19 January 2017
During a routine inspection
This inspection took place on 19 and 23 January 2017. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to ensure that the registered manager would be present. The inspection was carried out by one inspector. Following the inspection we met with the provider to discuss issues that we found during the inspection.
The service had a registered manager. A registered manger is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of law, as does the provider. The registered manager was present during the inspection.
Smile Care Agents had recently moved location. This was the first inspection at the current address. However, the service was last inspected 17 January 2014 at the previously registered location and was meeting all the standards inspected.
The service provides domiciliary care and support for 20 people in their own homes. The service works primarily with older people that have recently been discharged from hospital and require up to six weeks rehabilitation and support in their own home.
There were no risk assessments completed for any person that used the service despite serious risks having been identified by the referrer at the point of referral.
The provider did not ensure safe staff recruitment. There were no references from previous employers for any of the staff employed. Issues around criminal records checks for care workers were not followed up or risk assessed. Information held for care workers regarding their recruitment was inconsistent. The provider was unclear on how many staff were they employed.
People and relatives told us that they regularly experienced late visits. There were no rotas detailing staff deployment. Visit times for people were not documented on their care records.
We were unable to evidence if staff had received training in safeguarding vulnerable adults from abuse. There was no overview of training provided to care workers available.
Staff did not receive supervision. The registered manager confirmed that no staff member had received supervision.
There were no records regarding training for staff available. We were unable to check if staff had received any training. The registered manager told us that staff did receive training. We requested information on staff training. However, this was not provided.
There were no records to show whether staff had received an adequate induction when they commenced employment.
The registered manager confirmed that staff had not received training in the Mental Capacity Act (MCA). The MCA looks at staff responsibilities to ensure that they are aware of people’s capacity to make decisions about their care and wellbeing.
Care plans were not person centred and failed to provide staff with sufficient guidance on how people wished their care to be delivered. Of the 18 people’s care information that we looked at, only six people had a care plan in place. For the other 12 people, the service used the local authority referral form and did not complete their own care plan.
There were no records of complaints that the service received. Many people and relative that we spoke with said that they had made complaints. The provider was not ensuring the effective recording or actions with regards to complaints.
Audits on any aspect of the service were not completed. There was no management oversight of quality assurance to ensure that care was being delivered safely and effectively. The lack of audits meant that there was no on-going learning and improvement regarding the quality of care.
People and relatives told us that staff were good but required a lot of guidance to ensure that they completed the care tasks needed by people. People and relatives felt that care workers carrying out care tasks treated them with dignity and respect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
We identified six regulation breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.