Archived: Smart Homecare (Aylsham)

Updated 25 July 2019

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 is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This announced inspection was carried out on 31 January 2019 and telephone calls to people and staff took place on 1 and 4 February.

We gave the service 48 hours’ notice of the inspection visit. This is because the service is small and we wanted to ensure a member of the management team was available to assist us with the inspection. We needed to be sure that they would be in.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We visited the service before the PIR deadline date so we were not in receipt of this prior to the inspection. We also looked at information we held about the service, including statutory notifications. A notification is information about important events, which the provider is required to send us by law.

During the inspection we spoke with three people who used the service. We spoke with the registered manager, who was also the provider, as well as the administrator and three members of care staff.

We reviewed four people’s care records in detail and looked at three staff recruitment and training files. We also looked at documents relating to the day to day running of the service.

Updated 25 July 2019

Smart Homecare Aylsham 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 older adults, people living with dementia, sensory or physical impairments. At the time of our inspection, 17 people were using the service.

There was a registered manager in post who was also the provider. 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. For the purposes of this report they have been referred to as the provider.

We had previously inspected the service on 24 July 2018. We found that the provider was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider was in breach of seven of the regulations including person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, staffing and fit and proper persons employed. The overall rating for the service was inadequate and the service was placed in special measures.

During this inspection, we found that the provider was in breach of seven regulations. You can see what action we told the provider to take at the back of the full version of this report. During the inspection we mainly dealt with the administrator, this was because the provider was out of the office due to prior engagements. The administrator jointly oversaw the day to day running of the service along with the provider.

The provider had failed to comply with a number of the regulations as required under the HSCA 2008 (Regulated Activities) Regulations 2014. In addition, the provider had failed to sustain improvements where breaches of regulations had been identified during the previous inspection.

The provider was still in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because people’s medicines were not managed in a safe way and there were no risk assessments in place for people who were being supported with taking their medicines. There were also no care plans and risk assessments in place for people who were living with diabetes.

Individual risks relating to people’s health and wellbeing had not been adequately planned for and risk assessments failed to detail how staff could mitigate known risks. Risks relating to infection prevention and control had not been identified or planned for.

Not all accidents and incidents had been recorded, therefore no reviews of these had taken place to safeguard against future occurrences.

Processes for recruiting staff had not improved and the provider remained in breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) 2014. Appropriate background checks had not been completed to ensure staff were of good character and employment histories for staff were not complete.

At our previous inspection we found the provider was in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014. This was because a safeguarding incident had not been reported to the local safeguarding authority. We found the provider was no longer in breach of this regulation because they were reporting incidents to the local authority. However, we had not been notified of this incident and this meant the provider was in breach of Regulation 18 of the Care Quality Commission (Registration Regulations) 2009.

Training provisions for staff were not adequate and the training did not equip staff with the knowledge required to carry out their role effectively. Staff did not receive yearly appraisals and supervisions were not formalised meetings. This meant the provider remained in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider remained in breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014 because they did not act within the principles of the Mental Capacity Act 2005 (MCA). The provider and staff did not have a good understanding of the MCA and how power of attorney was applied.

Assessments of people’s care and support needs were not undertaken and people’s care records were not sufficiently detailed, reviewed or updated. As a result, the provider remained in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

The provider had failed to implement processes to monitor, assess and review the safety and quality of service being delivered and therefore remained in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider did not have any system in place to assess any area of the service. The provider also failed to implement and adhere to their own policies and procedures.

People told us they felt safe being cared for by the staff and that staff were caring. Staff understood what constituted abuse and what procedure they would follow to report concerns.

There was a complaints policy in place and people knew how to raise a complaint. People were given surveys to complete about their experience of using the service.

People’s end of life care had been discussed and detailed in their care records.

The overall rating for this service remains inadequate. Therefore, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, the service will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in “special measures.”