Bluebird Care (Bath and North East Somerset Ltd) is a domiciliary care service that can provide care for up to 78 people living at home who have a range of needs, including dementia and learning disabilities. We last inspected Bluebird Care (Bath and North East Somerset) in July 2016 and was rated Good. At this inspection we found the service had deteriorated and was rated as ‘requires improvement’, this was because the service was not consistently submitting notifications about alleged abuse.

At the time of our inspection, the service was providing care for 71 people.

The service had not consistently submitted notifications to the commission in line with their statutory responsibilities. Allegations of abuse had not always been submitted, however we saw evidence that the service took appropriate actions to protect people from the risks of harm and abuse.

People received care that was personalised and responsive to their needs. When people were admitted to hospital they received a complimentary visit. The service worked with people to develop new ways of communicating and people were treated with dignity and respect.

Risks to people were assessed, recorded and actions were taken to minimise these. The safety of people was monitored, and this included a monthly check of each person’s medication administration record (MAR). There was an emergency plan in place that informed staff about the people with the highest level of need and the steps that they should take in the event of an emergency.

People and relatives told us that staff members were kind and caring. Staff also said that they felt the management team cared about them and spoke positively about the registered manager and provider.

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

We found one breach of the Care Quality Commission (Registration) Regulations 2009 relating to notifications. You can see what action we told the provider to take at the back of this report.

Further information is in the detailed findings below

The inspection took place on 22 July 2016. We gave the registered manager 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be available at the office.

Bluebird Care provides personal care and support to older people who live own their own homes. At the time of our inspection there were 70 people receiving personal care with a variety of care needs, including people living with dementia

At the last inspection of the service in 28 February 2014 we found the service was meeting the regulations.

There was a no registered manager in post. However, there was and an acting 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 were complimentary about the care and support they received. People spoke highly about the care staff. They valued having care workers who were consistent and with whom they had built relationships. People and their relatives spoke positively about the skills of the care workers and felt staff were efficient and well trained.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. Recruitment records demonstrated that staff had been safely and effectively recruited.

Staff had received training in subjects such as safeguarding, moving and handling, medication, dementia, nutrition and health and safety. Each member of staff we spoke with told us they were happy with the training and support available to them.

There was a positive caring culture, which was promoted by the manager. Staff were passionate about providing high quality care and enjoyed caring for people. Care workers felt supported by the manager, describing them as approachable and supportive.

People had support plans in place which captured people’s histories and how people preferred their assessed needs to be met. The details in the support plans identified how people’s condition would be managed and the medicine administration records (MAR) contained information for care staff on how to manage medicines safely.

Staff had developed good relationships with people and were knowledgeable about the person they supported enabling them to provide care tailored to the person.

The manager and staff members demonstrated a good understanding of the Mental Capacity Act (MCA) and provided examples of when consideration had been given to the legislation in reaching best interest decisions.

Quality checking systems were robust. The manager had undertaken audits in regards to the practices and records at the service to ensure people were receiving safe care. We found that these were effective. The manager had also consistently developed action plans to show how issues identified in audits were being addressed and monitored. The manager demonstrated a commitment to address any issues identified in a planned and structured way.

We conducted a follow up inspection to check the provider had met the compliance actions we set at the previous inspection on 14 and 15 August 2013. We said the provider was not fully meeting aspects of outcome 4: care and welfare of people who use services, outcome 14: supporting workers, Outcome 16: assessing and monitoring the quality of service provision, Outcome 21: records.

The provider sent us an action plan telling us how and when compliance was to be achieved.

At this inspection we looked at six people's care records. The provider showed us the new care records they had introduced since our last inspection. All the care plans we viewed were written in the first person and were signed by the person using the service or their representative. They contained completed assessments, contact details, medical history, personal circumstances and a client summary.

The registered manager showed us the computer based tracking system which the provider had, and was used to keep a record of staff training. This included induction training, supervision, appraisal and annual mandatory training. They showed us how staff could only be allocated to work who were up to date with all their training requirements.

Incident reports were also collated and viewed on a case by case basis by the registered manager to monitor any remedial action required. These were also summarised on a monthly basis for review at the managers meeting. Any immediate issues arising would be communicated to staff through the office telephone system and followed up with a written memorandum.

We checked the information in six care records and found it was legible and had been reviewed this year. The daily records had been signed by staff to indicate the date time and care given. The provider told us they had audited daily records each month when they were returned to the head office. We saw the completed audit forms in each of the six files we looked at which showed they were all accurate and fit for purpose.

We spoke with 11 people who used the service by telephone. We also spoke to the registered manager, two senior staff and two care staff in the agency office. We interviewed a further two care staff by telephone.

People told us what they thought of the service from Bluebird Care - BANES. People told us “I am very pleased with the service they fit the bill so well”. “The regular ones are fine the problem is if people are not regular”. “I’m quite happy with the service”. “It is a very good service”.

People who used the service benefited because care plans explained what support they needed clearly and were helpful and informative. People were cared for and supported by staff who had an awareness and good understanding of their needs.

People felt they were treated with courtesy and respect by the staff who supported them in their homes. The staff knew what actions to take to keep people safe from abuse. We saw up to date information available to guide them on how to keep people safe.

People benefited because they were cared for by staff who had a variety of relevant training and development opportunities. This helped staff have a good understanding of people’s range of care and support needs.

We saw effective systems in place so the quality of the service people received was checked and monitored.

The agency was being run in the best interests of people who used it. It was being run in a flexible way that tried to treat people as unique individuals. One person told us “they do what I like them to do by following my care plan”. This comment suggested people received a unique and personal service.

We carried out a visit on 13th and 14th August 2013. We talked to people who used the service. We talked with carers and relatives. We looked at the personal care records of people who use the service and checked how people were cared for at each stage of their treatment and care. We looked at other records to see how carers were being supported and how the quality of the service was being monitored.

We noted the provider had contacted us during April 2013 regarding problems with aspects of the service management. The provider told us they had subsequently made action plans and were progressing these to resolve the issues they had identified.

We visited four people in their own homes who told us they were happy with the care they received and liked the carers. We met relatives of two people using the service who told us care was given in a respectful and dignified manner.

We spoke by telephone with other people who used the service and relatives who told us that occasionally carers did not arrive on time, and they were not always told by the provider when or why people were going to be late.

People told us they felt safe with carers. We spoke with staff who demonstrated an understanding of policies and procedures to safeguard people from abuse. Records showed the provider had responded appropriately with allegations and disclosures of abuse.

Bluebird Care had a new manager of care who told us policies and processes were being reviewed. We saw the provider did not have complete systems in place to be able to assess and monitor the quality of the service. Records showed not all carers had the supervision, training and support policies stated they should to enable safe care for people.

We saw assessments and care plans were personalised. We saw some information was missing from care plans that would protect people against the risks of receiving care that was inappropriate or unsafe.