Springfield Healthcare (Leeds & Wakefield)

People’s experience of using this service: Effective systems were in place to monitor the quality of service and action was taken where areas for improvement had been found. People, relatives and staff had the opportunity to provide feedback about the service. The provider worked in partnership with other services to support people’s quality of life and well-being, when needed.

People were supported safely and protected from harm. There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to individual people. The management of medicines was safe, staff had completed training and audits were completed and actions identified to reduce the number or recording errors. Staff followed infection prevention and control guidance when supporting people. Lessons were learnt, through accident, incident, safeguarding and complaints. These were shared with staff members to ensure changes were made to staff practice, to reduce the risk of further occurrences.

There were enough skilled and experienced staff to meet people’s needs. An induction was completed by new staff. Staff received appropriate training and support to enable them to perform their roles effectively. There was a system in place to monitor staff training. Recruitment processes and a staff retention programme were in place.

Staff involved healthcare professionals to support people's health needs, where required. Support plans identified nutritional and dietary requirements. People received support, with eating and drinking, when needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff gained people's consent before providing support.

People and relatives said staff were kind and caring. Staff described the importance of treating people with dignity and respect. Initial assessments were carried out to ensure people’s needs could be met. Support plans showed people were involved in their support and were personalised, with sufficient detail for staff to provide effective care and support. Some people required end of life care. The provider worked closely other organisations who facilitated their specific care needs and staff had received training, where appropriate.

Information was provided so people knew who to speak with if they had concerns. A complaints system was in place and these were managed effectively.

Rating at last inspection: At the last inspection, the service was rated ‘requires improvement’ (published 10 April 2018).

Why we inspected: All services rated ‘requires improvement’ are re-inspected within one year of our prior inspection report publication date. This was a planned inspection was carried out on 9 and 10 April 2019 to check the safety and quality of care people received.

Since our last inspection in December 2017, the provider had made improvements to the management of medicines, monitoring staff training and governance of the service. The operations manager was in the process of reviewing staff travel time between visits and improving the assessment of people’s mental capacity.

At this inspection we found the provider’s rating had improved to good.

Follow up: We will continue to monitor the service through information we receive. Further inspections will be planned for future dates as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger disabled adults.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always managed safely. Records of people’s medicines were not always accurate; therefore we could not be assured people received their medicines as prescribed. We saw that in other areas of medicines management and administration there was good practice.

We have made a recommendation about the management of medicines at the service.

The service provided good training and support for staff, which included mandatory training, induction, supervisions and appraisals. People told us they felt confident staff were trained to a good standard. However, we found that in the area of stoma and catheter care, there was a training gap which had not been identified.

There were systems and processes in place to monitor the quality of the service and identify and act upon issues found, however audits did not always take place as scheduled. Audits did not pick up the issues we identified in medicines recording and training needs.

People told us they felt safe in the care of staff, and there were systems and processes in place to protect vulnerable people from harm. Risks to people were appropriately assessed and managed.

There were enough staff to deliver care safely, and the service was actively recruiting to make sure staffing levels were increased to help cope with sickness, leave and absence.

People were supported to eat and drink enough to maintain a healthy diet, and people’s preferences were taken into account. People also told us they felt well supported to access healthcare services by staff who knew when to make an appropriate referral.

People told us they were cared for by kind and compassionate staff. People told us their independence and dignity were protected and promoted by knowledgeable and considerate staff.

The service was working under the principles of the accessible information standard by including information about the principles of the standard and what support people needed to accessible information in an equitable way.

Care plans were person centred, with clear guidance for staff on how to care for people in the way they wanted. Care plans included information about people’s life history, cultural and religious preferences and interests.

People told us they knew how to make a complaint, and complaints were responded to appropriately.

Staff supported people to maintain active social lives and participate in meaningful activities, and consulted with people of similar age groups to ensure activities were appropriate for them.

The service sought feedback from people who used the service and acted upon their responses accordingly, analysing data for trends and themes. Staff told us they felt well supported, and that there were plenty of meetings and communications from the service, which kept them up to date with important information and developments.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Good governance. You can see what action we have told the provider to take at the back of the full version of this report.

