Royale Carers Limited Also known as Royale Carers

Royale Carers Limited provide personal care to people living in their own houses, flats and specialist housing. This is a domiciliary care service and primarily provides a service to older people, older people living with dementia or who may have a physical disability. At the time of inspection there were 43 people using the service.

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

Staff knew the risks people needed support with, however these were not always documented in peoples care plans. People and those acting on their behalf told us they or their family member was safe, and they had no concerns about their safety. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Suitable arrangements were in place to ensure people received their medication as they should, but where errors had occurred these had been investigated. Generally, there were enough numbers of staff available to support people safely. Staff recruitment and selection practices and procedures were robust. People were protected by the service’s prevention and control of infection arrangements.

People told us the service was well managed. Quality assurance arrangements enabled the provider and registered manager to monitor the quality of the service provided and staff performance.

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 June 2021). At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 19 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and to check whether the Warning Notice we previously served in relation to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royale Carers Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Royale Carers Limited provide personal care to people living in their own houses, flats and specialist housing. This is a domiciliary care service and primarily provides a service to older people, older people living with dementia or who may have a physical disability. At the time of inspection there were 44 people using the service.

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

Recruitment systems were not robust to ensure the right staff are recruited to support people to stay safe. This remained outstanding from our previous inspection in April 2019 and had not been addressed by the provider. Risks for people were identified and recorded in relation to their care and support needs but information relating to how risks to a person’s wellbeing and safety were to be mitigated were not recorded. Lessons are not always learned to support improvement.

There was a low incidence of safeguarding concerns and these were recorded and investigated. There were suitable numbers of staff to keep people safe and meet their needs. People received their medicines and accurate records were maintained. People were protected by the prevention and control of infection.

Staff received an induction, supervision and support in their role and areas of responsibility. People's healthcare needs were promptly met, and staff supported them with any nutritional and hydration needs. 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; the policies and systems in the service supported this practice.

People state the service is consistently well-led. Improvements have been made in relation to the service’s governance arrangements. The service involves people, relatives and staff in a meaningful way. The provider worked alongside other agencies to meet people's needs.

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 provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 18 [Staffing]. However, the provider was still in breach of Regulation 19 of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

The last rating for this service was Requires Improvement (published June 2019). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the provider's recruitment processes.

Please see the action we have told the provider to take at the end of this report.

Why we inspected

We carried out an announced comprehensive inspection of this service on 29 April 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and staffing.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royale Carers Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Royale Carers Limited provide personal care to people living in their own houses, flats and specialist housing. This is a domiciliary care service and primarily provides a service to older people, older people living with dementia or who may have a physical disability. At the time of inspection there were 45 people using the service.

People’s experience of using this service:

Feedback from people and their relatives about the care and support provided was positive. People told us staff were kind, caring, respectful and always treated them in a dignified manner. They confirmed that the care and support provided by the domiciliary care service was responsive and flexible to meet their needs. Staff ensured people were supported to eat and drink throughout the day. People received ongoing healthcare support as required.

Suitable arrangements were in place to make sure there were enough staff, so people received a reliable service. People confirmed missed and late calls were minimal. The service made sure people were involved in making decisions and choices about the care and support they received.

People told us they were safe and had no concerns about their safety and wellbeing. The service had effective safeguarding arrangements in place to protect people from harm and abuse.

People’s care and support needs were documented, and staff had a good understanding and knowledge of these and the care to be delivered.

Safe recruitment practices were not in place. Improvements were required relating to staff training, induction and supervision arrangements. Relevant national guidelines around the administration and recording of medicines was not always followed.

Effective quality assurance arrangements were not in place as these had not identified the failings highlighted within this report.

Rating at last inspection:

Following the last inspection, the rating of the service was ‘Good’ (Last report published October 2016).

Why we inspected:

This was a scheduled inspection in line with our scheduled inspection methodology and based on the service’s previous rating.

Follow up:

We will continue to monitor the service through the information we receive, and inspect the service, if risk is indicated.

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

Royale Carers provides personal care and support to people in their own homes. At the time of inspection there were 39 people who used the service.

The service is required to and did have 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.

The service needed to improve their quality assurance systems. Monitoring systems were in the process of being developed to achieve robust quality monitoring of the service. Although systems were in place to make sure that people’s views were gathered, developments were being made to analyse and produce action plans to make effective use of people’s views.

There were sufficient staff employed to keep people safe and plans had been implemented to ensure adequate staffing levels were maintained. People were safeguarded from the potential of harm and their freedoms protected. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Care workers supported people with their medication as required.

Care workers were knowledgeable about their roles and responsibilities, had received regular training and instilled confidence in people. They had the skills, knowledge and experience required to support people with their care. The service worked well with other professionals to ensure that people's health needs were met. Where appropriate, support and guidance were sought from health care professionals, including dementia nurses and social workers.

Staff understood people's needs and treated people with dignity and respect. Care plans were in place detailing how people wished to be supported. People felt listened to and were involved in making decisions about their care. An open and inclusive culture had been formed.

People's needs had been fully assessed and their care plans clearly described the support that they needed. Care plans and risk assessments had been kept under review and they were updated to reflect any changing needs. People who use the service were protected from the risk of abuse. The premises were suitable for running a small agency.

The recruitment process had not been as robust as it could have been; however, the provider/manager has now taken steps to address this. Staff were trained and supported to do their work. One staff member said, 'I have regular meetings with the provider/manager where we discuss training, she is very supportive.'

There were systems and processes in place for monitoring the quality of the service. People received safe, effective and compassionate care from a well led service that responds quickly to their changing needs.