Archived: Bluebird Care (Tonbridge & Tunbridge Wells)

Our last inspection on 17 March 2017 was a focused inspection to check the service was meeting the legal requirements following a breach from the previous comprehensive inspection on 15 June 2016. The breach was in relation to medicines not being managed safely. At the focused inspection we found improvements had been made and the provider had met the legal requirements with regards to the management of medicines, however it remained as requires improvement in safe as we needed to see consistent good practice over time.

At this inspection we found that good practice with the management of medicines had been sustained. The service continued to support the rating of good overall and was rated good in each of the five questions we ask. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained good. Why the service is rated good:

There were policies and systems in place to safeguard people, assess risks and manage them, and to manage people’s medicines safely. There were enough suitably recruited and trained staff to meet people’s needs. Whilst there was some feedback from people around concerns with staff being on time for their visits, the provider had acted to manage and improve this and had implemented effective electronic records systems, which monitored any missed or late calls.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff supported people to be as independent as possible and remain living in their own homes. People’s needs were met, including support with eating and drinking and accessing healthcare. The provider ensured there were systems in place to ensure staff had the right training, qualifications, support and supervision to do their job.

The management team consisted of the director (owner), the operations manager, the care manager and the supervisors. This team promoted a caring and positive culture and were passionate about their roles which could be seen in practice. Staff protected people’s privacy and dignity and people were consulted, informed and involved with their care. The provider offered complimentary outings for people and showed how they valued their staff through complimentary events, recognition of milestones and awards. For example, they celebrated when staff completed their probationary period, work anniversaries and promotions; and held care assistant of the month and year awards.

People, relatives and staff were engaged in the service. People could raise concerns and the provider managed complaints and feedback received from people and their relatives. The provider had systems in place to promote continuous learning. The provider had good oversight of the quality and safety of the service and risks. Regulatory requirements were understood and managed.

Further information is in the detailed findings below.

We carried out an unannounced comprehensive inspection of the service on 15 June 2016. The service was in breach of one regulation relating to safe care and treatment. We found that medicines were not managed in a safe manner. Medicine records were not always accurately and fully completed.

Following our last inspection the service had provided us with an action plan telling us how they were going to ensure that the concerns raised were addressed. This report only covers our findings in relation to those legal requirements that were not met by the provider at our previous inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Bluebird Care (Tonbridge & Tunbridge Wells) on our website at www.cqc.org.uk.

We undertook a focused inspection on 17 March 2017 to check that the service now met the legal requirement.

There was a registered manager in post as required. 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.

We found the registered manager and provider had taken sufficient action to address the concerns raised at the previous inspection and met the legal requirements in relation to medicines management. We saw the provider had reviewed the medicines management process at the service. Staff had received refresher courses in medicines management. The provider had introduced an electronic medicine management system which had ensured people received their medicines as required. However, the system was not fully implemented in managing all people’s medicines and embedded. We will review the impact of the change to people using the service at our next comprehensive inspection.

The service had a manager in place. They were not registered with the Care Quality Commission but told us they were in the process of applying for registration. 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.’

Medicine records were not always accurately and fully completed.

We found one breach 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 the full version of this report.

The service had appropriate safeguarding procedures in place and staff were knowledgeable about their responsibilities with regard to safeguarding adults. Risk assessments were in place which included information about how to mitigate any risks people faced. There were enough staff working at the service to promote people’s safety and pre-employment checks were carried out on prospective staff.

Staff undertook an induction training programme on commencing work at the service and received on-going training after that. People were able to make choices for themselves where they had the capacity to do so and the service operated within the Mental Capacity Act 2005. Where people were supported with food preparation they were able to choose what they ate and drank. The service worked with other agencies to promote people’s health and wellbeing.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place for people which set out their needs and the support they required in a personalised manner about the individual person. The service had a complaints procedure in place and people told us they knew how to make a complaint if needed.

People and staff spoke positively of the management at the service and of the working atmosphere. Various quality assurance and monitoring systems were in place, some of which included seeking the views of people that used the service.

People felt they were able to make their own decisions and choices regarding their day to day care and support. People confirmed that they had given their consent and been involved in discussions about their care, sometimes with a family member, when the service had first started.

People we spoke with told us that they were 'on the whole' satisfied with the service they received and that their care was personalised to their needs. One person said, 'They are what I expect and reasonable'. Another person said, 'They are very good'. Some people felt the service could be improved with better continuity of care workers. People were aware of their care plan folder (a records folder kept in their home), although not always of their care plan. We found that care plans contained information about people's needs and preferences.

People felt that they received safe and coordinated care and support where more than one provider was involved.

People were generally complimentary about the staff and felt the staff had the right skills and experience to meet their needs. One person said, 'The majority do (have the right skills and experience)'. Another person said, 'Some are more experienced than others'.

Most people said they had been asked for their views and feedback on the service provided. There were systems in place to monitor the quality of the service.

The people we spoke with, or their relatives, told us that they usually had the same care worker visiting them, but sometimes it changed. They said when it changed the office staff were good at informing them of this. One person told us “communication is good” with the office staff, and they were told if there were delays or problems. Another person said the service was “excellent” at communicating with them.

The provider had processes in place for monitoring the quality of the service, which included a survey of people using the service. The results of the last survey in October 2012 were mostly positive. There were processes in place to keep people safe, and to deal with any complaints. A relative told us that if they had any concerns or complaints they felt able to talk to the staff about this. All staff had the necessary recruitment checks completed before they started work.