We carried out an announced inspection of this service on 26 and 27 March 2018.

Routes Healthcare Liverpool is registered to provide personal care to people living in their own homes and communities. It is also registered to provide services for the treatment of disease, disorder and injury (TDDI). At the time of the inspection 21 people were receiving the regulated activity of personal care. At the time of the inspection Routes Healthcare Liverpool was not providing TDDI services.

A registered manager was 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.

The majority of people that we spoke with had no concerns about the safety of services. However, some people commented on the lack of consistency of staff and irregularity of call times. We made a recommendation regarding this.

Staff were safely recruited following the completion of appropriate checks. The service had recruited sufficient staff to ensure consistency for people receiving care.

People were protected from potential harm because staff knew them well and were trained to recognise signs of abuse or neglect.

The care files that we saw showed clear evidence that risk had been assessed and reviewed when people’s needs changed. Risk assessments were sufficiently detailed and included guidance to reduce the level of risk.

Medicines were managed safely in accordance with relevant guidance. Staff were trained in the administration of medicines and had their competency assessed. Medicines’ audits had been completed and had identified minor issues which had been corrected.

Staff had been trained to ensure that they had the rights skills and experience to meet people’s needs. Staff told us they felt well-supported by the service and were given regular supervision. Annual appraisals were planned, but none of the staff had been employed for 12 months at the time of the inspection.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). Where required, people’s capacity was assessed in conjunction with families and professionals.

People’s day-to-day health needs were met by the service in collaboration with families and healthcare professionals. Staff supported people with their healthcare needs and used information to update care plans.

We did not have the opportunity to observe staff providing care as part of the inspection process. However, people told us that they very were happy with the quality of care and support provided.

Senior staff and managers were knowledgeable about each of the people that used the service and regularly worked along-side care staff. Care staff told us that they enjoyed providing support to people and were able to explain how they involved them in making decisions about their day-to-day care and support.

Staff respected people’s right to privacy and were mindful of this when providing personal care. Staff explained the practical steps they took to respect people and maintain their dignity.

People and their relatives contributed to the assessment and planning process and were given choice over each aspect of their care. Care plans had been reviewed when people’s needs changed and signed by the person or their representative. The care records that we saw were sufficiently detailed to instruct staff and contained person-centred information.

None of the people receiving care at the time of the inspection had specific needs in relation to equality and diversity. Relevant questions were asked during the assessment process to establish if people had any needs relating to equality and diversity which required specific consideration.

The service supported people with end of life care. We saw an example of an end