Bluebird Care Exeter

Updated 27 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was announced and took place over two days on 11 and 12 June 2018. We gave the provider 48 hours' notice because the location provides a domiciliary care service and we needed to make sure the provider and registered manager would be available for the inspection. It also allowed us to arrange to telephone and visit people receiving a service in their own homes.

The inspection team comprised of an adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses services for older people.

Prior to the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, such as feedback we received from health and social care professionals and notifications. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern.

During the inspection we visited three people in their own homes accompanied by a senior care worker and spoke by telephone to ten people and three relatives to seek their views about the service. We looked at six people's care records and at their medicine records. We spoke with the provider, registered manager, operations manager and with nine staff which included care and office staff, care supervisors and senior care workers, training manager and marketing manager. We looked at three staff files which included details of recruitment, training, supervision and appraisals. We also looked at staff meeting minutes, staff training records, accident and incident reports, and at complaints and compliments. We also looked at press releases and community awards relating to the services Bluebird Exeter provided. The service had also worked hard to collect a wide range of their own evidence together to further show what they did in relation to each CQC key lines of enquiry. We also looked at the provider's quality monitoring systems which included audits of medicines, care records and at 'spot checks' where senior staff monitored care staff providing care in people's homes.

Updated 27 July 2018

This comprehensive inspection took place on 11 and 12 June 2018 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure the registered manager would be available for the inspection. It also allowed us to arrange to telephone and visit people receiving a service in their own homes. At the last inspection in September 2015 Bluebird Exeter was rated Good. At this inspection we found the service to be Outstanding overall.

Bluebird Care Exeter is a domiciliary care agency. It provides personal care to older adults and younger disabled adults in Exeter, and surrounding areas. The provider is W & S Flint Services Limited, a husband and wife team who run three branches of the agency in the Devon area, Exeter, East Devon and Exmouth. At the time of the inspection the Exeter branch provided personal care to about 100 people and employed 44 staff, known as Devon Bluebirds, supported by a team of nine office staff.

The inspection was carried out by an adult social care inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses services for older people.

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.

People and relatives praised staff as exceptionally caring and compassionate. People were partners in their care. Their views, experience and contributions were sought and valued. The agency had a strong, visible person centred culture. People were at the heart of everything they did, they were made to feel valued and that they mattered. The service went that extra mile to exceed people's expectations of the service. For example, the service was building on their wellbeing agenda. Staff, led by a ‘Wellbeing’ Ambassador’ organised a monthly wellbeing programme to get people out socialising, having new experiences and having some exercise. Feedback showed this significantly improved people's physical and emotional wellbeing and reduced their risk of isolation. One relative who had been struggling to cope said, “[Person’s name] went to armchair yoga. They came back smiling from ear to ear, we had something to talk about and I was able to have time to myself.” The service was also working with Age UK venues so people using Bluebird could meet other people and promote social inclusion. A new partnership with a local charity was offering discreet personal care, complimentary treatments, on-site library and laundry as a ‘Wellbeing Hub’. They envisioned getting away from the traditional ‘elderly day centre’ service and offering an empowering, inclusive experience for young and old focussed on a preventative, trusting agenda. Intergenerational experiences were promoted where people could enjoy spending quality time, sharing their skills and lives with school children in a meaningful way.

People were supported in innovative ways, to be proactively involved in making decisions about their care, treatment and support. For example, the provider undertook a 'Talk Care' campaign to promote a conversation about care that was positive, informative, open-minded and inclusive. They made a series of informative short videos of conversations with health and social care representatives such as the local hospice director of nursing and GPs, to highlight key things people needed to know about care. These included the importance of planning ahead for care, options for care, and simple explanations about lasting power of attorney, benefits and paying for care. These were posted on social media which enabled people and families to be better informed about care options and what was important in planning their care and avoid ‘panic purchasing’. People of older years were celebrated and enabled to be involved in the campaign to raise awareness of social care issues with consent through social media. People using the service were interviewed for a local Devon magazine to share ‘nuggets of wisdom’ as part of a ‘Wisdom Project’. One person said, “My nugget of wisdom is to keep a routine and keep in touch with your friends.” This all helped people feel they were noticed and important within the community.

The service had embraced the possibilities of using technology in innovative ways to improve the quality of people's care and to enable them to stay living at home for longer. The service had explored possibilities of using sensor technology by working with a specialist provider to pilot its use to assist families to support and monitor a person's wellbeing. An electronic computer record system meant staff could read new people's care records before they visited, and follow up any health concerns. The system quickly highlighted when a person's needs changed, so their care needs could be reviewed. Other benefits included health professionals, such as paramedics and relatives being able to access parts of the system, with the person's consent.

The service worked in partnership with many local health and social care providers to respond to the changing needs of local people. For example, they participated in a pilot project to enable people to be discharged home from hospital as soon as possible.

People experienced a very personalised level of care and support that promoted their physical and mental wellbeing and enhanced their quality of life. People praised the exceptional skills of staff who supported them. A training manager had developed a very comprehensive, flexible training programme for staff that reflected various learning styles. They worked collaboratively with professionals to deliver bespoke training to meet individual health needs. A staff member was a 'Dementia Friends' champion to provide information and practical tips to encourage other staff and families to make a positive difference to people living with dementia. People using the service were encouraged to share their knowledge of living with particular health conditions. One person said they were looking forward to delivering a training session for care workers on ‘what it is like to receive care with a visual impairment’. They said staff treated them as an equal and promoted an independence focus.

People received a consistently high standard of care because the service used evidence of what works best to continually review and improve their practice. For example, by using The Social Care Institute for Excellence (SCIE) and National Institute for Health and Care Excellence (NICE) guidelines. People and relatives spoke about the exceptional quality of care provided by staff at Bluebird Care Exeter and recommended the service to others. Staff were highly motivated, enthusiastic and were proud to work for the agency and be known as ‘Devon Bluebirds’. The registered manager set high expectations of staff and was a role model working in partnership with their team. A provider award scheme recognised, re-enforced and rewarded positive staff values, attitudes and behaviours. For example, through 'Carer of the month' and 'Carer of the year' schemes as well as national Bluebird nominations.

The provider had very robust quality monitoring arrangements through which they continually reviewed evaluated and improved people's care. A range of national and local external awards showed the service was consistently high performing.

Personalised risk assessments provided comprehensive guidance for staff, who were vigilant in identifying risks and took steps to reduce them. People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely. Staff were trained to be aware of signs of abuse and were encouraged to report concerns, which were investigated. A very robust recruitment process was in place to make sure people were cared for by suitable staff, including a new applicant ‘taster’ session.

People were asked for their consent and staff acted in accordance with their wishes. Where people

appeared to lack capacity, mental capacity assessments were completed and involved the person, their family and professionals in best interest decision making. Complaints, concerns and feedback were taken seriously and used as an opportunity to improve the service.

The registered manager had informed the CQC of significant events. Record systems were accurate, well maintained and kept secure.