Archived: Bluebird Care (Teignbridge)

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.

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 106 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

Staff were highly motivated and the provider continually looked for new and innovative training methods. People were involved in delivering training. This meant staff understood people’s needs, what was important to them and what they looked for in care staff. Staff had opportunities for regular supervision and told us they were very well supported and valued in their role.

Staff supported people to access healthcare, when needed. Some staff were trained as champions to carry out health checks. If any concerns were identified, these could be raised with healthcare professionals without delay.

The provider looked for ways to continuously improve people’s lives and avoid social isolation. They employed a wellbeing ambassador who worked with staff and people to identify social opportunities, so people could live as full a life as possible. The provider paid for people and staff to go on outings to develop relationships with others.

People felt safe and comfortable when staff visited them in their home. People were kept safe as potential risks had been assessed and managed. There were enough staff to complete planned visits. Where staff assisted people with their medicines, this was done safely.

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.

People told us they had developed positive, caring relationships with their regular staff. They said, "They’re all so kind and happy and nothing is too much trouble” and “Carers are happy go lucky, I have a laugh with them.”

Several people felt staff continuity could be improved. The provider monitored continuity and worked to improve this. The provider told us staff sickness and changes to availability could have a short term impact on continuity.

People were involved in making decisions about their care and supported to maintain their independence. Care plans were very personalised and contained up-to-date information about each person's needs and preferences.

There were effective quality assurance and governance systems in place to assess, monitor and improve the quality and safety of the service. Two professionals told us they were happy with the care provided but felt communication could be better at times. As a result of this, the provider introduced a new quality tool. The provider had introduced a number of ideas and initiatives since our previous inspection and planned to further develop these.

We received some concerns before the inspection relating to training and communication. We found no evidence during this inspection that people were at risk of harm from these concerns.

Rating at last inspection

The last rating for this service was good (published 11 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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.

We visited the office on 30 November 2016. We carried out home visits on 5 December 2016. We carried out phone calls to people and their relatives on 6 December 2016. At the time of this announced inspection 83 people were receiving personal care from the service. The service met all of our regulations at the previous inspection in December 2013.

Since our last inspection, the provider had introduced a new electronic system. Prior to our inspection, we received a concern from a relative about the new system and not being able to access the care plan. We looked at the system during this inspection. People and relatives we spoke with did not raise any concerns and told us it had not made any difference to them. Relatives told us they were able to access up-to-date information using an app on their phone. People had a paper copy of their care plan in their home. We saw where other healthcare professionals needed access to records for monitoring purposes; these were kept on paper records in the person’s home. Staff told us they felt more empowered as they could read people’s care plans on their phones before they visited them and information was updated promptly. The provider had identified an issue that meant if staff turned off their internet connection, the information did not update on the system straight away. They told us they planned to get all staff a phone so the internet was on all the time.

People were happy with the staff who visited them. Comments included “Excellent” and “They’re always so kind”. Staff spoke about the people they cared for with compassion and concern. Staff told us they enjoyed getting to know people and enjoyed chatting with them. Staff commented “Best part is making people smile, like to make them laugh” and “I absolutely love my job”. People told us staff were respectful and polite. We saw staff and people interact in a friendly way. People were pleased to see the staff. The staff knew people well and chatted with them with warmth. Staff checked if they could do anything else for people before leaving.

People told us they felt safe and comfortable when staff were in their home and when they received care. People told us "I feel totally safe" and "I have no worries". Staff knew how to recognise signs of potential abuse and understood how to report any concerns in line with the service's safeguarding policy. Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be a risk to people. People told us staff knew how to meet their needs. People said "They’re absolutely spot on, I don’t have to worry” and “They just know what to do and do it well”. Staff told us they were happy with their training. Comments included “The training is very good. I know what I can and can’t do”; “I completely understand everything”; and “We’ve had lots of training in dementia which was helpful”. Staff told us they felt well supported and had regular opportunities to discuss their work.

Care plans were developed with each person. They described the support the person needed to manage their day to day health. People told us they were involved in their care and able to make choices about how they wanted things to be done. One person told us “I’ve had lots of input about how I like my care. That helped quite a lot”. Staff knew people's preferences and offered choices. They responded to people's requests and met their needs appropriately. The service was responsive to people's needs. For example, one person started to receive care after having a stroke. Staff worked alongside a physiotherapist and supported them with exercises. This person’s visits had reduced from every day to once a week when staff now supported them to go to the gym. The provider was delivering some live-in packages of care. They had recently taken on a new package. There had been some issues that had not been expected. Staff and healthcare professionals were working with the person and family to try and find solutions. The provider told us they would review the live-in policies and procedures to ensure they were appropriate.

