CQC report explained · a residential care home
What the CQC found at Little Smugglers
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Good
- Risks were assessed and managed, including risks linked to epilepsy, choking, mobility and anxiety. Staffing, recruitment, safeguarding, medicines and infection control were also found to be safe.
- Effective?
- Good
- This key question was not covered by this focused inspection, so no new rating was given in this report.
- Caring?
- Good
- This key question was not covered by this focused inspection, so no new rating was given in this report.
- Responsive?
- Requires improvement
- People had activities and support to use the local area, but staff did not always promote independence or achieve people's goals. Some care plan information was inaccurate or out of date, and not all advance care planning had been completed.
- Well-led?
- Requires improvement
- Management and governance had been inconsistent, with several management changes. Quality checks had improved but had not always identified inaccurate or outdated information, and the new manager had only been in post for two weeks.
What inspectors found, April 2023
Little Smugglers is rated Requires Improvement; inspectors found safe care, but personalised support and management were not yet consistent.
This was an unannounced focused inspection on 19 and 27 January 2023. Inspectors spoke with people, relatives and staff, observed care, checked care and medicine records, reviewed staff files and contacted two professionals.
The home was rated Good for Safe. Staff understood safeguarding, risks were managed, medicines were recorded properly and staffing had improved. People were supported by kind staff and had opportunities to go out and take part in activities.
The home was rated Requires Improvement for Responsive and Well-led. Some people needed more encouragement to do things for themselves. Care plans were not always accurate or fully updated, promised improvements had not always happened, and management changes had made it harder to keep improvements going.
The overall rating stayed Requires Improvement. The provider was no longer in breach of the regulations identified at the previous inspection, but the report says more improvement was needed and CQC would continue to monitor the home.
Risk management
The home had improved its management of health and safety risks. Staff had updated guidance for risks such as epilepsy, choking, anxiety and mobility.
“Risks to people were assessed and managed well for people's safety.” from the report
Kind staff
Inspectors found that staff knew people's needs and preferences and provided kind and compassionate support.
“People were supported by staff who delivered kind and compassionate care.” from the report
Improved staffing
Staffing levels were planned around people's assessed needs. Inspectors found that people requiring one-to-one support were receiving it.
“We reviewed staff schedules and found that staffing levels had been allocated consistently and in line with the providers assessment of how many staff were needed to support people safely.” from the report
Activities and community access
People were supported to go out, visit local places and take part in activities linked to their interests.
“People were supported to explore the local area and visit the local garden centre, local pubs and go shopping.” from the report
Support was not always personalised
needs fixingSome people needed more encouragement to do things for themselves. Inspectors found missed opportunities to build on people's strengths and support them to achieve better outcomes.
“There were missed opportunities to apply active support approaches.” from the report
Care records were not always accurate
needs fixingSome care plans had been reviewed but still contained information that was no longer correct. This could make it harder for staff to follow the right guidance.
“more oversight was needed to ensure all information was correct.” from the report
Management changes
needs fixingThere had been several management changes, and the home did not have a registered manager at the inspection. Inspectors said this had affected the home's ability to fully address earlier concerns and embed improvements.
“There had been a significant number of changes in management and governance of the home.” from the report
Uncompleted promised changes
needs fixingA planned improvement to one person's bedroom had still not been completed despite earlier assurances. Relatives also reported frustration about promises and communication.
“this had not been completed for one person despite previous assurances from managers and the provider.” from the report
- 01How will you help my relative do more for themselves rather than staff doing tasks for them?
- 02How will you make sure their care plan is checked and kept accurate after every change in need?
- 03What specific steps are being taken to make sure promised improvements, such as changes to bedrooms or support, are completed?
- 04Who is currently responsible for managing the home, and how will leadership remain consistent while the new manager settles in?
- 05Has my relative's advance care plan been discussed and recorded, including their wishes for future or end of life support?
This was an unannounced focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and the overall rating used previous ratings for the questions not covered. This explanation was written from the published report of 1 April 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2022
Rated Requires Improvement; inspectors found risks, staffing and leadership needed improvement.
This was a focused inspection on 11 and 15 February 2022. Inspectors spoke with people, relatives, staff and professionals. They observed care and checked care, medicine, staff and management records.
Some health risks were not properly assessed or managed. Staffing levels were often too low, especially at weekends, and agency staff were used frequently. This affected people's support, including help with distressed behaviour, one-to-one support and activities.
The home had detailed care plans and staff understood people's communication needs. Medicines were generally administered safely, infection control was well managed, and people were helped to keep in touch with relatives.
The overall rating changed from Good at the previous inspection to Requires Improvement. The Safe, Responsive and Well-led areas were rated Requires Improvement. Caring and Effective were not inspected during this visit, so their previous ratings were carried forward.
Medicines
Staff generally followed safe systems for administering, recording and storing medicines. Staff who gave medicines had been trained and assessed.
“People were supported by staff who followed systems and processes to administer, record and store medicines safely.” from the report
Infection control
Inspectors were assured that infection prevention measures were in place, including safe use of protective equipment and arrangements for outbreaks.
“We were assured that the provider was using PPE effectively and safely.” from the report
Communication support
People's communication needs had been assessed and included in care plans. Inspectors observed people communicating effectively with staff.
“People's communication needs had been assessed, and their care plans included information and guidance on how staff could communicate with them effectively.” from the report
Working with professionals
Staff worked with specialist and community learning disability services when needed. A professional said staff followed advice and understood how to support healthcare access.
“Staff and management worked with other professionals and specialists to support people's care when required.” from the report
Unmanaged health risks
seriousThere was no care plan or risk assessment to guide staff if one person had further seizure activity. A choking risk had also not been followed up with a specialist assessment or referral at the time of inspection.
“There was no care plan or risk assessment to guide staff with any potential subsequent seizure activity.” from the report
Insufficient staffing
seriousRotas often showed fewer staff than planned, particularly at weekends. This affected one-to-one support, distressed behaviour support and people's ability to take part in activities.
“The provider had not ensured that sufficient numbers of suitable, experienced staff were deployed to meet people's needs.” from the report
Limited activities
needs fixingMany people lacked structured routines and meaningful occupation at the home. Staffing problems limited access to the community and outdoor activities.
“However, our observations during the inspection was that there was limited organised occupation for people within the service.” from the report
Weak leadership and checks
seriousStaff and relatives described poor communication and inconsistent leadership. Audits had not identified issues found by inspectors, and actions were not always followed through.
“Although the provider has quality assurance systems in place, they were not always successful in identifying the issues raised in this inspection.” from the report
Medicine record error
minorInspectors found an administrative error where a medicine chart showed a medicine was still being given when they were told it had stopped. The error was corrected during the inspection.
“During the inspection we identified administrative errors in relation the recording and auditing of medicines.” from the report
- 01What has changed to make sure seizure and choking risks have a clear, current assessment and care plan?
- 02How many permanent staff are now working at the home, and how do you ensure one-to-one support is provided when it is part of a person's assessed need?
- 03What regular activities and community opportunities are now available for each person?
- 04How are agency and new staff shown the key information in each person's support and behaviour plans?
- 05What action has been taken to improve communication with families and to make sure audits identify and follow up problems?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were carried forward. This explanation was written from the published report of 13 July 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Little Smugglers
5 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- April 2023Requires improvementcurrent ratingstayed Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- July 2022Requires improvementdown from GoodSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- December 2019Goodstayed GoodSafe: GoodResponsive: GoodWell-led: Good
- April 2017Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- August 2011
Registered with the Care Quality Commission on 10 August 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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