Smarta Services Ltd

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. This key question has been rated requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

We found the service was in breach of legal regulations relating to safe care and treatment. The provider did not implement robust risk assessments to keep people safe, and staff did not always manage medicines safely.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not consistently promote a proactive and positive safety culture based on openness and honesty. Staff did not always report or investigate safety incidents thoroughly and did not consistently identify or share learning to improve practice.

The provider had systems in place for staff to report incidents and near misses. These included processes to review incidents, learn from them and make changes to people’s care to reduce risks. We reviewed incident and complaint records. Staff and leaders described some actions they had taken following incidents and complaints to improve safety. However, records did not consistently demonstrate what learning had been identified or how the provider used this to reduce the risk of similar incidents occurring.

The provider worked with people and healthcare professionals to establish and maintain systems to monitor and manage safety. They aimed to ensure continuity of care, including when people moved between services.

The provider supported people to transition into the service, including following discharge from hospital, and liaised with health care professionals to help ensure a safe return home. Staff completed initial assessments with people and, where appropriate, their representatives to identify needs and risks.

The provider did not always work effectively with people or healthcare professionals to understand what being safe meant to each individual or how best to support them to achieve this. They did not consistently focus on improving people’s lives or protecting their rights to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm or neglect. The provider did not always share concerns in a timely or appropriate way.

The provider reported safeguarding concerns to the relevant authorities and worked with them during investigations. However, they did not consistently notify CQC promptly, as required by law. The provider must submit notifications without delay and provide updates when further information becomes available to enable CQC to monitor whether appropriate action has been taken.

Staff completed safeguarding training and told us they felt confident in recognising and responding to safeguarding concerns, including situations where people declined care and may be at risk of self-neglect.

The provider did not consistently work with people to understand and manage risks, and staff did not clearly document risks in care records. As a result, staff did not always deliver care in a way that was safe, supported people effectively or enabled them to do the things that mattered to them.

Staff completed some risk assessments to identify risks to people and the staff who supported them. These included, for some people, assessments of environmental risks and moving and handling needs. However, these assessments were not always in place or sufficiently comprehensive. We found the provider had not identified or planned for some risks, which placed people at risk of harm. These included risks relating to fire safety, diabetes management, dementia, catheter care and the use of manual handling equipment. As a result, staff did not always have the information they needed to support people safely. People using the service told us they felt safe and supported with their regular staff. However, we were not always fully ensured of the providers understanding to some of our concerns.

Following the inspection, the provider submitted a sample of risk assessments, including those relating to the environment, manual handling, dementia and fire safety. However, these remained insufficiently robust and did not clearly set out the actions staff needed to take to keep people safe.

The provider did not consistently identify and manage risks within the care environment. They did not always ensure equipment, facilities and systems supported the delivery of safe care.

The provider completed some environmental risk assessments to identify and reduce risks; however, these were not always robust. People who used topical creams that presented a fire risk did not have risk assessments to determine the level of risk or the precautions required to keep them safe. Environmental assessments did not include sufficient detail about risks associated with smoking or whether additional control measures were necessary.

Records instructed care workers to read fire plans and familiarise themselves with escape routes from all rooms used. However, when we requested these records, the provider confirmed they were not in place for some people. This meant staff did not always have the information needed to support people safely in the event of a fire.

Records for people using equipment did not consistently list all equipment in use. For people who required manual handling equipment, including hoists, assessments did not clearly explain how staff should use the equipment safely. Records also did not consistently confirm whether equipment had passed required safety checks or when the next checks were due, in line with health and safety legislation.

The provider did not consistently ensure there were enough suitably qualified, skilled and experienced staff to meet people’s needs. Staff did not always work effectively together to deliver safe, person-centred care.

Call times varied, and some people experienced late or rushed visits, which meant they sometimes had to wait for support with personal care. One person said, “Sometimes they arrive a bit late and they don’t always call and let me know.” Another person told us, “They come more or less on time unless something like an accident happens, and then they let me know. I have not had a missed call in the two and a half years that I have been having them.”

Staff completed some relevant training, and the provider had systems to support staff development, including supervision, competency checks and team meetings. People we spoke with felt staff were trained. One person told us, “They (staff) are all well trained and know what to do and I feel safe with them”. However, training records showed gaps, including in key areas such as diabetes and dementia. Following the inspection, staff completed additional training in these areas.

The provider generally followed safe recruitment practices. However, for 1 staff member, the provider did not obtain a reference from their most recent care employment and had not completed a risk assessment to demonstrate this was safe. Recruitment records for other staff showed the provider completed appropriate checks.

The provider did not consistently assess or manage the risk of infection. They did not always identify, monitor or control the risk of infection spreading, or share concerns with relevant agencies in a timely way.

People’s care plans did not provide robust guidance for infection prevention and control. For example, for people with catheter bags, records did not clearly explain the risks of infection or the actions staff should take if they identified concerns.

The provider had infection prevention and control (IPC) policies and procedures in place to guide staff. People told us staff wore appropriate personal protective equipment (PPE) when providing care.

The provider did not consistently ensure medicines and treatments were managed safely or in line with people’s needs, capacity and preferences. Staff did not always involve people in decisions about their medicines.

Although the provider had medicines policies based on national guidance, staff did not always follow these when administering medicines, which increased the risk of errors. For example, records for ‘when required’ medicines did not always explain why the medicine was prescribed or provide clear guidance on when and how staff should administer it.

Records for people prescribed topical creams were often missing or unclear. They did not consistently state where creams should be applied, their purpose, or any potential side effects staff needed to monitor.

Medicines risk assessments were not always robust or clearly recorded. For example, people prescribed anticoagulant medicines did not always have risk assessments outlining the actions staff should take if the person fell or hit their head, despite the increased risk of internal bleeding.

Following the inspection, the provider submitted additional records for ‘when required’ medicines. However, these were not always sufficiently clear. For example, guidance for people prescribed paracetamol did not specify the required four-hour interval between doses to ensure safe administration.