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 understood their roles and responsibilities. Staff described effective communication and had developed working relationships with local partners including GPs, the local authority and other health care professionals.
We identified three breaches of the regulations. This is the second consecutive time that the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.