Springwood Healthcare Services Ltd is a homecare agency based in the London Borough of Barnet. At the time of this announced inspection, they were providing care and support to at least 10 people living in their own homes, primarily in the London Borough of Harrow. They were not providing any nursing care. The service’s stated specialisms include providing care to people with a learning or physical disability or those with a mental health condition. The service had a registered manager. 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.
At our previous inspection of this service, in June 2016, breaches of legal requirements were found. These were in respect of staff recruitment processes and accurate record-keeping. At this inspection, we found these matters had not been sufficiently addressed. We also identified new breaches of regulations.
Recruitment procedures were still not ensuring that staff were safe to work with people using the service before they started providing care. One staff member was found to have provided care to people before any recruitment checks were undertaken. Their criminal record (DBS) check subsequently showed some information that the provider needed to risk assess in respect of making an employment decision. However, the provider did not do that until we brought the matter to their attention. This meant that for over seven months, the provider had sent somebody to provide care who may not have been safe to work in people’s homes. Procedures were also not robust at acquiring all appropriate written references for new staff.
There continued to be cases where records were inaccurate or incomplete, despite some improvements in this area. In particular, there were a number of inaccuracies within records of the support staff provided people to take prescribed medicines, meaning people may not have been supported to take their medicines as prescribed.
There was mixed feedback about care visits occurring punctually. A system for agreeing visit times with individuals had not been embedded. Some people consequently experienced occasions when staff did not attend as planned, which failed to ensure care needs were met and put some people at avoidable risk to their health and welfare.
Complaints were not identified, recorded, handled and responded to effectively, despite prompt and apologetic replies. Complaint investigations were not robust. Complainants were not provided with options if they were dissatisfied with responses.
Governance processes were not effective at identifying risks to the delivery of high quality care, as demonstrated by our findings in respect of medicines, visit punctuality, complaints handling and record-keeping. This was despite some improvements in quality auditing processes, particularly around staff support and supervision structures.
We found the provider not to be consistently open and honest with us. This was primarily due to not declaring the names of everyone using the service and all care staff when we requested the information before the inspection. This undermined the inspection process.
Most people and their relatives said they would recommend the service. We found people were treated with respect and their dignity was promoted. People received the same small team of staff for their care, and were supported to be involved in making care decisions. Care plans were promptly set up, based around assessments of needs, preferences and risks. The service provided support for people’s health and nutritional needs where appropriate.
Staff training had improved since our last inspection. A training room had been added to the office structure. It contained various items by which to train staff. The registered manager told us she now did much of this herself, as she had completed courses to help her to do so. Staff were also completing a national training process called The Care Certificate, which helped demonstrate appropriate knowledge for their care roles.
We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action, including enforcement action, we have told the provider to take at the back of the full version of this report.
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 so that there is still a rating of inadequate for any key question or overall, 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating 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.