Blue Sky Enabling

This service is a domiciliary care agency. It provides personal care to people living in their own houses in the community. It provides a service to older adults and younger disabled adults.

Not everyone using Blue Sky Enabling receives regulated activity; CQC only inspects the service being received by people provided with 'personal care', and help with tasks related to personal hygiene and eating. For people who receive a regulated activity, we also take into account any wider social care provided.

The last inspection took place on 7 and 31 October, and 16 November 2016. We identified one breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because records did not consistently demonstrate a robust recruitment procedure.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question of whether the service was safe, to at least good. At this inspection, improvements had been made.

There was a new 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 registered manager was available throughout the inspection.

The registered manager began their role in December 2017. Since their appointment, they had developed the culture of the agency and various management systems. The registered manager had an open approach and encouraged people and staff to share their views about the service. This was on a day to day basis and more formally through surveys. Feedback was being used to enhance service delivery.

People and their relatives were happy with the service they received. However, feedback from health and social care professionals was variable. The registered manager told us they would consider this and make amendments where needed.

Whilst people had comprehensive support plans in place, staff did not always use objective terminology when writing daily records. The registered manager told us a staff training session would be arranged to develop this area. There were clear plans regarding the management of risk.

There was a strong focus on enablement and promoting independence. People were encouraged to make decisions and aspire to achieving their goals. They received a range of support from various health and social care professionals and enabled to lead healthy lives. People received support with meal preparation if needed and had enough to eat and drink.

There were enough staff to support people safely. People and their relatives were given the opportunity to be involved in recruiting the staff who would be supporting them. This enabled a sense of ownership and encouraged successful relationships. People were supported by a small team of staff which ensured consistency.

Staff received a detailed induction when they joined the agency. This was “signed off” by the registered manager to ensure all new staff were competent to work with people. Staff received support on a day to day basis and more formally through one to one meetings. They undertook a range of training to be able to support people safely and effectively.

A range of audits and monitoring visits assessed the quality of the service provided. The introduction of a new electronic record management system, was being used to give an overview of service provision.

At the last comprehensive inspection on 16, 22 September and 15 October 2015, we identified the service was not meeting a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s consent was not always gained before undertaking certain tasks, the agency’s ethos of person centred care was not consistently applied in practice and there was some concern about the registered manager’s practice. Following the inspection, the provider sent us an action plan, which detailed how improvements would be made. At this inspection, improvements had been made but further work was required to ensure a good service.

Blue Sky Enabling is a domiciliary care agency, which provides care and support to people in their own homes on a short and long term basis. The agency provides people with support on a sessional basis or staff can ‘live in’ the person’s home, to provide 24 hour care. At the time of the inspection, the agency was supporting eight people.

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 registered manager is responsible for the day to day management of the agency and was available throughout the inspection.

There remained some concerns about the registered manager’s manner and the way in which they interacted with those around them. The registered manager told us they had reflected on their practice and undertaken some additional training. However, they said it was very difficult to change something that was “built in”. In response to the concerns previously raised, the registered manager had made changes to the structure of the agency. This meant they only worked with the younger adults who required a service. This had minimised further concerns about the registered manager but not necessarily addressed their practice.

The registered manager told us they had expanded the management team. This had enabled greater expertise and more individuals to share ideas with. Decisions were being made more collectively and there had been greater liaison with other health/social care professionals and the local safeguarding team. However, there remained some techniques which staff used with people, which had not been formally agreed.

There were sufficient numbers of staff available to support people effectively. Additional staff were being recruited for any new care packages. Whilst a recruitment agency was sometimes used to find the right calibre of staff and check their suitability, records did not always demonstrate a robust recruitment process.

Staff felt well supported and received formal meetings with their manager to discuss their work. There had not been any incidents which required the agency’s disciplinary processes to be initiated. Those incidents which had occurred were appropriately reported to the local safeguarding team. Relatives told us they had no concerns about their family member’s safety. They said they had confidence in the staff who provided the support. Staff were confident when discussing how they kept people safe. They were aware of local safeguarding procedures and would immediately inform the registered manager if they had any concerns.

The registered manager and care manager had undertaken training so they could train staff in their area of expertise. A range of ‘person specific’ training and topics deemed as mandatory by the provider had been undertaken. This included safeguarding, Autism awareness and the safe administration of medicines. However, staff had not received training in positive behaviour management. This did not equip staff with the skills or confidence to keep them or the person safe during an incident which occurred. Following reflection, the registered manager confirmed this training had been arranged.

People were supported by a consistent member of staff or small team. This consistency enabled established relationships to be built. Staff knew people well and were aware of their needs. There was a strong emphasis on enabling people to be as independent as possible and achieve their goals. People’s rights to privacy and dignity were maintained.

There were no concerns about people’s safety. People had comprehensive support plans which they helped devise. The information was well written and contained a range of risk assessments, management plans and protocols. These documents gave staff added guidance to enable them to effectively meet people’s needs. Medicines were safely managed and people had access to a range of services to meet their health care needs. People were supported to prepare their meals and to make choices about what they wanted to eat and drink.

People and their relatives knew how to make a complaint and were encouraged to give their views about the service. The use of surveys and checks on staff’s practice were used to assess the quality of the service. Consideration was being given to how this evidence could be used to give a greater overview of the management systems in place.

Everyone we spoke with was complimentary of the staff and were satisfied with the care and support they received. Comments included: "I cannot fault the care and attention I receive. The staff go over and beyond the call of duty." Another person described the small staff team as "extremely caring and experienced and know me very well. Staff are very aware of the importance of privacy and dignity, they are polite and respectful. New staff have been introduced and work alongside me gradually until I have felt confident that the new staff knows me and my routine, which I value."

We found the management of people's medicines was well organised and staff were

trained effectively to carry this out safely.

We found the organisation had effective recruitment practices to assure staff employed were able to work with people safely and effectively. Several people commented on the staff support as being "consistent, as staff turnover is almost non-existent."

We saw there were systems in place to monitor and assess the quality of its service; which showed examples of improvements they had made to service delivery in response to comments people who used the service. Everyone we spoke to agreed they had opportunities to express their views regarding the care provided, and were confident any concerns would be dealt with effectively.