Background to this inspection
Updated
4 November 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 inspection took place on 23 and 28 September and 1 October 2015 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service; so we needed to arrange to visit and phone people to get their feedback.
The inspection team was an inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for an older person who uses this type of care service.
Prior to the inspection we reviewed information about the service from the Provider Information Return (PIR), and other information we held about the service. This included correspondence with the provider about the absence of a registered manager and information received from the provider from statutory 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.
We spoke with 20 people using the service or their close relatives, and we looked at nine people’s care records. We spoke with 12 staff, including the provider, manager, trainer, as well as with care and office staff. We looked at four staff records, and at incidents and complaints, training and at quality monitoring records such as audits and survey results. We sought feedback from health and social care professionals and commissioners of the service and received a response from three of them.
Updated
4 November 2015
The inspection took place on 23, 28 September and 1 October 2015 and was announced. We previously inspected the service in April 2014 and did not identify any concerns or breaches of regulations.
Bluebird Care is domiciliary agency that provides personal care to 42 people receiving personal care living in their own homes in Ottery St Mary, Honiton, Sidmouth, Whimple and the surrounding areas of East Devon.
This location is required to have a registered manager as a condition of its registration. It currently does not have a registered manager. However a new manager was recruited three months ago and has now applied to register. 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’s legal rights were not fully protected. Where people might lack capacity for day to day decision making, staff did not carry an assessment of mental capacity to establish whether they had the ability to consent to their care and treatment. Records were unclear about what day to decisions people could make for themselves and about what decisions people might need support with. Staff were not implementing the provider’s consent and mental capacity policy.
People were consulted and involved in assessing their care needs and signed their care plans to confirm they agreed with them. Risk assessments were carried out for each person, which identified steps staff needed to take to promote their safety and welfare. Staff were aware of these risks and were taking the steps needed to reduce risks and keep the person safe.
Staff knew about the signs of abuse and where concerns about suspected abuse were identified, they reported them to the local authority safeguarding team. The service worked closely with health and social care professionals to implement measures to safeguard people.
People received their medicines on time and in a safe way.
The agency had robust recruitment procedures in place for recruiting new staff. Previously, there had been some difficulties with staffing at the agency which meant there had been some concerns about reliability. In response, the provider had reduced the number of care packages provided to ensure the safety and quality of the service and people reported recent improvements. Staff arrived on time and stayed for the agreed length of time. Four new staff had recently been recruited and were undergoing a period of induction.
Most people and relatives thought staff had the appropriate skills and training to carry out their role. However, some relatives and professionals identified additional training needs. Staff also identified additional training needs in managing medicines, dementia, and in end of life care. The provider had comprehensive training arrangements for staff. However, most staff we spoke with were in their first year of employment and so far had only completed their induction training. The manager was aware of their additional training needs and further staff training was planned.
People were supported to maintain their health. Where any deterioration was identified, they were referred to health professionals for advice which staff followed.
People known to the agency as at risk of malnutrition or dehydration were supported and encouraged to eat and drink regularly.
People had developed positive and caring relationships with staff. They confirmed that staff treated them as an individual, respected their privacy and treated them with dignity and respect.
People were consulted and involved in their care plans and signed them to confirm they agreed with their content.
People’s care was individualised to their needs. Care records had detailed information about each person, their needs and preferences and what mattered to them. Care plans were reviewed and updated regularly although some lacked detail for people with complex needs, which the manager was aware of and was working to improve.
People knew how to raise any concerns or complaints and felt confident to do so. Where concerns were raised these were investigated and remedial action taken to make improvements. The provider was open and honest where mistakes were made, and offered apologies.
The culture of the service was open and care and office staff worked well together as a team. People and staff were very positive about the new manager and the improvements made at the branch since their arrival.
The provider had a range of quality monitoring systems within and external to the branch. These included a range of audits, questionnaires and checks on care and other records at the branch office and monitoring complaints and incidents. Where concerns or areas needing further improvement were identified, they were aware of them and were working to improve them.
The provider used a range of good practice initiatives to raise standards of care and promote good practice. These included recognising and rewarding staff and leadership and management development.
You can see what action we told the provider to take at the back of the full version of the report.