Archived: Spring Healthcare Limited

Spring Healthcare is a domiciliary care agency providing personal care to people living in the community. The service was providing support to 1 adult in Derbyshire and 3 children in the Nottingham area. At the start of this inspection the provider was also supporting 5 people in the Bolton area where the provider is located. Prior to the end of our inspection the provider was no longer providing support in the Bolton area.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People generally received support in line with their assessed needs. Assessments of people’s needs had improved since our last inspection; however, some care plans lacked specific detail which would provide staff with person centred guidance on how people wished to be supported. People's independence was promoted and support was in place to enable people to access the community. Staff supported people to achieve their goals, take part in chosen activities and pursue interests . here staffing levels allowed.

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; however the policies and systems in the service did not always support this practice.

Right Care: People's care was not always safe. Risk assessments associated with the provision of people's care had been improved but in some cases further detail was required to make them person centred. Medicines were not managed safely and we found inconsistencies across people's medicine records. This had been identified during our last inspection and the provider had introduced 2 new systems; however, this had caused inconsistencies with the information recorded in each system. We found paper records in particular contained gaps in recording which did not reconcile with information recorded on other systems. People and relatives were happy with care and support provided by staff who had an understanding of how to protect people's privacy and promote their independence. The provider evidenced positive communication with external partners in some cases; however, in others local partners had raised concerns around a lack of engagement.

Right Culture: The provider did not always place people's wishes, needs and rights at the heart of everything they did. The provider failed to ensure governance systems promoted, monitored and maintained quality care for all people. Staff did not always receive training in key areas before commencing employment. Other mandatory training courses had not always been completed before staff started to work with people. Concerns were shared with us regarding the registered managers approach to working collaboratively, particularly when complaints or issues were raised. A recent safeguarding investigation had been substantiated and an important action to be taken had not been completed by the provider. The provider shared their rationale for this and we advised seeking guidance from CQC’s registration team to discuss this and sharing the outcome with us; by the end of the inspection this had not been completed. The provider had revised their policies since our last inspection; however, some policies did not ensure staff would be trained before starting to work with vulnerable people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (supplementary report published 28 December 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended the provider consistently reviewed people’s care and involved people and relatives in reviews, work to improve communication with local partners, improved some staffs understanding of person centred care, source training around the management of complaints, reviewed duty of candour systems and policy and improved notification systems. The provider had acted in some areas for example, training had been sourced for the management team around managing conflict and complaints. However, further improvement was needed in some areas. Please refer to the safe, effective, caring, responsive and well-led sections of this report.

This service has been in Special Measures since 25 November 2022.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, good governance and staffing at this inspection.

We took enforcement action which resulted in the cancellation of the provider and registered manager’s registrations to provide and manage the regulated activity.

Spring Healthcare is a domiciliary care agency providing personal care to people living in the community. The service provides support to 9 adults within the Bolton area and 7 children in the Nottingham area.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support: People did not always receive support in line with their assessed needs. Assessments of people needs were mixed and some care plans lacked specific detail which would provide staff with person centred guidance on how people wished to be supported. However, people’s independence was promoted where they were supported to access the community and within their own homes. Staff supported people to achieve their goals, take part in chosen activities and pursue interests where staffing levels allowed.

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; however, the policies and systems in the service did not always support this practice.

Right Care: People’s care was not always safe. Risk assessments associated with the provision of people’s care were not always followed. The provider acknowledged people who were assessed as needing 2 to 1 support had been supported by 1 staff. The provider was aware this increased the risk of harm to people. Medicines were not managed safely and we found inconsistencies across people’s medicine records. This had been identified by the registered manager prior to our inspection but no effective action had been taken to improve staff’s practice. People and relatives were happy with care and support provided by staff who had an understanding of how to protect people’s privacy and promote their independence. We were unable to review evidence of the provider liaising with health professionals but observed evidence of the provider contacting social workers to report additional or reduced support needs.

