CQC inspection reports that cite us. CQC regularly cite us in their inspection reports of our customers and we’re also cited by the Scottish Care Inspectorate. The following are all extracts from CQC and Scottish Care Inspectorate reports as a result of inspections performed at care homes where Mobile Care Monitoring is being used.
Date: July 2017
People’s care records were held electronically and covered a range of information relating to people’s health and social care needs. For example they contained information to assist staff to provide care in a manner that respected people wishes. Staff held individual electronic monitors to add any information at any time to people’s personal care records. This helped to ensure care records were always updated and staff were able to respond appropriately. All the staff we spoke to were familiar with people’s needs and said information and guidelines were clear and easy to access. Care plans were personalised and included information about how people chose and preferred to be supported.
Date: July 2017
‘The provider had also recently installed person centred software (PCS) which was linked to the electronic devices staff used to record people’s daily notes. This system also provided alerts when required, for example; to remind staff if people had initially declined their medicines. This innovative system enabled relatives to see what their loved one was doing at any given time through a ‘relative’s portal’. Clearly visible icons displayed people’s moods so people authorised to visit their records could see at a glance how they were feeling. The relative’s portal also had a gallery of photographs showing people enjoying themselves completing different activities.’
‘Relatives provided positive feedback about the development of PCS. One person told us, “One of the strengths of this service has always been the joined up communication between relatives and the staff. They have always been excellent at providing important information, keeping us involved and updated. This new development again shows why they are always trying to make things even better.”‘
‘We observed one person decline their morning medicine and staff demonstrated how the electronic recording system reminded them to administer the medicine later. The person administering also set another alert to ensure the person did receive their medicines as prescribed. People were supported to take their medicines safely.’
‘We spoke with the provider’s positive support director who told us they were improving the capability of the PCS and in the next phase were going to include people’s care plans and risk assessments so authorised people, including relatives and advocates where appropriate, would be able to access live documents. The provider used innovative and inclusive methods to ensure people and those that mattered to them had information available to them when they needed it.’
‘Staff demonstrated how the PCS technology enabled people’s relatives, who could be on the other side of the world, to review this incident, the action taken by staff and the person’s recovery as it was recorded.’
Date: July 2017
‘The provider had researched national and international best practice measures and adopted innovative technologies to improve how people’s care was delivered, monitored and adapted to meet their changing needs.’
‘The provider was innovative and creative and constantly strived to improve the quality of people’s lives. The provider had researched and reflected on how an internationally recognised provider of excellence in dementia care provided care. They had implemented technological systems that […] ensured staff and management had access to the most up-to-date information at the press of a button and enabled relatives to be fully informed and involved in their relations’ care. People benefited from the technology because staff had more time to care for them.’
‘All the information in the care plans was available to staff electronically in hand-held devices they carried with them. A member of staff told us, “I have all the information I need, the care plan, contact details and medical information.” The management team used the risk assessments, care plans and their knowledge of people’s dependencies, to calculate the number of staff needed to support people according to their individual needs.’
‘The electronic care planning system raised a red alert to the management team if people were not weighed regularly, or did not eat well, or if their weight dropped out of an appropriate range for their height, age and health condition.’
‘A member of staff told us that all the information was available to them on a handheld electronic device and they were able to tell us, within seconds of accessing the device, which language one person had spoken as a child. Another member of staff told us, “I learnt about their history and now understand (them).”‘
‘The provider had transferred people’s care plans from paper to electronic records and all staff had handheld mobile devices so they had access to all the information they needed at the touch of a screen. Staff told us they really liked the new system as they no longer needed to spend time writing up daily records by hand. Every time they supported an individual, as agreed in their care plan, they were able to click a button to say ‘completed’. Each person’s electronic care plan included ten ‘must do’s, which were used to make sure time-critical actions were taken by staff. For example, actions by staff to minimise risks related to specific time medicines administration, poor food or fluid intake, risks of skin becoming sore or damaged and checks of people who stayed in their rooms were always relevant to the individual risks identified in their care plan.’
‘The electronic care planning system provided a new opportunity for relatives to stay fully informed and involved in their relations care. Relatives had a password protected access to an on-line ‘gateway’ into their relation’s care plan and daily records. Relatives were able to talk to staff through an associated messaging service, so were able to obtain immediate reassurance from staff if they had any concerns about their relation’s care, support or health. Relatives were able to ask staff to include specific actions into the person’s
10 daily ‘must do’ actions.’
‘Staff told us, “This is better” and “Whenever an intervention happens, we record it – where, how much, happy or unhappy, activities, mobility, in or out of bed” and “I can add ‘must dos’ for the next day, for example, blood sugar and insulin to be checked by district nurse.” We saw the system required staff to record details, such as the person’s response to care and support, their moods and appetites and how much they drank. All the information staff entered was instantly available to the duty manager, which meant they were able to continuously check that people received the care they needed.’
‘The electronic care system sent alerts to staff and managers when specific care actions were due, and showed a red flag if they were ‘late’. A member of staff told us, “The duty manager will come up or phone up very promptly to find out why anything is red.” The duty managers monitored the quality of the service through the same electronic care planning system and through monthly audits of people’s medicines, complaints, accident and incident records and housekeeping records. A service manager told us, “Any omissions, ‘late or asleep’ records are red flagged. At our three daily handover meetings, staff check the red flagged ‘hotlist’ and decide on actions needed. There is a footnote facility to explain why items on the hotlist are closed.”‘
Date: June 2017
There was an electronic records system in place which ensured that all aspects of people’s care was kept up to date which enabled the registered manager to monitor people’s general health and well-being and keep them safe.
