Background to this inspection
Updated
6 October 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 7 February 2023 and ended on 20 March 2023. We visited the location’s office/service on 7 February 2023.
What we did before the inspection
We reviewed information we had received about the service since our last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 2 people who used the service and 3 relatives to understand their experience of care provided. We spoke with 4 staff including the service manager, support staff and the registered manager who was also registered as the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records including 6 people's care plans, risk assessments and records relating to the provision of care. We looked at 4 staff files in detail and reviewed additional recruitment checks, training records and supervisions and appraisals. We also looked at records relating to the management of the service including audits and policies and procedures.
Updated
6 October 2023
About the service
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.