Bluebird Care (South Gloucestershire)

The inspection was carried out by one adult social care inspector and an expert by experience. An expert by experience is someone who has personal experience of using or caring for someone who uses this type of service.

At the time of this inspection the service were providing a service to 100 people in their own homes, had 33 care staff and five live-in care staff, six office staff as well as the registered manager and provider. Services were provided to people whose care and support had been arranged on a private basis or was commissioned by South Gloucestershire Council. The geographical area the service covered was within a 10 mile radius of the market town of Chipping Sodbury, South Gloucestershire. The service could be provided from a small number of hours per week up to a 24 hours live-in service.

The service was last inspected in January 2016 and at that time we gave an overall rating of Good. The provider has made significant improvements to the service since the last inspection.

There was 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.

Bluebird Care UK is a national franchise. A franchise is when a franchisee (the provider) has bought the rights to sell a specific company’s products in a particular area using the company’s name. Throughout the report we have referred to Bluebird Care (South Gloucestershire) as Bluebird Care.

Why we have rated this service as Outstanding.

The service was exceptionally caring. To ensure people received continuity of care, they were allocated to the least number of care staff. People had in the past raised concerns when this had not been the case and had been listened to. A new care coordinator had resulted in improved planning and better outcomes for people. Care staff knew the importance of developing good working relationships with the people they looked after and ensured they provided person centred care based on their specific needs. The feedback we received from people and their relatives was overwhelmingly positive.

The service went over and above to provide a person- centred service to each person. One example is their ‘Nobody is lonely at Christmas’ campaign where care staff had arranged for people to have a full Christmas meal with all the trimmings, when family and friends were unable to. Two of the care staff had received awards, one from the Bluebird Care Franchise office, 'Best carer in the South West' and the other ‘Best apprentice’, nominated by their external NVQ trainer.

The service was exceptionally responsive. The assessment, care planning and service delivery arrangements ensured each person was provided with a service that met their specific care and support needs. Their care plans were reviewed on a regular basis and changes made as and when required. Care staff would feedback to the office staff where people’s needs had changed so the service could then respond to these changes and support the person appropriately. People were provided with information about the service so they knew what to expect. These details included the provider’s complaints procedure so they would know how to raise any concerns they may have. The provider used feedback about the service to drive forward any improvements. Feedback from people and their relatives was gathered in care plan reviews and in regular surveys. The views and opinions of people were actively sought and acted upon. It was evident the service was fully focused on meeting people’s individual care and support needs and that they were satisfied at all times.

The service was exceptionally well led. Since the last inspection the office structure had been enhanced and now consisted of the registered manager, a recruitment and development manager, one care coordinator , a field supervisor, a live-in care supervisor and customer assessment supervisor and an accounts assistant. There were plans to recruit an admin/coordinator support. The provider was actively involved in the service, and had a daily presence in the office. The provider maintained a good oversight of how things were going.

Because the provider had exceptional systems in place to monitor the quality and safety of the service people were provided with a safe, effective, caring and very responsive service that was well led. There was a strong focus by the provider, registered manager, office staff and care staff in ensuring the service was of a high standard.

People received a safe service. The provider, registered manager and staff team were all totally committed to providing a safe service where service delivery was always of a high standard. The systems in place for the management of medicines were exceptional. Records of administration were made electronically and care staff could not log out of a care call until this had been completed. This meant the support people received with their medicines was as prescribed by their GP. Staff completed safeguarding adults training and knew what to do if there were any concerns regarding a person’s health and welfare. Staff also received regular moving and handling training to ensure they always moved people safely. Other risk assessments were completed as part of the care planning process and strategies put in place to reduce or eliminate the risk. The service followed safe recruitment procedures when taking on new staff to ensure people were looked after by care staff who had the right qualities and skills. The provider had an ongoing programme of staff recruitment in order to meet growing demand for their services. There were sufficient numbers of care staff to meet the care and support of people they looked after safely.

The service was effective. People’s care and support needs were assessed prior to a service being set up. The person was very much involved in the assessment and encouraged to have a say in how they wanted to be looked after. The assessments and the resulting care plan was person centred.

The care staff were well trained. New care staff to the team completed induction training and then a number of shadow shifts with an experienced member of staff. They then had a 12 week probationary period to complete during which they worked through the Care Certificate. During this time the new recruit was monitored by the recruitment and development manager and field supervisors. Ongoing mandatory training was arranged for all staff and included any specialist training where people had specific care needs.

People were provided with assistance to eat and drink well where this had been identified as a care need. The care staff were aware of the need for people to have good nutrition and to maintain good hydration, and had actively monitored people in the recent heatwave conditions. The registered manager, office staff and care staff all worked with other health and social care professionals to benefit the people they supported and ensure their health and wellbeing was maintained.

