Springfield Healthcare (North Yorkshire & York) is a domiciliary care agency, which provides personal care to people living in their own homes. The service supports younger adults and older people, as well as people who may be living with a physical disability, sensory impairment, mental health needs, dementia, a learning disability or autistic spectrum disorder and people who misuse drugs and alcohol.

Not everyone using Springfield Healthcare (North Yorkshire & York) receives a regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

Inspection activity started on 3 September 2018 and ended on 10 September 2018. It included speaking with people who used the service and their relatives or carers. We visited the office location on 3 and 10 September 2018 to speak with the registered manager and office staff. We also reviewed care records, policies and procedures.

The provider was given two days’ notice of our inspection, because the location provides a domiciliary care service and we needed to be sure someone would be in the location office when we visited. At the time of our inspection, there were approximately 160 mainly older people using the service.

At our last inspection in August 2016 we rated the service ‘Good’ overall. At this inspection, the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager. They had been the registered manager since May 2013. A registered manager is a person who has registered with the CQC 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 registered manager was supported by an operations manager, care manager, team leader, care coordinators and supervisors in the management of the service.

The provider took action in response to our feedback to make sure the rating awarded to the service following the last inspection was correctly displayed in the location offices and on their public website. Notifications had been written, but due to a technical issue with the provider’s systems had not been successfully sent to the CQC.

People told us rotas needed to be better managed and said they were not always informed when staff were running late. Accidents and incidents were recorded, but we made a recommendation about following their policy and procedure and documenting more detailed information about what had happened to improve accountability and oversight.

People told us they felt safe using the service. Staff were safely recruited and were trained to recognise and respond to safeguarding concerns. Risk assessments provided guidance to staff on how to support people in a safe way.

Staff received ongoing training, spot-checks, supervisions and appraisals to support them to develop the skills and knowledge needed to provide effective care.

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. The provider was developing more detailed paperwork in relation to mental capacity assessments and best interest decisions.

Staff supported people to make sure they ate and drank enough and to monitor their nutritional needs. They worked closely with healthcare professionals to seek further advice, guidance and medical attention when needed.

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This inspection took place on 24 August 2016 and was announced. At the last inspection in August 2014 the service was found to be meeting the Regulations assessed.

North Yorkshire Care is operated by Springfield Homecare Services Ltd. They provide a domiciliary care agency that supplies personal care, support and domestic services to people living in their own homes in Knaresborough, Harrogate, Wetherby, Boroughbridge and Ripon. The majority of people who use the service are referred to the agency by North Yorkshire County Council. The care packages delivered range from 15 minutes to block packages which are up to 12 hours a day.

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.

The registered manager had good oversight of the service and was experienced in their role. We found that quality monitoring systems were not always effective at identifying safety issues or areas for improvement. Records of accidents and incidents did not always reflect the action taken. This was identified as a breach in the Regulations and you can see what action we have told the registered provider to take in the main report.

Staff were confident about how to protect people from harm and what they would do if they had any safeguarding concerns. There were good systems in place to make sure that people were supported to take medicines safely and as prescribed.

Risks to people had been assessed and plans put in place to keep risks to a minimum. An ‘out of hours’ service was in place so that people could contact a member of staff in an emergency.

There were enough staff available to make sure people’s needs were met. The registered provider had robust recruitment procedures to make sure staff had the required skills and were of suitable character and background.

People were cared for by an enthusiastic and caring staff group. Staff were supported through training, regular supervisions and team meetings to help them carry out their roles effectively. There was an open and accessible management team.

The manager and staff were aware of the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). A decision to deprive a person of their liberty in a domestic setting must be legally authorised by the Court of Protection. The registered manager told us that no one was currently subject to any restrictions by the Court of Protection.

People told us that staff were caring and that their privacy and dignity were respected. Care plans were person centred and showed that individual preferences were taken into account. Care plans gave clear directions to staff about the support people required to have their needs met. People were supported to maintain their health and had access health services if needed.

People received support which was regularly reviewed and met their current needs. People knew how to complain and had opportunities to make comments about the service and how it could be improved.

In May 2014 we carried out an inspection of this service. We judged, at that time, that improvements were needed to some areas of how the service managed medicines. At this inspection, we found improvements had been made and the issues we identified had been addressed.

