About the service:

• Springwood Healthcare Services Ltd is a domiciliary care agency. It provides personal care to people living in their own homes in the community, so that they can live as independently as possible.

• At the time of the inspection, the service was supporting 20 people with the regulated activity.

People’s experience of using this service:

• People and their relatives told us that the service met their needs and was safe. Comments included, “I feel safe because my needs are being taken care of” and “I can leave my mum with them for her care.”

• Risks were assessed and reviewed. Staff understood the risks to people’s health and wellbeing.

• The registered manager and staff were clear on their responsibilities to safeguard people.

• Medicines were managed and administered safely.

• People and relatives commented on staff kindness and said they were respectful.

• People told us there were sufficient staff to meet their needs. Records showed enough staff were available to support people safely.

• Staff understood their roles and were supported to further develop their skills and knowledge.

• The provider had a process in place to enable them to respond to people’s concerns, investigate them and take action to address the concerns.

• 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.

• There were emergency backup systems in place to allow care to continue at all times.

• Audit systems were in place to improve quality.

• Further information is in the detailed findings below.

Rating at last inspection:

• Requires Improvement (Report published 13 February 2018). We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of governance processes because some audits were not effective at identifying incomplete care delivery records.

Why we inspected:

• This was a planned inspection based on the rating at the last inspection. At this inspection we found that improvements had been made to audit systems and governance processes.

Follow up:

• We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of this announced inspection, the service was providing care and support to 20 people living in their own homes, primarily in the London Borough of Harrow. The service’s stated specialisms include providing care to adults of any age including those with a learning or physical disability or a mental health condition.

Not everyone using Springwood Healthcare Services Ltd receives regulated activity. 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.

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 last inspection of this service, on 28 July 2017, we found four breaches of legal requirements. These were in respect of person-centred care, receiving and acting on complaints, recruitment procedures, and good governance. The service was rated ‘Inadequate’, placed in ‘Special Measures’ and we served enforcement warning notices for each breach on the provider and registered manager. They sent us an action plan in respect of the breaches. We undertook this inspection to check that the action plan had addressed the breaches. This was also a comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs and well-led.

We found significant improvements in service quality at this inspection. This matched the overall feedback we received from people and their relatives, most of whom praised the approach and effectiveness of the service.

Improvements had been made to systems of checking on and handling people’s concerns and complaints. There were more robust investigations where needed.

There were improving views on the punctuality of staff visits. The service had enough suitable staff to support people, and had hardly taken on new people since the last inspection so as to focus on ensuring a better service was provided to existing clients.

Staff recruitment processes were now sufficiently robust, as appropriate checks were taking place before staff started working for the provider.

There were improved systems for ensuring people were safely supported with managing their medicines.

The service continued to ensure people were treated with kindness, respect and compassion.

The service made sure staff had the skills, knowledge and experience to deliver effective care and support. A lot of emphasis was placed on the initial training of new staff, to ensure they could provide good care to people. There was good support of staff for their care roles.

The service assessed people’s needs and preferences, and checked on care delivery risks, so that appropriate care and support could be delivered. It worked in co-operation with other organisations including healthcare professionals to deliver effective care and support.

As far as possible, the service supported people to express their views and be actively involved in making decisions about their care and support.

There were improved governance processes in support of upholding quality and addressing service risks. For example, there were more checks on how well staff were providing care to people. However, audits were not always identifying cases where records were inaccurate or incomplete, meaning associated service delivery risks were not being addressed. This was particularly evident on recent care delivery records for people requiring two staff to attend, as audits of those recor

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 tra

Springwood Healthcare Services Ltd is a homecare agency based in Barnet. At the time of this announced inspection, they were providing care and support to one person living in their own home. 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 the last inspection in December 2013, we found that the service met the regulations we inspected against. At this comprehensive inspection the provider was in breach of two regulations.

Recruitment procedures, for example around appropriate written references and timely criminal record disclosures, were not ensuring that staff were safe to work with people using the service before they started providing care.

We also found that some records about people using the service and the management of the service were not accurate or complete, for example, keeping care plans up-to-date and that staff supervision was properly documented. .

We additionally made two recommendations, on implementing guidance relating to The Mental Capacity Act 2005, and on supporting people with developing independent living skills. Whilst we were assured that the service tried to help the development of independent living skills, the process was not well documented or kept under proper review.

The service was responsive and customer-focussed. The views of people and their family members were taken into account, and action was taken where dissatisfaction was expressed.

The service promoted people’s privacy and dignity. People received consistent staffing, which helped positive and caring relationships to develop.

The service provided support for people’s health and nutritional needs. There were effective safeguarding and risk management procedures in place that staff understood.

The registered manager was appropriately qualified for her role, and she had recently attended training in support of rebranding and expanding the business. The provider audited the quality of the service and there were good management systems in place.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

At this inspection, the agency did not have any people who used the service. We spoke with the manager and one care staff employed by the agency. They were aware that people should be treated with respect and dignity.

The agency had an appropriate recruitment policy and procedure. There was evidence that staff had been carefully recruited. The recruitment records contained references, criminal records disclosures and other essential documentation.

The agency had a policy and procedure for safeguarding adults. The manager and her staff could provide us with examples of what constituted abuse and knew how to respond to allegations or incidents of abuse.

There were arrangements for responding to complaints. No complaints had been recorded as none had been received.

The service was providing personal care and support to one person on an irregular basis. Feedback from a relative of the person who used the service was positive about the care provided by staff. Carers were described as sensitive to the person’s needs. When the relative requested changes in the way care and support was provided this was acted upon.

Staff had the knowledge and skills needed to protect people from abuse. Checks were carried out on staff before they started working for the service. The provider monitored the service to make sure that risks to people were minimised and an appropriate standard of care provided.

However, records of staff refresher training, induction and supervision were not kept by the provider. This meant staff records were not accurate and did not contain all necessary information relevant to the training and supervision of staff. Accurate records in relation to the persons employed for the purposes of carrying on the regulated activity were not being maintained.