The inspection took place on 23 January 2018 and was announced. The last inspection of this service was carried out on 19 November 2015. The service was meeting the regulations we looked at and was rated Good overall and in all five key questions. At this inspection we found the service remained Good. The inspection was announced 48 hours in advance because we needed to ensure the provider or registered manager was available.

Bluebird Care (Croydon) is a service which is registered to provide personal care to adults in their own home. At the time of our inspection there were 67 people using this service.

The service had a registered manager. 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.

People told us they felt safe. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. Staff were aware of the whistleblowing procedures and knew how to use them.

Robust employment checks were in place to help to ensure new staff were appropriate to be working with and supporting people.

The risks to people's safety and wellbeing were assessed and regularly reviewed. The provider had processes in place for the recording and investigation of incidents and accidents.

Where necessary people were supported appropriately with the management of their medicines.

People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005. People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required.

People were cared for and supported by staff who knew them well. Staff treated people with dignity and respect. People's views were actively sought and they were involved in making decisions about their care and support.

People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were given information about how to make a complaint and the people we spoke with knew how to go about making a complaint and were confident that they would be responded to appropriately by the provider. We saw evidence the registered manager responded to complaints received in a timely manner.

There was a positive culture within the staff team and staff spoke positively about their work. Staff were complimentary about the management team and how they were supported to carry out their work. The manager and other senior staff were committed to providing a good service for people. There were quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received.

We inspected Bluebird Care (Croydon) on 19 November 2015. The inspection was announced 48 hours in advance because we needed to ensure the provider or registered manager was available.

Bluebird Care (Croydon) is a service which is registered to provide personal care to adults in their own home. At the time of our inspection there were 52 people using the service.

The service had a registered manager. 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.

We previously inspected Bluebird Care (Croydon) in May 2015. We found that Bluebird Care (Croydon) was not meeting all the legal requirements and regulations we inspected. We found that people were not adequately protected against the risk of abuse. We were also concerned that there was a lack of continuity of care. We asked the provider to take action to make improvements to the way they planned people’s care and protected them from abuse. The provider sent us an action plan and this action has been completed.

During this inspection people told us they were safe. Staff had been trained in protecting adults from abuse and spoke confidently about how to identify abuse or report any concerns.

Care was planned and delivered to ensure people were protected against foreseeable harm. People had risk assessments which gave staff detailed information on how to manage the risks identified.

Staff arrived on time and stayed for the time allocated. People were cared for by a sufficient number of suitable staff to help keep them safe and meet their needs. Staff were recruited using an effective procedure which was consistently applied.

People received their medicines safely and in accordance with their care plan. Staff controlled the risk and spread of infection by following the service’s infection control policy.

Care plans provided information to staff about how to meet people’s individual needs. People were supported by staff who had the skills and experience to deliver their care effectively. Staff understood the relevant requirements of the Mental Capacity Act 2005 and how it applied to people in their care.

Staff supported people to have a sufficient amount to eat and drink. Staff worked with a variety of healthcare professionals to support people to maintain good health.

People told us the staff were kind and caring. People were treated with respect and were involved in making decisions about their care. Where appropriate their relatives were also involved.

People were satisfied with the quality of care they received and told us there was continuity of care. People were supported to express their views and give feedback on the care they received. The provider listened to and learned from people’s experiences to improve the service.

Staff understood their roles and responsibilities. People felt able to contact the service’s office to discuss their care. Staff felt supported by the manager and were in regular contact with the supervisors and manager.

The registered manager had worked in the adult social care sector for many years and understood what was necessary to provide a quality service. There were systems in place to assess and monitor the quality of care people received.

We inspected Bluebird Care (Croydon) on 14 May 2015. The inspection was announced 48 hours in advance because we needed to ensure the provider or registered manager was available.

Bluebird Care (Croydon) is a service which provides personal care to adults in their own home. At the time of our visit there were sixty five people using the service.

The service had a registered manager. 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.

We previously inspected Bluebird Care (Croydon) in May 2014. We found that Bluebird Care (Croydon) was not meeting all the legal requirements and regulations we inspected. Appropriate checks were not carried out before staff began to work with people, staff were not adequately supported by the provider through regular, relevant training, supervision and appraisal and the quality of care people received was not regularly assessed. We asked the provider to take action to make improvements to the way they planned people’s care. This action has been completed.

During our inspection in May 2015 we found that although people told us they were safe, staff did not have a good knowledge about how to identify abuse or report any concerns. This meant that people were not adequately protected against the risk of abuse.

Care was planned and delivered to ensure people were protected against foreseeable harm. People had risk assessments which gave staff detailed information on how to manage the risks identified.

