George Edward Smart Homes

George Edward Smart Homes is a residential care home providing regulated activity of personal care to up to 60 older people. At the time of our inspection there were 44 people using the service.

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

A range of audits and quality checks were completed. However, there was no clear strategy in place at provider level and no operational plan to ensure systems and process remained established to maintain accurate and complete records of people’s care.

Risk assessments and associated support plans used by staff as a point of reference were not always up to date or completed which put people at risk of otherwise avoidable harm. There was limited use of systems to take a holistic view of people’s needs, to record, manage and report concerns about risks, safety and incidents.

People told us they received their medicines safely. However, medicine audits failed to look holistically at medicines management and administration resulting in areas of incomplete record keeping.

People received support from a range of health professionals when required. However, care plans including risk assessments and support plans were not routinely updated to reflect any required changes for staff to use.

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.

The home was well maintained, clean with access to large outside garden and seating areas. Staff had good access to personal protective equipment to manage the risks associated with the spread of infection including Coronavirus and adhered to government guidance to protect people.

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; the policies and systems in the service supported this practice.

People told us they felt safe and were happy with their care. Enough suitably trained staff were employed who were knowledgeable and skilled. Staff received appropriate training and support to carry out their roles.

The manager was aware of the improvements required. Observations and feedback confirmed the failings we found had a low impact on people at the time of the inspection, but people were at risk if the required improvements were not quickly implemented.

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 3 January 2019).

Why we inspected

We received concerns in relation to the management of the home, provider oversight, management of risks and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe 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 George Edward Smart Homes on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the management of the service and provider oversight (including risk management and governance checks).

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 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.

We found the following examples of good practice.

All essential visitors had to wear appropriate personal protective equipment (PPE). Also, have a negative COVID-19 test result, have their temperature checked and carry out hand hygiene prior to entering the home. Staff completed online training and paper-based learning booklets provided by the local NHS infection prevention and control (IPC) team. Training included putting on and taking off PPE, hand hygiene and other IPC and COVID-19 related training and updates.

People were supported to keep in touch with their relatives. Relatives could visit using the indoor visiting room that had a screened area and robust cleaning procedures in place. For people whose relatives couldn’t visit other options were available using technology such as video calls.

The home had ample supplies of appropriate PPE which was stored hygienically and kept safe. Staff were provided with appropriate areas to put on, take off and dispose it safely.

Social distancing practices were in place at the home, staff took breaks separately and when people used communal areas such as dining rooms and lounge areas, they were able to share these spaces safely.

The home was very clean and additional cleaning of all areas and frequent touch surfaces was in place such as handrails. These were carried out and recorded regularly by housekeeping staff. Additional deep cleaning was also carried out where required.

About the service: George Edward Smart Homes is a care home that can provide personal care for up to 60 people aged 65 and over, some of who may be living with dementia. 50 People lived in the service when we inspected.

Why we inspected: This inspection was a scheduled inspection based on the previous rating.

People’s experience of using this service:

People and their relatives described the service as a ‘Hotel’. When we asked what this meant people explained that they received support they needed in the way they liked when they asked for it. People said staff knew them very well and could anticipate their needs and that support was delivered in a timely way. People described excellent provision of activities and events that were tailored to their needs. People were supported through technology to maintain relationships and afforded support to develop and build new relationships. People and their relatives described high levels of satisfaction with the service which impacted positively on their overall wellbeing.

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. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, this was carried out with compassion and dignity.

The environment supported people to have time on their own and time with other people if they chose this. The registered manager agreed that more work to help people living with dementia to find their way in the service would be beneficial. Cleanliness and health and safety were well managed.

Staff had appropriate skills and knowledge to deliver care and support in a person-centred way. Staff recruitment was safe. Staff understood how to keep people safe and used information following accidents and incidents to reduce the likelihood of future harm.

The registered manager and management team were well respected. They supported the team to deliver high quality person centred care. Lots of checks were completed to ensure people were safe and that their experience was positive. People, their relatives and staff all felt confident raising concerns and ideas. All feedback was used to continuously improve the service.