Date: June 2017
Staff had individual electronic tablets to record any interventions. Observation of the system demonstrated staff were familiar with the system. A staff member told us, “It’s a very good system because we record things at the time of the event rather than waiting to write it up at the end of the shift, when we might forget something.” The registered manager showed us how they were alerted when care had not been provided as required. This meant the service was responding to people’s needs when they needed the support.
Date: June 2017
Investment in an electronic records system provided the facility for the registered manager and the registered provider to have greater oversight and scrutiny of day to day care delivery, even remotely when not on site. This enabled the registered manager and provider to check at any time of day or night, the support provided to people, the administration of their medicines, food and fluid intake, personal care routines supported and activities participated in. This provided them with greater assurance that all aspects of the service were meeting requirements consistently and systems in place were being carried out as per their own policies and procedures.
The new electronic system enabled the provider and registered manager to scrutinise how many people were participating in what types of activity on any given day; they could identify where there were gaps in available activities or where particular individuals were at risk of becoming isolated through non participation and could take action to address this.
Date: June 2017
The provider utilised an electronic care plan system and each healthcare assistant was issued with a smartphone which they used to clock in and out, and checked off their tasks every time they visited a person to support them. This system allowed the managers to have an overview of when visits were carried out and if healthcare assistants attended visits on time. It also provided them with real-time information about the personal care tasks that had been provided at any particular time.
Healthcare assistants scanned their smartphones when they entered and left a flat to carry out personal care. This uploaded data onto the care plan system so the registered manager was able to view real time information about when people had been supported. The system also allowed for alerts to notify if a visit was late or had been missed.
The system was automated so when clinical staff completed a risk assessment, if the data inputted indicated a high risk there was an associated care plan in place to manage the risk. For example, one person had been identified as being at high risk following a waterlow risk assessment and they had an appropriate skin integrity care plan in place to manage the risk of developing pressure sores.
Observations such as temperature, pulse, blood pressure, blood oxygen, respiration and weight were recorded and could be analysed for any changes easily as they were presented electronically in a graphical format.
The provider used an electronic, paperless care planning system with a mobile application that was used by the healthcare assistants. Care records were created, updated and maintained electronically. The front page of each record had a summary and a checklist and the time of when personal care tasks had last been completed. This provided a visual confirmation of the last time that people had been supported.
The electronic care plan system was able to generate a hospital passport if needed. The aim of the hospital passport is to provide hospital staff with important information about people and their health when they are admitted to hospital. Any relevant notes such as therapy or GP reports were scanned into the system.
Date: May 2017
“People’s care records described the way in which they wished to be supported. These had been transcribed onto a new electronic format which staff accessed using mobile telephones issued by the provider. These had security log in codes and were stored in the home. Staff described how effective these were to use whereby they were able to update care records as they provided care and support. Another advantage was the responsiveness to changes in people’s care needs instantly updating care records. For example, a person had seen their GP and due to concerns about hydration they had asked staff to monitor their fluid intake. This had immediately been added to the electronic care plan and staff working around the home were immediately updated about this. If a person had not received the care and support as scheduled, the management team would be alerted and could follow this up to find out why. This meant people’s care was monitored closely to make sure they received their care and support when they needed it.”
“[Oakhaven] had recently introduced a new electronic care planning system which staff used interactively as they provided care. The impact of this was more time for staff to spend with people delivering care and support as well as staff having instant access to people’s care needs and any changes which had arisen. This also meant the response time for dealing with people’s changing needs was quicker and referrals for health care professionals could be made promptly.”
Date: May 2017
Provider had recently introduced a new electronic care plan software, which the registered manager told us had been very effective and enables staff to respond to people’s needs. Staff said, “If care is missed the device will flag this up. This is been effective for escalating health issues like vital signs and any missed two hourly turns and supplements of fluids”. Each person had an up to date care plan which set out for staff how their needs should be met. Care plans contained information about people’s likes, dislikes, allergies and their preferences for how care and support was provided.
Date: April 2017
Each staff member had an i-pod which allowed them to access people’s records only accessed via a password. These included care plans for personal care, safety and the environment, nutrition, activities, communication, continence needs, mobility, medication, emotional support and sleeping patterns. Staff were also able to access the handover notes for each shift and add to them if a GP had been called, for example and could also log any concerns raised by a person or their family. As staff had the i-pod with them they were able to refer instantly to the records which meant it was better for the person as they could remain with them while checking their records.
Care records resulted from the initial assessment and were person-centred. They included all key aspects of a person’s needs such as communication, lifestyle preferences, emotional support needs, mobility, nutrition skin integrity and medication. Each assessment discussed the present situation for a person, what their needs were and how these were to be met with very specific guidance for staff. The level of support required for people was highlighted according to the activity or decision they were undertaking. In one care record we saw ‘[Name] can communicate their needs but gets confused when people ask them questions. They may need more assistance making choices that are in their best interest…They sometimes find it easier to make decisions if given a choice of two or more.’ On each assessed need the person’s risk assessment scores were noted helping staff to see instantly how other aspects of their abilities may impact on their care need.