About the service: Bluebird Sefton is a domiciliary care agency registered to provide personal care to people who live in their own homes. At the time of the inspection the service was providing personal care to 124 people.

People’s experience of using this service:

People continued to receive a consistently good service and felt safe with the support they received from the staff. The staff team were well-trained and in sufficient numbers to meet people’s needs.

People supported by the service told us that staff were reliable, caring and professional in their approach to their work. They spoke positively about the quality of service provided. One relative told us, “The agency are excellent all round. Staff are genuinely caring." Another person told us, “ I would rate them as very good, a 10 out of 10. They often go the extra mile to make sure I'm okay.”

The provider assessed people's needs to help ensure they received appropriate care. Care plans covered a range of areas including the support people needed with their medicines, nutrition and healthcare.

People’s care and support had been planned in partnership with them and they felt consulted and listened to about how their care would be delivered.

Risks to people were assessed and mitigated. When incidents took place, the provider reflected on events to help reduce the risk of reoccurrence.

People were safeguarded against the risks of abuse and harm.

We made a recommendation to check that the service was using the latest good practice in reporting safeguarding concerns.

The service had introduced new IT systems to ensure the reliability and quality of the service provided. People told us they had never had a missed call and very few late calls, and even with these the office rang to confirm staff were on the way.

The service worked in partnership with healthcare professionals and families to ensure people’s health care needs were met.

Staff had access to training which was appropriate to their role. Staffing levels were continuously reviewed to ensure there were enough staff to provide a flexible and responsive care.

The service was well-organised and there was a clear staffing structure.

The registered provider and the registered manager used a variety of methods to assess and monitor the quality of the service.

Rating at last inspection: Good (19 March 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will monitor as part of the inspection programme for a Good service. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We undertook an announced inspection of Bluebird Care Sefton on 11 and 12 August 2016. The provider was given 48 hours’ notice in order to ensure people we needed to speak with were available.

Bluebird Care Sefton is a domiciliary care service that provides personal care and support for people living in their own homes. The registered provider for the service is Spyke Enterprises Limited. The service is located in business offices in Formby and provides services in the local Sefton area.

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 and associated Regulations about how the service is run.

Everyone using the service told us they felt safe.

People had copies of their care plan in their homes, and confirmed these were reviewed with them on a regular basis.

There were updated risk assessments in place to support staff to mitigate any risks to people’s health and wellbeing.

There were protocols in place for the safe administration of medications, and all of the staff we spoke with confirmed they had been trained in this area.

The agency had robust recruitment practices in place. No staff commenced duties until all satisfactory checks, including Disclosure and Barring Service (DBS) check had been received. (DBS checks identify if prospective staff have had a criminal record or have been barred from working with children or vulnerable people).

At the last inspection we found a breach of regulation in relation to staff training and support. The provider had taken action to improve their training programme and supervision structure. This breach had been met..

People’s privacy and dignity was upheld.

Staff monitored people’s health and welfare needs and acted on issues identified. The GP was contacted on people’s behalf when needed.

People told us the staff were kind and caring.

Staff said they benefited from regular one to one supervision and appraisal from their manager.

There was a safeguarding and a whistleblowing policy in place, which staff were familiar with.

There was a complaints procedure in place which was enforced when formal complaints were made about the service.

Quality assurance audits were carried out and feedback was collected regularly from staff, relatives and people using the service. These were analysed and responded too appropriately. We could see the registered manager was using this feedback to continuously improve the service offered. Other quality assurance audits we saw were highly detailed and the registered manager responded appropriately to shortfalls identified within the service provision.

The inspection of Bluebird Care helped answer our five key questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe and well cared for.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduces the risks to people and helps the service to continually improve.

Policies and procedures were in place to make sure that unsafe practice was identified and people were protected. For example, we saw that all care files had individual risk assessments of the home environment which identified any possible hazards or risks for people using the service and staff.

Is the service effective?

People’s health and care needs were assessed with them and they were involved in their plans of care. Mobility and equipment needs had been identified in care plans where required. People said that the care plans reflected their current needs.

We received some feedback form social care professionals who had completed reviews of people’s care. These were positive. Care had been carried out competently and effectively.

Is the service caring?

People were supported by kind and attentive staff. We were told by people using the service that care workers showed patience and gave encouragement when supporting people. People commented, ‘’The staff are excellent. They are careful to explain everything they do.’’ People said staff did everything needed to support them when they visited. One person commented, ‘’The staff are very professional’’ and ‘’I would recommend the agency to anybody.’’