People were supported to be as independent as possible. Their mental capacity was assessed as part of the whole assessment process. People were actively involved in making decisions and encouraged to make their own choices about their care and support and how they wanted to be looked after. The service was meeting the requirements of the Mental Capacity Act 2005.

At the time of this inspection the service was providing support to 69 people who lived in their own homes. Fifty-eight people were receiving a personal care service and the others received domestic assistance or companionship. The service was provided to people who lived in Thornbury and surrounding villages and Yate/Chipping Sodbury. The provider had plans in place to increase service provision and be able to deliver a service to people in the Kingswood area. All these areas are within South Gloucestershire. The service employed 36 care workers.

There was not a registered manager in post at the service however a care manager had been recruited who will apply to the Care Quality Commission to be registered. They had already commenced the process. 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.

The aim of the service was that people were looked after by the minimum number of care workers. This would ensure they received a consistent service. Due to expansion of the service and changes in where people being supported lived, this was not being achieved at the time of the inspection. Feedback from two people we spoke with during the inspection indicated this required improvement but this contradicted what others has said in the survey forms. The provider, manager and coordinator were already aware of some improvements and had a plan in place to review all care workers work schedules.

People were safe with the care staff who supported them. Care workers received training to ensure they were aware of safeguarding issues and were recruited following thorough recruitment procedures. Staff knew to report any concerns they had about a person’s welfare to the registered manager or directly to the local authority, CQC or the Police. Where risks were identified management plans were put in place to manage the risk with the aim of reducing or eliminating the risk. Where people were supported with their medicines this was safely managed.

People received the service they had agreed to receive when the service was set up. Care workers talked about the people they supported in a respectful manner and received the appropriate training to enable them to undertake their roles effectively. People received a service based on their individually assessed care and support needs. Where identified in the assessment process, people were provided with support to have sufficient food and drink. People were supported to access health care services if needed. Where appropriate care workers worked in conjunction with other health and social care providers.

People were treated with kindness and respect. Their preferences and choices were respected. They were encouraged to provide feedback about the service they received and to have a say about how their service was delivered. They were provided with a copy of their care plan and were told on a weekly basis which care workers were going to support them.

People and care workers said the service was well-led and well managed. There were no missed calls and people were not ‘let down’ by the service. Any feedback that was provided by people using the service, their families or the care workers was acted upon. Information received was used to drive forward improvements to service provision.

Below is a summary of what we found. This is based on our visit to the office, discussions with people who use the service and their relatives, and staff. Please read the full report if you want to see the evidence supporting our summary

Is the service caring?

People who we contacted as part of our inspection were positive about the care they received. We received comments such as "staff are very kind and caring" and "I am more than happy".

People confirmed that staff treated them with dignity and respect. Staff had clear ideas about what these terms meant and gave examples of how they would put them in to practice when providing care.

The support plans that people had in place were detailed and provided clear and consistent guidelines for staff to follow that would allow care to be delivered in a person centred way. It was clear that people had been involved in discussions about their care and people signed to give their agreement to the support plan.

Is the service responsive?

People's needs were reviewed regularly and the dates of these were recorded on file. This meant that staff were able to respond to any changes in the level of support that a person required. One person that we spoke with said that their plan was "always updated if my condition changes".

Where concerns arose that might indicate a person was at risk, appropriate action was taken in reporting the issues to the relevant authorities. Disciplinary procedures were followed if allegations were made against a member of staff.

The service kept a log of complaints and we saw that these were responded to appropriately. People who used the service could be assured that their concerns would be listened to and addressed.

Is the service safe?

People that we spoke with told us that they felt safe in the presence of staff. One person told us that staff contacted them if they had any concerns about their relative.

Staff received training in safeguarding vulnerable adults and told us they would feel confident in identifying and reporting concerns. There was guidance and policies in place for staff to follow in the event of identifying a safeguarding issue. Staff understood the term 'whistleblowing' and knew that they could report concerns to outside agencies if they needed to.

There were risk assessments in place to ensure that people were supported in a safe way. This included clear instructions for staff to support people with their moving and handling needs.

Is the service effective?

People's packages of care were reviewed regularly to ensure that they were meeting the person's needs. These reviews allowed people to give their opinions on the care they received and for the agency to make changes as required.

Staff received training and support to help ensure that they were able to carry out their roles effectively. Regular supervision and spot checks took place to monitor staff performance.

Is the service well led?

There was a registered manager in place at the time of our inspection. Staff that we spoke with told us they felt well supported and could approach senior staff with any issues or concerns.

A programme of quality monitoring was in place, which included gathering the views of people who used the service. We viewed some returned satisfaction surveys and noted that the responses were positive.