Bluebird Care (Ipswich) is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to adults. At the time of this announced inspection of 5 and 7 December 2018 there were approximately 100 people who used the personal care service. We gave the service 24 hours’ notice of the inspection to make sure that someone was available to see us.

At the service’s last inspection of 5 and 6 September 2017 this service was rated requires improvement overall. The key questions for effective, caring, responsive and well-led were rated good. The key question for safe was rated requires improvement. This was because improvements were required in the way the service managed people’s medicines and the ways that risks were assessed and mitigated. There was a breach of Regulation 12: Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service wrote to us to tell us how they were implementing the required improvements. At this inspection on 5 and 7 December 2018 we found that improvements had been made, there were no breaches of Regulation and the service was rated good overall and in all the key questions.

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.

There were systems designed to provide people with safe care. Improvements had been made in how the service assessed and reduced risks to people. Improvements had been made in how people were supported with their medicines. Risks to people were managed, including risks from abuse and in their daily lives. There were enough care workers to ensure that all planned visits for people were completed. Care workers were recruited safely. The service learned from incidents to improve the service. There were infection control procedures to reduce the risks of cross infection.

People continued to receive an effective service. Care workers were trained and supported to meet the needs of the people using the service. Where people required assistance with their dietary needs, this was provided. People were supported to have access to health professionals where needed. The service worked with other organisations involved in people’s care to provide a consistent service. The service understood and worked to the principles of the Mental Capacity Act 2005.

People continued to receive a caring service. People had positive relationships with their care workers. People’s dignity, privacy and independence were respected and promoted. People’s views were listened to and valued.

People continued to receive a responsive service. People received care and support which was assessed, planned and delivered to meet their individual needs. There were plans in place to improve how people’s end of life decisions were recorded, there were no people using the service who were at the end of their life. A complaints procedure was in place and people’s concerns were addressed.

People continued to receive a service which was well-led. There were systems to assess and monitor the service provided. Where improvements were identified actions were taken to address them.

This comprehensive inspection took place on 5 and 6 September 2017. Our previous inspection was on 20 July 2015 and, at that time, we rated the service as good.

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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults, younger disabled adults and adults with a learning disability. There are between 120 and 130 people using the service. Areas covered include; Ipswich and surrounding villages, Woodbridge, Manningtree, Claydon, Stowmarket, Woolpit and Bury St Edmunds.

At this inspection, we have found a breach in regulation relating to safe care and treatment. This was because medicines were not managed as safely as they should have been and risks to people were not effectively mitigated. This placed people at potential risks to their safety. This specifically related to moving and handling. The risk assessments were all the same and not specific to the person and their circumstances. The registered manager responded quickly after our feedback and has stated that actions have been taken. It will take time to review all plans in place and ensure practice is embedded. We will in due course follow up to ensure people are safe.

The strength of this agency was that people received a reliable service from staff that they knew and trusted. The service was consistent in terms of timings and staff that stayed the required time and provided the care and support people needed. The service was efficiently arranged from the main office. People told us that they felt safe and well cared for.

People told us that staff were caring and respectful in the way they delivered care and support. People spoke of genuine relationships being developed. The service was working within the principles of the Mental Capacity Act 2015. People’s consent was sought before any care was provided and care workers acted in accordance with their wishes. People’s decision-making was respected. People were consulted and involved in care planning and the running of the service. People knew how to raise concerns and we found that matters were effectively dealt with and responded to.

Where people required assistance with their dietary needs, there were systems in place to provide this support. People were supported to access health care professionals, where required, to maintain good health. The service worked with other professionals involved in people’s care.

Staff were well trained and were supported in their role by managers who were available and responsive to staff needs. Staff spoke highly of the service. Robust systems were in place for the recruitment of care workers.

There was an open and empowering culture in the service. People and care workers were asked for their views of the service and these were valued and acted on. There was a quality assurance system in place and we are confident that shortfalls will be addressed.

The inspection took place on the 20 July 2015 and was announced. Notice of the inspection was given to ensure that the people we needed to speak to were available in the office. We later talked to some of the people who use the service and some of their family members over the telephone so that they could tell us about their experiences of using the service.

Bluebird Care Ipswich is a medium size domiciliary care service with under a hundred people using the service, which provides personal care and support services for a range of people living in their own homes. These included older people, people living with dementia and people with a physical disability. They also offer a live in service.

The service had a 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 experiences of people were positive. People told us they felt safe, that staff were kind and the care they received was good.

There were good systems and processes in place to keep people safe. Assessments of risk had been undertaken and there were clear instructions for staff on what action to take in order to mitigate them. Staff knew how to recognise the potential signs of abuse and what action to take to keep people safe. The manager made sure there was enough staff at all times to meet people’s needs. When the provider employed new staff at the service they followed safe recruitment practices.

