We carried out a review of the data available to us about Spring Care PAs Battle Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Spring Care PAs Battle Limited, you can give feedback on this service.
Spring Care is a domiciliary care agency that provided support and personal care to older and some younger adults with a range of needs for example, those living with dementia, epilepsy and diabetes. At the time of the inspection, the service supported 52 people, 46 of whom received personal care.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating and drinking. Where they do, we also consider any wider care provided.
People’s experience of using this service and what we found
People told us they felt safe. Staff were split into three geographic teams which meant that in most cases people had the same small team of staff supporting them. There were no reports of missed calls and a system was in place to manage when a staff member was delayed when making a care visit. Staff understood safeguarding and were able to tell us what steps they would take on identifying risks to people. Assessments were carried out to identify risks and these were regularly reviewed. Staff were recruited safely and were employed in sufficient numbers to meet all care calls and needs. Accidents and incidents had been reported, recorded and investigated with any learning being shared with all staff and steps put in place to prevent recurrence. Some people required support with their medicines and this support was provided safely by staff trained in medicine provision. Infection prevention and control measures were in place and were regularly reviewed in line with government guidelines.
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. Some people lived with variable mental capacity and best interest meetings had taken place. Mental capacity assessments were carried out when required. Pre-assessments of people’s identified needs for example, epilepsy and diabetes were recorded and managers were able to ensure that staff had the required training and skills to look after people. Staff received a comprehensive induction which was supported with ongoing regular supervision meetings and a full training program. Some people received support with eating and drinking. People were supported to make choices about their health and social care needs.
Staff had received training in dementia and how to support people with communication needs. Staff told us about the importance of listening to people, looking at body language and signs that they were not feeling well. A complaints policy was in place and people and relatives were confident in raising issues and concerns. Care plans provided details of discussions concerning end of life care. This was person-centred and considered all aspects of people’s needs and wishes including their faith and culture.
Everyone we spoke to, spoke well of the registered manager. People, relatives and staff all had ways of providing feedback about the service. For people, this was achieved through a regular questionnaire although people told us that they could raise any issues with the registered manager or staff at any time. Care plans were person-centred and were accessible to all staff via a mobile telephone application. This had enabled staff to quickly update themselves on recent events and care visits and managers could quickly oversee care plans, picking up any trends or alerts. The registered manager used the application to conduct audits and reviews. The registered manager was aware of their responsibilities under the duty of candour which involves telling us and the local authority about important events that affect individuals and the service.
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 Requires Improvement (published 22 October 2019) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We carried out an announced, focused inspection of this service on 26 April 2021. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Spring Care PAs Battle Limited on our website at www.cqc.org.uk.
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.
Spring Care is a domiciliary care agency. At the time of our inspection they provided personal care
to 70 people living in their own homes. It provided a service to older adults and some younger adults with a physical or learning disability.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
People’s care documentation was not person-centred nor reflective of their current support needs. Where risks had been identified to people’s health and wellbeing, assessments had not been completed to detail support needs or when to seek further professional advice. There was a lack of oversight on incidents, which meant the registered manager had not always reflected on themes and trends. We also found that the provider had not always reported incidents to us that they were legally required to do.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. For people that had fluctuating capacity, consent had not been explored with them or relevant others such as relatives or professionals. For one person the registered manager had not recognised that their freedom was being restricted nor was this explored with professionals. The registered manager had not checked that some relatives had the legal authority to make decisions on behalf of people.
People and their relatives told us there was not always enough staff and that care calls could be missed or late. Staff also reflected that they were not always given enough time to travel between care calls. There had been several missed care calls, particularly during school holidays where more staff requested annual leave. The registered manager was aware of this and had started implementing measures to ensure this improved. This included improved communication between care and office staff, planning routes more carefully and reviewing the holiday policy. Although this had been identified as an area for improvement, more time was needed to implement changes and review effectiveness with people.
No-one was receiving end of life care at the time of inspection. Staff were able to give examples of when they provided end of life care in a kind and person-centred way. However, we found that people’s end of life wishes and preferences had not always been explored. It was also not clear whether they had resuscitation preferences in their care plans. The registered manager recognised this was an area for improvement.
People told us they felt safe. One person said, “I feel safe just having them here. I am alone most of the day and so it is nice and a comfort when they come in.” Staff knew people and risks to their wellbeing. People told us they received their medicines when they needed them and in the way they chose. Staff had all received training in safeguarding, could recognise signs of abuse and tell us actions they would take if they had concerns.
People and their relatives told us that staff were well trained and knowledgeable. Bespoke training had been organised, while engaging from other professionals in the community, to ensure individual needs had been met. Staff felt well supported in their roles with robust induction and regular supervisions.
People and their relatives told us that people’s wellbeing was valued, and they had access to health and social care professionals whenever it was needed. People were supported to appointments by staff if required. For those that required support with eating and drinking, their nutritional and hydration needs were met.
