-being were assessed and managed. Care records contained risk assessments in relation to areas such as pressure ulcers, skin integrity, medicines and moving and handling.

Some people who used the service required equipment such as hoists to assist them to move. All the staff we spoke with told us they had received moving and handling training and this was in a classroom so they could practice using the equipment. Whilst the service was not responsible for the maintenance of any equipment, staff knew to report any faults or safety issues to external agencies.

We noted records were kept in relation to any accidents or incidents that had occurred at the service, including falls. All accident and incident records were checked and investigated where necessary by the registered manager.

All the staff we spoke with, told us they had received training and were aware of their responsibilities in relation to infection control. The service had an infection control policy to guide staff in their roles and to reduce the risk of cross infection.

We asked the quality manager how they shared any lessons learnt. The service was open and transparent about lessons learnt. The quality manager told us all lessons learnt were discussed at

We carried out an inspection of Routes Healthcare – Burnley on 16 and 17 October 2017. We gave the service 48 hours of our intention to carry out the inspection.

Routes Healthcare - Burnley is registered to provide personal care to people living in their own homes. The agency specialises in providing rapid care for people nearing the end of their life. At the time of the inspection there were 37 people using the service.

The service had a manager in post, who was in the final stages of the registration process. Following this process, the manager will be registered with the Care Quality Commission. 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.

This was the first inspection of the service since the location was registered on 16 November 2016.

People using the service consistently told us they felt safe and staff treated them well. Safeguarding adults’ procedures were in place and staff understood their responsibilities to safeguard people from abuse. Potential risks to people's safety and welfare had been assessed and preventive measures had been put in place where required. People received their medicines safely and were supported to eat and drink in accordance with their care plan.

Staff support was planned flexibly in line with people’s needs. Staff had the knowledge and skills required to meet people's individual needs effectively. They completed an induction programme when they started work and were up to date with the provider's mandatory training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s healthcare needs were monitored as appropriate and staff worked closely with social and healthcare professionals.

Staff were respectful of people’s privacy and maintained their dignity. All people spoken with told us the staff were kind and caring. People were involved in the development and review of their care plans. This meant people were able to influence the delivery of their care and staff had up to date information about people’s needs and wishes. People were aware of the complaints procedure and processes and were confident they would be listened to.

People were provided with a safe, effective, caring and responsive service that was well led. Systems were in place to monitor the quality of the service, which included seeking and responding to feedback from people and their relatives in relation to the standard of care.