Bluebird Care (Islington) & Bluebird Care (Hackney)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

We reviewed accidents, incidents, complaints and concerns logs and found managers identified trends, risks and learning opportunities. Incidents and complaints were discussed in management meetings and actions were taken to reduce repeat issues and improve the quality of care provided.

The provider carried out analysis of accidents, incidents and complaints to monitor themes across the service. This included reviewing recurring falls, behavioural issues, environmental risks and concerns relating to staff practice and continuity of care. Managers used this information to review risks, update care plans and identify where further support was required.

Where concerns were raised, managers carried out investigations and took action to address concerns. Staff told us additional shadowing, guidance and competency checks were arranged following concerns about staff practice. Managers also used supervision and audits to monitor staff performance and support improvement.

Staff members told us they felt comfortable reporting concerns and were supported when concerns were raised. One staff member told us, “I would report any issues to my care supervisor in the office and they would act. I feel confident talking to anyone in the office about my concerns.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People’s care was planned safely when people started using the service or when their needs changed. Families were involved in reviewing people’s care plans. Staff shared information appropriately and worked with other services when people’s needs changed such as working with commissioners when people’s care package needed to increase. Professionals confirmed this was their experience of working with the service.

Staff used an electronic system to review care plans, daily notes and updates before visits. This helped staff understand people’s current needs, risks and support arrangements. One staff told us, “We are always briefed before a new care package starts.” Relatives told us they were able to access care information and daily notes using their phones to help them stay involved in people’s care.

People and relatives told us communication from the office was very good and they were informed in advance about changes to carers or visits. One relative told us office staff worked closely with the hospital discharge team and arranged equipment and medicines in blister packs to be delivered before their family member returned home from hospital. This helped support continuity of care and reduced the risk of delays or gaps in support when people moved between different services.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People and relatives told us they felt safe using the service and were able to raise concerns with the managers. One person told us, “I feel safe with all my carers.”

Staff had completed safeguarding training and were able to describe different signs of abuse and neglect, including unexplained injuries, poor hygiene, weight loss, fearfulness, lack of food and changes in behaviours. Staff told us they would report concerns immediately and escalate concerns externally such as the police or councils if needed. One staff member told us, “I’d report concerns immediately to my manager or safeguarding lead and document everything clearly in the electronic system.” Another staff member told us, “If someone was in immediate danger, I would call 999 and report it to the office.”

Safeguarding concerns were recorded, investigated and monitored appropriately. Managers maintained safeguarding logs and analysed records to identify themes, risks and learning. The service worked with local authorities, district nurses, GPs, social workers and the police when concerns were raised.

Safeguarding concerns related to skin breakdown, self-neglect and financial abuse were investigated and actions were taken. Referrals had been made appropriately to the local authority and CQC.

We reviewed financial audit records and found people’s money was being managed well to safeguard people from financial abuse.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff had clear guidance about the different risks people faced, for example, risks around moving safely, eating and drinking, skin breakdown, medicines and falls. This meant staff knew what to look out for and how to keep people safe during every visit.

People and relatives told us staff understood the support people needed to stay safe and respected their routines and preferences. One relative told us carers knew their family member well and supported them in the way they preferred. Another relative told us carers kept them informed about their family member’s wellbeing and reported any concerns immediately.

External healthcare professionals were involved where people required clinical advice or equipment to help manage risks safely. The service did not support anyone using restrictive practices.

The service detected and controlled potential risks linked to people’s home environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risk assessments were detailed and considered risks in people’s homes, including gas, electrical hazards, trip hazards, chemicals and pet safety. Steps were identified to reduce these risks and keep people safe.

Staff had completed health and safety and fire safety training, so they understood how to respond in an emergency. Staff told us they knew how to report environmental or safety concerns to the office so action could be taken. One staff member told us, “I make sure floor is clear, dry, no loose carpet before using mobility equipment to move or reposition service user.” Another staff member told us, “I always look for visible hazards when attending care calls.”

The service made sure there were enough qualified, skilled and experienced staff who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives told us staff were caring, arrived on time and understood how they preferred their care to be provided. One person told us carers were “absolutely brilliant” and another relative told us carers were all confident and well-trained.

Staff completed training for their role, including the care certificate, which is a set of national standards for staff new to social care. Specific training included safeguarding, medicines administration, moving and handling, health and safety and infection prevention and control. Training records also showed staff had completed additional training in dementia and autism care. Managers regularly carried out supervisions, spot checks and appraisals to make sure their practice stayed safe and met people’s needs.

Staff told us they could access support and guidance from the office when needed. Staff told us they understood how to report concerns, request advice and escalate issues appropriately. One member of staff told us, “The company always provide enough care workers whether double up or single.”

Recruitment checks were completed before staff started work. This included a Disclosure and Barring Service check, which confirms whether a person has a criminal record or is barred from working with adults or children. Employment history, references, proof of identity and right to work in the UK checks were also completed.

We reviewed electronic call monitoring data which showed people received visits as planned, with low levels of missed or late calls.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff received infection prevention and control training and told us they had access to personal protective equipment (PPE) such as gloves, aprons, hand gels and face masks to support safe care. One staff member told us, “Bluebird trains us to follow infection prevention procedures such as washing our hands and use PPE.”

People using the service and their relatives told us staff used PPE appropriately during visits and followed good hand hygiene. One relative told us care workers wore gloves and aprons when providing personal care and maintained a clean environment.

Care plans included guidance for staff about infection risks where relevant. Staff told us they understood the importance of safe disposal of waste and reporting infection concerns to the office. Daily care records showed staff supported people to maintain clean home environments, including changing soiled bedding, disposing of continence waste, cleaning surfaces and supporting laundry where needed.

Managers monitored infection prevention and control through regular spot checks, which included checking hand washing and PPE use.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff had completed medicines training, including classroom training on the safe administration of medicines. Managers carried out competency checks through spot observations to assess staff skills and knowledge before they supported people with medicines independently.

People and relatives told us they were happy with the support they received with their medicines. One relative told us care workers informed them when their family member’s medicines were running low and helped make sure medicines were collected when needed.

The service used an electronic medicines administration record (eMAR) system to record medicine support. We reviewed samples of MAR charts and found they were completed. However, recording was not always consistent for one person. The registered manager reviewed and addressed this through additional guidance for staff on medicines recording.

Managers carried out regular audits to monitor safe medicines practices, including reviewing medicines errors and making sure actions were taken to prevent them happening again. The registered manager told us they sought advice from healthcare professionals when medicines incidents occurred. Staff told us they understood what action to take if a medicines error occurred. One staff member told us, “If there is a medicine error, I’ll call NHS111 and seek guidance, then call the office to report and wait for their advice.”

Staff worked with external health professionals and families where people needed support with medicines given when required or medicines given in different forms, such as crushed medicines.

The registered manager was aware of STOMP (Stopping over Medication of People with Learning Disability, Autism or both) principles and told us this was being included within medicines training and policies. The service was not supporting anyone subject to a STOMP review at the time of assessment.