Joshi Home Care Limited t/a Bluebird Care (Ealing)

• Mortimer & Co Limited t/a Bluebird Care (Ealing) is a domiciliary care agency that provides the regulated service of personal care in people’s own homes. They were providing this service to 65 people at the time of our inspection and 9 of those people had a live-in care worker.

• Not everyone using Mortimer & Co Limited t/a Bluebird Care (Ealing) 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.

People’s experience of using this service:

• People and relatives spoke positively about their permanent care workers finding them caring and reliable. A few relatives found that staff who covered when permanent care workers were not available were not so good. The registered manager was aware of those issues and was in the process of addressing these.

• People and relatives told us they felt safe with the service provided. We found that staff could recognise signs of abuse and knew how to report safeguarding adult concerns appropriately. The registered manager had a good oversight of safeguarding concerns, incidents and accidents and complaints. They analysed service trends to ensure errors or mistakes were not repeated and shared their learning with the management team.

• Medicines were administered safely and medicines administration records were audited monthly. People were supported to access appropriate health care and there was guidance in place to support staff to recognise the symptoms of ill health.

• The registered manager met with people and their relatives prior to offering a service to assess and develop an effective care plan. Risks to the person were identified and measures to minimise the risks were in place. Care plans were reviewed on a regular basis and in response to changing circumstances.

• Staff received an induction and ongoing training. They received supervision sessions to support their individual development and address practice issues and they told us they felt well supported by the provider.

• The registered manager and management team completed audits and checks to ensure the quality of the service provided. They contacted people and their relatives regularly to check they were happy with the care provided. They utilised the support of the Bluebird franchise support team to audit the services provided and offer advice at regular periods throughout the year.

Rating at last inspection: We previously inspected on the 23 and 27 November 2017. We found the rating to be requires improvement. This was because the provider was not meeting all their responsibilities under the Mental Capacity Act 2005. At this inspection we found they had acted to address this concern.

Why we inspected: This was a planned comprehensive inspection based on previous rating of requires improvement.

Follow up: We will continue to monitor and inspect in line with our ratings protocol.

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 and is registered to provide personal care to people living in their own houses and flats in the community. They provide a service to older adults some of whom could be living with dementia and younger disabled adults with a physical disability.

Not everyone using Mortimer & Co Limited t/a Bluebird Care (Ealing) received a 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. At the time of our inspection the provider offered a service to 80 people and 50 of those people received personal care.

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.

At the last inspection in March 2016 the service was found to be ‘Good’ overall. At this inspection, we have rated that the service ‘Requires Improvement’. This was because we found that the provider was not meeting all of their responsibilities under the Mental Capacity Act 2005. As they were not assessing people’s mental capacity when there were grounds to question their capacity to consent to their care and treatment.

The registered manager and office staff undertook regular checks and audits to assess the quality of the service provided. However, our findings during this inspection showed that these had not been effective in a few areas, as identified above.

People and their relatives described staff as kind and respectful. The provider put an emphasis on the organisational values of acting in a caring and compassionate manner. Care staff demonstrated that they took measures to maintain people’s privacy and dignity.

People had thorough risk assessments that were personalised and contained measures to mitigate the risk of harm.

Staff had received safeguarding adult training and the registered manager reported safeguarding adult concerns appropriately to the local authority and the CQC.

The provider ensured that there were enough staff to meet the needs of people using the service and assessed the changing staffing needs of the service. The provider utilised robust recruitment procedures to ensure care staff were safe to work with people using the service.

Staff received a thorough induction and ongoing training to equip them to undertake their role. In addition staff were provided with regular supervision sessions and yearly appraisals.

Staff were trained in administering medicines and the provider undertook medicines administration observations to ensure staff were competent. Medicine administration records were completed appropriately and when an error had occurred this had been addressed with the staff member in supervision to prevent reoccurrence.

The provider had systems in place to investigate and learn from errors and incidents. Learning from the incidents was discussed and shared with the office team and where appropriate with the care staff. People and their relatives were encouraged to complain and complaints reported were investigated and addressed by the registered manager.

The provider obtained people’s written consent to provide the care offered. Staff demonstrated to us they asked people’s permission before offering support and gave people choice.

The office and care staff acted as a team to ensure people had access to appropriate health care. People were supported to eat a healthy diet that reflected their preferences and their cultural support needs. Care plans detailed the support people required to eat and specified when drinks should be given to help ensure people remained hydrated.

