Rosemont Care Medway

Updated 22 December 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection was carried out by two inspectors, one of whom was a medicines inspector. Two Experts by Experience spoke with people and relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager 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. Shortly after the inspection the registered manager left the service.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 24 August 2021 and ended on 8 September 2021. We visited the office location on 24 August 2021.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who commission the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they had not visited the service or received any comments or concerns since the last inspection. A local authority commissioner told us they had not received any concerns about the service.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with nine people who used the service and 11 relatives about their experience of the care provided. We spoke with nine members of staff including care staff, assessors, coordinators, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 11 people’s care records and eight people’s medicines records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, risk assessments and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data, COVID-19 testing records and quality assurance records.

Updated 22 December 2021

About the service

Rosemont Care Medway is a domiciliary care service providing personal care to people living in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. The service was providing personal care to approximately 63 people at the time of the inspection.

People’s experience of using this service and what we found

Feedback from people and their relatives about the service was mixed. Comments included, “We have only had them a couple of months and it was very hard going to start with, a different carer each visit, late every visit and just thoroughly disorganised”; “I am very happy with the carers and if they are running late or don’t turn up on time I get a call”; “I need the help now and they are providing good safe and sound care for me”; “Just as we get used to them they go and change. We never know who’s coming” and “I am utterly shell shocked and exhausted trying to sort it out and get my head around the calls and always having to be there to help.”

Staff had not always been allocated travel time to enable them to travel between care calls, this meant people received late care calls and staff were rushed to get to their next care call.

Individual risks were not always assessed and managed to keep people safe. People could not be sure their prescribed medicines were always managed in a safe way.

The systems and processes for ensuring all staff were regularly COVID-19 tested in line with government guidance were not robust. Not all staff were on the COVID-19 testing records held by the management team. We were assured that the provider was using personal protective equipment (PPE) effectively and safely.

The provider did not always have effective safeguarding systems in place to protect people from the risk of abuse. Some abuse allegations made evidenced that the service had not always acted in a timely manner to report abuse. These included self-neglect or changes to people’s health and social care needs.

Some people and relatives told us they were not always convinced that staff had received adequate training, they gave examples of staff not demonstrating safe practice using equipment in their homes. We were not assured that all staff had received training because training records did not evidence that all staff had been appropriately trained. Staff told us they received five days of training in the office when they first started and then staff received online refresher training. Records showed that staff were supervised and received spot checks.

Most care plans included people’s individual preferences and interests, personal history and staff understood these. Some care plans did not detail times of care visits. Care was person centred and planned with the person to meet their needs. People were given choice and control over their care. Detailed daily records of visits were kept by staff. However, care plans were not always updated in a timely manner when people’s needs had changed.

The systems in place to audit the quality of the service were not robust or sufficient to alert the provider of concerns and issues within the service. Audits relating to care plans had not been undertaken for some time. No audits had been undertaken to alert the registered manager to shortfalls in practices in relation to risk assessment, COVID-19 testing, medicines management, staff deployment and complaints.

People and relatives confirmed they knew how to complain. Some people and relatives did not feel that complaints were handled effectively. It was evident that registered persons had not reviewed the feedback gained from people and their relatives following surveys and telephone monitoring. No actions had been taken to address the issues people had raised.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Not everyone needed support with eating and drinking. Where they did, people and relatives said they were happy with the support they received. People confirmed meals and drinks meet their needs and they were provided with choices.

Where people needed support to access healthcare this was in place. Staff called an ambulance, accessed medical support via 111 and referred people to the GP as needed. Staff were clear about the action they would take when a person presents as unwell.

There continued to be a system in place to log accidents and incidents, clear actions taken place as a result. Staff continued to be recruited safely. Disclosure and Barring Service (DBS) criminal record checks were completed as well as reference checks.

People told us they were treated with kindness and compassion. On a day to day basis people directed their care. Care records promoted people’s right to independence and focused on what people were able to do for themselves. People and their relatives told us staff treated them with dignity.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were mostly meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. People had been encouraged and supported to maintain their independence.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights. People told us staff were kind and caring towards them. Relatives provided some examples of when staff did not always provide caring, kind and person-centred support.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services lead confident, inclusive and empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 7 June 2018).

Why we inspected

This was a planned inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified a breach of Regulation 18 (Staffing) in relation to effective deployment of staff. We identified a breach of Regulation 12 (Safe care and treatment) in relation to management of risk, management of medicines and COVID-19 testing staff. We identified a breach of Regulation 16 (Receiving and acting on complaints) in relation to management of complaints. We also identified a breach of Regulation 17 (Good Governance) in relation to operating a robust quality assurance process to continually understand the quality of the service and ensure any shortfalls were addressed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.