Archived: Smart Care

In November 2017 we carried out a comprehensive inspection of Smart Care Limited. We identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the provider’s management of people’s medicines was not always safe. We identified that the provider’s failure to operate effective quality assurance systems and processes to monitor and improve the quality and safety of the service for people was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we found the provider had taken the required action to improve the service and was now meeting the regulations.

The service is a domiciliary care agency which provides personal care to people living in their own homes. It provides a service to older and younger adults, people living with dementia, autistic spectrum disorder, physical disability, mental health needs and sensory impairment. The service enabled people living in Fleet, Farnborough and the surrounding areas to maintain their independence at home. At the time of our inspection there were 91 people using the service, who had a range of health and social care needs which were met by 36 staff.

The service had a registered manager. 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.

People were supported by staff who made them feel safe and experienced good continuity and consistency of care from regular staff, which reassured them. People were protected from avoidable harm, neglect, abuse and discrimination by staff who understood their responsibilities to safeguard people.

Risk assessments identified how potential risks should be managed to reduce the likelihood of harm occurring to people. Staff understood the risks to people and delivered safe care in accordance with their support plans.

Incidents and accidents were recorded appropriately and investigated where necessary. Learning from incidents or changes to support plans or support guidelines were discussed and action was taken to reduce the risk of further incidents and accidents.

The management ensured there were always sufficient staff deployed to meet people’s needs. Staff underwent relevant pre-employment checks that assured they were suitable to care for people made vulnerable by circumstances in their own homes.

Staff had completed the required training to manage people’s prescribed medicines safely and had their competency to do so regularly assessed by the management team. Staff had received additional training to support people with risks associated with certain prescribed medicine. Community nurse specialists provided further guidance to staff in relation to the effective monitoring of people’s blood glucose levels.

People were supported by staff who underwent the provider’s training and understood their roles and responsibilities in relation to infection control and hygiene. Staff followed current national guidance to ensure people were protected from the risk of infections. People were supported by staff to maintain high standards of cleanliness and hygiene in their homes, which reduced the risk of infection.

Staff had the required skills and knowledge to provide the support people needed. Staff training was up to date, which ensured that staff had been enabled to gain the necessary skills required to meet people’s needs and then to maintain them.

The provider and registered manager effectively operated a system of spot checks, supervision, appraisal and monthly meetings which supported staff to deliver care based on best practice.

Staff followed required standards of food safety and hygiene, when preparing or handling food. People were supported to have a healthy balanced diet and had access to the food and drink of their choice, when they wanted it.

Staff demonstrated concern for people’s wellbeing in a meaningful way and responded to their healthcare needs quickly when required.

Whilst the service did not provide accommodation, staff effectively supported people with applications to achieve adaptations to their home environment to meet their individual care needs.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The service was working within the principles of the Mental Capacity Act, 2005, which ensured people’s human rights were recognised and protected.

People experienced caring relationships with staff who knew about their individual needs and how to support them to meet the challenges they faced. Staff understood people’s care plans, people’s life histories and the events that had informed them.

Staff treated people with dignity and respect and were sensitive to their needs regarding equality and diversity. People were encouraged and enabled to be involved, as much as possible, in making decisions about their care.

Staff understood people’s different communication needs and ensured they followed the guidance provided in people’s care plans to enable them to communicate their views.

People’s needs had been assessed regularly, reviewed and updated. Their support plans were detailed and personalised to ensure their individual preferences were known. People’s support plans promoted their independence and opportunities to maximise their potential.

People were supported to take part in activities that they enjoyed. Staff supported people to maintain relationships with those that mattered to them, which protected them from the risk of social isolation.

The management team sought feedback in quality assurance visits, satisfaction surveys and telephone calls. The registered manager ensured this feedback was acted upon through staff meetings and supervisions.

Complaints and concerns formed part of the provider’s quality auditing processes so that on-going learning and development of the service was achieved. People and relatives felt that staff listened to their concerns, which were quickly addressed.

The service provided good quality end of life care which ensured people experienced a comfortable, dignified and pain- free death. When people were nearing the end of their life they received kind and compassionate care.

The registered manager was highly visible and regularly went to see people if they were upset or had raised concerns. The registered manager provided clear and direct leadership to staff who had a good understanding of their roles and responsibilities.

The registered manager effectively operated systems to assure the quality of the service and drive improvements. The provider ensured the service delivered high quality care by completing regular audits, site visits and reviewing the registered manager’s weekly monitoring report, which detailed all significant events. People’s and staff records were stored securely, protecting their confidential information from unauthorised persons.

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.

People’s medicines were not always managed safely as robust processes were not all in place as required. One person had been placed at risk of harm, as they had not always received their medicines as prescribed.

There was a lack of robust processes in place to systematically: audit, monitor, identify areas for improvement and to be able to demonstrate the actions taken as a result to improve the safety of the service for people. The processes to assess the safety of people’s medicines management had failed to identify the issues we found at this inspection.

Staff had undertaken relevant safeguarding training and understood their role to protect people from the risk of abuse. The registered manager had not made a required referral to the disclosure and barring service, following a recent safeguarding incident but ensured this was done during the inspection.

Risks to people had been assessed in relation to areas such as: falls, pressure areas, moving and handling for example. However, staff were not always provided with sufficient amounts of written, up to date information to ensure they could always provide people’s care safely. The incident reporting system required review in order to consider whether it was sufficiently robust to ensure people’s safety.

People told us and records confirmed that overall they received a good level of continuity in the staff who provided their care. The provider operated safe staff recruitment practices.

People were protected from the risk of infection as staff underwent training and followed the guidance provided.

People’s needs had been assessed and they had a written care plan to meet their identified needs. However, the amount of detail they contained was not always sufficient to provide a holistic assessment of the person’s needs and to enable all staff to have access to sufficient detail to promote the best outcomes for people. This risk was mitigated for people by the overall sound knowledge of staff about the needs of the people they cared for.

Staff were well supported with their induction, mandatory training and supervision programme. However, there was a lack of written evidence to demonstrate staff had undergone additional training as required, in relation to the specific healthcare needs and conditions of the people for whom they provided care. The registered manager took action during the inspection to arrange further training in stoma care and diabetes care for relevant staff.

People received sufficient assistance from staff to ensure they were able to eat and drink enough to meet their needs. Staff ensured people’s health care needs were met. Staff worked proactively with other services to ensure people received the care they required when they moved between services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff had undertaken Mental Capacity Act (MCA) 2005 training but could not all demonstrate their knowledge to ensure they could identify when a MCA assessment might be required for a person. This has been brought to the registered manager’s attention for them to address.

People we spoke to told us the staff were very caring and kind. People told us they were very much involved in making decisions about their care and that their wishes were respected. Staff ensured people’s privacy and dignity was upheld in the provision of their care.

The service was responsive to people’s needs; staff knew people and their needs well. Any required changes to people’s care were acted upon promptly.

There was a process in place to enable people to raise issues either verbally or in writing. People reported that they felt confident any issues raised would be listened to and addressed accordingly.

People could be supported where required within the service to have end of life care from familiar staff supported by community clinicians.

There was a clear mission statement in relation to the provision of peoples’ care, which staff strived to meet. Staff were supported by a registered manager who was open and accessible to them and who understood the issues related to delivering this type of service. There was a clear organisational structure with defined roles for staff. Staff worked in partnership with other agencies in the delivery of peoples’ care.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the providers to take at the back of the full version of the report.