Bluebird Care (Plymouth and South Hams)

The service provides personal care to adults in the categories of dementia, learning disabilities or autistic spectrum disorder, mental health, older people, sensory impairment and younger adults.

Staff supported people with personal care, access to the local community, shopping and preparing meals. Some people received 24-hour care from staff at Bluebird Care [Plymouth & South Hams] to enable them to remain safely in their own homes.

What life is like for people using this service: People supported by the service continued to receive personalised care which was responsive to their individual needs. Staff had an excellent understanding of the care and support people required and provided this with great care and patience.

People's care and support had been planned proactively and in partnership with them. People felt consulted and listened to about how their care would be delivered.

The registered provider and registered manager were passionate about the quality of service delivery and led by example. They followed best practice and pursued opportunities to improve care and people's experiences to attain better outcomes.

There was an open, honest, caring and positive culture across the service and staff demonstrated a high value base. This was clearly led from the top down. The registered manager was also supported by a team of exceptionally motivated and dedicated service managers and team leaders.

People consistently gave examples of the registered provider and staff team as kind and caring people. They told us they valued their relationships with the staff who supported them which had often exceeded what they had requested.

Systems, processes and practices were embedded to safeguard people from abuse and risk of harm. Good practice guidance had been followed to keep people safe.

Risk assessments were in place to support people to take positive risks and remain safe.

Staffing levels were continuously reviewed to ensure there were enough staff to provide a flexible and responsive care. The registered manager and locality managers ensured people had a consistent staff team.

Medicines were managed safely to ensure people received them safely and in accordance with their health needs and the prescriber's instructions.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs.

People, and where appropriate their representatives, were involved in decisions made about their care. Members of the management team from Bluebird Care [Plymouth & South Hams] visited people prior to them receiving care visits, to discuss their care needs and ensure the service could respond to them.

More information is in Detailed Findings below

Rating at last inspection: Overall Good. Outstanding in Care domain (report published 25/11/2016)

Why we inspected: We inspected this service as part of the scheduled programme.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

A manager was employed to manage the service. They were in the process of registering with CQC to become the registered manager of the service. 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 manager was supported by other senior staff who had designated management responsibilities. People told us they knew who to speak to in the office and had confidence in the management and staff team. Clear communication systems were in place to ensure people, family and staff queries were handled swiftly and without repeat calls having to be made. Staff told us they felt supported in their work and the registered provider and manager told us they worked hard to make sure staff felt appreciated.

The registered provider and registered manager had a strong ethos of caring for people and staff, and this had clearly been adopted in the way staff treated the people they supported. People told us staff were kind and staff gave examples of how they went above and beyond their normal role to show they cared for people. Staff spoke about people they supported with fondness and respect. Comments included, “It’s nice to help other people. I go out of my way to treat each customer as a person. I have a giggle with people and they enjoy that” and “I enjoy putting a smile on people’s faces. I like to make a difference to their morning.”

When required, people received compassionate end of life care from a dedicated staff team who also focused on the needs of friends and family, to help ensure they felt supported throughout. A relative fed back how much they and their loved one had looked forward to visits from the staff during this time, and described them as “angels”.

People received support from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. A person said, “All the carers are lovely and efficient.”

People told us they felt safe using the service. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected. There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The recruitment process of new staff was robust to ensure the right staff were employed to look after people.

The risks associated with staff supporting people to move were assessed and updated as required. However, where people had risks relating to specific health care needs, such as diabetes, these were not always assessed to provide staff with guidance on the risk and how to mitigate it. The manager told us they would review all risk assessments to ensure risks were identified and assessed as needed. This would ensure staff had the required guidance to refer to.

Some people received support with their medicines. Staff were trained to do this and people told us they received the right medicines at the right time. Medicines records did not detail when staff were responsible for administering people’s medicines and when family members were. Nor did they include guidance for staff about when people needed medicine that was prescribed to be taken ‘as required’. The manager told us they would ensure records included this detail.

People told us staff respected their homes and protected their privacy and dignity. Staff had received training on the Mental Capacity Act 2005 (MCA) and people told us staff always asked their consent before delivering any care or support.

Feedback about the quality of the service was encouraged and any information received was used to aid learning and drive improvement across the service.

The manager and staff monitored the quality of the service by regularly undertaking a range of audits and speaking with people to ensure they were happy with the service they received. People and their relatives, told us the management team were approachable and included them in discussions about their care and the running of the service.

