Archived: SMS CARE LIMITED

Updated 4 November 2023

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Three inspectors, 1 medicines inspector and 1 Expert by Experience undertook the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One inspector and 1 medicines inspector visited the service on 6 June 2023, 1 inspector visited on 8 June 2023, and 2 inspectors visited the service on 3 July 2023.

Service and service type

SMS CARE LIMITED is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. SMS CARE LIMITED is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was no registered manager in post. There was a temporary manager, who was also the temporary regional manager. They confirmed they would remain at the service until a suitable manager was recruited.

Notice of inspection

This inspection was unannounced. Inspection activity started on 6 June 2023 and ended on 3 July 2023. We visited the service on 6 and 8 June and 3 July 2023.

What we did before the inspection

We looked at the information we held about the service. This included, feedback, notifications and the actions taken by the provider since the last inspection. We asked for feedback from professionals about the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We undertook a tour of the building, including communal areas and some bedrooms. We spoke with 4 people who used the service and 3 relatives on the telephone. We spoke with 3 visiting professionals as well as a range of professionals as part of multi-agency meetings as a result of concerns raised. We undertook observations in the communal areas. We spoke with 7 staff members. These included 4 care staff, the temporary manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We looked at a range of information. This included 5 care records, 5 medicines administration records and associated documents. We also checked staff files, training records and information about the operation and management of the service.

Updated 4 November 2023

About the service

SMS CARE LIMITED is a residential care home providing accommodation for persons who require nursing or personal care for up to 11 people. The service provides support to people living with learning disabilities or autistic spectrum disorder. At the time of our inspection there were 6 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. DoLS assessments, care planning and risk assessments had not been completed.

Safeguarding allegations were not being acted upon or managed appropriately, referrals were not being made to the relevant authorities.

Medical assessments and reviews were not always completed. There was no record missed appointments had been followed up. Professionals told us the service did not engage with them.

We saw some basic activities taking place. People told us they accessed community activities including a recent holiday to Blackpool. Records had not been developed to confirm activities had been undertaken.

People’s communication needs had been considered.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Medicines were not managed safely. Individual risks were not being assessed or managed safely and accidents and incidents were not actioned safely or lessons learned.

Some improvements were needed in relation to infection prevention and control.

Weights were not being recorded appropriately and one person’s individual needs in relation to their meals had not been provided. Supplies of fresh food was limited and some foods were not stored in line with guidance and the kitchen cupboards were disorganised. People told us they were happy with the meals they were provided.

People told us they were happy with the care they received however, the feedback from relatives was mixed. One person’s care record was stern and derogatory in their content. One person was concerned about a medical need, staff did not act on this.

Care records were incomplete, basic or inaccessible and failed to provide information and guidance to support people’s individual needs. Preadmission assessments were not seen. People and some relatives told us they were involved in decisions about their care. End of life care plans had not been developed. None of the staff had undertaken end of life training.

Policies and procedures were in place electronically and were up to date

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

No environmental risk assessments were completed. Fire safety had improved. We have made a recommendation about ensuring the environment was safe for people to live in.

Staffing was insufficient to meet the needs of the people and the service, and staff were not always recruited safely, agency profiles were incomplete. Gaps in staff training was evident and supervisions were not undertaken regularly.

A system had still not been developed to ensure complaints or concerns were managed. People told us they were happy and knew how to raise concerns. The service had not acted when things went wrong.

Systems to ensure quality oversight and governance had not been developed. Very little audits had been undertaken and no senior audits were done. The service was not submitting statutory notifications when incidents had occurred, as required.

Professionals raised concerns about the service and a number of professionals meetings were held to discuss the concerns.

Evidence of meetings with staff and people were seen and surveys had been conducted. However, the findings had not been reviewed or action taken.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 21 January 2023).

We issued the provider with a warning notice asking them to make improvements in relation to safe care and treatment and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to requirements. At this inspection we found the provider remained in breach of regulations.

At our last inspection we made recommendations in relation to, infection prevention and control, supporting people to eat and drink enough to maintain a balanced diet, ensuring consent was obtained and people were protected from unlawful restrictions. We also recommended people were supported with activities, care plans which reflected people’s needs, and the management of complaints or concerns. The provider had acted on some of the recommendations but not all.

Why we inspected

This inspection was prompted by a review of the information we held about this service and to follow up from the previous inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, response and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for SMS CARE LIMITED on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to people’s dignity, people’s end of life care needs and the support available to access activities of their choosing. We also identified breaches in relation to risk, monitoring of people’s individual needs and the safe management of medicines.

We also identified breaches in relation to unlawful restrictions and to ensure safeguarding concerns were reported and monitored and people were exposed to the risk of harm as they were not support with their meals safely. The provider had not developed systems to investigate and manage complaints, failed to ensure care records directed staff in relation to their individual needs and how to manage them as well as ensuring detailed assessments took place for people. The provider failed to ensure sufficient numbers of suitable staff were in place, that staff received appropriate support, training and as is necessary to enable them to carry out the duties they are employed to perform. We also identified breaches in relation to good governance and ensuing statutory notifications are submitted to CQC where required.

We have made recommendations to support changes so the service is suitable and safe for people to live in and that people have access to meaningful activities.

Regulatory enforcement action was taken, no representation or appeals were received as a result of this action. We have therefore cancelled the providers registration.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.