Smartway Health and Social Care Limited

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified 1 breach of regulation as the service did not have suitable systems of oversight to ensure people received safe and effective care. This meant action to address shortfalls was not taken in a timely way. Staff spoke positively about the registered manager and people and staff mostly felt able to raise concerns. However, it was not evident that sufficient action was taken to address issues such as call management and staffing. The service did not have clear visions, processes for learning and driving improvement and shared responsibility between the registered manager and provider for oversight of the service.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt they were able to raise concerned if needed with one relative commenting, “We have no complaints about it and we are confident if we need them to do anything they would do it within their remit.” The registered manager was aware some staff were disgruntled with the new staff recruited who were on sponsorships. However, we have found no evidence of the registered manager or provider bringing staff together to discuss the vision, values and strategy of the service. The registered manager was fully aware of the issues connected to the accuracy of the care management system. However, work to address this had been minimal and no work had been undertaken with staff to ensure they were aware of the risks of not using accurate times.

Feedback about the culture of the service was mixed from staff and people’s relatives. Some staff felt their work hours were removed from them in order to ensure the staff on sponsorships had sufficient hours. This was impacting upon people using the service with one relative commenting, “I hear a lot of disgruntled staff. Most of them are actively looking for new jobs.”

We were not always assured there was sufficient capacity, capability and integrity to ensure that the organisational vision could be delivered, and risks were well managed. The registered manager was unable to show how they supported teamwork. Staff generally spoke positively about the registered manager. One member of staff commented, “I feel the management team that exists does [deal with poor practice] but there were a lot of inherited issue in the service.” Although we received positive comments from staff, we were not assured by the leadership at the service. The registered manager was aware there was a poor culture in the way some staff completed people’s care calls, that may affect the quality of people’s care. We have not been assured that these matters were being addressed.

Feedback from people’s relatives was mixed in respect to whether the service provided a truly compassionate service. One relative commented, “One evening, no one turned up as far as we are aware. I raised it with Smartway, they looked into it, and they said it was a new person who they think rang the wrong bell and their phone died. They were apologetic but we thought it was alarming and concerning….They said mum should have phoned them. The lack of communication is an issue. They generally come within in 1 hour of the set time. They never phone to say they are running late.” The registered manager informed us they welcomed feedback from people or their relatives on the service. A recent survey was generally positive although feedback from people indicated not everyone had been fully involved in this. A staff survey was also positive. However, it was not evident that high-quality leadership at all levels was in place, or that a response to elements of the poor culture at the service was being addressed in a timely way.

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

In the main staff told us the registered manager was approachable and supportive and felt able to raise any concerns about people's care with them. Some staff told us that there had been historical issues of poor culture that had not yet been resolved. One member of staff commented, “Ok now we have the new manager.” Staff told us the support had improved but this was not reflected in the supervision records or competency assessments. One relative commented that, “There is never any staff coming in from the office to observe care.” Although staff spoke positively about the new manager, we were not assured the manager had consistent knowledge and oversight over some aspects of the service. For example, the manager was not aware of the major shortfalls connected to people’s scheduled call times.

Quality assurance processes and audits were not routinely completed at the service. No evidence of audits being completed by the registered manager or provider were provided as requested. The provider's call-cramming approach towards staff rotas and call scheduling meant it was inevitable people's care needs would not be safely and effectively met or not met at all. The provider's electronic call data demonstrated clear and widespread evidence of significantly late, early, short and missed calls. However, the provider failed to take timely action to recognise the seriousness of the situation. Record keeping in relation to people's daily care was not always being recorded and where they were, they lacked detail and completeness. Incidents did not prompt learning to improve care.

We did not look at Partnerships and communities during this assessment. The score for this quality statement is based on the previous rating for Well-led.

There was a lack of provider oversight at the service to focus on continuous learning, innovation and improvement at the service. The provider did not have any systems to checks on the service but was looking to introduce mock inspections of the service. The process of driving improvement with the service was not shared equally between the registered manager and provider.

Staff were unable to share examples of how the service used learning to improve. Improvements were needed to ensure people consistently received empowering, high-quality care and good outcomes. We have found no evidence of the service considering measures to improve their systems particularly around care monitoring and management. There was no approach to measure outcomes and impact for people. People gave examples where shortfalls were addressed with one relative comments, “It was addressed quickly, and the carer was removed from the care package.” And another relative telling us, “If there is an issue, they are receptive to listening to what I have to say.’