ASRA-Smethwick improved from Requires Improvement to Good across all five key questions, resolving five previous regulatory breaches relating to safeguarding, recruitment, complaints, communication, and governance. The service demonstrated consistent person-centred care, effective risk management, and strengthened leadership and quality assurance systems.
Strengths
· Safeguarding systems improved from previous breach of Regulation 13; staff demonstrated clear understanding of abuse recognition and reporting responsibilities.
· Recruitment practices strengthened following previous breach of Regulation 19; DBS checks and references consistently obtained.
· Medicines administered safely using electronic MAR charts with regular competency checks and manager audits.
· Staff trained in IPC with regular spot checks to ensure PPE use in practice.
· Care plans included up-to-date risk assessments, people's communication needs, and protected characteristics under the Equality Act 2010.
ASRA Smethwick is a small domiciliary care service rated Good across all five key questions at its July 2016 announced inspection. The service demonstrated consistent strengths in staff training, dignified care, person-centred practice, and quality assurance, with no areas of concern identified.
Strengths
· Staff understood how to recognise and report abuse; no safeguarding concerns identified
· Robust recruitment procedures including DBS checks and references in place
· Medication Administration Records completed fully with monthly manager audits
· Staff received regular training, induction including Care Certificate, and quarterly supervisions
· People supported in their preferred language, including Punjabi-speaking staff matched to service users
ASRA Smethwick deteriorated from Good to Requires Improvement across all five key questions, with critical regulatory breaches found in safeguarding (Reg 13), fit and proper persons (Reg 19), dignity and respect (Reg 10), complaints handling (Reg 16), and good governance (Reg 17). The provider failed to notify the local authority of serious abuse allegations, operated unsafe recruitment practices, did not meet Accessible Information Standards, and lacked effective quality assurance systems to identify and address widespread service failures.
Concerns (12)
criticalSafeguarding — “The local authority safeguarding team had not been notified and the provider did not take appropriate and effective action to protect people either during or after the providers investigation.”
criticalStaff training — “Not all staff had received safeguarding and whistleblowing training. Where training had been provided the training was not put into practice.”
criticalRecord keeping — “Staff recruitment practices were not safe. The provider did not keep clear records of the recruitment process.”
criticalComplaints handling — “There was not a record of complaints in place. We saw and heard that complaints were not dealt with in keeping with the complaints policy and procedures.”
criticalGovernance — “The provider did not have an effective overview of the service. We identified issues at this inspection that had not been identified by the providers quality assurance processes.”
moderateStaff competency — “New staff that did not have a health or social care qualification, were not given the opportunity to complete the Care Certificate.”
moderateCare planning — “Care plans were not always personalised to the individual. Care plans did not always record details about each person's specific needs and how they liked to be supported.”
moderateCommunication with families — “There was no information in place to enable the provider to meet the requirements of the Accessible Information Standards (AIS), should this be required.”
moderateIncident learning — “There was not an overview or analysis of incidents. There had not been any incidents recorded since the new Registered Manager was appointed.”
moderateCultural competency — “Two relatives told us they preferred to receive written communication in Urdu, and two in Punjabi. We did not see any alternative communication for people with communication difficulties.”
moderatePerson-centred care — “The provider did not fully consider people's equality characteristics, for example where people's first languages were Punjabi and Urdu written consultations were not available in these languages.”
minorEnd-of-life care — “The care plans we reviewed did not cover end of life care. We did not see any evidence that people or their relatives were being given the chance to consider this subject.”
Strengths
· Staff received regular supervision and annual appraisals.
· Good infection control practices were in place, with staff using gloves and aprons during personal care.
· The service was working within the principles of the Mental Capacity Act 2005.
· Staff sought permission before delivering any aspect of care, respecting people's dignity and independence.
· Medication was administered as prescribed and staff competency in medicines was checked regularly.
Quality-Statement breakdown (20)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
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Requires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement