Archived: Rosemont Care Medway

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.

The last comprehensive inspection took place on 25 May 2017. The service was rated as Requires improvement overall. Breaches of Regulations 11, 12, 16, 17 and 19 were identified. The provider had failed to follow the principles of the Mental Capacity Act 2005. The provider and registered manager had failed to adequately assess and mitigate risks to people and staff. The provider and registered manager had failed to establish and operate effective recruitment procedures. The provider and registered manager had failed to establish and operate effective complaint systems. The provider and registered manager were required to make further improvements to establish and operate effective systems to monitor and improve the quality of the service. We issued the provider warning notices in relation to Regulations 11 and 12 and told the provider to meet the Regulations by 31 July 2017. We also served one warning notice in relation to operating effective recruitment processes and told the provider to meet Regulation 19 by 14 August 2017.

The provider sent us an action plan on 25 October 2017. This identified that Regulation 16 had been met at the end of June 2017 and Regulation 17 had been met and ongoing monitoring was taking place.

We carried out a focused inspection on 20 September 2017 to check that the provider had met the warning notices which had been served following the previous inspection on 25 May 2017. We looked at the Safe and Effective domains. At the focused inspection we found that the provider had met Regulation 19 and Regulation 11 but had failed to meet Regulation 12. We also found a new breach of Regulation 18.

The provider sent us an action plan on 29 November 2017. This identified that Regulation 12 and Regulation 18 had been met and systems were in place to review and increase staff training.

Rosemont Care Medway 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 people living with dementia, learning disabilities or autistic spectrum disorder, mental health, older people, people who misuse drugs and alcohol, people with physical disability, people with a sensory impairment and younger adults.

Not everyone using Rosemont Care Medway receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were 54 people receiving personal care at the time of the inspection.

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. The registered manager was present at the service during the inspection.

At this inspection we found that there had been further improvements to the service. People and their relatives were positive about the care and support they received.

Risks to people's safety and welfare had been assessed and risks had been mitigated where possible. Each person receiving care had risk assessments in place. Further improvements were planned to ensure that risk assessments were person centred.

The provider had deployed enough staff to provide people’s care and support. Staff had travel time and breaks allocated to them. There were sufficient numbers of office staff to keep up with the demand for care and support services which included carrying out assessments, developing care plans, supervision of staff and scheduling care and support.

Effective recruitment procedures were in place to ensure that staff employed were back ground checked and had the skills and experience needed to carry out their roles. Staff had received training relevant to their roles.

Medicines administered were adequately administered and recorded to ensure that people received their medicines in a safe manner. Where medicines audits had found concerns in relation to recording appropriate action had taken place.

People were protected from abuse or the risk of abuse. All staff were aware of their roles and responsibilities in relation to safeguarding people.

There was a stock of personal protective equipment (PPE) kept in the office which staff could access regularly to stock up. PPE was located at each person’s home for staff to use.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included the steps staff should take to comply with legal requirements. Staff had a good understanding about how to apply the principles of the MCA 2005 to their work to enable them to protect people's rights.

People were supported and helped to maintain their health and to access health services when they needed them. Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

People and relatives told us that staff were kind and caring. Staff treated people and their relatives with dignity and respect.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known. The management team were still working on reviewing and updating care plans to ensure they were person centred. Plans were in place to review the assessment process so that people’s religious, cultural, sexual and end of life care needs were discussed. People and their relatives had been involved with planning their own care.

People and their relatives knew who to talk to if they were unhappy about the service. When complaints had been received, these had been recorded, investigated and responded to within suitable timeframes.

People’s views and experiences were sought through quality assurance surveys. Relatives were also encouraged to feedback through surveys.

Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to. Staff received regular supervision and were in the process of attending annual appraisal meetings to discuss their performance.

Effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were accurate, complete and securely stored.

Rosemont Care Medway is a domiciliary care agency which provides personal care and support for adults in their own homes. The agency provides care for people in the Medway area. At the time of our inspection they were supporting approximately 85 people who received support with personal care tasks.

