Bluebird Care (East Hertfordshire)

Bluebird Care (East Hertfordshire) is a domiciliary care service providing personal care and support to 87 people at the time of the inspection.

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 felt they were safe and most felt well supported by the service. Some people felt care could be more person centred. The interim manager acknowledged that more work was needed to ensure that all care plans reflected people’s needs, choices and preferences. A plan was immediately put in place to address this.

People and relatives told us staff were kind and caring. Staff enjoyed working for the service and told us the culture was to ensure care was person centred.

Individual risks were assessed, and staff were aware of these. Reviews of events and accidents were completed, and any actions needed were carried out. Staff supported people with their medicines, and this was monitored by a member of the management team. Staff knew how to report any concerns about a person’s safety or welfare.

People told us staff did not miss visits, however, at times they were later than planned but they were informed. The provider had a system for monitoring visits for variation in arrival times and shorter visit times. An explanation was sought and recorded when this arose.

Staff received appropriate training for their role and people felt staff had good knowledge and skills. Staff felt well supported by the provider and management team. People told us staff assisted them with eating and drinking as needed. People were asked to give their consent for support and the principles of the Mental Capacity Act 2005 were followed.

People and relatives were asked for their views about the service. However, there were mixed views about how often feedback was sought and the effectiveness of action taken in response to issues being raised. Staff were also asked for their views and felt listened to. There were monitoring processes in place to help ensure a good standard of service and identify any shortfalls. Quality assurance systems identified any areas that needed further development. The manager who had applied to be registered was away from the service at the time of the inspection, the service was supported by an interim manager who had been working with the service for a number of months. They worked closely with the care supervisors and local authority to help ensure a good service for people.

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

Rating at last inspection

The rating at the last inspection (published 16 September 2021) was inadequate and there were multiple breaches of regulation. We issued the provider with a warning notice.

This service has been in Special Measures since 16 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information, and video and phone calls to engage with people using the service as part of this performance review and assessment.

Bluebird Care (East Hertfordshire) is a domiciliary care agency providing personal to older people and young adults some of whom may live with dementia, physical disability and sensory impairments.

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. At the time of the inspection 115 people used the service, 105 receiving the regulated activity of personal care.

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

People and staff told us there was ineffective leadership at the service since the registered manager left. The quality of the service people received deteriorated and their needs were not met.

People told us the level of care they received was inadequate because staff only stayed the minimum amount of time and they were rushed, at times not even turning up for the visits. Visits to people were not carried out at the agreed time often people waited hours for their support to arrive which meant they received personal care, food and drink and their medicines late.

The provider’s governance systems were not used effectively to ensure the service provided to people was safe and effective. The manager and the provider did not check if staff stayed the contracted length of time when visiting people, if support was provided by two staff to people where this was a requirement or that the invoices people paid reflected the care and support they received.

Safeguarding systems and processes were not robust and staff failed to report concerns appropriately. The manager and the provider failed to identify where people were exposed to the risk of financial abuse and neglect by the service they operated.

People and staff told us there were not enough staff to provide a good service. Often one staff member was allocated to provide care for people who needed two staff to maintain safety. Travel time was not effectively factored into staff’s schedule which meant they were late arriving to people’s homes from the beginning of their shift. The training staff received did not prepare them for their roles and their competencies to carry out tasks, such as manual handling, medicine administration, were not assessed.

Inexperienced staff members were sent to support people with complex needs often on their own which led on one occasion to staff sustaining injuries as well as putting people at risk of harm.

We observed staff not following government guidance in wearing Personal Protective Equipment (PPE) and people confirmed this. Staff in the office did not wear masks when they left their desks and people told us that staff often turned up at their home without wearing masks, aprons or gloves when they provided personal care.

Relatives were not happy with the care and support their family members received. They told us they had raised issues with the management, however no improvements were made. They told us their life had been negatively impacted by the poor service provision.

The manager and the provider failed to take immediate actions following our first day of inspection to keep people safe. When we returned to the service we found that the management team were still allocating one care staff to support people where two staff were required and there were numerous visits where staff did not stay for the length of the agreed time.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 24 October 2018).

