Blue Moon Care Limited

Blue Moon Care Limited is a bespoke domiciliary care agency in the Taunton area. It was established by a group of people and their carers to provide personal care to people living in their own home with Myalgic Encephalomyelitis/Encephalopathy (ME). ME is a serious disabling chronic neurological illness with a range of neurological symptoms. These include severe fatigue and muscle pain, sensitivity to light/noise and smells and with poor sleep patterns. People experience difficultly concentrating which sometimes affects speech and suffer regular relapses and remissions.

One person was currently receiving personal care from the agency and they provided wellbeing services to two other people. 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

People received an exceptionally caring and compassionate service from a small team of staff, they knew well, who understood how their condition affected their daily lives. The service demonstrated a strong and visible person- centred culture which put people at the heart of everything they did. People praised staff who were excellent at promoting each person's dignity, wellbeing and independence, which improved their quality of life.

The registered manager promoted people’s human rights and inclusivity through equality and diversity training. People and staff advocated for improved services for disabled people through their ‘ME uncut’ project. They raised awareness of the condition through distributing information leaflets distributed to GP practices, schools and to the public and wrote an article for a local health journal. They also challenged and tackled disability discrimination wherever they experienced it, for example, in restaurants and public buildings.

People received an exceptionally personalised service because staff had an excellent understanding of their needs. Staff were committed to enabling people live fulfilling lives and supported them to achieve their goals. For example, they supported a person to obtain a master's degree in education and to work towards gaining employment. The registered manager used their educational expertise to teach a graduate how to amend the person’s study material to make it suitable for their use. This included breaking the information down into smaller sentences, and through the use of coloured text and larger fonts to make it more accessible to them.

People’s wellbeing was improved through an innovative wellbeing programme to support them with social interaction, mental stimulation and to learn new skills. For example, staff supported people to grow produce and make craftwork items, which they exhibited annually at the Taunton Flower show. Pictures of the 2019 show, an array of prizes and judges’ comments were proudly displayed in the agency’s office to celebrate their success.

People who used the service had a very close friendship and it was important to them to spend time together. When people were less well and unable to go out much, staff were increasingly using technology to support them to maintain social contact and prevent isolation. For example, using information technology (IT) to share messages of support, photographs, do arts and crafts and play games, watch films and other events virtually together.

The agency was exceptionally well led by the registered manager and their deputy who led by example. People and staff spoke about the high quality of care provided. Staff were motivated, enthusiastic and were proud to work for the agency. The provider promoted a positive culture that was person-centred, values based, open, inclusive and empowering. People, staff and management all worked together with input on priorities and decision making. For example, on training, developing policies and setting new goals.

Managers and staff worked tirelessly to give people with ME a voice through continually developing their ‘ME Uncut’ project and through contact with a member of a panel of experts developing clinical guidelines about ME for the National Institute for Health and Care Excellence (NICE). There was a strong emphasis on learning and continuous improvement. For example, the registered manager compiled a regular newsletter featuring articles of interest and relevance to people and staff. Following attendance at a training event about the introduction of General Data Protection Regulations (GDPR), they shared that knowledge by working with people and staff to create a local policy.

People received consistent support from well-trained care staff who knew them well. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People said they felt safe as they were supported by a small team of staff they knew and trusted. Staff knew about the different types of abuse, ways to protect people and how to report concerns. Complaints and incidents were opportunities to learn and improve.

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 Outstanding (report published 18 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Blue Moon Care provides support and assistance with personal care to people who live in their own home. The agency provides a small bespoke service to two people who suffer with Myalgic Encephalopathy, also known as Myalgic Encephalomyelitis (ME). ME is characterised by a range of neurological symptoms and signs, muscle pain with intense physical or mental exhaustion, relapses, and specific cognitive disabilities.

At our last inspection of the service in April 2014 we did not identify any concerns with the care provided to people.

At the time of our inspection there were two people using the service.

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 service demonstrated a very strong and visible person centred culture and they were committed to providing a service which put people at the heart of everything they did. The agency was set up with and for the two people who used the service. The agency employed a small team of five staff; many of whom had worked for the agency since its registration in 2012 this meant they had got to know people very well. A person who used the service described the staff as “kind and very friendly.”

