About the service:

Romie care Services Ltd is a domiciliary care service which is registered to provide personal care to people living in their own homes. At the time of inspection, 70 people were receiving care and support services.

The service had a registered manager who is registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

People’s experience of using this service:

• The provider’s systems had not been effective at improving the quality of the service and the service had failed to achieve and sustain a minimum overall rating of ‘Good’ at four consecutive inspections.

• In the previous Inspection (report published 05 December 2018), we found three breaches of regulations and we issued a warning notice, requiring the provider make the required improvements. This was a focussed inspection to check their progress and if they had now met the regulations.

• At this inspection we found some improvements had been made. The service has improved in the key question of responsive, which we now rate as good and the regulation had been met. Improvements have also been made under safe and well led, however, further improvements were needed and the rating for safe and well led remain as ‘requires improvement.’ The provider remains in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

• Since the last inspection improvements had been made and rotas and calls times had been re-organised. People told us call times had improved and were now consistent. Staff told us the rotas were better organised and much improved. However, we found some calls were still shorter than agreed and allocated call length, for example, we found evidence that some people had received some calls that were less than half of the agreed time

• Some risk assessment records, giving staff guidance on people’s risks, had not been updated and reviewed in line with the provider’s own guidelines.

• We found that comprehensive audits were not in place in all areas and that areas identified as requiring improvement at the last inspection, for example, call lengths, had not been addressed.

• Improvements had been made in the management of concerns and complaints. A daily log of calls had been developed to give the action taken in response to each call and this was analysed monthly. Written complaints received had been logged, investigated and responded to and subsequent follow up calls made to ensure people remained satisfied.

• People and their relatives said the management of the service had improved since the last inspection.

Rating at last inspection: At the last inspection we rated Romie care Services Ltd as ‘Requires Improvement’ (report published 05 December 2018).

Why we inspected: In the previous Inspection, we found breaches of regulations and we issued a warning notice. This was a focussed inspection to check their progress and if they had now met the regulations.

Enforcement:

Full information about CQC’s regulatory response to the more serious concerns found in inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At our last comprehensive inspection of this service in November 2017, we rated the service as ‘requires improvement.’ This was because we found sometimes people did not receive the care and support as planned as calls were late, early or missed. People felt this was due to staff not being available and due to shortfalls in rostering of calls, shortage and lack of appropriate deployment of staff. Management systems did not always identify the shortfalls in the planning and management of the service so that actions could be taken to rectify the issues in a timely manner.

At this inspection we found the required improvements had not been made and the service in now in breach of regulations. This is the fourth inspection where we have rated the service as requires improvement. This shows that the provider has been unable to make or sustain the improvements required.

We gave the provider 48 hours’ of our intention to undertake the inspection. This was because the service provides domiciliary care to people in their own homes and we needed to make sure someone would be available at the office.

Romie care (which runs as a franchised branch of Surecare) is registered to provide personal care to people living in their own homes. On the day of our inspection the service was provide personal care to 100 people. A registered manager was in place. A 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 told us that staff frequently arrived late for calls. People were reliant on staff and late calls had a negative impact on them. People told us late calls left them waiting for personal care and support with meals and medicines.

The provider had a call monitoring system in place, however, records showed that calls were being scheduled later the agreement times.

Staff understood how to protect people from abuse and were clear about the steps they would need to take if they suspected someone was unsafe.

People told us they received their medicines as required and staff said they had received medication training to support people appropriately.

The provider completed employment checks to ensure staff were suitable to deliver care and support before they started work. They need to strengthen the process further and ensure a full employment history was completed for all staff.

People told us staff knew them well and had the skills and knowledge to meet their needs; Staff told us they received the right training for the people they supported.

People said staff supported them by preparing a choice of meals and drinks to support their wellbeing. Staff understood they could only care for and support people who consented to being cared for.

People said staff were caring and treated them with privacy and dignity and respected their homes and belongings.

People told us when they raised concerns these were not always listened to or action taken to resolve them. The provider had not logged concerns of late calls as complaints therefore learning had not been taken to minimise the chance of things going wrong again in the future.

