Archived: Bluebird Care Hurley Office

Updated 17 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. The inspection was prompted in part by information of concern received from members of the public, about the standard of care being provided.

The comprehensive inspection took place on 6 and 20 September 2017. The first day was announced, this was to ensure the managers, the provider and the staff were available to talk with us about the service when we visited. The second day was not announced. The first day of the inspection was conducted by two inspectors and the second day was conducted by one inspector.

Before the inspection visit we reviewed the information we held about the service. We looked at information received from relatives, members of the public, healthcare professionals, local authority commissioners and reviewed the statutory notifications the provider had sent us. A statutory notification is information about important events which the provider is required to send to us by law. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority. The local authority provided us with information regarding recommendations it had recently made to improve the quality of the service. We considered this information when planning our inspection of the service.

This inspection was a follow up visit to check improvements had been made in the management of the service. During this inspection, we asked the provider to supply us with information that showed how they managed the service, and the improvements they had made. We considered this information along with the action plan they had submitted to us following their inspection in June 2017.

During our visits we spoke with the manager, the operations manager, the provider, the director and the senior carer. We reviewed seven people’s care plans to see how their care and support was planned and delivered. We looked at other records related to people’s care and how the service operated, including medicine records, staff recruitment records, the provider’s quality assurance audits and records of events and complaints. Following our first visit we contacted people who used the service by telephone. We spoke with 5 people who used the service and six representatives, including relatives. We also spoke with five care staff.

Updated 17 November 2017

Bluebird Care Hurley Office is registered to provide personal care and support to people living in their own homes. The service operates across Warwickshire and Staffordshire. There were 63 people using the service at the time of our inspection visit.

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.”