The inspection took place on 13 March 2018. The inspection was unannounced.

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

The inspection was carried out on 20 September 2017. The inspection was unannounced.

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 abou

We inspected this service on 25 May 2017. The inspection was announced.

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

We inspected this service on 05 October 2016. The inspection was announced.

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 th