Bluebird Care (Richmond & Twickenham)

155 people using the service were receiving personal care. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

The agency culture was very open, honest and positive with transparent leadership and management. Its vision and values were clearly defined, understood by staff and followed. Areas of responsibility and accountability were identified, staff understood them and were prepared to accept responsibility on the ground and report any concerns they may have to the management, in a timely way. Service quality was constantly reviewed, and the agency made real changes to continually improve the care and support people received. This was in a way that best suited them. This included continually updating IT systems that enabled the agency to run more smoothly and improve people’s experience of it. Thorough audits were carried out, records kept up to date and performance shortfalls identified and acted upon. The agency played a prominent role in the community through well-established working partnerships that promoted people’s participation and minimised social isolation. Registration requirements were met.

The service the agency provided was safe for people to use and staff to work in. People were enabled to live safely by the support they received from the agency and its staff, because risks to people were assessed and monitored. Safeguarding concerns and accidents and incidents were reported, investigated and recorded, by the agency. Enough appropriately recruited staff were available to meet people’s needs. Medicines were safely administered; by staff who were trained and competent to do so.

People and their relatives said they were not discriminated against and their equality and diversity needs were met. The staff were very well-trained, supervised, and appraised. The induction for new staff included valuable input from people using the service in person. People and their relatives praised the way staff provided care and conducted themselves, which more than met their needs and expectations. People said staff spoke to them clearly, and in a way and at a pace that they understood and explained things to them and their choices and options. Relatives said that regarding people with dementia, staff were very patient and repeated information as many times as was required for them to understand.

Staff encouraged people to discuss their health needs and these were passed on to other community-based health care professionals, if appropriate. The agency had cultivated and developed a professional’s network that enabled seamless joined up working between services based on people’s needs, wishes and best interests. This included any required transitioning as people’s needs changed and interaction within the local community to reduce social isolation.

People were protected, by staff, from nutrition and hydration risks, and were encouraged to choose healthy and balanced diets that also met their likes, dislikes and preferences. People were supported to have maximum choice and control of their lives staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service support this practice.

People and their relatives were very complimentary about the way staff provided them with care and support, particularly field staff, with attention to small details making all the difference. People’s rights to privacy, dignity and confidentiality were respected by staff. They were encouraged and supported to be independent and do the things, they could, for themselves. This promoted their self-worth and improved their quality of life. The agency provided staff who were very friendly, caring, and compassionate. They were also passionate about the people they provided a service for and the way they provided it.

People received person centred care and had their needs assessed and reviewed. They were supported to follow their routines, interests and hobbies, and reminded of their choices. People were provided with suitable information to make their own decisions and end of life wishes were identified, if appropriate and adhered to. Complaints were recorded and investigated.

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

Rating at last inspection

The last rating for this service was Good (published 22 August 2017).

Why we inspected

This was a planned inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Bluebird Care (Richmond and Twickenham) is a domiciliary care agency registered to provide personal care to people living in their own homes. They provide care, support and assistance, shopping and companionship. The organisation is a franchise and most of the people who use the agency, pay for the service privately

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.

At our last inspection in June 2015 we found that the service was overall good and rated good for the five key questions of safe, effective, caring, responsive and well-led.

The agency had been highly successful in incorporating new technology to drive up the standard and quality of the service people received. The impact of this was people said they were very satisfied with the service the agency provided. The agency maintained very good communication with people using the service and normally they were given notice of any changes to staff and the timing of their care, unless it was unavoidable short notice. The impact of this was that people were kept up to date and informed about changes to their care very quickly. The agency staff carried out the tasks that had been agreed with people to their satisfaction. People also said that staff were thoughtful and really cared. People generally thought the service provided was safe, effective, caring, responsive and well led.

The management team had been outstanding in the way they successfully promoted and championed equality and diversity by providing excellent support to staff that challenged stigma and discrimination. Staff were knowledgeable about the people they gave support to and the way people liked to receive support. When required they also worked well as a team, for instance when calls that required two members of staff. People said the care and support provided by staff was delivered in a professional and friendly way that was focussed on the individual. Their attitude made them approachable and accessible to people using the service and their relatives and they had appropriate skills to carry out their tasks well.

The records we looked at including those for people using the service and staff were kept up to date and covered all aspects of the care and support people received, their choices and identified that their needs were met. Information was clearly recorded, fully completed, and regularly reviewed enabling staff to perform their duties to a high standard.

People told us they found the manager, management team and organisation were accessible, supportive, responsive, encouraged feedback and selected and provided good staff that were well trained and provided a quality service. Staff said that they received good support and training from the manager and organisation, the organisation was a great place to work and they got a lot of satisfaction from the job they did. They said the management team was approachable, generally receptive to their ideas and there were opportunities for career advancement.