People and their relatives told us that staff were kind, caring and attentive. One person said, “It is nice to have professional, well trained people coming to the house, they come as friends and seem to be part of the family.” A relative said, “They will do anything for my mother, even offer to shop for her, she really loves them, and they love her.” People’s privacy, dignity and independence was promoted and encouraged by staff. Staff had a good understanding of equality and diversity and respecting people’s differences and choices.
People and their relatives told us that their preferences and support needs were always met. Staff knew what they liked and constantly checked they were happy with the support provided. They knew people’s communication needs well and several tools had been implemented to support people with sight impairments. People told us they knew how to complain, and any concerns were responded to straight away by office staff.
Although we found improvements were needed to people’s care documentation, people, their relatives and staff thought the service was well led and spoke highly of the registered manager. One person said, “They are really caring” and a staff member told us, “As a team, we try our hardest to provide the best care.” Feedback was sought to improve the service and actions fed back to keep people well informed of progress. The registered manager had built relationships within the community to improve outcomes for people. They had plans to further improve quality of life, which included a training centre for relatives and social events for people.
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 (published 17 January 2017). The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection. This was in relation to people’s consent not always being explored when they were deemed as not having capacity. People’s care plan documentation also lacked person centred information and were not up to date with current support needs.
There was also a breach of the Care Quality Commission (Registration) Regulations 2009 where the provider had not consistently reported incidents to us.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Spring Care PAs is a domiciliary care agency based in Battle which is registered to provide personal care. The service provides care and support for adults living in their own homes at key times of the day and includes support for people with physical disabilities, learning disabilities and dementia. At the time of the inspection there were 55 people using the service.
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.
People told us they felt safe receiving the care and support provided by staff. Staff understood and could recognise the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern. Training schedules confirmed staff had received training in safeguarding adults at risk.
Robust recruitment and selection procedures were in place and appropriate checks had been made before staff began work at the service. There were enough staff to protect people’s health, safety and welfare.
People said staff were caring and kind and their individual needs were met. One person told us, “The carers are kind and exceptionally good.” Another person said, “The carers are absolutely lovely.” Staff knew people well and had a good understanding of their needs and choices.
Care plans and risk assessments reflected people’s level of care needs. People were encouraged to be as independent as possible. One person told us, “I am involved in making changes to my care plan. It’s an open book. If we need to change things we do it.”
Staff felt supported managers and understood what was expected of them. They were encouraged to report concerns and provide feedback that the registered manager could then use to improve the quality of care people experienced. A member of staff told us, “Management are supportive and approachable and staff in the office sort out any issues if I have any.”
There was a complaints policy and information regarding the complaints procedure was available. Complaints were listened to and investigated in a timely manner and used to improve the service.
Regular audits were in place to measure and monitor the quality of care and service provided. The manager monitored people’s support and took action to ensure that improvements were made and recorded.
People and staff surveys were positive about Spring Care PAs. One person commented, “I have no grumbles about the care. Staff do their job well.” A member of staff told us, “I love my job. It doesn’t seem like work. It feels like I am just doing things to help people in my community.”
Below is a summary of what we found. The summary describes what people using the service and staff members told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
Is the service safe?
People received appropriate care that met their needs based on a thorough assessment. The provider carried out thorough risk assessments in people's homes which meant that people were cared for in an environment that identified and minimised risk.
Staff had received appropriate training to quickly recognise and respond to emergency situations and could provide care and treatment which promoted people's safety and welfare.
The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening as staff members had a good awareness of safeguarding issues. Staff had attended relevant safeguarding training and were aware of how to access support when needed.
People using the service were being cared for safely by suitably skilled staff who were competent to carry out their role. Staff members followed a thorough induction and ongoing training process which promoted the safe delivery of care within the service.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). While no applications have needed to be submitted, proper policies and procedures were in place. The manager was aware of DoLS and had received relevant training. Support staff had not attended specific DoLS training. The manager told us that they recognised this was an important requirement and were hoping to arrange training for staff in the near future.
Is the service effective?
It was clear that staff knew people well and understood their care and support needs from the written feedback we looked at and the people we spoke to with who used the service. Staff had received relevant training to meet the needs of people in their care.
Positive written feedback from people using the service demonstrated that the service was effective.
Is the service caring?
People's needs were assessed and care was planned and delivered in line with their individual care plan. People we spoke with were satisfied with the care and support that they received from the service. One person told us, 'Staff go out of their way. We are impressed. They are flexible and accommodating'.
One person told us that their needs were discussed along with their daughter which supported them in making decisions about their care.
Before people received any care or support they were asked for their consent.
Is the service responsive?
The care records that we looked at during our inspection confirmed that people's preferences and wishes had been identified and recorded.
People's care plans were re-assessed regularly and specific changes were put into place where necessary. People confirmed to us that when they required changes to be made to their care needs, these were put into place accordingly.
The provider had a complaints procedure in place and had an awareness of their responsibilities for recording and dealing with complaints.
Is the service well-led?
The provider had robust quality assurance processes in place. Staff were supported with regular team meetings and we saw evidence of staff receiving supervisions.
A member of staff told that they felt supported in their role and the manager was approachable. We observed that the manager was knowledgeable of staff members' training and development needs.