This announced inspection was undertaken on Thursday 7 September 2017. The inspection was announced to ensure it could be facilitated on that day by the registered manager. This was the first comprehensive inspection we had undertaken at this service since they registered with us in January 2016.

Routes Healthcare Manchester is a domiciliary care agency based in Salford. The agency provides personal care to people in their own homes. The service covers a wide range of dependency needs including adults and younger adults, children, people with a learning disability, nursing care, people with mental health problems, The service also provides an end of life care service for people who prefer to stay at home whilst receiving care and support.

At the time of the inspection the manager of the service was not yet registered with CQC, however an application had been submitted and was being processed. 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 people we spoke with told us they felt safe. The staff we spoke with had a good understanding about safeguarding and whistleblowing procedures and told us they wouldn’t hesitate to report concerns about people’s safety.

We looked at how medication was handled. We found Medication Administration Records (MARs) were signed by staff when medication had been administered. People who used the service also told us they received their medication as part of their care package and told us they always received it on time. MARs were also checked by management when they were returned to the office to ensure there were no discrepancies.

We found there were sufficient staff to care for people safely. Staff spoken with didn’t raise any concerns about staffing numbers within the service and said their rotas were well managed.

Staff were recruited safely, with appropriate checks undertaken before they began working with people who used the service. This included ensuring Disclosure Barring Service/Criminal Records Bureau (DBS/CRB) checks were undertaken and references from previous employers sought.

The staff we spoke with told us they had access to sufficient training and supervision as part of their on-going development. Staff said they felt supervision was an important part of their job role where they could discuss different aspects of their work. Staff also had access to training in more complex areas relating to people’s care such as tracheostomy, catheter care and gastrostomy. Competency checks were also carried out to ensure sure staff had the correct skills before delivering this level of care.

Staff provided support to people to eat and drink as necessary. This included assistance with food preparation and ensuring people were left with something to drink when their call had finished. Where staff needed to provide direct support at meal times, the people we spoke with said this was done well.

The people we spoke with and their relatives told us they were happy with the care provided by the service.

Each person who used the service had a care plan in place and we saw a copy was kept in the person’s home and at the office. The care plans provided an overview of each person’s care needs and were updated when things changed. The people we spoke with also said an initial assessment was undertaken, when they first started using the service. This enabled the service to understand the level of care people needed.

The service distributed satisfaction questionnaires to people, asking for their comments about the service. This enabled the service to continually improve its practice with the aid of people’s experiences of using the service.

There was a complaint’s procedure in place, this procedure enabled peop