Bluebird Care (Rother & Hastings)

Bluebird Care (Rother & Hastings) is a domiciliary care agency providing personal care to older people, people with physical disabilities and people living with dementia. At the time of the inspection the service was supporting 20 people with personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were supported by staff who knew them well and understood their needs. One person’s relative said, “The calibre of the carers is very good indeed. They are attentive, caring and cheerful.” Another person’s relative said, “They all very polite and friendly. They are very efficient and kind. We are glad we chose Bluebird.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People were supported to be as independent as they were able to be. People told us their homes and belongings were respected by staff, and their privacy and dignity protected.

People received personalised care. Staff knew people’s care needs but also their interests and hobbies. People’s needs were assessed before they started using the service and regularly reviewed. When people needed support about eating and drinking, accessing the community or taking their medicines, this was provided safely.

Risks to people’s safety and well-being were addressed and monitored, with ways to reduce the risk identified and put in place. People were supported to live healthier lives, with staff supporting and contacting health care professionals when needed. Staff worked in partnership with other professionals to ensure people received the right support.

People told us they did not feel rushed during their care visits. There were enough staff to meet people’s needs. Staff were trained to meet the needs of people using the service, including when people had specialist needs, such as epilepsy. Staff were recruited using safe recruitment processes.

The service was well-led. The provider and registered manager led a positive and person-centred service. People told us they could speak to the office when they wanted to and were confident to make a complaint if needed. Staff felt well supported by the management team and their hard work was recognised and rewarded. A quality assurance framework supported the registered manager to identify and address areas for further improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 7 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bluebird Care is a domiciliary care service. It provides personal care to people living in their own houses and flats in the community and in some specialist housing. It provides a service mainly to older adults and some younger adults with specialist needs. The service supports people in Rye and the surrounding areas. The service also provides live in carers to give relatives a respite from their caring responsibilities. At the time of inspection 43 people were receiving the regulated activity of ‘personal care’.

The service had a registered manager in post. A registered manager is a person who is 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 our last inspection in 2017 we rated the domain of ‘Safe’ and ‘Well led’ as requires improvement. Three recommendations were made in relation to good practice regarding staff knowledge of escalating safeguarding concerns, accident reporting, and processing references for new staff. At this inspection we found that the provider had made improvements in these areas.

We found that a safe recruitment process was in place to check the suitability of staff but minor improvements were needed to ensure the completion of some documentation. We have made a recommendation regarding staff recruitment records.

Medication was managed safely but auditing could be improved by extending the practice of dating liquid and ointment medicines to boxed medicines and this is an area for improvement.

A range of audits had been developed to inform the registered manager and provider of where the service was operating well and areas that needed attention, the audit of staff records however, is an area for improvement..

Staff understood their responsibilities for the protection of vulnerable adults, and how to escalate suspicions and concerns both within and outside the organisation. Action had been taken to improve the accident /incident reporting process; peoples care records could be accessed remotely by office staff that monitored and audited records to alert them to any omissions in recording and reporting. The registered manager analysed accidents and incidents for patterns and trends, and reviewed actions taken.

There were enough staff to support people’s day to day needs, staff and people said they were never rushed; there was good continuity of staff and no missed calls. People and relatives spoke positively about the reliability and dedication of staff. A suitable system was in place for the assessment and management of risk to keep people safe. Guidance was provided to inform staff how to support people when they became over anxious to de-escalate their behaviour and reassure them.

Staff had been trained in infection control and prevention and implemented this in their daily practice. New staff received an induction to their role before working unsupervised; all staff received regular training updates to enhance their knowledge and skills. Staff felt well supported and found the registered manager and office team approachable. Arrangements were in place for regular staff supervision and annual appraisal of their performance and development.

People referred to the service were assessed before a decision was made to accept the care package to ensure this could be met, the assessment took account of any additional support people may need regarding their sexual orientation, ethnicity, culture, or religion and this was recorded in the care plan to inform staff. Each person had a plan of care that was developed with them and their relatives. This guided and informed staff in the tasks they undertook for each person. Office staff reviewed care records daily to ensure needs were supported in accordance with care plans and preferences and were kept updated. People received a copy of their updated care plan. Formal reviews of care plans were conducted on a six monthly cycle with complex cases reviewed more frequently. The registered manager and office staff were aware of changes to Data Protection Law and people and staff records were kept securely.

