This inspection took place between 9 February and 6 March 2018 and was announced. When we last inspected the service we found the provider had breached the regulations relating to safe care and treatment because the arrangements for managing medicines were not always safe. We rated the service as Good. Following this inspection, to reflect the improvements the provider has made, we have rated the service as Outstanding.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions is the service safe. We found progress had been made and the provider was now meeting the regulations. In particular medicines were administered safely and there were robust quality assurance processes to check on medicines management.

Blue Ribbon Community Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of our inspection it provided a service to approximately 43 people.

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, relatives and staff described the registered manager as supportive and approachable. They told us since the registered manager had started there had been significant improvements made to the service.

People, relatives and staff told us about the exceptional care the service provided. Words used to describe the care included amazing, wonderful, brilliant and first class. Staff were described as ‘highly competent’. They said staff were especially caring. Special relationships had developed so that staff felt like part of their extended family. Staff regularly went above and beyond to ensure people’s needs were anticipated and met with the utmost dignity and respect. The registered manager led by example and also regularly went the extra mile to ensure people were safe and well cared for. Staff were creative in how they developed relationships with people so that people received the best care in personalised and meaningful ways.

The registered manager and staff team worked enthusiastically to provide an excellence in line with the service’s values of compassion, respect, collaboration and promoting independence. People were at the heart of how the service operated which was flexible and adaptable to suit people’s changing needs.

The registered manager was extremely proactive in attending multi-disciplinary team meetings to ensure people received consistent care across all services. They also promoted joint working with other professionals to develop the skills of the staff team.

The provider had a particularly effective quality assurance system to drive sustained improvement.

People, staff and relatives felt the service was safe.

A reliable and consistent staff team provided people’s care. People said staff turned up on time and stayed for the full length of the call.

The provider had effective recruitment systems to ensure new staff were recruited safely.

Staff showed a good understanding of the provider’s procedures to keep people safe and knew how to report concerns. Previous safeguarding concerns had been dealt with effectively. They told us they had no concerns about people’s safety.

Staff felt extremely well supported and received the training they needed.

Staff supported people to meet their nutritional and healthcare needs. People confirmed staff supported them to have enough to eat and drink.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People

The inspection took place on 11 and 23 December 2015 and was announced. The service was last inspected on 21 and 28 May 2014 and met the regulations we inspected against at that time.

Blue Ribbon Community Care is a domiciliary care service that is registered with the Care Quality Commission for the regulated activity of personal care. The service provides care and support to people in their own homes in the Sunderland area. At the time of our inspection 44 people were using the service.

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.

The registered provider had breached regulation 12 of the Health and Social Care Act 2008. This was because medicines records did not accurately account for individual medicines given to people. We found unaccounted for gaps in medicines administration records (MARs) for three out of four people whose records we checked. Daily logs did not provide a full explanation about people’s medicines. Where people had been assessed as requiring staff to administer their medicines, records confirmed staff did not always supervise the administration of medicines. Medicines audits were inconsistent and did not always evidence that action had been taken to investigate gaps in records.

You can see what action we told the provider to take at the back of the full version of the report.

The registered provider planned to make improvements to the management of medicines. However it was too early to assess how effective these improvements would be.

People were happy with their care. They were cared for by attentive staff who listened to them and knew their needs well. One person said their care was, “Excellent, it has been really good.” Another person said their care was, “Brilliant.” A third person said, “Fantastic, couldn’t be anything better. They are always there for you.” Another person commented, “Staff know my needs well. When a new girl started they read my care plan.” People said staff treated them with dignity and respect. One person said staff were, “Very respectful.” Another person said, “I am treated very well. There is not a thing bad about each and every one of them.”

People told us they felt safe. One person said, “Yes I feel safe, no problem.” New people to the service were assessed to help protect them from any potential risks.

Staff had access to information about safeguarding. They had a good understanding about safeguarding alerts and whistle blowing, including how to report concerns. One staff member said, “I would go and tell somebody at the office.” Another staff member said, “I would have no concerns using it [whistle blowing procedure]. The manager would look into it [a concern] straightaway. It wouldn’t be just left.”