People said the management of the service needed improving to ensure calls were made on time to meet their needs and concerns were responded to.

The provider did not have effective systems in place to check and improve the quality of the service. The provider confirmed that prior to the inspection they were not auditing call times to assess if calls were on time and take appropriate action where required. The provider said audits checks that people were receiving medication as required were completed, but these were not available to the inspector on the day of the inspection, therefore we could not be assured these checks were in pla

This inspection took place over three days. We carried out home visits to some people on 7 November 2016 and carried out visits to the office on 25 November 2016 and 1 December 2016.

We gave the provider notice so that they could organise the visits to people for us. We gave 48 hours notice for the first day of our office visit and 12 hours notice for our second visit to ensure that someone was available to assist us.

We previously inspected the service on 19 November 2015 when we rating the service as requires improvement in four of the five questions we asked. These were is the service safe, effective, responsive and well led. At this inspection we found that improvements had been made in all these areas however, we felt that some further improvements were needed to the questions is the service safe and well led to ensure that people received a good quality service.

Romie Care Ltd provides care and support to people living in their own homes. At the time of our inspection the service was support to between 170 and 180 people.

There was a registered manager in post at the time of our inspection. 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.

Sometimes people did not receive the care and supported as planned as calls were late, early or missed. People felt this was due to staff not being available and due to shortfalls in rostering of calls, shortage and lack of appropriate deployment of staff. Management systems did not always identify the shortfalls in the planning and management of the service so that actions could be taken to rectify the issues in a timely manner.

People received a safe service because the provider had procedures in place to ensure that staff were trained and followed the procedures to ensure the risk of harm to people was reduced. The risk of harm to people receiving a service was assessed and managed appropriately; this ensured that people received care and support in a safe way. Where people received support from staff with taking prescribed medicines, this was done in a way that ensured the risk to people was minimised.

People’s rights were protected and they had choices in their daily lives. People were supported to maintain their diet and health needs where required. Staff were caring and people’s privacy, dignity independence and individuality was respected and promoted by staff and the management.

People received care from staff that were suitably recruited. This was because the provider had undertaken the relevant checks to ensure the staff they employed were suitable to work with people.

People were able to raise their concerns or complaints and their complaints were acted upon, so people could be confident they would be listened to and their concerns resolved.

This inspection took place on 19 November 2015 and was announced. We told the registered manager two days before our visit that we would be visiting to ensure the registered manager was available to answer any questions we had or provide any information we needed to see.

We last inspected this service on 22 and 31 July 2014 when this service was rated as requires improvement in some of the questions we ask including, is the service safe, effective, responsive and well led. At this inspection we saw that improvements were still required in these areas and that further improvements were needed to ensure that the provider had good governance processes so that the quality of the service improved.

Romie Care Services Limited provides personal care to people in their own homes. At the time of our inspection there were 75-80 people who were receiving a service. Most people were elderly, had complex health needs or a physical disability.

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.

The provider had some systems in place that enabled them to assess and monitor the quality of the service provided. These systems were not sufficient to ensure that people received a consistently good quality service and there were on going improvements in the quality of the service. You can see the actions we have asked the provider to make at the end of this report.

People felt safe with the staff that supported them because staff knew how to protect people from harm. Procedures were in place that ensured the service was safe and that people’s rights were protected. Where concerns had been raised the registered manager liaised appropriately with the local authority to ensure people’s safety.

There was a system in place to ensure that checks were undertaken when staff were first employed by the provider. These included police checks and checks with previous employers. The usual recruitment checks were not always carried out when staff left and returned after a few months. This meant that the appropriate checks were not carried out to ensure that staff remained suitable to be employed by the provider.

Risks associated with people’s care needs were not always appropriately identified and plans put in place to ensure people were protected from unnecessary risk.

People felt there were sufficient staff to meet their needs during weekdays. Some people felt the service during the weekends did not always meet their needs because calls were not carried out at the required times.

People were generally supported to take their medicines and received their meals as required except when calls were late.

People were supported by staff that had received training to equip them with the skills and knowledge to support people safely.

