This focused inspection took place on 10 May 2018 and was announced.

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.

The inspection took place on 16 November 2017 and was announced.

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