24 August 2021
During a routine inspection
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.