People told us staff were usually on time and had time to meet their needs in the way they wanted. People were provided with visit record so they knew which staff would be visiting them. Staff told us they tried to ring people with any changes, and the majority of people confirmed this happened.

Risk assessments had been undertaken for each person. These included information about action to be taken to minimise the chance of harm occurring to people. We saw risk assessments had been carried out in relation to mobility, epilepsy, medication, and skin care. Risk assessments relating to each person's home environment had been completed. Staff identified when people were not safe and raised concerns.

People were supported safely with their medicines and told us they were happy with the support they received. Staff completed an electronic record to confirm people had been given their medicines. If a medicine had not been given, this was alerted on the computer system in the office immediately after the visits. We saw evidence that when medicines had been refused, action had been taken promptly and the person’s GP had been informed.

The service sought regular feedback. People told us they were asked for feedback over the phone, during visits and through questionnaires. People and their relatives felt able to raise concerns or make a complaint. They were confident their concerns would be taken seriously. People told us they didn't have any complaints. Comments included “If I was dissatisfied I would say” and “They couldn’t do anything better”. Where complaints had been received they had been managed in line with the company policy. One person told us when there had been an issue in the past it had been dealt with promptly.

People told us the management were approachable and they were happy with the service. Comments included “They’re extremely good”; “very supportive” and “very approachable”. The provider told us the most important thing to them was to provide the best possible service for people. Staff told us there was open culture, and they felt supported and valued by the management team. Comments included “This is the most fantastic place I’ve ever worked”; “(Provider name) is amazing, I could not ask for better” and “(Provider name) and (manager name) are second to none”; “They’re always at the end of the phone and never stop checking their emails”.

The registered manager was keen to develop and improve the service. They kept up-to-date with best practice and met up with other care providers to share good practice. Records were clear, well organised and up-to-date. An audit system was in place to monitor the quality of the service. Unannounced checks to observe staff's competency were carried out on a regular basis.

People who used the service told us they had been able to make choices and decisions in relation to their care planning. One person told us "staff tell me what they're going to do, and check I'm happy with it". Where the provider had identified people may lack capacity, they had carried out a mental capacity assessment. Best interest decision making had improved.

The provider had carried out appropriate checks to ensure staff were suitable. The service employed enough staff to cover all of their visits. Staff had received appropriate training so they could carry out their job role effectively.

There were systems in place to monitor the quality of the service provided. People were asked to give their views about the care and support they received. People told us 'I have no problems at all' and 'if I had any worries I could ring them up'.

Records were accurate, kept securely and could be located promptly when needed.

Where people were able to make their own decisions, we found that consent had been obtained for care and treatment. Mental capacity assessments and best interest decisions were not in place for some people who were not able to make decisions.

People who used the service and their relatives told us they were happy with the care they received. They said "I'm very happy' and 'when I needed more care they rallied round and sorted it out'. Two people told us they had not received their visit when care workers were not available. The provider told us that all visits had been assessed on a risk basis and essential visits were always covered.

People told us they felt safe when care workers came into their homes. Care workers knew how to report concerns to ensure people were protected from the risk of harm. Care workers told us they had completed training in how to meet people's needs.

The service had quality assurance systems to ensure they were able to assess and monitor the quality of the service. However, we found concerns relating to consent, quality assurance and record keeping that had not been identified and put right by the service's monitoring systems. Records were stored securely. We found records that had not been updated and were not accurate.

People's health and welfare needs were assessed and each person had a care plan detailing how these needs would be met. Staff had a good understanding of these care plans. They had received some training in how to meet people's needs. However, we found that further training in moving and handling and in caring for people with dementia was needed. People spoke very highly of the care workers. However, they thought that office staff might benefit from an improved understanding of care work and training.

Recruitment procedures were in place. People felt safe and staff had a good understanding of abuse, and how to recognise different types of abuse. Care staff would report any suspicions to the manager. However, the manager was not familiar with the locally agreed procedure to be followed if abuse were suspected.

Effective systems were in place to monitor the quality of services and to manage identified risks. These included gaining feedback from people using the service, and listening and acting on complaints. The owner had a good understanding of the risks associated with the service, and was taking action to address them.