Archived: Royale Care UK Limited

Royale Care UK Limited is a domiciliary care agency supporting older people living in their own homes. Not everyone using Royale Care UK Limited receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

At the time of our inspection the service was supporting 13 people, eight of whom were receiving personal care.

People’s experience of using this service and what we found

There was no registered manager in post which impacted on the service people received. This had led to a lack of organisation and responsive action when concerns were raised. Managerial oversight of the service was poor and quality systems were not effective in identifying concerns.

People and their relatives told us they rarely received a rota informing them which staff members would be supporting them. They told us that care calls were often late and they were not informed, and some care calls had been missed. People said that they found it difficult to get a response from the provider regarding this and said their complaints were not responded to. During our inspection we informed the provider of two missed calls which they were unaware of. Audits and systems to check the quality of the service were not always effective and the provider did not always respond to concerns in an open and transparent manner.

Recruitment checks to ensure staff were safe to work at the service had not been fully completed. The provider failed to produce training and supervision records to confirm if staff received on-going support and completed the training required for their role.

Assessments lacked detail which meant there was a risk the service would be unable to meet people’s needs. Care plans and risk assessments were not personalised and did not give sufficient guidance to staff on how to provide people’s support. This issue had previously been highlighted by the local authority quality assurance team, but had not led to improvements. Records were not securely and accurately maintained. The provider told us they were unable to access a number of records as they had changed IT provider. We have made a recommendation regarding people’s communication needs being recorded in detail in line with the Accessible Information Standard.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice.

Although people expressed concerns regarding the management of the service, they told us that individual staff members treated them with respect and knew their needs well. We observed staff show kindness and consideration when speaking with people.

There were multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 17 June 2018)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service and what we found

During our last inspection in June 2019 we found significant concerns regarding the governance of the service and the care people received. At this inspection we found there had not been sufficient improvement in the management and leadership of the service. There was a continued lack of management oversight and governance which meant the provider could not ensure people received a safe, effective and responsive service. Audits and action plans had not been effective in driving improvement in all areas and deadlines for completing actions had been missed. The provider had failed to fully engage with external agencies in order to monitor risks and to develop and maintain improvements. Information was not provided in a transparent and timely manner when requested.

Staff were not fully aware of their responsibilities in safeguarding people from harm. Requests for information in relation to safeguarding concerns were not always responded to. The local authority is in the process of investigating safeguarding concerns in relation to two people’s care. The provider had failed to ensure people’s confidential records were securely stored. Risks to people’s safety were not always monitored. Robust medicines management processes were not followed. Changes to people’s needs were not always responded to in a timely manner which put people at risk.

Staff were not always recruited safely and checks on agency staff were not completed. The provider had not assured themselves that staff had the skills and experience required to provide people’s care safely. Staff had not received training and supervision to support them in their roles. Staff rotas were not always followed. There was evidence that staff did not always stay for the full duration of people’s calls and missed calls were reported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not fully support this practice as staff were not fully aware of the Mental Capacity Act 2005 and how this impacted on their role. We have made a recommendation regarding this.

People were positive about the individual staff members supporting them and described them as caring. People and their relatives told us they had been involved in developing their care plans since the last inspection. Concerns raised by people were being responded to promptly and the complaints policy had been reviewed. People received support with their food where required and staff supported people to access health and social care professionals.

Rating at last inspection and update: The last rating for this service was Inadequate (12 August 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We took enforcement action to issue a Notice of Decision to cancel the provider's registration. Royale Care UK Limited is now de-registered and is no longer able to provide regulated activities.

Follow up: We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures: The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Royale Care UK is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults. At the time of the inspection the service was providing personal care to 17 people.

The service was last inspected on 6 November 2017 and was given an overall rating of ‘Good’.

At this inspection on 10 May 2018, we made a recommendation about the management of medicines. We also found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection was carried out in response to concerns we received about the service provision in relation to the management of the service, after our comprehensive inspection had taken place. We inspected the service against two of the five questions we ask about services: is the service well led and is the service safe. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going 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.

