Archived: SMS CARE LIMITED

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.

Dixon House is a residential care home providing personal care for to up to 11 people. The service provides support to people living with a learning disability or autistic spectrum disorder. There was 5 people on both days of the inspection.

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: There was a range of policies and procedures. However, these required updating and had not all been signed. Staff understood people’s individual needs. Community activities were being provided and we saw household duties and meal preparation was undertaken with people. Activity plans had not been developed and there was limited evidence recorded of activities undertaken. Care record were noted however, some of these required a review to ensure they reflected people’s needs. Individual risk assessments were not always up to date. Gaps were identified in staff training and recruitment.

People were not always supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We have made a recommendation in relation to ensuing records were up to date and guided staff on protecting people from unlawful restrictions.

Right Care: Person centred individualised care was provided. The staff team understood people’s needs. Good relationships were noted between people and staff and positive engagement was seen. All bedrooms were of single occupancy with communal areas on both floors. People were seen choosing where they wanted to spend their day either in their own rooms or communal areas. Relatives told us they were kept up to date and were involved in reviews of their family member’s needs. People were happy with the care, and relatives told us they were informed and involved. The nominated individual provided a lockable storage cupboard for confidential records. We saw evidence of the involvement of advocates for important decisions.

Right Culture: The atmosphere in the service was homely and people and staff fedback that it was a family. There was no consistent manager in post and the feedback was that this was the biggest concern. We identified a number of shortfalls at the inspection. These included investigations, audits and monitoring and the operation and management of the service. The provider did not provide all of the information we requested as part of the inspection.

Risks were not being managed safely. Environmental risk assessments had not been completed and individual risks assessments required reviews to ensure they reflected people’s current needs. Accident and incident records had been completed however, there were no records of analysis or lessons learned. Not all relevant checks had been undertaken on the environment or fire risks. There was information and guidance in relation to infection control, and supplies of PPE were available. However, we saw staff not always wearing masks appropriately. There was evidence of safeguarding referrals however, we did not see details of the investigation or actions taken.

Staff were not recruited safely and we saw only one record of inductions for newly recruited staff. The provider told us they would introduce a dependency tool to ensure sufficient staff were in place to support people in the service. Medicines were not always managed safely across the service. People were mostly confident in the staff skills however, records failed to confirm that they had received relevant training. Not all staff confirmed they had completed the required training. People were happy with the food and that they were given enough to eat. Weights were being recorded but these had not been done consistently where required. Whilst some kitchen cleaning and temperature checks were being done, these were not being undertaken consistently. Information about reviews and referrals to professionals was recorded. The service was homely and people had personalised their own rooms.

Care plans were in place. One person’s care plan required updating to ensure it reflected their individual need. The supporting manager told us they were planning to update these. Positive feedback was received, however a system was required to ensure any complaints raised confirmed the investigations undertaken and any actions as a result. People’s communication needs were considered.

We identified a number of failings throughout the inspection. These were in relation to the management of risk, safe management of medicines, ensuring safeguarding procedures were in place, to ensure staff received the required training and support. As well as systems to demonstrate that the provider acted in an open and transparent manner and good governance. Audits were not being undertaken on a range of areas and where audits had been done for example care plans, these had not been done recently. Team meetings were taking place, we discussed some feedback in meeting minutes and improvement to their content going forward. Positive feedback was noted from professionals and the involvement of professionals to support people’s care needs was seen.

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 requires improvement (published 31 March 2020).

We asked the provider to complete an action plan after the last inspection to show what they would do and by when to improve. This was not provided. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider ensured staff received the learning and development they need to meet people's needs, including ongoing updates, and that the provider consider current guidance on managing medicines. At this inspection we found further concerns in relation to the management of medicines and learning and development for the staff team.

We made recommendations in relation to infection prevention and control, ensuring people’s diet and fluid needs were assessed and monitored. As well as ensuring records were up to date and guided staff on protecting people from unlawful restrictions and obtaining consent. As well as ensuring plans were developed in relation to planned activities and people were supported to access meaningful activities of their choosing, ensuring care plans reflected people’s individual needs and how to support them. And ensuring a robust system is in place for recording and acting on complaints.

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was prompted in part due to concerns received about the management and oversight, staffing, lack of choices for people, meals, activities and stimulation, and the environment. A decision was made for us to inspect and examine those risks.

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.

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 Dixon House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 is therefore 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 questi

Dixon House is a residential care home providing personal care and support for up to 11 people with a learning disability. This is larger than current best practice guidance. However, the potential negative impact of the home being bigger than most domestic properties was eased by the building design fitting into the residential area. At the time of the inspection eight people were using the service.

The service in the main, reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having opportunities for them to gain new skills and become more independent. Some progress was needed with goal planning and this was ongoing.

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

People and their relatives were happy with management of the service. However, the provider had not given proper attention to overseeing the service and checking people were receiving safe and effective care. There had been changes in management and leadership which had an influenced on the day to day running of the service. Staff did not have access to policies and procedures to guide their conduct and there were no development plans for the service.

People said they felt safe at the service, but we found the provider had not ensured people were provide with a safe environment. Some risks had not been properly assessed and managed. We found some shortfalls with the support people received with medicines. We have therefore made a recommendation about the management of medicines. Staff were aware of safeguarding and protection matters. Staff recruitment checks had not always been fully completed, the registered manager took action to introduce better systems.

