Archived: Bluebird Care Exmouth

Updated 7 November 2018

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.

This announced comprehensive inspection took place on 4 and 5 September 2018. We gave the provider 48 hours' notice because the location provides a domiciliary care service and we needed to make sure the provider and registered manager would be available for the inspection. It also allowed us to arrange to telephone some people receiving the service and visit others to ask for their feedback.

The inspection team comprised of an adult social care 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 services for older people.

Due to technical problems, we did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider 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 other information we held about the service, such as feedback we received from health and social care professionals and notifications. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern. The provider also gave us a self-assessment folder of evidence they compiled, to demonstrate how they were meeting all the requirements of the standards and regulations.

During the inspection we visited two people and their relatives in their own home and spoke by telephone to 10 people and three relatives to seek their views about the service. We looked at five people's care records and at their medicine records. We spoke with the provider, registered manager and with 10 staff which included the deputy manager (branch manager), two care supervisors and care staff. We looked at five staff files which included details of recruitment, training, supervision and appraisals. We also looked at staff meeting minutes, staff training records, accident and incident reports, and at complaints and compliments. We looked at the provider’s quality monitoring systems which included audits of medicines, care records and at ‘spot checks’ where senior staff monitored care staff providing care in people's homes.

We sought feedback from commissioners, and health and social care professionals. We received a response from five of them.

Updated 7 November 2018

This announced comprehensive inspection took place on 4 and 5 September 2018. Bluebird Care Exmouth is a domiciliary care agency. It provides personal care to older adults and younger disabled adults in Exmouth, Budleigh Salterton, Clyst St Mary and surrounding areas. The provider is W & S Flint Services Limited, a husband and wife team who run three branches of the agency in the Devon area. This was the first inspection since the location was registered in September 2017. At the time of the inspection the branch provided personal care to 26 people and employed 23 care staff, known as Devon Bluebirds.

The service had a registered 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.

People and relatives praised staff as exceptionally caring and compassionate. People were partners in their care. Their views, experience and contributions were sought and valued. The agency had a strong, visible person-centred culture. People were at the heart of everything they did, they were made to feel valued and that they mattered. The service went that extra mile to exceed people's expectations of the service. For example, they held a monthly wellbeing programme to get people out socialising, having new experiences and taking some exercise. Feedback showed wellbeing events significantly improved people's physical and emotional

wellbeing and reduced their risk of isolation.

People were supported in innovative ways, to be proactively involved in making decisions about their care, treatment and support. For example, the provider undertook a 'Talk Care' campaign to promote a conversation about care that was positive, informative, open-minded and inclusive. They made a series of informative short videos of conversations with health and social care representatives to highlight key things people needed to know about care. These included the importance of planning ahead for care, options for care, and simple explanations about lasting power of attorney, making wills, benefits and paying for care. These were posted on social media and provider’s website, which enabled people and families to be better informed about care options and what was important in planning their care.

The service had embraced the possibilities of using technology in innovative ways to improve the quality of people's care and to enable them to stay living at home for longer. They worked with a specialist provider to pilot exploring the possibilities of using sensor technology to assist families to support and monitor a person's wellbeing. For example, data about frequent trips to the bathroom highlighted early signs of a urine infection for one person. This led to them being seen earlier by their GP and antibiotic treatment started, which helped them recover more quickly. An electronic computer record system meant staff could read new people's care records before they visited, and follow up any health concerns. The system quickly highlighted when a person's needs changed, so their care needs could be reviewed. Other benefits included health professionals and relatives being able to access parts of the system, with the person's consent.

The service worked in partnership with local health and social care providers to respond to the changing needs of local people. For example, they worked with their local NHS to pilot providing temporary night support to people in Exeter, East and Mid Devon. This enabled people to be discharged home from hospital as soon as possible, enabled the ambulance service to prevent people being admitted to hospital at night and to support people dying at home. The pilot was so successful, the service was expanded in May 2018 to provide five night care staff seven nights a week. Other examples of partnership working included joint visits working with local physiotherapists and occupational therapists to work with people and staff to show them how to use equipment and mobility aids. This supported people to remain at home for longer.

People experienced a personalised level of care and support that promoted their physical and mental wellbeing and enhanced their quality of life. People praised the exceptional skills of staff who supported them. A training manager had developed a comprehensive flexible training programme for staff that reflected various learning styles. They worked collaboratively with professionals to deliver bespoke training to meet individual health needs.

People received a consistently high standard of care because the service used evidence of what works best to continually review and improve their practice. For example, by using The Social Care Institute for Excellence (SCIE) and National Institute for Health and Care Excellence (NICE) guidelines.

People and relatives spoke about the exceptional quality of care provided by staff at Bluebird Care Exmouth and recommended the service to others. Staff were highly motivated, enthusiastic and were proud to work for the agency. The service was well led by the registered manager and deputy manager, who led by example. People, relatives and staff were regularly consulted and involved in developing the service. A provider award scheme recognised, re-enforced and rewarded positive staff values, attitudes and behaviours. For example, through 'Carer of the month' and 'Carer of the year' schemes.

The provider had robust quality monitoring arrangements through which they continually reviewed

evaluated and improved people's care. A range of awards showed the service was consistently high performing.

Personalised risk assessments provided comprehensive guidance for staff, who were vigilant in identifying risks and took steps to reduce them. People received their medicines safely and on time from staff who were trained and assessed to manage medicines safely. Staff were trained to be aware of signs of abuse and were encouraged to report concerns, which were investigated. A robust recruitment process was in place to make sure people were cared for by suitable staff.

People were asked for their consent and staff acted in accordance with their wishes. Where people

appeared to lack capacity, mental capacity assessments were completed and involved the person, their family and professionals in best interest decision making.

Complaints, concerns and feedback were taken seriously and used as an opportunity to improve the service. The registered manager had informed the CQC of significant events. Record systems were accurate, well maintained and kept securely.

Further information is in the detailed findings below.