Bluebird Care (Aylesbury and Wycombe) is a domiciliary care service offering care and support to adults, in the Buckinghamshire area. On the day of our visit there were 45 people using the service. The service offer support to people who have mobility limitations, mental health problems, and other long term conditions.

There was a registered manager at the service who had been in post since 20/12/2011.

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.

One person told us, “Yes friendly and efficient, they help me with house work, have a cup of tea and a chat. It’s nearly always the same staff”. Comments we read included, ‘Very happy with the girls who visit’. ‘Most happy and grateful for the happy and cheerful service’.

Comments from staff about the management were, “Absolutely brilliant, well led and organised”.

Staff received training in safeguarding. They told us they would not hesitate to report any concerns. One member of staff told us, “The company are good, they always put clients first”. We saw evidence staff had raised concerns about a person’s well-being. It had been appropriately followed up and investigated in line with the company’s policy and procedure.

Safe recruitment procedures were carried out. Files contained relevant documentation required to ensure only suitable staff were appointed. Staff received appropriated induction, training and supervision. Staff received a training programme that spanned the first 12 weeks of working for the company.

Staff support was on-going and an essential part of continuing development. Policies and procedures for the safe management of medicines were in place and being followed. Medicine charts we saw had been completed appropriately. People were given support if required to manage and administer their own medication. However, where people required staff to administer their medication a risk assessment was in place to ensure the request was appropriate and staff were competent to carry out this role.

People said they knew how to make a complaint and were given the information to do so when they first joined the service. One relative told us, “If I had any concerns I just ring the office they are approachable and listen and usually sort things out quickly”.

People had access to healthcare services to maintain good health. One member of staff told us, “If we need support it’s always there. We can go straight to them (office) if we need advice”. The registered manager told us they work alongside nursing staff when required.

The service had effective quality monitoring systems in place to drive improvements and ensure the safety of people who use the service. Quality assurance checks were carried out by the Care Supervisor or Care Manager in people’s homes.

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an announced inspection, we gave the provider 48 hours notice prior to the inspection. Bluebird Care provides personal care and support to people with dementia, learning disabilities, physical disabilities and older people. At the time of our inspection they provided care for 48 people in their own homes.

The service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives told us they were involved in the planning of their care and were treated with dignity and respect. They told us they were happy with their care. Staff were appropriately trained and understood their needs, they provided care in a safe and compassionate way.

The service was personalised in its approach. Staff valued people as individuals regardless of their needs. Diversity and equality were considered when care was provided to people. Staff told us they respected and valued the people they care for. This was verified by people who use the service.

The records we looked at showed each person had a care plan and risk assessments in place. These were in a format that meant information was easily accessible to staff and people. Records were up to date and had been consistently and frequently reviewed.

Where people required assistance with food and nutrition we saw risk assessments and care plans were in place. Clear directions were given to staff about people’s food choices, health needs and nutritional requirements. Staff were assessed to ensure they had the skills to prepare nutritional meals in line with the person’s choice.

The service operated a robust recruitment procedure. Checks and monitoring were carried out to ensure staff were safe to work with vulnerable people. They received an induction and training to ensure that the care they delivered was safe and effective. The information they learnt on their training was tested before they were deemed competent. Ongoing support was offered through regular supervision and appraisals.

We spoke with staff about the Mental Capacity Act 2005 (MCA).The service was following the MCA code of practice and making sure that the human rights of people who may lack mental capacity to take particular decisions were protected. Staff knew about capacity and consent, and acting in people’s best interests. They understood how the MCA related to their role, and how a person’s human rights were protected by the act. Records showed all staff had completed training in MCA.

Staff had received training in how to safeguard people from the risk of abuse. They were knowledgeable and knew how and who they would report their concerns to if they had any. If staff had concerns about people’s health they knew what action to take and who to speak to. They knew how to respond in emergency situations.

The registered manager assessed and monitored the quality of care consistently. They encouraged feedback from people, their relatives and staff, which they used to make improvements to the service. Audits were carried out on how staff delivered care and the records they kept. This enabled the registered manager to make improvements to the service, such as, the way staff recorded information about people, and how medicines were administered.

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When we inspected the service on the 5 June 2013 we found areas of concern relating to the management of medication.

During this follow up inspection we spoke with the manager, and read documents relating to staff members and people who used the service. We saw that the manager had put in place closer monitoring of staff and had increased the frequency of medication training for all staff. An audit tool was being used to monitor staff performance, and appropriate action had been taken to resolve any medication issues.

We met the registered manager and spoke on the telephone with four people who used the service and five staff members. We read the care plans of five people and reviewed documents relating to medication and staffing levels.

The staff and four people who used the service told us they believed Bluebird Care provided a good service. One person told us the care they received was “Tailored to what I require.” Another person told us the staff were “Very helpful.” We were told by the people who used the service the staff were helpful, polite and friendly.

We read the care plans, and saw they included risk assessments, care plans and daily records which were completed by the care staff. We read how each person had consented to the care before it was provided.

We saw in the care plans copies of medication administration charts. We noted there were gaps in the recordings and insufficient information on the sheets to show people had taken their prescribed medication safely and in accordance with the prescription.

The five people using the service whom we spoke with said that they were involved in the planning of their care. They were able to choose the times they wished staff to visit to provide them with the level of support they required to maintain their independence.

People said “they were very happy with the care and support they were receiving from the staff.” They told us that staff treated them with respect and upheld their dignity. For example, personal care was provided in the privacy of their bedroom or bathroom. Staff covered them with a towel to maintain their modesty.

People told us that “the staff followed the care plan and were very accommodating.” An example given was if they needed to change the times and frequency of visits this had not presented a problem.

People said that “staff were always punctual and stayed for the allocated time.” They said that staff enabled them to make choices.

People told us that they felt safe and comfortable with staff looking after them. They said that staff spoke to them in a calm and respectful manner and were appropriately trained to meet their needs.