Archived: Bluebird Care (Harrogate)

At our last inspection on 12 February 2015 the provider was meeting all the regulations that were assessed. Although some further improvements were required the provider had made improvements in relation to the care and welfare of people, staff recruitment and training, record keeping and quality assurance.

Bluebird Care (Harrogate) is registered to provide care and support to people who live in their own homes. At the time of our inspection, there were 38 people receiving a service.

There was a new manager in post who was required to submit an application to the Care Quality Commission (CQC) to be the registered manager. 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.

Staff reported the manager was supportive and they had attended recent staff meetings, training and supervision sessions with them. We could see the new manager had introduced management systems and regular contact with people using the service, to check they were satisfied with their care packages. However, these had yet to be fully established for the service to be able to demonstrate continuous development.

We received conflicting information from staff about the quality of training. Some staff told us they would like more training while others commended the level of training they received. A new training programme was being developed to provide staff with the knowledge and skills to support people effectively. Staff had undertaken training on a range of topics in June 2016. This included awareness training to enhance their knowledge and understanding of their roles and responsibilities under the Mental Capacity Act (MCA) 2005.

People were positive about the care staff and said they received consistent support from caring and kind staff. When we spoke with staff they understood the importance of people being supported to make decisions for themselves. Staff liaised with healthcare professionals at the appropriate time to help monitor and maintain people’s health and wellbeing.

Although there had not been any safeguarding issues the staff understood their responsibility with regard to safeguarding and said they would raise any concerns with managers. Recruitment checks were in place for the safe recruitment of new staff. These checks were undertaken to make sure staff were suitable to work with people who used the service.

There were systems in place for assisting people to take their medicines and the manager had put in place a system of audits to monitor medicines administration.

People were consulted about their health and care needs before a service was provided. This meant that people were involved in planning the care and support they wished to receive. Care plans were sufficiently detailed to provide information for staff on how to carry out individual care and support for people. Care plans and daily records were maintained on a mobile system and we saw that staff were confident in the use of this system. When people were identified as being at risk, their care plans showed the actions required to manage these risks. We saw that records were updated when people's care and support needs had changed. This meant staff had up to date information to deliver consistent care and support. People told us how their service was effective in meeting their needs.

Appropriate systems had been introduced to be able to gather feedback from people using the service via questionnaires and we saw the provider acted upon the results of this feedback.

People we spoke with said they had not needed to raise a complaint. However, they felt confident that the provider would act upon any concerns raised with them. In their written feedback to us people said that when they raised concerns these had been addressed appropriately.

As part of this inspection we reviewed 11 surveys completed by people using the service or people commenting on their behalf. We spoke with the nominated individual acting on behalf of the provider, registered manager, children's manager, field care supervisor, care co-ordinator, four care staff and three health and social care professionals. We also reviewed records relating to the management of the home which included four care plans, daily care records for one person and 15 staff records.

Below is a summary of what we found. The summary describes what people described in the surveys they had completed, what care professionals and staff told us, what we observed and the records we looked at.

Is the service safe?

Health and social care professionals said people were not confident that their care staff would always call at the right time. Comments included, 'Timing is a big issue,' 'Staff are rushed' and 'Staff are here, there and everywhere it is an impossible ask.'

Care staff were not always using the electronic systems that would alert management to scheduling issues. This meant that people were at risk of late or missed calls.

We found that detailed policies and procedures were in place. This included policies and procedures in relation to staff recruitment. However, we found these processes were not being followed in practice. This placed people at potential risk of receiving care from people who had not been assessed as suitable to work with vulnerable adults and children.

People could not be confident that they would be supported by adequately trained and skilled staff. Some staff had received limited induction training. Ongoing training and checks including observed practise, spot checks and individual supervision sessions were not organised or recorded in a systematic way. This placed people at risk of receiving unsafe and inappropriate care.

In a survey one person had commented staff needed 'Better training'. Another person commented 'No one new to be on duty before being trained at the premises beforehand, especially in the case of night time catheter care'.

Is the service effective?

People had an individual care plan. We saw that the care plans for children contained some useful information and families had been involved in the development of these. However, care plans in use for adult services that we checked lacked a full description of the care and support people required. The risk assessments that were available were not sufficiently detailed to identify and minimise risks.

There was no evidence that adults using the service were being actively involved in the development or in reviews of their care plans. Personalised care plans and risk assessments were not in place for important care issues such as 'end of life' care, medication, or behaviour that might place people at risk of harm.

Is the service caring?

The management team were keen and enthusiastic to effect improvements and provide a sustainable, effective service.

Individual managers spoke confidently about the high standard of care they wanted to provide and how the service could develop. The children's manager told us they took care to make sure parents had confidence in the care staff they used and described a good system of introductory visits and family involvement that was in place.

Is the service responsive?

As part of our inspection we fed back our concerns to the nominated individual and the registered manager about the shortfalls we had found during our visit. The lack of quality assurance checks meant that errors for example, in staff recruitment and training had not been addressed. This put people at potential risk of harm.

Following our inspection the provider agreed to restrict new care packages to allow time to effect improvements and in a meeting held with the Care Quality Commission (CQC), the nominated individual and the registered manager and office manager on 3 June 2014 they confirmed areas of improvement that had been made.

We have also asked the provider to consider the report and to tell us in writing what they are going to do to improve the service.

Is the service well-led?

The service did not have a system in place to assure the quality of the service they provided. Surveys had been sent out to people who used the service. The manager told us the issues identified in surveys had been addressed but this had not been documented anywhere. This meant that shortfalls in the service were not identified and action plans not produced to address them in a timely way.

Quality assurance systems are important to make sure that managers and staff learn from events such as accidents and incident, complaints concerns, whistleblowing and investigations. This would reduce the potential risks to people and help the service to improve.

Greater emphasis needed to be given to the development of effective management systems in order to safeguard and promote people's safety and welfare.

We visited the agency office and looked at how the quality monitoring system had improved. We also telephoned six members of staff, but only spoke with three, they all confirmed that the agency had introduced an effective system to ensure they were carrying out their job properly and safely and ensured that people's needs were being met appropriately.

We found the agency had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.

People experienced care, treatment and support that met their needs and protected their rights. We did not observe any direct care being provided to people as care was provided in people's own homes. We spoke with people who received a service and their relatives. They expressed satisfaction with the support they received and said they always received a visit and in most cases at the arranged time. Most people told us they had continuity of carers to support them.

Records showed and staff confirmed they had completed 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 did not have any concerns that people were being abused.

Records showed that every new member of staff undertook induction training which helped to support them in their role. Staff completed mandatory training in areas such as moving and handling, safeguarding adults and infection control. The majority of people we spoke with told us they thought staff were well trained. Staff were described as 'Very nice', 'Kind' and 'Very helpful.'

The provider did not have an effective system to regularly assess and monitor the quality of service that people received.

During our last visit we identified some concerns about the way in which complaints were managed. As this was a follow up visit to look at systems for managing complaints we did not speak with people about this area during our visit but we looked at the complaints record. We found that some improvements had been made in the area of complaints management. The provider had put in place a system to record and manage complaints received by Bluebird Care.

Most of the people that we spoke with told us that they were happy with the service provided. Some of the people told us that they had continuity of carers. One person said about the staff. 'They are very flexible and will support you anyway they can'. Another person said 'I am more than happy with their services and if I have any problems then they will sort it out for me'.

Some people we spoke with told us that they had raised concerns with the manager and said these issues had been dealt with. One person told us 'I asked for a carer not to come to my home because of their attitude and Bluebird didn't send them again'.