People using the service were encouraged to discuss health and other needs with staff and had agreed information passed on to GP’s and other community based health professionals, as appropriate. People were protected by staff from nutrition and hydration associated risks by them giving advice about healthy food options and balanced diets whilst still making sure people’s meal likes, dislikes and preferences were met.

The agency staff were familiar with the Mental Capacity Act and their responsibilities regarding it.

The manager, management team, office staff and organisation frequently monitored and assessed the quality of the service provided.

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

Is the service safe?

We saw that the agency had a policy and procedure for treating people with dignity and respect that staff had been trained in. People and their relatives told us they were treated with dignity and respect. People said they received the care they needed, felt safe and staff were very supportive. One person said "I feel safe with the service I get and person who provides it".

We saw that the safeguarding procedures in place were robust, staff had received suitable training in them, knew how to operate them and they understood how to safeguard people. Areas or circumstances of concern specific to individual people or their homes were identified during the assessment process and recorded in the sample of ten care plans we looked at.

The organisation had systems that ensured the manager and staff learnt from accidents and incidents, listened to people's concerns, complaints, whistleblowing and investigations. This reduced risks to people and helped the service to improve. This meant that people and their rights were safeguarded.

People's individual care and support needs were taken into account by the manager when making decisions regarding the required staff numbers, qualifications, skills and experience. An emphasis was put on continuity once an appropriate carer or carers were identified by the agency and people using the service. This was reflected in the staff rota and ensured that people's needs were met.

No staff were currently subject to disciplinary action and policies and procedures were in place to make sure that unsafe practice was identified and people were protected. There were no current safeguarding alerts.

Is the service effective?

The agency assessed people's health and care support needs with them and they were supported to contribute as much as they wished to their care plans. Any specialist care and support required such as diet, mobility or equipment needs were included in the sample of the support plans we saw, that had been signed identifying that people had been involved in producing them. People's relatives were also involved and consulted as appropriate. People and their relatives said "We have been fully involved in the care planning" and "Very happy with the service, carers turn up on time, carry out the tasks and stay for as long as they are supposed to".

Is the service caring?

People told us that the carers were kind, professional and supportive. They carried out their tasks with patience and encouraged people to give their opinions if they thought their care needs had changed. People said, "They are really good, I've been with them four years and wouldn't stay with them if they weren't' and "There was an initial problem with timing of visits but I contacted the office and that has now changed".

People and their relatives completed an annual satisfaction survey and the agency operated spot checks. Where shortfalls or concerns were raised these were addressed by the manager and organisation.

We saw in the support plans we sampled that people's preferences, needs and wishes had been recorded and that care and support had been provided in accordance with this information and changed when needs changed.

Is the service responsive?

People told us that staff and the agency were responsive to their needs, care support provided met them and this was changed to reflect any change in their requirements. We saw this in the sample of care plans we looked at. People also said they knew how to make a complaint if they were unhappy and who to although this had not been necessary.

Is the service well-led?

People told us that the organisation was accessible, manager and staff listened to their needs, opinions and acted upon them. The service worked well with other agencies and services to make sure people received linked support as required. This was demonstrated by the relationship between the agency and community based health services.

Appropriate notifications were made to the Care Quality Commission.

We saw there were clear procedures for the assessment of people when they initially contacted the service to identify their care needs.

People we spoke with said that the information they received when they first started using the service was good.

We saw that the care plans and risk assessments were up to date but some care plans did not reflect the support needs of people using the service. The daily records were also task focused and did not record the experience of the person receiving care.

One person said "They give me total respect" and several people said they felt that the care workers had becomes friends.

We saw that some staff had not received appropriate training to provide support for a person with specific care needs.

We spoke with three newly recruited staff and asked them about their experiences of the recruitment process. Staff we spoke with gave examples of questions they were asked at their interview and examples of documents they were requested to provide, which included pre employment references from previous employers. References were traceable and requests were followed up.

Staff told us that the recruitment process was thorough. One person said "It was very professional and up to date; the service has high standards of new employees". Another staff member remarked "It was a pleasant experience; I was very impressed with the interview procedures". Someone else said "I was asked questions and gave two references".

Another person told us 'the person who comes to me is delightful, they know what I like and understand my needs'. Someone else told us 'staff wash their hands and change their gloves; they wear a tabard, look clean and well presented'. We spoke with eight staff who told us that they enjoyed working for Bluebird Care (Richmond and Twickenham) and received very good support. One employee told us 'the training we receive is excellent, this is the best service I've worked for'. Two staff members told us 'we aim to be as flexible as we can in providing the service'.

We looked at records about the service and the care people received. We found that people were assessed, and received regular care reviews. We also saw that unannounced checks were made by senior staff to ensure that people received an effective service.

We looked at employment, selection and recruitment records and found that not all staff recruited, had received a full and reliable employment reference check history.