How the trustees or provider monitored the service so they provided leadership to the registered manager was being developed. This would ensure appropriate governance was in place.

A full description of our findings can be found in the sections below.

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

George Edward Smart Homes is registered to provide care for up to 60 people. Personal care and accommodation is provided to older people for long term, or respite care, nursing care is not provided. At the time of our inspection 51 people were using the service. The service comprises of two large buildings over two floors which are linked together

At the last inspection on 24 March 2015, we asked the provider to take action to make improvements in their assessments relating to the Mental Capacity Act and this action has been completed.

At the time of our inspection the service had a registered manager in post. 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. We have referred to the registered manager as the manger throughout this report.

At this inspection we found the service required improvement in the domains of safe and well led, therefore required improvement overall. This is the first time the service has been rated Requires Improvement

We found a breach of regulation in relation to staffing. We found that sufficient numbers of staff were deployed during the day but night staffing levels were inadequate, particularly in the eventuality of a crisis or emergency. This was discussed with the manager who immediately implemented an additional sleep over night staff whilst a permanent position was recruited to. You can see what action we told the provider to take at the back of the full version of the report.

The manager did not have a dependency tool in place to support them to deploy staff effectively. After discussion the manager devised and implemented a dependency tool to inform them of the staffing levels required to meet people's needs.

We have made a recommendation about the provider’s responsibilities in relation to good governance of risks to the people they are providing a service to.

The manager had systems in place to ensure that safe recruitment processes were followed. Disclosure and barring checks were in place and two references were obtained for all staff prior to their employment commencing.

Medicines were safely managed. People's medicine administration records (MARs) were accurate and updated by staff once people had their prescribed medicines. The manager completed audits of medicines management to help them identify and address any errors.

Staff were well trained and had access to support. This included induction, on-going training, regular supervision and the completion of annual appraisals. This allowed staff to obtain skills and knowledge and share their personal and professional needs with their line manager.

Staff understood how to protect people from risks associated with harm and abuse. Safeguarding procedures and policies were in place and staff were aware of their responsibilities to identify and report any allegations of abuse to the local authority.

Risks to people's health and well-being were identified. Staff had access to risk assessment outcomes and guidance to support them to reduce risks and keep people safe.

People were supported to have maximum choice and control of their lives and the policies and systems in the service supported this practice. People were cared for within the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People were involved and consulted when planning their care.

Staff respected and protected people’s dignity and privacy. For example, staff knocked on doors before entry. People said staff knew them well and treated them with kindness and compassion.

Primary health care services were accessed when people’s health deteriorated; the provider had good working relationships with local doctor’s surgeries and the local hospice. Staff followed health professionals' guidance regarding people's specific needs. People’s preferences around food and drink were respected and support was in place for people with specialist dietary requirements.

Care assessments identified people's needs. Care plans detailed how the service arranged care so people's needs were met in relation to their preferences. This supported people to maintain their health and well-being.

The manager sought people's views on the service, including the quality of care provided. The manager and the staff monitored and reviewed the quality of care through audits, spot checks, and reviews of the service. The Care Quality Commission was kept informed of incidents that occurred at the service.

People said members of staff were respectful to them and they respected their privacy. They also said they could make their own choices about what they did and how they spent their time.

People spoke highly of the staff and the care they received. One person said 'I have had the best support and care.' A relative who told us they had been fully involved in important decisions about their relative's care said 'It has been like coming home; people here have been so helpful.'

People were aware of the meetings that took place in the home and they told us they had completed questionnaires in the past. All of the people we spoke with said they were happy with the service they received and said that if they were unhappy they could approach the staff to talk about this. We found the service had taken action to respond to suggested improvements.

We found that the premises were maintained to a good standard of repair and refurbishment. Effective systems were in place to safeguard people and to promote their welfare. We found that appropriate checks were in place to make sure that staff were recruited safely.