Assessments were undertaken to identify people’s support needs and care plans were developed outlining how these needs were to be met. We found that care plans were detailed which enabled staff to provide the individual care people needed. People told us they were involved in the care plans and were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

The provider had arrangements in place for the safe administration of medicines. People were supported to receive their medicine when they needed it. People were supported to maintain good health and had assistance to access to health care services when needed.

The service considered peoples’ capacity using the Mental Capacity Act 2005 (MCA) as guidance. Staff observed the key principles in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded.

People were supported at mealtimes to access food and drink of their choice where needed. The service had good leadership and direction from the manager. Staff felt fully supported by management to undertake their roles. Staff were given training updates, supervision and development opportunities. For example, staff were offered to undertake additional training and development courses to increase their understanding of needs of people using the service.

Feedback was sought by the manager via surveys which were sent to people and their relatives. Survey results were positive and any issues identified acted upon. People and relatives we spoke with were aware of how to make a complaint and felt they would have no problem raising any issues. The provider responded to complaints in a timely manner with details of any action taken.

During our inspection of 30 April 2013 we found that the provider was not compliant with outcome 14, Regulation 23. We completed a follow up inspection on 7 August 2013 to check that improvements had been made.

We found that the provider had made improvements to the way they supported and trained their staff. This meant that the staff were supported and trained to meet the needs of the people who used the service. We were satisfied that the provider had taken all necessary actions to meet with this regulation.

We visited the office to talk with the manager and checked four staff files. We did not talk with any of the people who used the service on this occasion. During our previous inspection of 30 April 2013, people told us that they were satisfied over all with the service they received.

We had the opportunity to talk with five of the people who used the service or their family member. People we spoke with told us that the staff knew how they wanted to be supported and that they made sure they got what they needed. One person, who we asked what they thought of the quality of care said, “Things have improved a lot recently, for a while things were a bit hit and miss.” Another person said that, “I have always found the carers to be patient and understanding.”

People told us that they were included when their care plans were written and were given an opportunity to read them before they were finalised.

We spoke with three staff members who told us that they received supervision. However, one staff member and two people who used the service told us that they did not think staff were trained to a sufficient level.

Recruitment policies were followed, but we found that references were not always collected from a robust source.

There had been three different managers at the service since November 2012 and at the time of the inspection the manager was off work due to illness. The care co-ordinator was acting as manager and facilitated the inspection. Since the inspection we have been told that the manager had resigned and the care co-ordinator had been appointed as the new manager.

We carried out this inspection to investigate some concerns that had been bought to our attention. We spoke to the provider and checked 50% of the staff files. We found that the concerns raised with us could not be substantiated.

We did not talk with people who used the service on this occasion as the information we received focused on staffing issues. When we inspected the service on 3 May 2012 people told us that they were happy with the care they received. They told us that they were supported in the way they wanted to be and were able to make their own minds up about the decisions they took regarding their care. They were complimentary about the staff who supported them.

We had the opportunity to talk with three of the people who use the agency. All of the people we spoke with were happy with the care they received. They told us that they were supported in the way they wanted to be and were able to make their own minds up about the decisions they took regarding their care. They were complimentary about the people who supported them.

At the time of our inspection there were 68 people using the service. We spoke with eight people, two people's relatives, the manager and the provider. We also spoke with two of the office staff and four care staff and looked at six people's care records. Other records viewed included health and safety records, policies and procedures, complaints and satisfaction questionnaires completed by the people who used the service.

During our inspection and during analysis of our inspection findings we considered the questions we always ask, is the service safe, effective, caring, responsive and well led?

This is a summary of what we found;

Is the service safe?

We saw that the service had taken precautions to protect people from infection and that staff had received appropriate infection control training.

We saw that risk assessments had been completed so that risks associated with people’s care and support could be minimised.

Is the service effective?

People told us that they were happy with the service and that their needs were met. One person said, "I am happy, they (the carers) do a good job." Another person said, "The service is excellent."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that care workers were provided with up to date information about how people's needs were to be met.

Is the service caring?

People told us that the care workers and office staff listened to them. One person said, "We get on like a house on fire." Another person said, "They (care workers) are always polite and respectful."

Is the service responsive?

People using the service completed satisfaction questionnaires. Where shortfalls or concerns were raised these were addressed.

People told us that they knew how to make a complaint if they were unhappy. One person said, "I have no complaints." Another person said, "I've got a book here (at their home) about how to complain, but don't need to."

The provider worked in co-operation with others to ensure people’s wellbeing. We saw records that showed that the provider had worked with the speech and language team, occupational therapist and people’s GPs.

Is the service well-led?

The service had effective quality assurance systems in place and records showed that they identified shortfalls and acted to address them with the expectation that the quality of the service would continue to improve.