Background to this inspection
Updated
11 January 2022
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 carried out by one inspector, an assistant inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received since the last inspection, and asked health professionals for feedback. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We visited the office and reviewed a range of records, including three recruitment files, scheduling records, induction and supervision records. We spoke with the registered manager and four members of office staff. We spoke with 13 care staff, seven people who use the service and four people’s family members.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We received feedback from three health professionals.
Updated
11 January 2022
About the service
Bluebird Care (Teignbridge) is a domiciliary care agency that was providing personal care to people in their own homes in Newton Abbot and the surrounding areas. At the time of our inspection 46 people were receiving support with personal care. 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
There had been significant changes in the senior leadership and office teams over the months leading up to this inspection. This had, at times, led to confusion about staff roles and responsibilities. The registered manager covered scheduling, supervisory and care roles, leaving management time limited. There was limited oversight of quality performance. Care and medicines records had not been audited and there was no analysis of complaints records to identify themes and trends. There was no formal provider oversight in place, although the registered manager told us the provider was supportive.
We received mixed feedback about the culture of the service. Some staff and some people’s families did not feel the service was led in an open and honest way. Staff were tired after working through the pandemic and felt the quality of the service and leadership had declined. One staff member said, “It’s a different company now than when I started working for them six years ago. Because of Covid, a lot of things changed.” Staff recognised that is had been an exceptionally challenging period. One told us that the registered manager, “Is trying their best at this very challenging time.”
Recruitment systems were not operated effectively, and staff files did not contain the information required to demonstrate staff had been recruited safely. New staff did not always complete the required shadow shifts to ensure they had the skills and experience needed to meet people’s needs when working independently. Following the inspection, the register manager told us they had appointed a member of staff to oversee recruitment, and that they were working through the staff files to ensure all the required documentation was obtained.
The service had experienced difficulties recruiting new staff and had experienced a high level of sickness. This had resulted in a shortage of staff and an inability to meet some people’s care needs. They had asked the local authority to find alternative providers for some people. Staff told us they had been short staffed, and people told us this had meant visits had been at different times, late or cancelled. They didn’t always know which carer would be supporting them. One person said, “I used to know who was coming and have a rota, but that doesn’t happen now.” A staff member said, ““It’s been difficult, but we do the best we can.”
Systems were in place to safeguard people from abuse; however, action was not always taken in line with the providers policy or best practice. Concerns raised were not shared with the Local Authority safeguarding adults board in an open or timely way.
People were supported to receive their medicines safely. Staff had been trained to administer medicines and had been assessed as competent to do so. Staff reported any medicine errors or issues and when a staff member had made a mistake, they completed an additional training session. The service worked with the person, their family and pharmacist to resolve any issues relating to their medicines.
Individual and environmental risks were assessed, and measures were in place to control the spread of infection. People and their families told us they felt safe. One person said, “I feel very safe with the girls when they are in my home and they are well trained and very good.” A family member told us, “My husband is safe with the carers.”
Staff made efforts to engage and socialise with people during their care visits and people were positive about the staff who supported them. One person told us, “They are very good companions, and very chatty.” A family member told us, “They go over and above what you would expect and spend a substantial amount of time with Mum to support her.” Care plans contained specific information to help staff support people in the way they preferred, and people and their families told us their individual needs were met. People knew how to raise concerns or make complaints. One person told us, “I have the office number, so I know who to contact if I need to.”
The service worked with other health professionals where appropriate. One health professional told us “care staff were “very professional and caring”, another said, “I have worked with them for many years with no concerns. The last 18 months have been very challenging for everybody.” People told us they were happy with their care and feedback, both positive and negative, was recorded and acted upon.
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.
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 (25 September 2019).
Why we inspected
We received concerns in relation to staff recruitment and induction, staffing levels and the management of the service.
As a result, we undertook a focused inspection to review the key questions of safe, responsive 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 requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe 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 (Teignbridge) on our website at www.cqc.org.uk.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to staff recruitment and induction, safeguarding and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.