Right Culture: The provider did not always place people's wishes, needs and rights at the heart of everything they did. The provider failed to ensure governance systems promoted, monitored and maintained quality care for all people. Staff did not receive training in key areas for a service registered to support people with learning disabilities and autism. Other mandatory training courses had not always been completed. Concerns were shared with us regarding the registered managers approach to working collaboratively particularly when complaints or issues were raised. A recent safeguarding investigation had been stalled for several months due to the registered manager being on leave from the service; a lack of an effective management system being in place meant the day to day running of the service was not sufficiently carried out. We were unable to obtain records as requested due to the records having been erased in error on the providers recording system in approximately July 2022. We checked the properties of records submitted and found these had often be amended after deadlines we set for them to be sent across to us. The provider was not working in accordance with several of its own policies including duty of candour, safeguarding, supporting people with autism and training amongst others.

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 (23 June 2021)

At our last inspection we recommended the provider ensured increased staffing levels and development of the management team as the service accepted new packages of care and people to provide support to. At this inspection we found staffing levels and members of the management team to maintain oversight of practice had not sufficiently grown and this had impacted several areas of the service.

Why we inspected

The inspection was prompted in part due to concerns received about the providers support of autistic people, governance of the service, the conduct of the registered manager and the providers management of safeguarding concerns and risk. A decision was made for us to inspect and examine those risks. 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 Spring Healthcare on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing at this inspection.

We issued warning notice's against the provider and registered manager relating to the breaches of safe care and treatment and good governance. The provider and registered manager did not submit an appeal or representations against the warning notice's.

Follow up

We will meet with the provider and ask them to complete an action plan following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Spring Healthcare Limited is a domiciliary care agency. It provides short stay and respite support to children living in their own homes with various needs including, learning and physical disabilities, mental health conditions and sensory impairments. The service is registered to also provide support to younger and older people. At the time of inspection, the service was providing support to three people, with another five people identified for the service to provide care for.

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

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People who the service supported were unable to provide any feedback. However, relatives reported that they were involved in decisions made about people’s care and in the development of care plans, risk assessments and activity plans. Communication plans had incorrect information recorded in them and were not always personalised. After we raised this with the registered manager, this was amended. We recommend the provider ensures the accurate recording of information is maintained.

The provider demonstrated robust recruitment systems, which were used to identify staff who could work with specific individuals and meet their support needs. The provider had robust systems in place to ensure staff wore personal protective equipment (PPE) appropriately. People reported that staff wore PPE correctly and staff had a good understanding of what PPE should be used.

Staff had received a robust induction programme and subsequent training relevant to their role. Systems were in place for the management, supervision and support of staff. However, these had not been utilised yet due to people’s support being provided by the registered manager and the care co-ordinator. We discussed this with the registered manager and more staff were due to start, once other people’s care started; they showed evidence of recruited staff and feedback from staff confirmed this was accurate. We have made a recommendation the provider ensures staffing levels meet the needs of the people they support, as the service continues to grow.

Person centred care was evident in people’s records, such as risk assessments and care plans; it was also evident in the providers policies. Relatives praised the services flexibility in how they supported people and felt staff were warm and caring in their approach.

Not all audits had been used yet, due to the provider only recently, becoming an active provider of care. However, quality assurance systems undertaken were robust and ensured the provider would be able to identify any concerns or errors. Feedback had been sought from people to inform learning and identify areas where things had gone well. Recording systems were in place and although these had been used minimally, they evidenced a detailed and accurate account of people’s support.

At the time of inspection, the service was still developing and identifying people who they could provide support for. Difficulties with identifying people in the local area, had led the provider to widen their catchment area and they were supporting people in the Nottingham area. Future packages of care had been identified in the Cheshire area. The provider had robust plans in place to maintain oversight of the care provided, in the event they supported people in different areas. As well as linking in with local authorities, the registered manager had actively sought advice from similar services and partners in the local area.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

This service was registered with us on 30 July 2020 and this is the first inspection.

Why we inspected

This service had not been inspected since their registration in July 2020, therefore, this inspection was carried out to gain assurances about the quality of care and systems used to monitor and manage the service.

Follow up

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