This inspection took place on 17 April 2018 and was announced. 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 people living with dementia, mental health, older people, physical disability, sensory impairment and younger adults.

Not everyone using Butterfly Home Help receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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.

Staff were not safely recruited. The provider had not always asked for a full employment history of staff prior to starting work at the service. Where there were gaps in employment history, these had not been explored with the member of staff to determine the reason. When staff had started prior to a satisfactory check with the disclosure and barring service, the service had not assessed the risks.

Risks had not always been assessed, so that safety measures could be put in place. There was not always clear guidance for staff on how to use equipment needed to keep people safe such as bed rails.

Quality assurance systems were not robust. There were no overarching quality assurance documents and action plans for the service as a whole. Only the satellite office in Bath produced monitoring information.

We have made a recommendation that the service reviews its quality monitoring systems.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice.

Medicines were managed safely and staff had received training in administration of medicines prior to doing that activity. There were sufficient staff employed and available to meet the care packages the provider had agreed to.

Staff understood their responsibility to keep people safe from harm. They had received training on safeguarding and knew the signs to be aware of. If needed the staff would have no hesitation reporting abuse and were confident the office would take appropriate action.

Training and supervision was provided to staff and updated when needed. Staff told us they felt supported and could ask for training in any area. People and their relatives told us they felt staff were well trained and had the skills needed to do their jobs.

Personal protective equipment was supplied to staff and people told us the staff wore it when supporting personal care.

People were supported to access healthcare if needed; the service supported them to call GP’s, district nurses or any other healthcare professional.

People and their relatives thought the service was caring and the staff respected their privacy and dignity. Person centred values were demonstrated by staff that told us they enjoyed the work they did. Care plans were person centred and people told us they had been involved in their assessments of care needs. People felt listened to and were able to have a review on a regular basis.

Confidential information was kept secure and only authorised personnel were able to access records. Staff used hand held devices to record daily notes, which required a password to access.

Complaints were well managed and records demonstrated all complaints were logged with the action that had been taken. People, their relatives and staff told us they thought the service was well managed. Staff found the management to be open, transparent and approachable.

At our last inspect

We visited the offices of Butterfly Home Help (Wiltshire) at the provider’s head office in Bath and spent the day talking with management, administration and care staff. The Wiltshire branch of this domiciliary care agency had been recently established and was building a client base in the Westbury area. We found the organisation well run. Staff were able to tell us with confidence about treating people they supported with kindness, respect and dignity. People's care assessments were clear and staff knew what support people needed while maintaining people's right to be as independent as possible.

We spoke on the telephone with people and/or relatives of people who used the service provided by Butterfly Home Help. A relative said: "they are extremely good. They were very pleasant when setting everything up and my confidence was not misplaced." Another person who was supported by the service said: "they are all very helpful. I feel very safe and well looked after by them all."

People and their relatives told us their needs or those of their family member had been well assessed and safely managed by the service. People said they were treated with privacy, dignity and respect. We were told by a lot of people we spoke with that, for them, the most important part of the care provided was having just a small number of different carers. They felt this provided consistency of care and staff got to know people well.

We found the organisation had effective recruitment practices to assure staff employed were able to work with people safely and effectively. Staff worked with other health and social care professionals when this was required to ensure care was coordinated. The organisation also used its knowledge, experience and systems in place to ensure it was able to keep to its appointed time to visit people. This involved having sufficient staff, scheduling staff visits carefully, and factoring in planned and unplanned staff absence.