People’s preferences and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

We saw that people were supported to complete a range of daily activities and these included some support with social activities as well as personal care. People were supported as their care needs changed. This was particularly evident with changing health and care needs.

People using the service and /or their relatives, completed a satisfaction survey. Where shortfalls or concerns were raised these were addressed. One person told us that they had had concerns about too many changes of care staff but this had been sorted out once they had raised it with the service manager.

People knew how to make a complaint if they were unhappy. People could therefore be assured that complaints would be investigated and action taken as necessary.

Prior to our inspection the service had responded positively to concerns raised by staff regarding some aspects of training. The manager had developed more in-depth training in key areas of care.

Is the service well-led?

The service had a quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and the quality assurance processes that were in place. This helped to ensure that people received a good quality service at all times.

We spoke with four people about the service that they received. They told us they were happy with the way staff supported them and the tasks they carried out for them.

Those people we spoke with said the staff knew what support they required and did everything that was needed for them. One person told us, ‘’ The care staff know me well and are never rushed.’’ Another person said, ‘’The care gets reviewed regularly and I always know what’s going on.’’

We spoke with the manager and two staff members. They told us they had received training and understood how to report any concerns or allegations of abuse. The staff told us they felt supported in their job and received supervision from their manager.

We asked people who used the service about the skills of the support workers. They told us the staff worked very hard and knew how to do their job. They felt staff were competent.

We spoke to people about their involvement in the quality of the service. They told us the managers were easy to contact and very responsive. One person said, I’ve had one or two issues in the past but they were sorted out quickly.’’

You can see our judgements on the front page of this report.

The inspection was carried out on 5 and 12 February 2015. We gave the provider 48 hours notice of the inspection in order to ensure people we needed to speak with were available. This is in line with our current methodology for this type of service.

Bluebird Care Sefton is a registered with the Care Quality Commission to provide personal care. The service supports people who live in their own homes. At the time of our inspection the service was supporting approximately 37 people who required support with personal care across the borough of Sefton.

The office base is located in Formby, Merseyside. The office is on the first floor of a building and is not accessible for people who use wheelchairs. The provider told us they can have the use of a room on the ground floor which is accessible. The office premises provide the facilities required for the running of the business.

We found that people who used the service were protected from avoidable harm and potential abuse because the provider had systems in place to minimise the risk of abuse. Procedures for preventing abuse and for responding to allegations of abuse were in place. Support staff were confident about recognising and reporting suspected abuse. The manager was aware of their responsibilities to report abuse to relevant agencies, however they were not aware of the limitations of their role in investigating safeguarding concerns.

People were provided with good care and support that was tailored to meet their individual needs. Each of the people who used the service had a support plan and these were sufficiently detailed to provide guidance to care staff on how to meet people’s needs. Risks to people’s safety and welfare had been assessed and information about how to manage risks was included in people’s support plans.

Staff worked alongside health and social care professionals to make sure people received the care and support they needed. The manager was able to provide recent examples of how they had referred to outside professionals for advice and support.

People’s care plans included guidance about how to support them with their medicines. The agency was only supporting a small number of people with their medicines as most people managed their own medicines or were supported by relatives.

The manager had some knowledge and understanding of the Mental Capacity Act 2005 and their roles and responsibilities linked to this. They were able to tell us how they would ensure a decision was made in a person’s best interests if this was required. This included referring to multi-disciplinary professionals as appropriate.

Staff told us there was an open culture throughout the service. They told us they would be confident raising any concerns and felt that any concerns they did raise would be dealt with appropriately.

Pre-employment checks were carried out on new staff before they started working for the agency. Staff told us they felt well supported in their roles and responsibilities and they felt they had thetraining and experience they needed to carry out their work effectively. However, we found that systems in place to support staff such as appraisal, supervision and training were not consistent across the service. You can see what action we told the provider to take at the end of the report.

There was no registered manager at the service at the time of our inspection. 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. It is a condition of the provider’s registration to have a registered manager in post. At the time of our inspection the manager had submitted an application for registration to CQC.

Systems were in place to check on the quality of the service and ensure improvements were made. These included audits on areas of practice and seeking people’s views about the quality of the service. We found there was room for improvement in this area as some checks were not being carried out consistently or on a regular basis.