Although people were happy with the support they received, there were some shortfalls with ensuring staff had enough skills and knowledge. We made a recommendation about staff training and development. Some progress was needed to ensure people’s assessed needs could be appropriately met at the service and in providing a homelier environment. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. People were satisfied with the variety and quality of the meals. People were supported with their healthcare needs.

People made positive comments about the caring and friendly attitude of staff and said their privacy and dignity was respected. Staff were respectful of people's choices and opinions and had an awareness of their individual needs. Staff had enough time to support people and listen to them.

People had a support plan to respond to their needs and choices. People were supported with their chosen activities, relationships and community involvement. Activities and goal planning were not properly included in people’s support plans, but the registered manager agreed to make improvements. People did not have any complaints about the service they received. They had access to a complaint's procedure and were confident they could raise any complaints and concerns.

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

Rating at last inspection

The last rating for this service was good (published 2 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection we have identified breaches in relation to risks to people’s health, safety and wellbeing and monitoring and oversight of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to ensure improvements are made. We will monitor the progress of improvements, working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

At the last inspection this service was rated overall Good. This was an unannounced inspection which took place on the 8 and 9 August 2017. At this inspection we found the service remained Good.

People who used the service told us they felt safe when being supported by staff members at Dixon House. Staff had been trained in safeguarding adults and knew their responsibilities to report any concerns. There was also a whistle-blowing policy in place to protect staff who reported poor practice.

Risk assessments such as, epilepsy, bathing, diet and nutrition, bedrooms and manual handling were in place to keep people safe whilst staff members were providing support. These were reviewed on a regular basis to ensure they remained relevant and up to date.

Records showed that robust recruitment processes were followed by the service when employing new members of staff. We saw references and identity checks were carried out as well as Disclosure and Barring Service checks.

Medicines were managed safely in the service. Only those people trained to do so were permitted to administer medicines. One person was assessed as being able to self-administer and the relevant risk assessments were in place in relation to this.

Staff received an induction and were supported when they commenced employment to become competent to work with vulnerable people. Staff were well trained and regularly supervised to feel confident within their roles.

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.

All the people who used the service had been given a copy of the complaints policy and staff knew how to respond to any complaints they may receive. Records we looked at showed there had not been any concerns or complaints raised since our last inspection.

We observed a good rapport between people who used the service and staff. We saw that staff appeared to know people well and understand their needs. People who used the service appeared relaxed.

Care plans we looked at were person centred and contained detailed information that was easy for staff to follow to ensure people’s support needs were met. We saw these were reviewed on a regular basis with the person and their relatives (if they wished). All care records were in an easy read format to assist people to be more involved in the planning of their care and support.

Policies and procedures were in place to guide staff in their roles. These were accessible to all staff and we saw they had been reviewed on an annual basis to ensure they remained relevant and appropriate.

Regular meetings were held with people who used the service, their relatives and staff members to ensure the service received feedback and improve the service. Surveys were also sent out as another means of gaining feedback on the service.

All the people we spoke with who used the service, relatives and staff members told us they felt the management team were approachable and supportive.

Further information is in the detailed findings below.

People told us they were happy with the support they received. One person said, 'It's a nice place; I like it here'. We found people's support plans contained some useful information about their preferred routines and likes and dislikes. This would help staff to support people in the way they needed and wanted.

All areas of the home were bright, safe and comfortable and there were systems in place to maintain standards of the environment. People had access to a range of appropriate equipment to safely meet their needs and to promote their independence and comfort. One person said, "I like my room it is lovely and quiet; I have all the things that I need".

Staff had undertaken training that gave them the skills and knowledge to meet people's needs. One member of staff commented, 'It's a good place; I enjoy working here'. People made positive comments about the staff team. They said, 'Staff are very nice' and 'Staff are lovely'.

People were encouraged to express their views and opinions of the service through regular meetings, reviews and during day to day discussions with staff and management.

People told us they were happy with the current system used to administer their medication. During the inspection we observed a member of staff administering medication to people who used the service and saw that medicines were safely administered.

We found that work had been done to repair the lighting in an en suite shower room. And loose carpets on the staircase and landing had been fitted securely. People told us they felt the entrance lighting and fitted carpets helped them feel safer in their home.

We found there was an up to date homes maintenance log which identified how the premises would be maintained with timescales.

We looked at the support plans of two people who used the service and saw there were procedures in place to ensure their consent was gained in relation to the care provided.

People spoken with told us they received appropriate support with their medication. We saw systems in place for the administration of medicines. We observed staff who did not follow the homes medicine administration procedure. We saw that not all medicines were stored according to the homes medicine policy. This meant that people might be at risk from the unsafe management of medicine.

People spoken with told us they were happy living at Dixon House. They said, 'It's nice here, I like my bedroom' and 'I had a bedroom upstairs, but the one I'm in now is better'. We saw systems in place to record maintenance due in the home. However the provider had not ensured that all areas of the home were safe for people who used the service. This meant that people might be at risk from unsafe surroundings.

We saw evidence that support workers were appropriately qualified and provided with training relevant to their role. We observed staff using inappropriate moving and handling to a person who used the service. This meant that people might be at risk from unsafe care and support practices.