This inspection took place on 27 and 28 September 2016 and was announced. The provider was given 48 hours’ notice of the inspection because the location provides a domiciliary care service and we needed to be sure that someone would be in to facilitate the inspection. The service had not been inspected since re-registering at the location address on 2 December 2014. At this inspection we found three breaches of Regulations in relation to the management of medicines, maintaining accurate records and monitoring and improving the quality of services.

Raye of Sunshine Care Services Ltd. is a specialist care provider, supporting children in their own homes. The aim of the service is to ensure families remain away from the hospital setting where possible and support is offered to children and their families. The service offered specifically designed training packages directed towards children’s individual care requirements, in partnership with the child’s multi-disciplinary team.

The people who used the service were all young children with complex care needs who did not have the capacity or capability to contribute their verbal opinion to the inspection. However, we observed and evaluated the interactions between the children, their parents and care staff which provided evidence of the quality of care provided.

There was a 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.

People received their medications as prescribed and care plans were used to outline key aspects of medicines management. Care staff were familiar with the range of medications used and what they were used for. There was no use of covert medicines being administered at the time of the inspection.

However a much more comprehensive policy was needed in relation to medicines management as the current policy being used for medicines management did not follow clinical, professional and industry guidance. We did not find any evidence of medication audits being undertaken. Staff said they were not always confident that the training they received was sufficient for the complex care packages they were involved with. There were no clear plans in place for reassessment of staff competencies over time, or following medication changes.

These issues meant there was a breach of Regulation 12 (2) (g) the proper and safe management of medicines; of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider did not have appropriate arrangements in place to manage medicines safely. You can see what action we told the provider to take at the back of the full version of this report.

The relatives of children who used the service told us they felt that staff had the right skills and training to do their job. There was a process of staff induction in place which was used to audit the progress of new staff relative to the induction process.

However there was no overarching staff training analysis or matrix in place that would assist the service to understand what types of training were needed and the dates training had been achieved or was planned. The Managing Director and Registered Manager were unclear when asked about mandatory training for their staff.

Staff received supervision and appraisal from a nurse, who acted as their immediate line manager. We saw records in staff personnel files of meetings that had previously taken place.

We found there was insufficient planning in place to ensure that the necessary theory and practical training was provided to the care team.

At the home visits, we observed care staff demonstrated a good awareness of the child’s needs and how to deliver effective care interventions. We found tha