When we visited, the agency provided personal care services to approximately 84 people (including some for whom it was a short-term arrangement only) and employed 43 care staff. The agency also provided domestic help and other services which were not regulated by us and therefore not inspected.

From information provided by the agency, we saw that the great majority of people using the personal care service had support needs due to older age. A very small number of people were younger adults and/or those with needs due to learning disabilities, dementia or mental health needs. A very small number required two staff ('double ups'), rather than one staff, to provide care on visits, or had live-in care staff. We chose a proportionate sample of people across these groups, to be contacted for their views of the service. We also included people with different funding arrangements (private or with some sort of state support), from different geographical areas served by the agency, and differing lengths of service provision by the agency. All received between one and four care visits a day or had live-in care staff.

We visited six people in their homes with their agreement, and looked at their care records in their home or at the office. We spoke with a further 11 people who used the service or their representative. Another seven people declined to speak with us for various reasons or were not available. We spoke with five care staff, the agency's office staff, the Registered Manager and one of the directors. Office staff were responsible for supervising staff and managing people's care provision on a day-to-day basis (including care reviews and requests for changes to agreed visits, for example). They sometimes also provided care. We looked at records related to the running of the agency.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Below is a summary of what we found. The summary is based on what people using the service, and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. One person commented, for example, 'They know I'm unsteady on my feet ' they stay with me, when I'm walking from the bathroom, and then go back [to the bathroom] to tidy up.' People were protected from the risk of infection because appropriate guidance had been followed.

They were supported by suitably qualified, skilled and experienced staff, with recruitment systems in place to check the suitability of prospective staff. The provider had taken reasonable steps to safeguard people in other ways, by identifying the possibility of abuse and preventing abuse from happening.

Is the service effective?

The majority of people told us that they were very satisfied with the support and care they received to meet their needs. One person said, of the staff, 'Can't find any fault with them.' Another said 'They do exactly what they've got to do and seem to know exactly what to do." Two people were in discussion with the agency regarding their preferences about staff allocated to assist them. Staff we spoke with evidenced that they understood people's care and support needs, and that they knew them as individuals.

Is the service caring?

Typical comments people made, in reference to staff, included 'So kind, caring and helpful,' and 'They seem really professional and caring.' People told us the staff did not appear to be in a rush, with two people appreciating that they could have a 'laugh and a joke' with them. People also reported that staff ensured their privacy and supported their independence as much as possible, upholding their dignity. One person said 'They treat people as they should be treated.'

Is the service responsive?

People's needs had been assessed before they started to receive a service. People were consulted about their care through care planning and reviews of care plans, which we saw were carried out both regularly and if a person's needs changed. People and care records confirmed that they received support that met their needs. We saw evidence that the agency worked with those who raised issues about the service they received, to try to meet their wishes and improve their service.

Is the service well-led?

A variety of quality assurance processes were in place. Systems were also in place to manage risks to the health and welfare of people when receiving care and to the staff supporting them. These included risk assessments and audits. People told us they felt staff supported them safely, and staff told us the risk assessments were sufficient to alert them to potential risks in their work with individuals.

We saw that people had opportunities to give their views of the service through surveys, care reviews and phone contact with the agency's office, where calls were monitored for improvement purposes. There was evidence of ongoing action to improve the service both for individuals and in general, on the basis of quality assurance findings. Staff told us they were listened to, with changes made as a result of their comments or suggestions.

People who had not made a complaint felt they could do so if necessary and that they would be listened to. The great majority of those who had made complaints were satisfied with the response they received, and all felt able to make a complaint again if they wished to.

People who used the service told us that their care workers were always pleasant, friendly, reliable and respected their privacy and dignity. Care workers were described as "very kind and caring", "very efficient" and "well dressed, presented and well mannered". People told us "they care about providing a good service", "they do an excellent job", and "I don't know how I'd cope without them.

People told us they were involved in an assessment of their individual needs and the plan of how those needs were to be met. Care plans and records were regularly reviewed and updated. People told us how their personal care needs and confidence had improved with the help of the services from the agency which were described as "brilliant" and "superb".

People told us that the care workers were very good at their work and the care workers told us that their training and supervision/support from the management team enabled them to do their work well.

The agency had systems in place to obtain feedback from people who used the service and monitor the quality of care provided.