The registered manager of the service was on sick leave. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 operations manager assisted us during the inspection.

At the last comprehensive inspection, the service was rated requires improvement overall.

We carried out an unannounced comprehensive inspection of this service on 25 May 2017. Three continuing breaches of legal requirements were found in relation to Regulations 11, 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two other breaches were found in relation to Regulation 16 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served the provider warning notices in relation to Regulations 11 and 12 and asked them to meet the legal requirements by 31 July 2017. We served the provider a warning notice in relation to Regulation 19 and asked them to meet the legal requirements by 14 August 2017.

We asked the provider to write to us by 12 August 2017 to tell us what they would do to meet legal requirements in relation to the breaches of Regulations 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider submitted an action plan in relation to this on 25 October 2017.

We undertook this focused inspection to check that the provider had met the warning notices. We checked to see if the service was safe and effective. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rosemont Care Medway on our website at www.cqc.org.uk.

At this inspection, we received mixed feedback from people and staff about staffing levels and rostering and the impact this had on them. People told us they received effective care.

Risks to people's safety and welfare were not always managed to make sure they were protected from harm. People who had started to receive a service from Rosemont Care Medway in August 2017 did not have risk assessments or care plans in place.

The provider had not deployed enough staff within the office to safely assess, monitor and schedule care provided to people. As a result care staff did not have all the relevant information they needed to carry out their roles effectively. People and staff did not receive their rotas in a timely manner. Some staff did not always have sufficient travel time or breaks allocated to them. Communication in relation to rota changes was not effective.

Recruitment practices had improved. Effective recruitment procedures were in place to ensure that staff employed were of good character and had the skills and experience needed to carry out their roles.

Medicines administered were adequately administered and recorded to ensure that people received their medicines in a safe manner.

People were protected from abuse or the risk of abuse. The operations manager and staff were aware of their roles and responsibilities in relation to safeguarding people.

Staff had received training relevant to their roles.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included the steps staff should take to comply with legal requirements. Staff had a good understanding about how to apply the principles of the MCA 2005 to their work to enable them to protect people's rights.

People were supported and helped to maintain their health and to access health services when they needed them. Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

Rosemont Care Medway is a domiciliary care agency which provides personal care and support for adults in their own homes. The agency provides care for people in the Medway area. At the time of our inspection they were supporting approximately 56 people who received support with personal care tasks.

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. The registered manager was present at the service during the inspection but had distanced themselves from the inspection. The newly appointed manager was involved with the inspection. The newly appointed manager planned to apply to become the registered manager of the service.

At our previous inspection on 05 October 2016 we found breaches of Regulation 9, 11, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured people’s care and support was person centred. The principles of the Mental Capacity Act 2005 had not always been followed. Relevant consent to care and treatment had not always been gained. The provider and registered manager had failed to adequately assess and mitigate risks to people and staff. The provider had failed to establish systems and processes to safeguard people from abuse. The registered manager and provider had failed to establish and operate systems to assess, monitor and improve the quality and safety of the services provided. The provider had not established and operated effective recruitment procedures. Staff had not received appropriate training in order to meet the needs of people they provided care and support. We also made a recommendation. We asked the provider to take action in relation to the breaches of regulations.

The provider sent us an action plan on 06 December 2016 which stated that they had already complied with Regulation 12 and 13 and that action had been taken to address Regulation 9, 17, 18 and 19 and this action was on going. The provider planned to meet Regulation 11 by January 2017. The provider had made some improvements to the service, however further improvements were needed.

At this inspection we found that people had mixed feedback about whether they received a safe, effective, caring, responsive and well led service.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm. Recruitment practices were not always safe; gaps in employment history had not always been explored.

Staff had not all received training relevant to their roles. We made a recommendation about this.

There were suitable numbers of staff on shift to meet people’s needs. However staff did not always have travel time or breaks allocated to them. Communication in relation to rota changes was not always effective. We made a recommendation about this.