Springfield Home Care Ltd is a domiciliary care agency which provides personal care to people in their own homes. At the time of our inspection there were 517 people using the service. There was a registered manager in post; however, they were on annual leave when we visited. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Although there was some activity designed to measure, monitor and improve the quality of the service we found this was not robust and the policy in place to define quality assurance activities was generic and incomplete.

Without exception people told us they felt the personal care provided was safe. The provider had ensured staff were trained in safeguarding and staff we spoke with understood the principles of this and their duty to report any concerns.

We found risk assessments in care plans were often generic and did not provide clear guidance for staff to ensure they worked in ways which minimised that risk. We saw the provider had identified this issue and was already working to make improvements in this area. We looked at some care plans which contained the new risk assessments and found they contained more detail.

Staff were recruited safely and we concluded the provider had sufficient staff to meet people’s needs. Staff told us they were not always given sufficient time to travel between calls, although people we spoke said care staff being late was an issue of concern for them. The provider was investing in new software to help plan calls, which would improve things in this area.

We looked at records of medicines and found it was clear who administered their own medicines and how this had been risk assessed. Some care plans lacked guidance relating to medicines given as and when needed, also known as PRN medicines. The operations manager told us this would be addressed.

The provider had a rolling programme of training and refresher training in place. We saw new staff completed a thorough induction programme lasting 12 weeks, after which they had a formal appraisal to discuss their progress. All staff had an annual appraisal, however, we found there had been a misunderstanding between the management team and provider about what constituted formal supervision. Although staff had monthly face to face contact with supervisory staff, this was not as described in the provider’s policy. The operations manager began working to rectify this during our inspection.

The provider had systems in place to request social workers undertake capacity assessments with people who may not have been able to make decisions about their care. Staff understood how to escalate any concerns about people who used the service whose capacity may have deteriorated.

People who used the service were very complimentary about the staff and their approach to providing care. Staff spoke about people they supported with fondness and respect. The provider had embedded principles of equality, diversity and human rights into their training..

The provider undertook an assessment of people’s needs to ensure these could be met. We found care plans were regularly reviewed, although this process did not always evidence people’s involvement. Some information such as desired outcomes for people’s care and support were generic rather than specific to the person.

There were robust processes in place for the management of concerns and complaints. We also saw complimentary feedback had been recorded as part of the latest survey completed by people who used the service.

Staff and people who used the service gave positive feedback about leadership in the service. People and staff said they valued the fact senior staff had also been care workers. Staff told us they felt able to give feedback and make suggestions about the service which the registered manager listened to. There were regular staff meetings at which this could happen.

We found one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the report.

An Expert by Experience contacted 11 people who used the service and 5 relatives. Everyone spoken with directly spoke highly about how they felt in control of their care and staff seemed to promote independence wherever possible. Their comments included:

Their carers would 'help with whatever they asked them to'.

'Very good staff team and they are very happy with the service'.

Staff were 'friendly, competent and empathic'.

We spoke with three carers, two supervisors, a care coordinator, the HR and training manager, the care coordinator and the registered manager. The staff we spoke with gave good examples of how they treated people with dignity and respect and how they involved people in their care.

We looked at a sample of seven care records and saw each person had a care plan and risk assessment which covered their needs. We saw people's plans of care were reviewed and updated when circumstances changed.

We looked at how staff were recruited and found that the agency had a clear and thorough process in place to make sure staff were suitable to care for people. Staff received regular supervisions and the agency had a system in place to ensure mandatory training was kept up to date.

The agency monitored the quality of the service by obtaining people's views through bi- annual service user questionnaires, spot checks , telephone monitoring and care record reviews.

We visited the agency and spoke with the general manager, the human resources manager, the care coordinator manager, two care coordinators, two supervisors and three care staff. We also looked at records at the agency. For example we looked at feedback forms which confirmed peoples' views were sought and followed up.

Staff were happy with how the organisation operated and they told us that their views were always considered and responded to. Staff also said they had received enough training to equip them with the right skills to do their job well.