This inspection took place on the 20 June 2018 and was announced. The provider was given 48 hours’ notice as we needed to be sure that someone would be available in the office and to support us to visit people in their own homes.

Butterflies Home Care is a domiciliary care agency. It provides personal care to older people living in their own homes in the community within the Hampshire and Dorset area. At the time of the inspection, Butterflies were providing a service to 48 people in the Dorset and Hampshire area to people with a variety of care needs, including people living with physical frailty or memory loss.

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.

Robust governance and quality monitoring systems were not established or embedded within the service. Improvements were required in how the service was managed and how arrangements for accountability and delegation of management tasks were recorded. Monthly audits which included reviewing people’s records, staff files and training were not established which would ensure the quality of the service and identify where improvements could be made.

Risks were not monitored adequately, or completed within care plans to ensure the effective monitoring and mitigation of the risk. This meant the provider was not doing all that was reasonably practicable to manage risks.

Some people self-administered their medicines, whilst others needed support. Although people told us they received their medicines as they should, staff had not received spot checks or competency checks to ensure they were administering medicines safely.

We have made a recommendation about the provider refers to current NICE guidance in regards competency and assessment for staff administering medicines.

There was a risk that people may be moved by staff who had not been assessed as competent to move and assist them. Although staff had in date training from previous employers the registered manager had not assured themselves staff were competent to perform specific tasks through monitoring and direct observations.

Although staff received an induction when they started working for the service, which included shadowing staff they were not receiving regular monitoring, supervision or appraisals.

We have made a recommendation that the provider considers good practice guidance to ensure all staff receive appropriate support, training and supervision and appraisal to carry out their roles.

There was a risk people may not be supported in line with their assessed care needs, as there were shortfalls in the information held within care plans. We observed four care plans which had missing information in regards the support people required. The registered manager told us, “I know that the care plans are not as person centred as I would like but I am working through it.”

Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding. Professionals, staff and relatives told us they had no concerns relating to safeguarding.

We checked whether the service was working within the principles of the Mental Capacity Act. People told us that staff sought their consent before providing care. One person said, “They always ask me first”.

Staff demonstrated a kind and caring approach towards people. People told us staff knew them well and treated them as individuals. People were consulted about the care they received and were given opportunities to express their views. People were supported to make decisions about things such as what they wanted to eat or drink, what they wanted to wear, and how they wished to spend their day.

Relevant

This inspection took place on the 16 and 18 May 2017 and was announced. The provider was given 48 hours because the location provides a domiciliary care service; we needed to be sure that someone would be available in the office.

Butterflies in Hampshire provides personal care and support to people in their own homes. At the time of this inspection Butterflies was providing a service to 35 people with a variety of care needs, including people living with physical frailty or memory loss due to the progression of age.

The service had a registered 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

At our last inspection on 2 March 2016, we found four breaches of regulations. The service was non-compliant with safe recruitment procedures, safeguarding procedures were not effective, staff did not receive regular supervision and the provider did not have effective systems in place to monitor the service. The provider sent us an action plan detailing the steps they would take to become compliant with the regulations. During this inspection we found action had been taken but further improvement was required.

Relevant recruitment checks were conducted before staff started working at Butterflies in Hampshire to make sure staff were of good character and had the necessary skills. However, there were unexplained gaps in staff employment histories. Improvements were needed to ensure that all of the required checks were made before new staff started working at the service.

Quality assurance processes had been developed. However, further improvements were needed to be fully effective.

There were appropriate arrangements in place for managing medicines. Staff were trained in the handling of medicines. However, the registered manager had not assessed that staff were competent to support people with medicines to people in a safe way.

Providers are required to conspicuously display their CQC performance ratings on their website. At the time of our inspection the previous CQC inspection was not displayed on their website. However during our inspection it had been uploaded to their website.

People and their families told us they felt safe and secure when receiving care. However, we found that information about the safe use of bed rails was not included in the risk assessment relating to people's health and well being.

Staff received training in safeguarding adults. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction designed to ensure staff understood their new role before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development. There were sufficient numbers of staff to maintain the schedule of care visits to meet people’s needs.

Staff knew what was important to people and encouraged them to be as independent as possible. People who used the service felt they were treated with kindness and said their privacy and dignity was respected. People were supported to eat and drink when needed. Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices.

Staff were responsive to people’s needs which were detailed in peoples care plans. Care plans provided comprehensive information which helped ensure people received personalised care. People felt listened to and a complaints procedure was in place.

Staff felt supported by the registered manager and could visit the office to discuss any concerns.

Butterflies in Hampshire is a domiciliary care service providing a range of services including personal care for people in their own homes. There were 17 people using the service and five employed care workers at the time of our inspection.

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.

The provider did not follow safe recruitment procedures. Application forms and references were not always completed or requested.

The provider did not have effective arrangements in place to supervise care workers. Formal supervision for experienced and new staff did not always take place.

The provider did not have effective policies and procedures in place. Staff were not supplied with accurate safeguarding information.

The service did not always have effective systems in place to monitor and improve some aspects the quality of the service provided.

The service had sufficient numbers of suitably skilled and competent staff to keep people safe.

People told us they felt safe and were confident in the staff that supported them. People were safe because staff understood their role and responsibilities to keep them safe from harm.

Risks to people had been assessed and reviewed regularly to ensure people’s individual needs were being met safely.

People were supported by staff who received regular training and support to help them provide effective care.

Staff understood the requirements of the Mental Capacity Act 2005 and their responsibilities to ensure that people who were unable to make their own decisions about their care and support were protected.

People were supported by staff who promoted their independence, respected their dignity and maintained their privacy.

There was an effective complaints system in place. People told us they were confident to raise any issues about their care and that they would be listened to and addressed.

The culture in the service was open, inclusive and transparent. Staff were supported, felt valued and were listened to by the management team. Staff were confident to raise any concerns they had and bring forward ideas that could make improvements to the service.

We found four 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 this report.