Archived: Smart Care Limited

Smart Care Limited is a domiciliary care service providing personal care to people living in their own homes. The service is for adults of all ages who are living with a physical or a learning disability or with dementia. At the time of this inspection, there were 63 people receiving a personal care service.

Why we inspected

We had previously carried out an unannounced comprehensive inspection of this service 20 December 2018. At this time, one breach of legal requirements was found which was Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good Governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met the legal requirements.

This report only covers our findings in relation to the Well- Led Key Questions which contain those requirements. The ratings from the previous comprehensive inspection for the other Key Questions were not looked at on this occasion. The overall rating for the service is now Good in every Key Question with no breaches of Regulation.

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

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

At the previous inspection, people were experiencing the delivery of good and safe care. This had continued, and we had no new concerns. Since the inspection, the provider had addressed the issues we reported on about missed care calls, quality of care records, monitoring of care staff and reporting accidents and incidents.

People’s care records had been reviewed and provided a comprehensive and person-centred approach that supported good care delivery. Staff had been supported to ensure they always recorded information in a person-centred way. The service received positive feedback from people and their relatives. One family member wrote, “Communication between the agency and ourselves is excellent. The staff are very approachable.”

Care delivery was now scheduled and monitored using an electronic system. This had been embedded into the service since the last inspection. The service was confident about ensuring all care was delivered as expected and there was a backup process for dealing with any emergencies.

People were cared for by staff who were supervised and monitored in a regular and robust way. The provider could demonstrate that care staff were delivering good quality care. Any shortfalls were identified and addressed. Staff were motivated and incentivised to give their best and do what was expected of them.

There was a positive and committed leadership team at the service. Although the registered manager was not present, another manager was able to support staff and demonstrated that all the improvements had been made. Staff spoke highly of the good communication the team and supportive environment they worked within.

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 Good (published 15 April 2019). However, there was a breach of regulation found, regarding the good governance of the service. At this inspection we found improvements had been made. The provider was no longer in breach of the care regulations and the service was well led.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Smart Care is a domiciliary care agency. It provides personal care to people living in their own homes in the community. It provides a service to older and younger people some of whom may be living with dementia or have a learning or physical disability. At the time of our inspection the service provided a regulated activity to 68 people.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good for Safe, Effective, Caring and Responsive but improvements were required in Well Led. The service has been rated as Good overall.

The provider had not put in place robust systems to ensure that they were aware that staff attended calls. Records were not always being maintained to ensure they were accurate and up to date.There was insufficient guidance in care plans that we reviewed around the support that people required.

Staff were not always receiving appropriate supervision that related to their role. There was insufficient records that staff were signed off as competent to deliver care. We have made a recommendation around this.

People were safe because staff were aware of the safeguarding procedure. There were sufficient levels of staff on duty to ensure that people’s needs were met. Recruitment was robust to ensure that only appropriate staff were employed.

Risks to people’s care was managed well by staff and people received their medicines in a safe way. The provider had up-to date procedures to help ensure people remained safe should there be an emergency. Staff understood how to reduce the risk of spreading infections.

Assessments of people’s needs were undertaken before they started receiving care. People were supported with their health needs and referrals were made to health care professionals where needed. People were provided with sufficient food and drinks when needed.

People felt that staff were caring, and kind and developed good relationships with them. They felt that staff treated them with dignity and were respectful towards them. People were involved in their care planning and where asked how they wanted their care to be delivered.

People told us that they would speak to staff if they had any concerns. There was a complaints procedure should anyone wish to complain and we saw that these were investigated fully.

The provider carried out other quality assurance checks to ensure people received a good standard of care. Staff consulted with outside professionals to ensure the best delivery of care.

People, relatives and staff felt that the service was well managed. Staff felt supported, valued and listened to.

The registered manager had informed the CQC of significant events including safeguarding and incidents.

Further information is in the detailed findings below.

Smart Care Limited is a domiciliary care agency that provides people with personal care and support in their homes. Based in the Surrey area, the main registered office is located in Weybridge with smaller satellite offices in Farnborough and Egham. At the time of our inspection the service provided care and support to approximately 160 people. People who used the service were mostly older adults and had a wide range of health care needs and conditions. Some people were living with dementia. The majority of people receiving support were funded by their local authority but some people also pay privately for support from the service.

