24 October 2017
During a routine inspection
Springwell Care Ltd is a domiciliary care agency based in Enfield, North London which provides personal care to people living in Hertfordshire, Buckinghamshire and Enfield. At the time of the inspection there were 22 people using the service. The service provides personal care to older people some of whom are living with dementia or have physical disabilities.
The service had a registered manager who was also the registered provider. 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.
The provider did not ensure safe staff recruitment. Not all staff had undergone appropriate recruitment checks prior to working with vulnerable people as identity checks had not been carried out, references not obtained and criminal records checks not completed.
People were at risk of receiving late or missed care visits as there were insufficient staff available to cover care visits as a result of non-payment of wages. Missed visits occurred during and after the inspection.
People were not always receiving care from staff who were competent, skilled and experienced. There was a risk that people were receiving care from staff who had not received training to meet the needs of people with certain health conditions. The provider did not keep appropriate records of training. Staff did not receive regular documented supervisions or appraisals.
Many people and relatives that we spoke with said that they had made complaints. The provider did not effectively record complaints that were received or the actions taken with regards to complaints. Complaints were not analysed to ensure improvements could be made.
Care plans were not in place for all people receiving support. People’s preferences were not appropriately recorded and care plans were not always reviewed on a regular basis.
Effective systems were not in place to assess and monitor the quality of the service. Although some quality checking had been undertaken these had not been used to improve the quality of care for people.
Overall governance of the service was ineffective and staff told us that they were not supported by the registered manager. Most staff had not been paid and the registered manager was unresponsive to concerns raised by staff. We observed poor staff morale throughout the inspection.
The provider did not adequately assess risk for all people using the service.
Records indicated that people received their medicines, as prescribed. However, we could not be assured that staff were trained and competent to administer medicines.
We received positive feedback from most people and relatives who told us staff were caring and responsive to their needs. However, some people and relatives told us they often received care from different care staff who did not know them or their care needs.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe, where a rating of inadequate for any key question or overall remains, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement and the service is again rated inadequate for any key question or overall, we will take action to prevent the provider from continuing to provide this service. This will lead to cancelling their registration or to varying the terms of their 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.
We identified seven regulation breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.