The service did not have a registered manager in place. At the time of the inspection the manager had submitted an application to the Commission to become registered. 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.

There were systematic and widespread failings in the oversight and monitoring of the service. Auditing systems in place were not comprehensive and failed to identify issues we identified during the inspection.

Records management was not in line with good practice. The provider was not always clear on what records the service were required to maintain in relation to the management of the service.

Records were not easily accessible or in place.

The management of the service was minimal as there was no manager based at the service and due to staffing levels, the provider was required to carry out the regulated activity ‘personal care’. Although staffing levels appeared adequate, records relating to missed or late calls, was not sufficiently recorded and actioned.

People’s medicines were not managed safely and in line with good practice. Medicine recording charts were not always completed correctly and medicine audits did not highlight errors identified during the inspection.

The provider had developed risk management plans that identified known risks and gave staff guidelines on managing the risks. Staff were aware of the different types of abuse and how to respond to, raise and escalate suspected abuse.

People were protected against the risk of cross contamination as the provider had clear policies and provided staff with personal protective equipment in the management of Infection control.

The provider had carried out appropriate pre-employment checks prior to ensure the staff’s suitability for the role.

Incidents and accidents were reviewed and action taken to minimise the risk of repeat incidents. However records of all incidents and accidents were not always maintained effectively.

The provider sought people’s views of the service provision to drive improvements, however it was not always clear what action had been taken to address people’s identified concerns.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older and younger adults. At the time of our inspection the service was supporting 22 people, 18 of whom required support with their personal care.

There was no registered manager 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 previous registered manager had recently left the service. The provider told us that recruitment for a new registered manager was underway. During the inspection we were supported by the provider and care coordinator for the service.

People told us they felt safe with the staff supporting them. People were supported by regular staff members who arrived for the care calls on time and stayed for the planned duration of the visit. Staff were knowledgeable about their responsibility to keep people safe from harm. All staff had completed safeguarding training and were aware of protocols for reporting suspected abuse. Risks to people were assessed and managed to help keep people safe. Accidents and incidents were reported and action taken to minimise the risk of them happening again. Staff followed safe infection control procedures and this was checked by senior staff during unannounced spot checks. There was an on-call service available to people over a seven day period to provide support in an emergency and to ensure all care calls were covered. The service had plans in place regarding how people’s support would be provided in the event of an unplanned event or emergency.

Recruitment checks were completed to ensure that staff were suitable to work in the service. New staff were supported through an induction process to ensure they knew people’s needs well and understood their responsibilities. On-going training was provided to staff and one to one supervisions were completed to monitor performance. Staff told us they felt supported by the provider and their colleagues.

People received support to access healthcare professionals where required. Staff understood the importance of reporting any health concerns and senior staff ensured that appropriate health referrals were made for people. Staff received training in the administration of medicines and their competency was assessed. Records showed that people received their medicines in line with their prescriptions. Care plans were in place for people who required support with meal preparation. People told us that staff offered a choice and always ensured they had a drink available. People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed. People told us they felt involved in decisions regarding the care.

People were supported by staff who knew them well. Staff were introduced to people prior to supporting them and supported the same people on a regular basis. People told us that staff treated them with kindness and respected their privacy. Staff ensured that people’s dignity was protected and their independence promoted.

People’s needs were assessed to ensure they could be met prior to the service starting. Detailed care plans were developed and people felt involved in this process. Regular reviews of people’s care needs were completed to ensure changes were implemented where required. Where appropriate, care plans included details of the support people wanted when nearing the end of their life. People told us that staff were responsive to their needs and the care provided was person centred.

There was an open and positive culture in the service. People, relatives and staff told us they felt the provider and office staff were approachable and worked together as a team. Quality assurance processes were in place to monitor the service provided and prompt action was taken to address any shortfalls. People and relatives were regularly asked their views on the service provided and where improvements could be made. There was a complaints policy in place which was shared with people and their relatives. Where complaints had been made these were responded to quickly and to people’s satisfaction.

This was the first inspection of the service since it’s registration with the Care Quality Commission in November 2016.