The inspection took place on 9 January 2019 and was announced. We also contacted staff, people using the service and their relatives by telephone to gain feedback about the service. The service was first registered on 14 December 2017 and this was their first ratings inspection.

Routes Healthcare (North) Ltd is a domiciliary care agency. It provides personal care to adults living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and children. On the day of our inspection 45 people were receiving support.

A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 service had a manager in place who had applied to register with CQC, however the application had not yet been finalised.

People told us they felt safe with staff from Routes Healthcare (North) Ltd. Staff had a good understanding of how to safeguard adults from abuse.

Staff were aware of their responsibilities if they were concerned a person was at risk of harm. Care files contained detailed individual risk assessments to reduce risks to people’s safety and welfare.

An electronic call monitoring system, to alert office-based staff in the event a person’s call had been missed, was in place and this was monitored.

People told us staff were usually on time and were not rushed. Some people told us they would prefer more consistency of care staff, although appreciated this was not always possible. Staff recruitment was safe.

A system was in place to ensure medicines were managed in a safe way for people. Staff were trained and supported to ensure they were competent to administer medicines. A sample of medicine administration records (MARs) were audited on return to the office to enable any concerns to be addressed. A gap in auditing due to previous staff shortage had now been addressed.

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. We saw evidence people had given their consent to the care and support they were receiving and mental capacity assessments and best interest decisions were in place where needed.

New staff were supported in their role, which included training and shadowing a more experienced staff member. We saw evidence staff had received regular on-going training in a variety of subjects. Staff received supervision and field-based observations of their performance, although the frequency was not always in line with the registered providers policy of four times a year. Plans were in place to address this.

People received support with meals and drinks if this was part of their care plan. Staff knew how to access relevant healthcare professionals if their input was required. The service worked in partnership with other organisations and healthcare professionals to improve people’s outcomes.

People told us staff were caring and supported them in a way that maintained their dignity and privacy. People were supported to be as independent as possible throughout their daily lives.

Individual needs were assessed and met through the development of detailed personalised care plans, which considered people’s equality and diversity needs and preferences.

Systems were in place to ensure complaints were encouraged, explored and responded to. People told us they knew what to do if they had any concerns or complaints about the service.

Most people told us they thought the service was well led. The registered provider had an effective system of governance in place to monitor and improve the quality and safety of the service.

People who used the service and their rel