We spoke with four people by telephone. Two people who received a service from the agency and two relatives of people who were in receipt of a service. Everyone spoke highly about the service they received. People made comments such as “I am satisfied with everything” and “I am quite happy with everything.” Relatives told us “They support my mum with her medication and I find them exceedingly good.”

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, and the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People spoke positively about the care they received and about their care workers. People said they knew who to speak to if they had any worries or concerns and were confident that action would be taken if they raised any issues.

Effective management systems were in place to make sure the manager and staff learned from events such as accidents and incidents, complaints, concerns and investigations. Our audits identified that further work needed to be done to develop quality monitoring the quality monitoring systems to identify shortfalls earlier. For example, we found issues in relation to medication records which required improvement.

Recruitment procedures were rigorous and thorough. However the provider may wish to consider their recruitment processes to make sure that they assure themselves of people’s suitability when they have previous experience of working with vulnerable adults and to confirm everyone has the right car insurance.

Procedures were in place for dealing with emergencies and staff were able to explain these to us.

Overall we found that staff worked well with other health and social care agencies in order to promote and safeguard the people in their care.

Is the service effective?

People’s files contained pre-admission assessments, which showed that people's health, personal and social care needs were assessed before care was delivered to them at home.

When people were identified as being at risk, their care plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Is the service caring?

We spoke with four people who were using or had relatives using the service. We also checked some of the feedback people had provided. Everyone told us they were satisfied with the care they received and spoke positively about individual care workers, one comment we saw described the record of care for their relative as “Excellent”.

Is the service responsive?

People told us their care workers generally arrived on time and they stayed for the correct length of time that had been agreed. People told us if they had any problems they contacted the supervisor who would make sure any issues were sorted out. People said they were kept informed about any changes to the usual care workers who attended to them. They said they wouldn’t hesitate to speak to the manager or the supervisor in case of any worry or difficulty. They said they felt confident any concerns they had would be dealt with appropriately.

When we looked at people’s care records we saw evidence that staff identified and took action if people needed to access other health care professionals for support and spoke to staff in the agency office in case of concern. Because information was then recorded back in the office the provider may wish to consider how staff can also record the outcomes of these referrals so staff working in someone’s home can be confident action has been taken in each case.

Is the service well led?

People told us they had confidence in the management team and the manager was approachable and listened to what they had to say.

We found the service had quality assurance systems in place although greater emphasis needs to be given to this aspect of the service to make sure audits identify concerns at an early stage so action can be taken. Some records relating to people’s care and welfare such as medication records had not been completed correctly. However the manager was able to explain the steps she had already taken to develop quality assurance systems.

We have asked the provider to tell us what they are going to do to meet the requirements in relation to the administration and recording of medication.

We spoke with the care manager of this service, the provider’s staff trainer, six members of care staff and ten people, via the telephone, who currently used the service.

Everyone spoken with expressed satisfaction with the support they received and said they always received a visit and in most cases at the arranged time. People told us they had the same team of carers to support them. Comments included: “They are our lifeline.” And “They are always so cheerful and more than helpful. X cleared the snow for me; which obviously wasn’t in the agreed package! These people go the extra mile.”

We saw very detailed care records which contained personal information about people's needs and the service that the carers would provide. This included information that would help carers to do things in the way that people wanted.

Records showed and staff confirmed they had completed mandatory training on safeguarding at the required level to be able to report or respond to an allegation. The staff we spoke with told us they would report any abuse or potential abuse immediately to their supervisor.

Records showed that staff completed an induction programme which included mandatory training in areas such as moving and handling, safeguarding adults and infection control. People we spoke with told us they thought staff were well trained.

We found the provider had systems in place to ensure the quality of their service provision.

We spoke with two people who used the service and a relative, on the telephone. We were told that the care staff were “kind and caring” and that “nothing was too much trouble.” People reported that they were supported by the service and that the care staff were ‘exceptionally cheerful, capable & always courteous.’ The relative we spoke with said, “ The carers have made a positive impact; without them Mum would not be able to live at home.”

People also commented on the consistency of the care provided, one person said “I normally have the same carer, it is helpful to know who is coming. I am glad I don’t have a lot of changes.” All the people we spoke with were more than happy with the care provided by North Yorkshire Care.