This inspection took place on 8 August 2018 and was announced. Regal Home Care 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, younger disabled adults, adults with mental health conditions and sensory impairments.

There were 77 people receiving a service at the time of the inspection. People were living with a range of needs including, sensory loss, Parkinson’s disease, diabetes, arthritis, dementia and mental health needs.

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.

At the last inspection on 6 July 2016 we found one breach of regulations and other areas of practice that needed to improve. This was because there was a lack of appropriate support and training for the staff.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key question of, is the service effective? to at least good. At this inspection on 8 August 2018 we found that they had followed their action plan and made the necessary improvements to address the breach of regulations. However, we found three other breaches of the regulations.

Safeguarding alerts had not always been sent to the local authority in line with local safeguarding practice. This was identified as a breach of regulations.

Risks were identified but assessments and care plans lacked detail. This meant that staff did not always have the information they needed to provide safe care. Complaints were not always resolved and used to make improvements to the service. Management systems were not always effective in identifying and managing risks, ensuring accurate records and making improvements to the quality of the service. This was identified as a breach of regulations.

Care plans lacked detail and did not always provide staff with information about what was important to people. This meant that staff did not always have the information they needed to provide care in a person-centred way. People told us that their regular care staff knew them well but they were not always sure who would be coming. The times of care visits were not always consistent with people’s needs and preferences. This was identified as a breach of regulations.

Staff had received the training and support they needed to be effective in their roles. One staff member told us, “Training is very thorough and informative.” Staff understood the importance of seeking consent from people and had received training in the Mental Capacity Act 2005.

People were supported to have enough to eat and drink. Staff supported people to access the health care services they needed. People’s needs and choices had been assessed in a holistic way to take account of people’s physical and mental health and their social needs.

People told us that they were happy with the support provided by their regular care staff and said that they had developed positive relationships with them. One person said, “I have a team of regular carers who know me well and understand what I need.” Staff supported people with their medicines safely. There were enough staff to cover all the visits that people needed. There were safe systems in place for the recruitment of staff.

People, and where appropriate their relatives, were involved in planning their care and support. A relative told us, “The care plan has been checked to make sure it meets my relation’s requirements.” Staff supported people to remain as independent as possible. People’s privacy and dignity were respected.

There was a clear management structure and staff understoo

The inspection took place on 6 July 2016 and was announced. We did this as the service is a domiciliary care agency and we wanted to ensure that appropriate office staff were available to talk with us, and that people using the service were made aware that we may contact them to obtain their views.

Regal Home Care Limited is a domiciliary care service providing support to over one hundred people living in their own homes, some of whom are funded by the local authority, whereas others fund their own care. The service provides care and support to enable older people, some of whom are living with dementia, to continue living in their own homes. The service is based in Pease Pottage, West Sussex.

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 care and support from staff that had access to essential training. However, some staff’s training was not up-to-date and there were concerns about the quality of the training staff had received and the impact of this on people’s care, particularly in relation to the administration of medicines. Staff told us that they were adequately supported and that they could approach the registered manager if they had concerns. However, staff did not always have access to regular supervision or observations of their practice. The lack of staff support and access to training are areas of concern.

People had their needs assessed and care plans devised to inform staff of their care and support needs. People told us that they were involved in their care and could make their thoughts and suggestions known. However, there was a lack of personalised information in relation to people’s hobbies and interests and people's care had not always been reviewed to ensure that it was up-to-date and meeting their current needs. This is an area in need of improvement.

The registered manager undertook some quality assurance processes to measure and monitor the standard of the service provided. However, there was not a robust quality assurance system and those that were carried out had sometimes failed to identify when systems were not working or required improvement. For example, the medication audit had not identified that there had been several occasions where people’s medication had run out and they had gone without medication for several days, nor did it identify that staff had failed to inform the office or a healthcare professional of this, to ensure that the person had access to their prescribed medication. Care planning systems were audited each month and the observations and supervision of staff were also monitored on a monthly basis. However, despite this monitoring showing that these were not up-to-date there appeared to have been no action taken to address this. This is an area in need of improvement.

People’s safety was maintained as they were cared for by staff that had undertaken training in safeguarding adults at risk and who knew what to do if they had any concerns over people’s safety. Risk assessments ensured that risks were managed and people were able to maintain their independence. Accidents and incidents had been dealt with and recorded appropriately.

People’s consent was gained and staff respected people’s right to make decisions and be involved in their care. Staff were aware of the legislative requirements in relation to gaining consent for people who lacked capacity and people confirmed that they were asked for their consent before being supported. One person told us “Yes they always do ask what I would like done or what I want them to do. It is very politely done”. Another person told us “They always ask my permission before they help”.

People

We looked at the care plans for five of the people who used the service. We saw that the provider had implemented a system to show people were included in decisions about their care. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. All the people we spoke with said that they were satisfied with the care they received. One person told us that their regular carer knew "Exactly what I like".

During our inspection we spoke with three people receiving a service and two of their relatives. We also spoke with three members of staff.

People told us they were satisfied with the service they received. Their comments included, “They are very thorough and are always polite and caring."

“They are very good and I am respected and treated properly."

"They come when they're supposed to and they're amenable if I want to change the way things are done."

We were concerned that people were not consistently supported to make an informed choice and consent to their care.

We spoke with one person who received support from Regal Home Care Limited. They said, “I am quite happy with the service”. We spoke with four relatives who told us that they were pleased with the care provided. One said, “The two main carers are amazing”. We looked at the compliments file and found many letters and cards expressing appreciation for the service. The most recent read, ‘Your staff were all kind and encouraging’ another, ‘Without exception all your ladies were very helpful and very friendly’.

We spoke with four care workers. They told us that they felt supported and that they had received appropriate training. One said, “It’s a brilliant job”, another, “We are there to support people, you become friends”.

We found that the agency asked for views and feedback from people and their relatives and that this was acted upon.