About the service:

• Bluebird (Brent) is a domiciliary care agency which provides care to people in their own homes.

• There were 76 people using the service at the time of our inspection.

• Most people using the service were older adults (over 65 years of age), although some younger adults with physical disabilities received a service.

• People using the service lived within the London Borough of Brent and the majority had their service commissioned by the local authority.

• The service provided covered a range of areas including prompting with medicines, personal care, housework and laundry.

People’s experience of using this service:

• There were effective systems and processes to minimise risks to people. We reviewed evidence, which showed people were protected from abuse and avoidable harm.

• Generally, people received their calls on time. A few people told us they did not always receive their calls on time. We saw evidence there were on-going improvements in relation to staff punctuality.

• People’s needs had been assessed. There was evidence that their care and support needs were met.

• People were treated with dignity and respect. We saw evidence that the service involved people and treated them with compassion, kindness, dignity and respect.

• People told us that they received personalised care that ensured their needs, preferences, and interests were met. There was evidence to support this.

• There were governance systems and processes in place. However, these were not always used effectively to monitor people’s calls and identifying gaps in the accurate recording of people’s records.

We have rated the service as good overall. However, there are areas that require improvements. We have therefore rated well-led as ‘requires improvement’.

Rating at last inspection:

At our last inspection, the service was rated "Good". Our last report was published on 25 August 2016.

Why we inspected:

• This was a scheduled inspection based on the previous rating.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We undertook an announced inspection on 29 June 2016 of Bluebird Care (Brent). Bluebird Care (Brent) is registered to provide the regulated activity personal care and provides personal care, housework and assistance with medicines in people’s homes.

At the time of the inspection, the service was providing care and support 66 people and had 34 care workers working for them.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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.

At our last inspection on 8 May 2015, we found breaches of legal requirements in relation to Regulations 10, 17 and 18 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. This is because the provider had failed to ensure their was insufficient numbers of suitable staff deployed to keep people safe and meet their needs. There were instances where people’s privacy and dignity had not been respected and maintained and the systems in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people.

We received an action plan from the service telling us what action they would take to meet legal requirements in relation to the breaches. At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to respond to the issues identified and was now meeting regulations. Feedback from people using the service and relatives also indicated an improvement with the service they received since the last inspection.

Although there some instances of lateness, overall people using the service and relatives told us their care workers turned up on time and they received the same care worker on a regular basis and had consistency in the level of care they received. The service had a system in place to monitor care workers punctuality.

Care workers had a good understanding of and were aware of the importance of treating people with respect and dignity. Feedback from relatives indicated that positive relationships had developed between people using the service and care workers and people were treated with dignity and respect.

Systems were in place to monitor and improve the quality of the service. We found the service had obtained feedback about the quality of the service people received through review meetings, telephone monitoring and satisfaction surveys. Records showed positive feedback had been provided about the service.

The service also undertook a range of checks and audits of the quality of the service and took action to improve the service as a result.

People and relatives told us that they were confident that care workers had the necessary knowledge and skills they needed to carry out their roles and responsibilities. Care workers spoke positively about their experiences working for the service.

Systems and processes were in place to help protect people from the risk of harm and care workers demonstrated that they were aware of these. Care workers had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse. Risk assessments had been carried out and care workers were aware of potential risks to people and how to protect people from harm.

Arrangements and checks were in place to manage medicines safely in respect of medicines. Care workers had received medicines training and policies and procedures were in place. We looked at a sample of Medicines Administration Records (MARs) and found that all these were completed fully. We found the service had an effective medicines audit in place.

People received care that was responsive to their needs. People's daily routines were reflecte

We undertook an announced inspection on 8 May 2015 of Bluebird Care (Brent). Bluebird Care (Brent) is registered to provide the regulated activity personal care and provides personal care, housework and assistance with medicines in people’s homes.

At the time of the inspection, the service was providing care and supporting 53 people and 43 care workers working for them.

There was a registered manager in post. 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.

At our last inspection on 11 September 2014, the service did not meet Regulations 9 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to Regulation 9 and Regulation 17 of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. At this inspection the registered manager was able to demonstrate that measures had been put in place since the last inspection to respond to some of the issues identified.

However, we found people experienced a lack of consistency in the care they received. There were instances of care workers turning up late for their visits and some people did not have regular care workers. Some people were also not aware of which care worker was coming to support them and were not routinely informed of any changes.

Records showed and staff told us they received regular training and received support from the registered manager. Appropriate checks were carried out when staff were recruited. However, people using the service and relatives told us they felt the care workers were not sufficiently trained to provide the care and support they needed.

Some people spoke positively about the care workers, however we found instances where people felt staff were more task focused as there was a lack of consistency in the care demonstrated by staff and there were instances where people’s dignity and privacy was not respected and maintained.

There was a complaints policy and procedure in place however there was a lack of evidence to demonstrate how the service routinely listened and learnt from people’s experiences, concerns and complaints.

There was a management structure in place with a team of two care supervisors, one human resource administrator, the registered manager and the provider. However, people felt there was a lack of communication and transparency between the management and people using the service.

The current systems in place were not robust enough to monitor the quality of the service being provided to people using the service and to manage risk effectively. We found staff’s performance was not being monitored effectively, the continuing lateness and lack of consistency in care being provided by care workers had not been resolved, instances in which people’s privacy and dignity had not been maintained and respected were not identified and effective measures had not been put in place to ensure improvement and to minimise the reoccurrence of such issues.

We have made two recommendations about reviewing the effectiveness of the training currently being provided to staff and that concerns and complaints are reviewed to identify underlying trends to help improve the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.