Communication between staff was mainly good. Staff were made aware of significant events and any changes in people’s behaviour.

Effective systems were in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had picked up some of the concerns we found during our inspections. However audits had not picked up concerns in relation to recruitment records, risk, staff training and mental capacity. Further improvements were required.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included the steps staff should take to comply with legal requirements. Staff had a limited understanding of the MCA 2005 to enable them to protect people’s rights. Care plans and documentation did not evidence that the MCA had been followed in some cases.

People’s information was treated confidentially. People’s paper records were stored securely in locked filing cabinets.

People and relatives told us that staff were kind and caring. Staff treated people with dignity and respect.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known. The management team were still working on reviewing and updating care plans to ensure they reflected the care people received from the service. People and their relatives had been involved with planning their own care.

People were supported and helped to maintain their health and to access health services when they needed them. Medicines administered were adequately administered and recorded to ensure that people received their medicines in a safe manner. Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

People and their relatives knew who to talk to if they were unhappy about the service. When complaints had been received, these had not always been recorded, investigated and responded to within suitable timeframes.

People were protected from abuse or the risk of abuse. The manager and staff were aware of their roles and responsibilities in relation to safeguarding people.

People’s view and experiences were sought through quality assurance surveys. Relatives were also encouraged to feedback through surveys.

Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to. Staff received regular supervision and were in the process of attending annual appraisal meetings to discuss their performance.

We found breaches 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 this report.

Rosemont Care Medway is a domiciliary care agency which provides personal care and support for adults in their own homes. The agency provides care for people in the Medway area. At the time of our inspection they were supporting approximately 82 people who received support with personal care tasks.

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.

The provider did not follow safe recruitment practice. Gaps in employment history had not been explored to check staff suitability for their role.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments had not always been reviewed and updated when people’s health needs changed.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. The provider was not aware of the concerns we found at the inspection.

People’s medicines were not always well managed and recorded. There was no evidence that medicines records had been checked and audited, we found gaps on one person’s medicines records. We made a recommendation about this.

Staff were not given clear information about how to report abuse. The safeguarding policy did not give staff all of the information they needed to report safeguarding concerns to external agencies as it related to the provider’s other service. Staff had a good understanding of what their roles and responsibilities were in preventing abuse.

People’s care plans did not always detail their life history and important information about them. Some care plans did not detail what people’s preferred names were. One care file did not contain a care plan at all, which meant that staff did not have the necessary information to provide care and support.

The provider’s training records contained gaps and omissions which did not tally with staff training certificates. Training had not always been provided to staff in relation to meeting people’s assessed needs.

Staff had mixed understanding of the Mental Capacity Act 2005; however they could describe and demonstrate how they provided people with choice and respected decisions. Some care records did not follow the principles of the act.

People had not always been given a choice of the gender of their staff who would provide them with support. We made a recommendation about this.

Records did not all show that the provider complaints policy had been followed in relation to acknowledging the complaint, investigating the complaint and responding to the complaint. We made a recommendation about this.

There were enough staff deployed to meet people’s needs, people told us that most staff arrived on time for their care and support however there were times when staff were unavoidably late through traffic or issues relating to emergencies.

People told us staff were cheerful, kind and patient in their approach. Staff treated people and their families with dignity and respect.

Staff received support from the management team, they were encouraged to complete work related qualifications. Staff received a planned induction into their roles.

Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

People were supported by staff to be as independent as possible.

People gave us positive feedback about the support they received. People’s care records evidence that people received medical assistance from healthcare professionals when they needed it. Records evidenced that the service had responded to people’s changing needs as they had contacted people’s GP to request visits, contacted pharmacies, paramedics and district nurses when necessary.

Staff showed us that they understood the vision and values of the organisation; all staff gave examples of providing support to enable choice, control, rights and independence. Feedback gained from people and their relatives evidenced that staff put this in to practice whilst they delivered care and support.

We found breaches 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 this report.