Staff were mindful of those people who could be nutritionally at risk or from poor hydration and took appropriate action to support them with meals and extra drinks. Staff supported people with their health appointments where required, they monitored people’s health and referred them appropriately for additional health support when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People’s capacity to consent was assessed and recorded in their care plans.

People and relatives were complimentary about the staff and the quality of service provided, they felt listened to. Their views were sought and were influential in service development. Staff encouraged people to remain as independent for as long as they wished to be, and supported them to maintain a community presence if that was their wish. People told us that staff were kind and caring and treated them with respect and dignity. People were supported to retain their independence; care plans made clear what people could do for themselves. Peoples sensory and communication needs were documented and information provided in an accessible format if required. Staff supported people with social inclusion who wished to continue with activities they enjoyed such as shopping or attendance at events. People and relatives felt able to approach staff with any concerns and those who had thought these had been handled to their satisfaction.

Where known peoples end of life wishes were recorded. The service provided people with palliative and end of life support and this was well thought of by health professionals.

People and staff found the registered manager and senior staff approachable and supportive, staff received regular supervision and assessment of competency, Annual appraisal was carried out for those in post for more than one year. Staff were kept informed by emails of care plan changes, and policy and procedures updates they needed to be aware of if this informed everyday practice. Staff visited the office on regular occasions to make use of the facilities and to liaise with office staff. Staff were assessed individually in the community, whole staff meetings were held on occasion and staff were confident of raising issues within these and that they would be heard and issues addressed.

The provider made use of new technology to enhance the productivity and effectiveness of staff; this enabled remote monitoring daily to ensure people received timely care in the way they preferred. They have kept the Care Quality Commission appropriately informed of any notifiable events. They have developed good working partnerships with health and social care professionals and are well thought of. They have developed a community presence and have engaged with the local community through events.

Bluebird Care (Rother and Hastings) is a domiciliary care agency based in Rye. This was the provider’s first inspection at this location since they registered with the Care Quality Commission (CQC) in May 2015. They provide support and care for predominately older people living in their own homes. People had been assessed at risk of falls and some had long term healthcare needs such as diabetes, multiple sclerosis and people were living with dementia type illnesses.

Bluebird Care (Rother and Hastings) were able to, in line with their franchise agreement, offer their services over a large geographical area in East Sussex. However at the time of our inspection most people lived within 15 miles of the provider’s office in Rye. At the time of our inspection 21 people were using the service. There was a registered manager in post, a registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People spoke positively about the services provided. However we found some areas related to safety required improvement. We found an example where a staff member had not followed the provider’s policy in regard to reporting an accident. Completed accident and incident paperwork had not consistently recorded what corrective actions had been taken to reduce a reoccurrence. Staff were clear on what constituted abuse. However we found some staff were unable to identify who they should escalate a safeguarding concern to. Although staff records related to recruitment were predominately complete and assured the provider staff were suitable to work in care, one staff member did not have all previous employment references in place.

All people, their relatives and staff told us they considered the service was well led. However we found some shortfalls in areas where the leadership of the service was accountable. We found examples where people’s care records did not provide an accurate reflection of the support staff were providing to people. Although this had not impacted on care delivery, care records should document the specific care being provided. Senior staff were not having their supervision documented which meant it would be more difficult to set and track defined objectives. The providers electronic scheduling and care call monitoring software had the potential to allow staff to ‘tag’ into the same call as another staff member. This increased the risk that aspects of care delivery may be overlooked.

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines records were audited and reviewed to check for errors or omissions.

There were enough staff to meet people's care needs and care staff had regular training, supervision and appraisal to support them. Staff gave positive feedback about the quality of the training they completed and people who use the service said staff were well trained and knowledgeable.

People's care and support needs were assessed and routinely reviewed. Care plans were developed to detail how these needs should be met. People and their relatives told us they felt involved in their care. Most people’s care plans were detailed and provided clear guidance to staff to be able to provide individualised care. People knew how to make a complaint or raise concerns with the senior staff or the registered manager. There was an appropriate complaints system in place.

People told us they were supported by friendly, reliable and caring staff who respected their privacy and promoted their independence. People who required support or encouragement to eat and drink received appropriate care and staff knew what to do if they thought someone was at risk of not eating or drinking sufficient amounts. People were supported with their day to day health care needs such as liaising with health care professionals.

A range of audits and quality assurance systems had been established to ensure people experienced safe and good quality care and enable senior staff to have oversight of the service provided. People were routinely asked for their feedback about the quality of the service and had confidence in senior staff responding positively to them.