This inspection took place on 19 October and 03 November 2016 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be available to speak with us.At our previous inspection in October and November 2015, we identified a breach of Regulation 12 Safe Care and Treatment under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider had submitted an action plan with information on how they intended to meet the breach. During this inspection, we checked and found the actions implemented meant the registered provider was not in breach of this regulation.
The service provides personal care to people who live in their own homes in and around the city of York. At the time of the inspection there were 75, predominantly older people receiving care and support services from Bluebird Care York.
There was a registered manager in place who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 registered provider had implemented a new system and process that electronically managed records for the care and support people received and we saw this was in place in conjunction with paper records for people. We found information in these records was not consistently recorded, accurate, complete or reflective of people’s current needs.
The registered provider completed medication audits that were designed to ensure people received their medication in line with their prescription and that information was available that ensured this was done safely. We found that people received their medication safely but medication records for people were not detailed, accurate and consistent. Audits completed were ineffective, as they had not addressed the lack of complete and accurate records that we found.
The registered provider had measures in place to keep people safe from avoidable harm. Care plans included risk assessments for people and their environment but we found there was ineffective monitoring that ensured this information was up to date, accurate and complete. We also found the information did not guide staff on how to mitigate the identified risks.
During our inspection, we found policies and procedures provided for staff were not always up to date. This meant they did not always have access to current guidance.
The above concerns meant that at the time of our inspection systems and processes implemented to assess, monitor and improve the quality and safety of the service had not been fully established and were not always effective. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the end of the full version of this report.
People receiving a service were protected from avoidable harm and abuse by staff who had received training in safeguarding. Staff had access to policies and procedures on safeguarding adults from abuse and understood how to raise any concerns.
Sufficient competent and skilled staff were employed and staff deployment was managed electronically. The registered manager told us they recognised the importance for people in receiving care and support from a regular group of caring people and we saw rotas were planned to ensure people had contact with familiar staff who had sufficient time to travel between calls. This ensured people received their care and support at the times they wanted.
The registered provider had completed pre-employment checks on care workers that helped to ensure they were of suitable character to work with vulnerable people. It was clear from staff records that these checks had been undertaken and that the registered provider had received this information prior to the new employees starting work.
Care workers told us they felt supported in their role and there were systems to monitor the quality of the care provided. There were regular spot checks and competency checks of care worker’s practice and they were supported to improve and develop in their roles.
Accidents and incidents were managed effectively with systems in place to record actions and outcomes that helped to improve the service and keep people safe.
We checked and found the registered provider was working under the Mental Capacity Act 2005 (MCA) legal framework. People using the service were supported to make decisions and signed consent was sought in line with relevant legislation and guidance. Care workers had completed training in the MCA and encouraged people to make decisions and have choice and control over the support they received.
People were supported to maintain a healthy diet. Care plans included records for people’s individual nutrition and hydration requirements. Where people had any food allergies, these were recorded along with information on food that people liked or disliked.
People were supported with their health and wellbeing. We saw care plans contained detailed information about people’s medical history as well as contact details of healthcare professionals involved in providing their care and support.
Care workers were observed to be caring and we found the people they supported mattered. People had their privacy and dignity respected by care workers who were considerate of people’s individual preferences.