Background to this inspection
Updated
28 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was completed by two inspectors
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
The service did not have a manager registered with the Care Quality Commission. The registered manager and provider are legally responsible for how the service is run and for the quality and safety of the care provided. A manager had been recently employed. They told us they intended to register.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used all of this information to plan our inspection.
During the inspection
On the 4 and 5 December, we visited the office location to review records related to the running of the service. This included records related to ten people’s care needs. We also looked at four staff recruitment files and a variety of records relating to the management of the service.
On 9 December, we visited three people’s homes to observe care being provided. On 11 December, we phoned people and relatives to discuss their experience of care provided. We spoke with six people who used the service and three relatives about their experience of the care provided. During the inspection, we spoke with six members of staff, the (recently recruited) manager and the provider.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
28 March 2020
About the service
Bluebird Care is a domiciliary care agency. At the time of our inspection, the service was supporting 24 people with personal care in their own home.
People’s experience of using this service and what we found
Care plans did not provide sufficient guidance to staff. This provider did not have adequate oversight of what training staff had received. Therefore, there was a risk that people’s needs may not be supported safely. Incidents that had occurred were not always responded to safely.
Medicines were not managed safely. There were no audits to identify these concerns. This had put people at risk of not receiving their medicines and having ill health.
Staff were not safely recruited, as they began work before references and police checks were returned. People reported that staff were often late to support them. Records showed that this punctuality was worsening on a monthly basis. People reported that this had resulted in them completing tasks themselves unsafely. This neglectful practice had not been resolved. There was a lack of oversight at the service, to ensure that people’s needs were safely met. Staff followed safe infection control procedures.
The provider did not keep an accurate list of what training staff had received, so we could not be assured that staff were provided with the relevant skills to complete their roles. Health professionals were not always communicated with, and professional guidance was not always recorded for staff to follow. People told us that they had access to food and drinks of their choosing. People did not receive good quality end of life care.
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.
The ethos of the company was uncaring. We observed undignified language to describe people. Care visits were often late which left people anxious or completing tasks themselves unsafely. People told us that staff treated them in a caring way in their homes.
Care was not person centred. Expected national standards were not met, as people did not receive personalised care to meet their needs. Complaints were not always recorded, and themes were not analysed. Ongoing complaints of poor punctuality had not been resolved.
The service has been rated ‘inadequate’ for a second time. There has been a provider failure to oversee the quality of the service and drive improvements. The registered manager had left one month prior to our inspection, and it was not clear what improvement plan was in place. No new governance had been completed in their absence. The provider is legally accountable for the safe running of the service. They had failed to oversee a safe and effective service. This has put people at long term risk of harm. A new manager was in position, and intended to become the registered manager. It is a legal requirement for the service to have a registered manager.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was Inadequate (published 22 August 2019) and there were multiple breaches of regulation.
After the last inspection, we added a condition to the providers registration. This is a legal requirement. which the provider must follow. We requested that the provider sent monthly summaries of the action taken to improve the service. The provider sent us monthly summaries of the action taken. However, this inspection found that improvements had not been made as described.
At this inspection, not enough improvement had been made and the provider was still in breach of regulations. This service has been in Special Measures since 22 August 2019. The service remains in Special Measures.
Why we inspected
The inspection was prompted in part due to ongoing concerns received about medicines, staffing levels, staff training and overall governance. A decision was made for us to inspect sooner than originally planned and examine the risks in a comprehensive inspection.
We have found evidence that the provider needs to make improvements. Please see the report for full details.
Enforcement
The provider remains in breach of regulation 11 (consent), regulation 12 (safe care and treatment) and regulation 17 (Good Governance). At this inspection, we identified additional breaches of regulation 9 (person centred care) and regulation 19 (Fit and proper persons employed).
You can see what action we have asked the provider to take at the end of this full report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service remains 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.