People received care and support from staff they had got to know and built up a relationship with them. Individual staff were caring and respected people’s privacy and dignity but systems in place did not ensure that that people always felt cared for.

The agency was supporting approximately 90 people who received care in their own home at the time of our inspection. We spoke with 13 people (or their representatives) who used the service. We spoke with three members of staff by telephone, and we met with the manager and one member of staff in the office where we looked at records.

We saw and records confirmed that people’s needs were assessed and support provided to meet their needs. Everyone we spoke with was happy with the service they received and felt they were involved in the planning and carrying out of their care. One relative told us, "Ninety nine per cent of the carers come on time and stay with dad. They will sit and chat with him. He is comfortable with carers. Dad is happy with them. Do more than they supposed to."

Records confirmed staff had received training in protecting people. This meant staff had the skills and knowledge to ensure that people were protected from harm. All the people we spoke with told us they felt safe with the staff.

People were asked for their views about the service and these were listened to. Action was taken to make improvements where needed. One person said, "I am very happy with care provider, management and staff is excellent and very helpful."

We spoke with four people using the service, four staff and the manager during our inspection. We looked at the care records for five people using the service and the personnel files for four staff.

All of the people we spoke with were generally happy with the standard of care that they were receiving. One person said, “X (carer) is excellent, nothing is too much trouble and she is flexible with tasks”. Another person told us, “Staff are polite and respectful. If I ask for something to be done it is done. I have no problems”. Three people commented that sometimes they had different carers to those they expected. One person said, “There are different people at different times. If I ask who is coming they sometimes say they don’t know.” This meant people did not always know who would be supporting them.

Care plans and risk assessment were in place to support people's needs. People had choices available to them and their care was person centred so that they received their care in the way that they preferred.

Safeguarding procedures were in place and staff were confident that they would recognise and report any allegations of abuse so that people were protected from the risk of harm.

Systems were in place to ensure that staff were supported, supervised and trained to provide safe and effective care. Follow up monitoring was not always carried out when a need had been identified.

The provider had systems in place to monitor the service provided.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.  This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by Care Quality Commission (CQC) which looks at the overall quality of the service. This was an announced inspection.  We gave the provider two days’ notice that we intended to inspect the service.

Romie Care Services Limited is a domiciliary care agency that provides personal care to vulnerable people in their own homes.  The services currently provides care and support to 79 people, most of whom are elderly or who have complex health needs or physical disability. The service has a registered manager. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People who received care and support and their relatives told us that they were happy with the care being provided and the staff who delivered support. People told us that they were being supported by kind and attentive staff and that staff respected their privacy and dignity.

People’s health needs were met. We found that people’s health and care needs were assessed, and care planned and delivered in a consistent way. From the three people’s plans of care we looked at, we found that the information and guidance provided to staff was detailed and in formats that people receiving care could understand.

We found that the service followed safe recruitment practices. We checked records and saw that all new employees were appropriately checked through robust recruitment processes to ensure that they were suitable to work with older people. We found that most staff were well trained, knowledgeable and had a good knowledge of the people they were caring for, including their preferences and personal histories. However, we found that some staff did not have the skills and training to provide appropriate care to people with more complex physical needs that included the use of ‘specialist’ equipment.  

People’s health and welfare needs were not always being met because there were insufficient numbers of staff available. We found that there were staffing difficulties at weekends whereby people received visits to their home’s later than agreed in their care plans. Carers arriving late for calls can potentially result in people receiving inappropriate care (such as late medication and meals) and might prevent them from maintaining a good and healthy lifestyle.  People's care and support was therefore not always planned and delivered in line with their individual care plans to ensure safety and welfare.

We found that people were encouraged to make their views known about the care, treatment and support they received from the service. This gave people the opportunity to provide feedback and to make suggestions for improvements about the service they were receiving.

People who received care and support, and their relatives were very complimentary about the manager of the service. The care staff also made similar positive comments about the manager, stating that she was approachable and supportive.

A check of records showed that the provider had a system to regularly assess and monitor the quality of service that people received and a system to manage and report accidents and incidents. Findings from these systems were analysed and used to make improvements.