Archived: Bluebird Care Hurley Office

The inspection took place on 6 and 20 September 2017 and was announced on the first day. We called the service an hour before our arrival to ensure the manager and provider were available to speak with us when we arrived. The inspection was prompted in part by information of concern received from members of the public, about the standard of care being provided.

There was no registered manager at the service. The previous registered manager had left their post in June 2017. The service was being managed by a care manager [referred to as the manager throughout this report] and an operations manager, who both began their role in June 2017. The manager left the service following this inspection visit and the service continues to be managed by the operations 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.

The service was previously inspected on 20 March 2017 where we found the service was not meeting the Health and Social Care Act 2008 and associated Regulations and there was a breach in Regulation 17 Good Governance. The service was rated as ‘Requires Improvement’. This was because insufficient improvements had been made since our previous inspection and there were continuing concerns. Processes had not been established to consistently assess, monitor and mitigate the risks relating to the health and safety of people who used the service. One referral about an important event which called into question one person’s safety had not been made to the CQC. We found some identified risks relating to people’s needs had not been assessed in full on their care plans and there were some gaps in guidance for staff. Some people experienced late calls and had not been contacted by the service to warn them in advance. We found best practice was not always followed when recording why medicines were not administered to people.

At this inspection we looked to see if the provider had responded to make the required improvements as set out in their action plan dated June 2017. During this inspection we found the same issues continued to require improvement and we found additional concerns.

There were insufficient numbers of suitably skilled staff to meet people's individual needs. Missed and late calls and medicine errors were not monitored or recorded effectively to manage and reduce risks of them occurring in future. We found events that might mean a person was at risk of harm were not consistently identified and managed effectively in accordance with the provider’s different processes. Medicines were not always administered safely and best practice was not always followed when recording why medicines were not administered. Care plans were not all accurate and there were gaps in guidance given to staff about how to support people safely. Some identified risks had been recorded but not assessed in full on people’s care plans.

Staff had not been provided with consistent training or support from the provider to enable them to carry out their role effectively. The provider did not always work within the principles of the Mental Capacity Act 2005. Where people lacked the capacity to make certain decisions, mental capacity assessments had not always been conducted thoroughly to establish which decisions they could make themselves. People's nutritional needs were not always met. Care plans were not accurate and it was difficult to see what action had been taken to ensure people received on going healthcare support.

People were positive about how caring the staff were. They told us staff respected their privacy and dignity. However, carer workers had not been treated in a caring way by senior staff, which meant they were not always able to provide person centred care for people.

People were involved in planning their care, however care reviews had not been completed in a timely way. People did not always receive the personalised care they needed, because care plans were not always up to date. People knew how to complain, however not all complaints were identified or managed in accordance with the provider’s complaints process.

There was a continued lack of oversight by the provider which meant people were placed at risk of harm and actions identified as requiring improvement at our last visit had not been addressed. Management systems continued to be ineffective because they did not identify concerns we found during our inspection visit.

We found a continued breach, and additional breaches of the Health and social care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means the service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.”

Bluebird Care Hurley Office is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service supported 54 people.

The service was last inspected on 8 March 2016, where we found they were meeting the Health and Social Care Act 2008 and associated Regulations, however there were issues which required improvement in the safe and well led questions. The service had been rated as requires improvement, because we found between the period August 2015 to January 2016, when there had been no registered manager at the service, there had been a lack of oversight by the provider. During this period the provider had not ensured all their responsibilities had been fulfilled. For example, not all notifications were sent to the CQC about important events that occurred at the service. Systems were not in place to ensure that information, for example around falls and medicine errors, were reported to senior managers to review and learn from. Some identified risks to people's health, had not been recorded and assessed in full on their care plans.

At this inspection we looked to see if the provider and registered manager had responded to make the required improvements. Whilst we found some areas of improvement had been made, we also found some of the same issues continued to require improvement.

The registered manager had been in post since January 2016 and was registered in June 2016. 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.

Staff understood their responsibility to keep people safe and understood the risks relating to people’s care. However not all events which called into question people’s safety had been managed to reduce the risks to people. One referral had not been made to the CQC. Some identified risks had not been assessed in full on people’s care plans and there were some gaps in guidance for staff.

There were sufficient numbers of suitably skilled staff to meet people’s individual needs. However some people experienced late calls and had not been informed by the office in advance. People received their medicines as prescribed, however best practice was not always followed when recording why medicines were not administered.

People felt able to speak with the registered manager and senior staff if they needed to. Staff told us they felt supported and they were encouraged to share ideas to make improvements to the service. There were some processes to ensure good standards of care were maintained for people. However, insufficient improvements had been made since our last inspection and processes had not been established to consistently assess, monitor and mitigate the risks relating to the health and safety of people who used the service.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff understood the principles of the MCA, where people had capacity to make their own decisions, these were respected and consent was gained before staff provided personal care.

People's nutritional needs were taken into account and people were supported to make referrals to other healthcare professionals when their health needs changed.

People told us staff were kind and caring and had the right skills to provide the care and support they required. Staff treated people in a way that respected their dignity and promoted their independence.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s needs and preferences and care plans were regularly reviewed. People knew how to complain and were able to share their views and opinions about the service they received.

We found a breach of the Health and social care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Bluebird Care Hurley Office is a domiciliary care agency which provides personal care and support to people in their own homes. At the time of our visit the service supported 85 people. The service was last inspected on 10 April 2013 when we found no breaches of Regulations.

The service is required to have a registered manager in post. 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. At the time of this inspection, the service did not have a registered manager in post and had been without a registered manager since August 2015. There was a new manager who had been in post since January 2016, who was in the process of applying to become the registered manager.

People told us they felt safe using the service and staff understood how to protect people from abuse. However not all important events had been recorded, shared with senior managers for analysis or referred to appropriate agencies, during the period between August 2015 and January 2016. We found some identified risks to people’s health, had not been recorded and assessed in full on their care plans. People received their medicines as prescribed, however there was no consistent process to identify medicine errors.

There were enough staff to deliver care and support to people, however some people told us staff were sometimes late. Staff received an induction and training to support them in meeting people’s needs, however there were some gaps in staff training. Risk assessments and checks on staff to ensure their suitability to work with people who used the service, minimised risks associated with people’s care.

The manager understood the principles of the Mental Capacity Act (MCA) and was in the process of providing staff with training and information on the MCA. Staff respected people’s decisions and gained people’s consent before they provided personal care. It was not clear on people’s records if they required support to make decisions.

People told us staff were kind and caring and had the right skills and experience to provide the care and support they required. Staff treated people in a way that respected their dignity and promoted their independence.

Care was planned to meet people’s individual needs and care plans were reviewed. Some care plans were not up to date and the manager was taking action to improve them. People were involved in planning how they were cared for and supported. Staff understood people’s individual needs and information was shared about changes in people’s care. People knew how to complain and were able to share their views and opinions about the service they received.

People were satisfied with the service and felt able to contact the manager if they needed to. During the period where there had been no manager in place, the provider had not ensured all their responsibilities had been fulfilled. Systems had not been put in place to ensure information about important events was shared appropriately, so that some information about important events was not analysed by senior managers and learning could not take place across the service to minimise future risks. There were some processes to ensure good standards of care were maintained for people, however these were not all effective. The new manager had recognised these issues and had taken steps to make improvements since starting their role in January 2016.