Staff arrived on time and stayed for the time allocated. People were cared for by a sufficient number of suitable staff to keep them safe and meet their needs. Staff were recruited using an effective procedure which was consistently applied.

People received their medicines safely and in accordance with their care plan. Staff controlled the risk and spread of infection by following the service’s infection control policy.

Care plans provided information to staff about how to meet people’s individual needs. People were supported by staff who had the skills and experience to deliver their care effectively. Staff understood the relevant requirements of the Mental Capacity Act 2005 and how it applied to people in their care.

Staff supported people to have a sufficient amount to eat and drink. Staff worked with a variety of healthcare professionals to support people to maintain good health.

People told us the staff were kind and caring. People were treated with respect and were at the centre of decisions about their care. They were fully involved in making decisions about their care. Where appropriate their relatives were also involved.

People were satisfied with the quality of care they received but told us there could be greater continuity of care. People were supported to express their views and give feedback on the care they received. The provider listened to and learned from people’s experiences to improve the service.

Staff understood their roles and responsibilities. People felt able to contact the service’s office to discuss their care. Staff felt supported by the manager and were in regular contact with the supervisors and manager.

The registered manager had worked in the adult social care sector for many years and understood what was necessary to provide a quality service. There were systems in place to assess and monitor the quality of care people received.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to how the provider protected people from abuse. You can see what action we told the provider to take at the back of the full version of this report.

Our inspection team was made up of an inspector who answered our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

During the inspection we spoke with three people using the service, three of their relatives and four members of staff. We also reviewed records, policies and procedures.

Is the service safe?

People using the service told us staff treated them with respect and that they felt safe. This was also the view of relatives we spoke with. Some but not all staff had received recent training in safeguarding vulnerable adults. We spoke with four staff members and they understood the procedures they needed to follow to ensure that people were safe.

Managers and some staff had received training in the Mental Capacity Act 2005. The service had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards although no applications had needed to be made.

We were concerned that appropriate checks were not carried out before staff began to work with people. Some staff had been allowed to work with people before the results of their criminal record checks had been received by the service. We found that where job applicants had criminal convictions, the service did not carry out a risk assessment to check whether allowing them to work with people using the service would pose a risk to people.

We saw evidence that some staff were allowed to work with people before they had received training in the areas relevant to their work, such as moving and handling people, safeguarding vulnerable adults and infection control.

This meant there was a risk of people being cared for by staff who lacked the necessary knowledge, skills and experience to do the job. We have asked the provider to make improvements to their recruitment procedures and the way in which they support their staff.

Is the service effective?

People had individual care plans which clearly set out their care needs. We spoke with people using the service and their relatives and they were satisfied with the quality of care and the way it was delivered. One person told us, " I'm happy. They usually turn up on time and they know what they have to do." A relative comments included, "I'm mostly happy." "Mum has had a lot of carers from different agencies, this is the best bunch she's had."

Is the service caring?

People told us staff were kind and supportive and that they were treated with respect. Comments we received from relatives included, "The carers are eager to please." "The carers are patient and encourage X to be independent." and "The service is giving mum the care she needs".

We reviewed completed questionnaires from the last annual feedback and found several which complimented staff for being kind and caring. The staff we spoke with said they enjoyed working as carers.

Is the service responsive?

People’s needs were assessed before they began to use the service and were reviewed on a regular basis. People and their relatives told us they were involved in the review of care plans. A relative told us," The staff are flexible and X care plan changes with her needs."

However we were concerned that the service was not responsive to the views of people using the service, their relatives and staff because apart from an annual satisfaction survey, the service did not have systems in place to regularly seek their views.

Two of the relatives we spoke with told us that when they made a complaint, the service was slow to respond. We saw evidence that staff had raised concerns about the way people's care was organised and this had not been dealt with.

This meant there was a risk of people receiving care that was inappropriate or unsafe. We have asked the provider to improve the effectiveness of the systems in place for monitoring the quality of care people receive.

Is the service well-led?

The manager of the service knew the systems that had to be in place to ensure the service offered the quality of care people required. The service had appropriate policies and procedures in place in relation to care planning and review, keeping people safe, staff recruitment and development and monitoring the quality of service people received. However, we were concerned that many of these policies and procedures were not being applied. Records we reviewed demonstrated that as the service had expanded in recent months, the systems that were in place were being applied less and less.

We considered that this was due to an insufficient number of administrative staff in the office and this view was supported by two of the staff members we spoke with. One staff member told us, "I don't think there are enough staff in the office. Another staff member told us, "There are not enough office staff."

This meant there was a risk of people receiving care and treatment that was inappropriate or unsafe. We have asked the provider to improve the way it assesses and monitors the quality of service provided.