We inspected Routes Healthcare Tameside on 11 and 12 October 2017. We gave the provider 48 hours' notice that we would be visiting the office to make sure that the appropriate people would be there to assist us with our inspection. This was the first inspection after the service registered with the Care Quality Commission in May 2016.

Routes Healthcare Tameside is a domiciliary care agency that works closely with healthcare commissioning teams in supporting people who have complex healthcare needs or are at the end of their life. The hours of support vary depending on the assessed needs of people. The service provides 24 hour support for some people with complex needs. At the time of our inspection 29 people were receiving a service.

The service had a registered manager. 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.

People received extremely personalised care which was delivered in accordance with their wishes and lifestyle. The service employed a nurse, who with the support of care coordinators, carried out assessments which looked at people's interests and lifestyle choices as well as their needs. This enabled them to match people to staff who shared their values and therefore helped them to build relationships. This had proved valuable when working with people who found it hard to accept help.

Staff developed exceptionally positive and caring relationships with people and their families. Staff were very motivated and demonstrated a commitment to providing the best quality care to people in a compassionate way. People told us their privacy and dignity was maintained at all times.

There was a clear management structure in place and oversight from the provider. There were systems in place to monitor the safety and drive the continuous improvement of the quality of the service provided. A comprehensive programme of audits and checks were in place to monitor all aspects of the service, including care delivery, accidents and incidents, health and safety and medicines. Audits resulted in clear action plans to address shortfalls or areas of improvement.

The manager displayed good leadership qualities, drive and enthusiasm. They empowered staff to provide care that was tailored to people's individual needs. Without exception, people, their relatives and professionals told us they experienced and we observed, compassionate care from staff who strove for excellence. This ensured the service was run in the best interest of people who used the service.

Risks that were associated with people's care were assessed and managed well. Where people received support from staff with taking prescribed medicines, this was done in a way that ensured people were supported with their medication safely.

Safe recruitment procedures were followed before new staff were appointed. Appropriate checks were undertaken to ensure staff were of good character and were suitable for their role. The staff induction programme was comprehensive. Staff views were very positive about the support, guidance, training and supervision they received.

People were safe because staff had received training and understood the different types of abuse and knew what actions they should take if they thought that someone was at risk of harm. Staff were knowledgeable about the actions to take in the event of emergencies and about how the risks to people in respect of their care should be managed.

Staff demonstrated an in-depth awareness of the principles of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards (DoLS) within a community setting. The service was in the process of incorporating a section in people’s care plans that assessed their mental capacity.

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