Archived: Smart Care

Updated 30 June 2018

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.

Before the inspection we reviewed the information we held about the service. This included previous inspection reports and statutory notifications. A notification is information about important events which providers are required to notify us by law. We did not request a Provider Information Return (PIR) at the time of our visit. The PIR is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. We gathered this information throughout our inspection.

The inspection took place between 29 May 2018 and 7 June 2018. It was conducted by one adult social care inspector. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

In the course of our inspection we spoke with 18 staff, 15 people who use the service and five relatives of people who had limited verbal communication.

On 29 May and 1 June 2018, we visited the provider’s office and spoke with three people who had invited us to see them in their homes at the time of their care visits. During the office visits we spoke with the registered manager, the nominated individual, the provider’s area manager, the quality support supervisor, the service medicine’s champion, the care coordinator, the office administrator and seven staff. Between 1 and 7 June 2018, we spoke with 12 people who use the service, four health and social care professionals who had engaged with the service and two commissioners of people’s care.

We reviewed eight people’s care plans, including daily records and medicines administration records. We looked at eight staff recruitment files, and reviewed the provider’s computer training records. We reviewed the provider’s policies, procedures and records relating to the management of the service, including quality assurance audits and complaints. We considered how comments from people, staff and others, as well as quality assurance processes were used to drive improvements in the service.

Updated 30 June 2018

This announced inspection of Smart Care Limited took place between 29 May and 7 June 2018.

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.