Why we inspected

We received concerns in relation to staff training, one staff allocated to support people who required two staff, poor leadership. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Bluebird Care (East Hertfordshire) on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Bluebird Care (East Hertfordshire) is a domiciliary care service that provides care and support to people in their homes. Not everyone using Bluebird Care receives the regulated activity of personal care. CQC only inspects the service being received by people provided with personal care. At the time of our inspection, Bluebird Care was providing personal care to 66 people.

At our last inspection on 15 May 2017, the service was rated requires improvement with breaches of regulation 12, 13, 17 and 18 Of the HSCA 2008. This was in relation to assessing the risks to the health and safety of the service users, proper and safe management of medicines, staffing levels. Systems and processes were established but not operated effectively to prevent abuse of service users and assessments to monitor and mitigate the risks relating to the health and safety and welfare of service users were not effectively completed.

At this inspection, we found that the provider had taken the required action to address these shortfalls and were meeting the required standards. The service has been rated good. However further improvement was required in relation to ensuring people received their calls at their preferred times.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Potential risks to people’s health and well-being were identified by staff and they knew how to manage these effectively and protect people from harm. Risk assessments were completed to keep people safe.

People told us that they were involved with their care and staff always asked for their consent when providing care.

People and their relatives told us that their family members were kept safe and well cared for when they were being supported by the service. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse.

Recruitment processes were robust and ensured staff employed to deliver care and support for people were of a good character and suitable to meet people`s needs safely.

People told us staff supported them to take their medicines. Staff were trained in safe administration of medicine practices and had their competency regularly observed.

People and their relatives were very complimentary about the abilities and experience of the staff that provided care and support. Staff received training and regular updates to ensure they were up to date with their knowledge and best practice guidance.

Staff supported people to stay safe in their homes, and people were supported to maintain their health and well- being. Staff developed appropriate positive and caring relationships with the people they supported and their families, and feedback from people was consistently positive about the service they received.

People and their relatives where appropriate were involved in the planning of the care and support people received. People's personal information was stored securely and confidentiality was maintained.

People told us that staff provided care and support in a way that promoted their dignity and respected their privacy. Staff were knowledgeable about people`s preferred routines and delivered care that was individualised to the person they were supporting.

People told us they felt that staff listened to them and responded to them in a positive way. People and their relatives knew how to raise concerns and they were confident that the manager would take appropriate action to address any concerns in a timely way.

People were asked to provide feedback about the service they received regularly and we saw these were positive.

People and their relatives were positive about the staff and the management of the service. The registered manager regularly audited the service any improvements needed were actioned.

Bluebird Care (East Hertfordshire), provides personal care and support to people in their own homes. At the time of the inspection 80 people were receiving support with personal care. We gave the provider 48 hours' notice that we would be visiting the office to make sure that the appropriate people would be there to assist us with our inspection.

During the inspection we spoke with nine people who were being supported by the service, seven relatives, six members of staff and the provider. We looked at care plans relating to three people who used the service, three staff files and other information which related to the overall monitoring of the service.

The registered manager had left the service and the provider was fulfilling this role. The recruitment process to employ a registered manager had been started by the provider. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Medicines were not always managed safely to ensure people were safe.

There was an electronic call monitoring system in place that was audited regularly to ensure people received their care calls at the agreed time. However, people did not always receive their calls on time and we found that people did not always know which staff member was coming to support them.

People who were being supported by the service and their relatives were positive about the skills, experience and abilities of staff who worked in people’s homes. Staff told us they had training and regular updates which helped them develop their knowledge and skills to support people effectively. Staff had regular supervisions and told us they felt supported. However staff had not received appropriate training on equipment used in one person’s home.

People felt safe and were happy with the care and support they received in their homes. Staff had received training in how to safeguard people from the risk of abuse and knew how to report concerns. However, safeguarding concerns raised by staff and documented in the accident and incident logs were not referred to the local authority to make sure that they were properly investigated.

Recruitment practices were safe and effective to help ensure that all staff were suitable to work with people in their own homes.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way. People and relative’s we spoke with were positive about the staff and the way in which they delivered the care.

People were involved in the planning and reviews of the care and support provided. People’s personal information was securely maintained within the office.