People were supported by a consistent staff team. One person said, “I see the same person 99% of the time.” They went on to say, “Staff stayed for the full-time and are on time.” New staff had been checked to confirm they were suitable to work with vulnerable adults.

The registered provider had up to date procedures to deal with emergency situations. Incidents and accidents had been investigated and action taken to help prevent a repeat of the incident.

Staff said they were well supported and trained to carry out their caring role. One staff member said, “I am really, really well supported.” Another staff member said, “I have had all my training.” One person also described staff as, “Very well trained.” New staff members had completed an induction programme, including shadowing more experienced staff.

Staff had a good understanding of MCA and knew how support people with making day to day choices and decisions.

Peopl

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found.

The summary describes what people using the service, their relatives 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?

Where staff had identified a potential risk, either during the initial assessment or after admission, we found that a risk assessment had been completed to ensure people were safe. We saw that the risk assessment clearly identified the potential hazards and the control measures in place to manage the risk.

The provider operated an out of hours on-call system so that people who used the service, their family members and staff had access to support and advice at all times. All staff had completed safeguarding training since starting their employment with the provider. Staff were able to describe the various types of potential abuse and could give examples of possible warning signs.

Is the service effective?

People or family members on their behalf had signed their assessments and care plans to give consent to their care. They said staff always asked them for permission before delivering any care. People commented: “They (staff) ask me what I want”; and, “I always get to choose.” One family member said, “They talk to (my relative) and say would you like to do this.” The provider had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 to protect people who were unable to make decisions for themselves.

The provider undertook its own assessments both before and after a person started to receive a service. The assessment focussed on what people needed help with and what outcomes they hoped to achieve from receiving care. The initial assessments were used to develop detailed and personalised care plans. Care plans identified a clear outcome with specific steps for staff to follow to ensure they provided consistent care.

Staff we spoke with told us they were well supported and had opportunities for further development. They said the managers were approachable and accessible at all times. Staff told us they could phone up the manager with ideas at any time and that their feedback was always well received. One staff member said, “There is lots of communication to make sure everybody is happy.” The provider had systems in place to ensure that staff training was kept up to date.

Is the service caring?

People told us they were happy with the care they received and were happy with the care staff. Comments included: “Excellent care”; “The carers are lovely”; “Care is very good”; and, “I am very pleased with them.” Family members told us they had no concerns about the care their relative received or the staff delivering the care. Their comments included: “The care is spot on”; I can’t emphasise enough what a lovely person (the carer) is”; “I am happy with everything”; “The care is absolutely outstanding”; and, “The staff know what they have to do.”

Staff described how they delivered care in a way that maintained people’s dignity and privacy. One staff member told us, “Treating people with dignity and respect is drummed into us by Blue Ribbon.”

Is the service responsive?

Care plans were reviewed regularly as people’s needs changed. For example, one person’s medication care plan had been updated as it had become apparent during a care review that they needed more help with taking their medication.

Family members also said that staff took on board any suggestions they had to change or improve their relative’s care.

Is the service well-led?

People who used the service and family members were asked for their views about their care and they were acted on. We saw from care records that the provider reviewed people’s care with them and where appropriate family members. One person commented, “(The manager) always says to me are you happy with what we are doing. He is very good.”

All of the staff we spoke with confirmed they had received at least one spot check. This involved a direct observation of care delivery by their manager including staff interaction with people and the correct use of equipment.

We viewed the feedback received so far from consultation with people, family members and staff and saw that the views of the service were positive.

The provider had a system of quality audits in place to identify gaps in care records and to ensure action was taken to address any gaps. The provider also had systems to log and investigate incidents and accidents.

People and family members we spoke with had no concerns about the care. People’s comments included: “I have no complaints”; “No concerns”; and, “The carers are all excellent.” One family member commented, “If something was wrong I would just tell them.” Another family member commented that the care was “absolutely fantastic.” We saw that there had been no complaints made to the provider about the service.