The agency was committed to enabling the people who used the service to live fulfilling lives and supported them to achieve their goals. For example one person was being supported to work towards a master’s degree. Another person was supported to complete a computer course which meant they could join in with interactive staff training sessions. The person also enjoyed supporting a member of staff, whose first language was not English, to complete their on-line training sessions. Another person who used the service was working towards a career they could conduct from their own home.

People were supported to follow a wellbeing programme. Staff supported people to care for their pets. Both people were keen gardeners and staff supported them to grow produce which they regularly exhibited at the Taunton Flower Show. Both people who used the service were involved in the agency’s ME Uncut project which was set up by the registered manager and both people to raise awareness of ME. The registered manager and the person we met with told us how, when exhibiting their produce at the Taunton Flower show, they had created cards for the public which gave brief information about ME to raise awareness of the illness.

People’s views were valued and responded to. For example, one person identified a training need for staff and this was arranged. A person who used the service explained how they were involved in the recruitment of staff. They said “I go through the application forms and help to decide who to short list. I then interview the staff with [name of registered manager.]” The registered manager told us “It’s down to our clients who we employ.”

Care was planned and delivered in a way that was personalised to each person. Staff monitored people’s healthcare needs and, where changes in needs were identified, care was adjusted to make sure people continued to receive care which met their needs and supported their independence.

Staff were well trained and people were confident they had the skills to meet their needs. One person said “I have a regular carer who is just brilliant. She really knows what she is doing. She knows what needs to be done and how to help me.”

The agency’s recruitment procedure ensured staff were thoroughly checked before they began work. Staff knew how to recognise signs of abuse and all said they were confident that any issues raised would be appropriately addressed by the registered manager. People felt safe with the staff who supported them.

There were systems in place to monitor the quality of the service and plan on-going improvements. People using the service and staff felt involved and able to make suggestions or raise concerns.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? This is a summary of what we found.

Is the service safe?

We found that a flexible, specialist service, individually tailored to people's care needs was provided. People were treated with dignity and respect by the staff and people told us they felt safe. There were systems, policies and procedures in place which ensured risks to people were reduced and that the service was safe.

Risk assessments had been undertaken and people were given choice and options about how their care and support was provided. People remained in control of decisions about their care and lives.

Policies and procedures in operation were comprehensive and ensured that risk was reduced, unsafe practice was identified and people were protected. A strong emphasis on training ensured that staff were competent and knowledgeable in their roles.

Is the service effective?

Both people who received a service were involved in the development of their care plan. We examined care plans which were clear in explaining what care and support was needed. Daily task sheets records were detailed and up to date which showed us that staff provided the appropriate care and support specified in the care plan.

Is the service caring?

We spoke with both people who received a service about the care they received. They told us they were involved in every aspect of their care. Staff we spoke with respected people's decisions and gave people options and choice. People were not rushed. Staff said they was always time to talk with people. We observed friendly, caring relationships between people and the staff who knew each other well.

Is the service responsive?

The agency was small and able to respond immediately to any request by the person for a change in their care. People and staff told us that everyone worked together closely. People who received care were involved in all aspects of the operation of the agency and were fully consulted at every stage. People told us the service was constantly being improved and that if anyone had an idea for improvement it would be tried. We observed open easy communications between everyone involved with the agency.

People were aware of the complaints procedure but no one had any complaint. People told us they had no hesitation raising any issue if there was ever a concern.

Is the service well led?

The agency had formal systems in place to monitor the quality of the service provided. There was a clear management structure in place and lines of accountability were clear. Staff had a good understanding of the ethos of the agency and to quality processes in place. The provider who was also the registered manager was actively involved in the day to day operation of the service and committed, alongside other staff to the continuous improvement of the service.

During this inspection we visited the agency office; we spoke with the two people the agency provided care and support for. We also spoke with a care worker, the deputy manager and the registered manager/provider.

Both people spoken with told us they felt the care provided was relevant to their needs. One person told us, 'I am always involved and if I want things done differently they always listen '.

We found people were involved in all areas of their care. From developing and agreeing their care plans to being involved in staff training and recruitment.

We saw care plans were person centred and included clear guidance for care workers about specific needs.

People told us they felt safe using the service and knew who to speak to if they had concerns.

Staff told us they received relevant training which was specific to the care needs of the people they looked after.

The provider had an effective system in place to assess and monitor the quality of service provided.