The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

People felt safe with the support provided by the service. Staff were supported to take appropriate action to ensure people were protected if they suspected they were at risk of abuse or being harmed by discriminatory behaviour or practices. Risks to people’s health, safety and wellbeing had been assessed by senior staff. Plans were put in place which instructed staff on how to minimise any identified risks to keep people safe from harm or injury. Staff followed good practice for cleanliness and hygiene to reduce risks to people from acquired infections.

People were supported by staff that were suitable and fit to work for the service. The provider carried out employment and criminal records checks on all staff. The majority of people told us they had no concerns about staff turning up late or missing a scheduled visit. This indicated there were sufficient numbers of staff available to support people. Staffing levels were monitored by senior staff to ensure people’s needs could be met at all times.

Staff received relevant training to meet people’s needs. Senior staff monitored training to ensure staff skills and knowledge were kept up to date. Staff received supervision so that they were appropriately supported in their roles to care for people. They had access to specialist advice and support for safe medicines administration and for supporting people living with dementia.

People were involved by staff in discussions about their care and support needs. Each person had a support plan which set out for staff, their needs and preferences for how they wished to be cared for and supported. People said staff met their needs. Staff demonstrated a good understanding of how people’s needs should be met. They supported people to engage and pursue activities and personal interests to promote their overall wellbeing and reduce the risks to them from social isolation. Senior staff reviewed people’s care and support needs regularly to ensure staff had up to date information about people’s current care and support needs.

Where the service was responsible for this, people were encouraged to eat and drink sufficient amounts to support them to stay healthy and well. Staff supported people to take their prescribed medicines when they needed these. Staff monitored people’s general health and wellbeing. Where they had any issues or concerns about this they took appropriate action so that medical care and attention could be sought promptly from the relevant healthcare professionals.

The provider had clear goals and objectives about what people and their carers should expect from staff and the service in terms of standards and conduct. The majority of people were satisfied with the care and support they received. People knew how to make a complaint if needed. People said staff were kind, caring and respectful. People’s right to privacy and dignity was maintained by staff, particularly when receiving personal care. People were encouraged to do as much as they could and wanted to do for themselves to retain control and independence.

The provider sought the views and experiences of people and staff about the quality of care and support provided and how this could be improved. Senior staff used this information along with other checks to assess and review the quality of service people experienced. Where there were any shortfalls or gaps identified through these checks senior staff addressed these promptly.

We checked whether the service was working within the principles of the Mental Capacity Act (MCA) 2005. Staff received training in the MCA so they were aware of their responsibilities in relation to the Act. Records showed people’s capacity to make decisions about aspects of their care was considered when planning their support. Where people lacked capacity to make specific decisions there was involvement of their relatives or representatives and relevant care professionals to make these decisions in people’s best interests.

All of the people we contacted were happy with the service. One person told us 'They have been really helpful, far beyond what I thought they would do.' Another person told us 'This is a brilliant service. They always go that extra mile and I can relax knowing my relative is well cared for.'

People told us that staff asked their permission before they did things for them. One person said 'They always ask me if I am happy with what they are doing. No one makes me to do things I don't want to do.'

People received care and support that met their needs. All the people we spoke with felt their care needs were met. One person told us 'They are absolutely first class; they put a lot of other companies I have used to shame.'

Staff understood their roles with regards to cleanliness and infection control. People who used the service told us that staff wore gloves and aprons when they provided personal care.

The staff we spoke with said they felt supported in their roles. They received training and supervision to enable them to provide good quality care.

The manager had regularly sought the views of people to ensure they were happy with the service.

The people we spoke with all told us that they felt the care they received was good and that they had been fully involved in their care plans. One person told us 'The staff are very good, they are all willing to do what you need.' Another person told us the service was 'Absolutely first class.'

The relatives of the people who used the service told us that they felt the people who used the service were safe in the staff's care and that they were treated with dignity and respect. One relative told us that the staff were 'Absolutely brilliant' whilst another said 'The service listen to me when I have a concern.'

We found that appropriate checks were undertaken before any member of staff started work at the service. We looked at staff files and spoke to staff who confirmed this.

The service had systems in place to monitor the quality of the service and to identify when things needed to be improved. We saw that this included sending questionnaires to people and relatives and to gather their views of the service.