Bluebird Care Harrow and Brent

Bluebird Care (Brent) is a domiciliary care service which provides personal care and support to people in their own homes. At the time of the inspection there were 127 people using the service, of which 91 were receiving 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

We have made one recommendation regarding accessible communication.

Moving and handling assessments lacked some detail and could be further developed. The assessments did not include the sling size, when the hoist was last serviced, hoist type, or what checks needed to be completed to ensure the sling was fit for purpose.

The provider did not have an effective system for reviewing lessons learned from incident investigation. For example, two recent falls incidents had not prompted action to prevent a recurrence of similar incidents.

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 protected from the risk of harm and abuse. There were effective systems and processes in place to minimise risks. Care workers had been recruited safely and they knew how to identify and report concerns.

People received person centred care. Their assessments showed they had been involved in the assessment process.

Care workers were knowledgeable about people’s needs. They had completed essential training and we saw from records they were up to date with it.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.

There were governance structures and systems which were regularly reviewed. There was a complaints procedure in place, which people’s and their relatives were aware of.

Quality assurance processes such as audits and spot checks were in place.

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 good (published 13 May 2019).

Why we inspected

The inspection was prompted in part by notifications of two incidents following which two people using the service sustained serious injuries. The incidents are subject to initial inquiries to determine whether to commence a criminal investigation. As a result, this inspection did not examine the circumstances of the incidents. However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of falls from moving and handling equipment. This inspection examined those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk assessments and a lack of an effective quality assurance system.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

• Bluebird (Brent) is a domiciliary care agency which provides care to people in their own homes.

• There were 76 people using the service at the time of our inspection.

• Most people using the service were older adults (over 65 years of age), although some younger adults with physical disabilities received a service.

• People using the service lived within the London Borough of Brent and the majority had their service commissioned by the local authority.

• The service provided covered a range of areas including prompting with medicines, personal care, housework and laundry.

People’s experience of using this service:

• There were effective systems and processes to minimise risks to people. We reviewed evidence, which showed people were protected from abuse and avoidable harm.

• Generally, people received their calls on time. A few people told us they did not always receive their calls on time. We saw evidence there were on-going improvements in relation to staff punctuality.

• People’s needs had been assessed. There was evidence that their care and support needs were met.

• People were treated with dignity and respect. We saw evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

• People told us that they received personalised care that ensured their needs, preferences, and interests were met. There was evidence to support this.

• There were governance systems and processes in place. However, these were not always used effectively to monitor people’s calls and identifying gaps in the accurate recording of people’s records.

We have rated the service as good overall. However, there are areas that require improvements. We have therefore rated well-led as ‘requires improvement’.

Rating at last inspection:

At our last inspection, the service was rated "Good". Our last report was published on 25 August 2016.

Why we inspected:

• This was a scheduled inspection based on the previous rating.

Follow up:

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

At the time of the inspection, the service was providing care and support 66 people and had 34 care workers working for them.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [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.

At our last inspection on 8 May 2015, we found breaches of legal requirements in relation to Regulations 10, 17 and 18 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This is because the provider had failed to ensure their was insufficient numbers of suitable staff deployed to keep people safe and meet their needs. There were instances where people’s privacy and dignity had not been respected and maintained and the systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people.

We received an action plan from the service telling us what action they would take to meet legal requirements in relation to the breaches. At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to respond to the issues identified and was now meeting regulations. Feedback from people using the service and relatives also indicated an improvement with the service they received since the last inspection.

Although there some instances of lateness, overall people using the service and relatives told us their care workers turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received. The service had a system in place to monitor care workers punctuality.

Care workers had a good understanding of and were aware of the importance of treating people with respect and dignity. Feedback from relatives indicated that positive relationships had developed between people using the service and care workers and people were treated with dignity and respect.

Systems were in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service people received through review meetings, telephone monitoring and satisfaction surveys. Records showed positive feedback had been provided about the service.

The service also undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

People and relatives told us that they were confident that care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers spoke positively about their experiences working for the service.

Systems and processes were in place to help protect people from the risk of harm and care workers demonstrated that they were aware of these. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and care workers were aware of potential risks to people and how to protect people from harm.

Arrangements and checks were in place to manage medicines safely in respect of medicines. Care workers had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that all these were completed fully. We found the service had an effective medicines audit in place.

People received care that was responsive to their needs. People's daily routines were reflected in their care plans and the service encouraged and prompted people's independence. Care plans included information about people's preferences.

The service had a complaints procedure and there was a record of complaints received. People and relatives spoke positively about the service and told us they thought it was well managed. There was a clear management structure in place with a team of care workers, office staff, care coordinators, the registered manager and the provider.

Staff were informed of changes occurring within the service through regular staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.