Archived: Butterflies in Southampton

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

Two people we spoke with told us they felt safe when staff from Butterflies visited them to deliver care. However, we were aware of over eight safeguarding investigations where people had been put at risk and staff had acted inappropriately. This had led to action from commissioners and local social services to safeguard people using the service.

We saw staff had completed training in the safeguarding of vulnerable adults. Staff told us about different types of abuse and how they would recognise if someone was being abused. Staff knew how to report concerns to their line manager. The provider was aware of past concerns around reporting these on and had completed further training to improve their knowledge. Reporting of these events to Social services had improved. Appropriate checks were carried out on staff before they began working with people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to safeguarding people who use the service from abuse.

Is the service effective?

People we spoke with told us they were involved in planning their care. One person told us, 'I was able to identify when I wanted support and agreed with staff what they were going to do on each visit.' They told us, 'I am happy with the staff who support me in the morning and lunch time. I do not like the staff who support me at night. They are often late or hurried and on some occasions don't turn up'. Some care plans we saw in the office detailed all aspects of the care people should receive at each visit. However, a social care professional told us about a person who did not have a care plan in their home for over three months. This meant the person was at risk of not receiving care as the arrangements were not robust and care and support were not planned.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care and welfare of the people who use the service.

Is the service caring?

People were supported by staff who were aware of their needs and how they wished to be supported. One person told us 'I was happy with the majority of staff who visited me. They were very caring and kind and were like friends.'

However, we were aware of complaints received about staff turning up late, not spending enough time with people or delivering poor care. Due to the numbers of safeguarding concerns received people's experiences of care received varied from good to poor. We were aware of an incident where a person was administered a medication by a member of staff who had not been trained to give that medication.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in respecting and involving people who use the services and in the management of medicines.

Is the service responsive?

The provider was not always responsive. An assessment of needs was carried out before people began to receive support from the service. The care records contained details of how each person wished to be supported, including their personal likes and dislikes. However we found one person did not have a care plan in their home. People told us they could change some aspects of their care and could discuss this with staff or by ringing the office. One person told us of an incident where a member of staff had visited but the person had gone out and forgotten to cancel the visit. The member of staff had notified the office and phone calls were made to try to find the person.

People told us they had not received notification if staff were going to be late or not turning up at all. One person said, 'I know it was a Bank holiday but my night carers did not turn up. I tried ringing the out of hours number but nobody answered.' This had also been the case in some of the safeguarding concerns we had been made aware of. This meant the service had not been able to respond and were unable to attend when some calls had been missed.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to care and welfare of people who use the service.

Is the service well-led?

Staff told us the management team were supportive and always available for advice and help. Supervisions were occurring regularly. They said they received regular training and updates which recently included administration of medicines. Due to concerns around missed calls the provider had put in place a logging in system, used by all staff when they arrived at people's homes. This meant the office were able to monitor calls made and alerted them if staff were late.

However, we were aware the provider had not responded in a timely way to reported incidents or safeguarding concerns. This meant people were put at risk of receiving inappropriate care as action had not been taken to suspend staff whilst incidents were being investigated.

We had asked the provider to notify us of all safeguarding concerns around abuse. We had received one notification in a period where we knew more concerns had been reported to social services. The provider had not responded in a timely way to notify us of these events.

We have asked the provider to tell us how they are going to meet the requirements of the law in relation to notification of other incidents.

One person told us, "I don't have a care plan and I have to tell staff what I need them to do". A member of staff told us," I went to a person's home but could not find a care plan so I had to rely on them telling me what staff usually did." We found the two people did not have a copy of their care plan in the provider's offices. The provider told us one of the people had a hand written care plan which outlined a list of tasks staff should carry out. These were not detailed and did not give staff clear guidelines on how to carry out the assigned tasks. People's needs were not fully assessed or planned before staff started working with the person.

We looked at administration of medicines as we had received a concern about this. We found staff received appropriate training in the administration and recording of medicines. Where people were able to self-administer they were supported to do this by staff.

We looked at recruitment processes, especially looking at the most recent appointments. A member of staff told us, "I was interviewed on Thursday and on Saturday I was working in someone's home". We found Adult First checks had been carried out and the provider had arranged for Disclosure and Barring Services (DBS) checks to be completed. We found staff did not complete a comprehensive induction process before being allowed to work on their own in someone's home.

We spoke with two relatives of people who use the service, three care staff, two senior staff and the provider. We looked at relevant records of care and reviewed records to support management of the service.

One relative told us "We are always pleased to see them and they provide good care. Another relative told us they were impressed by the service and felt their opinions had been listened to by the provider.

One member of staff told us "I absolutely love my job as I can provide people with the care they need and deserve." Another member of staff told us "I give the people the care I would like to receive and listen to what they want."

We found people were involved where possible in choosing times for care visits and what they wanted staff to do on those visits. Relatives were able to contribute to the care assessment and planning and told us they were involved.

We saw people's needs were assessed and care plans reflected areas identified. Risk assessments were used to minimise risk and ensure people's safety.

Staff were aware of safeguarding the vulnerable adults in their care. They were supported to carry out their role and received suitable training.