People contributed to their care planning to ensure their preferences were met and there were regular reviews to ensure the care support remained appropriate. People signed their care plans prior to the commencement of the service and at review to confirm that they agreed with the contents.

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

The agency was registered with Care Quality Commission (CQC) since 17 December 2010. The last inspection took place on 29 January 2013 and the provider was compliant with the regulations we checked.

Mortimer & Co Limited t/a Bluebird Care (Ealing) is a care agency that provides personal care and support to people living with dementia, learning disabilities and are on the autistic spectrum disorder, as well as older people, people with an eating disorders, physical disabilities or sensory impairments.

On the day of our inspection, the agency provided support for 64 people out of which 37 were receiving personal care.

There was a registered manager in post, who had been managing the service since 3 November 2015. 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 a director who was the owner of the company and an operations manager as well as a care coordinator and a support supervisor. At the time of our visit, the agency employed 40 care workers.

The agency had effective safeguarding procedures and people using the service were protected from harm and abuse. The agency assessed risks to people’s health and safety. Care workers had access to risk management plans that gave them guidance on how to mitigate/manage these risks.

The agency managed people’s medicines in a safe way and ensured any changes to people’s medicine were promptly noted and addressed. The registered manager regularly audited medicine administration by care workers.

The agency had a rota system to ensure all care workers knew who they were assigned to visit that week and that all care worker’s planned absences were covered. People said they received regular support from the same care workers and the agency informed them if a different care worker was to attend instead.

The service had robust recruitment procedures to ensure only suitable care workers were appointed to work with people who used the service.

Care workers had sufficient skills and knowledge to provide effective support for people they cared for. Newly appointed workers received induction training before they started working unsupervised. All care workers were required to repeat training that the agency considered mandatory on a yearly basis.

Care workers received effective support in the form of regular one to one meetings, yearly appraisals, observations of their work and by attending team meetings.

The agency work within the principles of the Mental Capacity Act (MCA) 2005. Where people did not have mental capacity to make decisions, the agency encouraged them to express their wishes about their care and enquired if those who were making decisions on their behalf had the legal right to do so.

People received personalised care that was responsive to their needs. The agency carried out initial assessments of people’s care needs, health and wellbeing and personal likes and dislikes. The agency then used this information to, together with people and their relatives, formulate individual support plans for people who used the service.

People told us that care workers treated them with dignity and respect while providing personal care.

The agency had a complaints procedure and people and their relatives knew how to raise any concerns about the care they received. The agency dealt with complaints promptly and to the satisfaction of people and their relatives.

People using the service and their relatives described the service as well organised and efficient and the management team as approachable and caring.

The agency introduced a care worker of the month award. Therefore, care workers knew that the management team appreciated and noticed their hard work.

The agency had robust quality assurance and audit systems to ensure effective reporting, monitoring, analysis and review of all aspects of the service provision.

The agency had a folder of policies and procedures that were regularly updated and care workers had access to this.

People told us that staff were polite and respectful when providing care for them. For example, one person said, "the girls are delightful." Another person told us, "they are very professional and efficient." All of the people spoken with told us that they generally had named staff who visited regularly and knew their needs. This meant that people received continuity of care and did not have to receive care from lots of different staff who were unfamiliar with their needs.

Staff received medicines awareness training and were able to demonstrate how they assisted people with medicines safely and the service monitored staff competency in this area.

Staff received training to equip them with the skills and knowledge to enable them to meet people's needs effectively. They also received regular supervision and annual appraisals to monitor their performance and support them in their role.

Quality monitoring systems had been implemented to ensure that any areas for improvement were identified and addressed.

We looked at the recruitment records for five staff during this inspection. We found that they contained all of the required information such as detailed references, criminal record checks and a full employment history and the manager had introduced a new system to monitor that these checks were being completed.

People told us they were happy with the care they received and that they had been involved in the planning of their care. However, people also told us that they were not always kept informed about who would be providing their care and some people did not receive continuity of care as they did not have a named carer who knew their needs. People told us that staff treated them respectfully.

There are systems in place to ensure that people are protected from abuse and staff were able to demonstrate their knowledge of safeguarding and what action they would take if they had concerns about the welfare of someone they were providing care for.

Although there were appropriate recruitment and selection processes in place some of the checks completed were not sufficient to ensure that adequate information was obtained before staff commenced employment. For example, references were not always obtained from the person's most recent employer and gaps in employment history had not been adequately explored.

People told us that they knew how to make a complaint and said that they felt able to raise any concerns that they had. There were no complaints recorded for the service.