The service is a domiciliary care agency providing support to adults of all ages including those living with dementia. Not everyone being supported 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. There were 28 people who were being supported with personal care. This assessment was undertaken to review any improvements from the last inspection completed October 2024 when it was rated requires improvement with 3 repeated breaches to regulation and enforcement action was taken. A condition to their registration was imposed to require evidence of governance to be sent to the CQC on a monthly basis. The provider was previously in breach of the legal regulations related to good governance, safe care and treatment and safeguarding. Significant improvements were noted at this assessment; this meant the provider was no longer in breach of these regulations and the service has been rated Good. The service now had a registered manager who had established effective governance procedures that provided clear oversight for the provider and management team. Concerns identified at the last inspection had been actioned with monthly reports submitted to the CQC to document. Audits were completed and included the review of care plans and risk assessments. Care plans were reviewed and updated regularly. Staff were clear on their roles and responsibilities, and this had improved staff accountability. Appropriate records had been completed to record concerns, complaints and incidents, showing these had been responded to appropriately. When necessary, referrals and advice was sought from other agencies and documented. Staff worked with other professionals promoting good outcomes for people. People were involved and consented to care and support provided. People were treated as individuals and encouraged to be independent. Staff were kind and compassionate and enjoyed working with people. Staff well-being was promoted by their managers. People and relatives knew how to raise concerns and were confident they were acted on. People received fair and equal care and support was provided in a tailored and flexible way. Staff and people benefited from an open and positive culture that had been developed by the registered manager. People were supported by a team of staff who knew them well and worked well together. Staff felt valued, undertook regular training and received supervision.
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Bluebird Care (Eastbourne & Wealden) was rated Requires Improvement overall and Inadequate for well-led, with breaches identified in safeguarding, safe care and treatment, consent, person-centred care, and good governance, leading to warning notices. Significant concerns included unreported safeguarding incidents, unsafe medicines management, out-of-date risk assessments and training, poor oversight of agency staff, and ineffective auditing under the previous provider.
Concerns (15)
criticalSafeguarding — “The registered manager failed to report safeguarding concerns to CQC or the local authority. Incident forms showed safeguarding incidents had occurred but not reported.”
criticalMedication management — “Medicines were not managed safely. Peoples electronic medicine administration records (EMARs) were not always up to date and gaps were found.”
criticalCare planning — “Care plans were not regularly reviewed to include relevant and up to date information. Initial assessments were carried, but changes to people's care were not updated.”
criticalGovernance — “The provider did not have a robust auditing system in place. Lack of effective oversight failed to identify the concerns we found during the inspection.”
criticalLeadership — “widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalIncident learning — “The registered manager failed to learn and improve from incidents. An incident occurred where an agency worker became unfit... led to similar events occurring on two other occasions.”
criticalStaff training — “Staff training had not been completed or kept up to date. Core topics such as safeguarding adults and health and safety were included in out of date training.”
criticalConsent / capacity — “Staff were not always following the principles of the MCA. Mental capacity assessments were carried out for people, but they were not always decision specific.”
moderateSupervision / appraisal — “supervisions had not been kept up to date, which included spot checks on staff.”
moderatePerson-centred care — “Care plans were not always person centred and included generic information... People were often referred to as 'the individual' rather than their own name.”
moderateStaffing levels — “There were not always enough employed staff to meet the needs of the service. Outside agencies were used to cover most live-in care calls.”
moderateStaff competency — “We spoke with the local district nurse involved with this person and they believed staff lacked confidence and training.”
moderateRecord keeping — “evidence and information of visits were not always recorded in people's care plans... care records were not updated so staff had access to relevant and up to date information.”
moderateEnd-of-life care — “there were no records of staff receiving training in this specialist area of care... End of life care plans were not always completed for people.”
moderateCommunication with families — “People and their relatives told us they hadn't been involved in the care planning for some time... 'Regular reviews don't happen.'”
Strengths
· Staff were recruited safely with DBS checks, references, identity and employment history verified
· People and relatives reported care calls were on time and consistent, with communication when changes occurred
· Staff used PPE correctly and people praised infection control practices
· People reported being treated with kindness, dignity and respect, and having independence promoted
· Staff supported people with dietary needs and offered choice at mealtimes
Quality-Statement breakdown (20)
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Assessing risk, safety monitoring and management; learning lessons when things go wrongNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Ensuring consent to care and treatment in line with law and guidance
Date of Assessment: 28 October to 11 November 2024. The service is a domiciliary care agency providing support to adults of all ages including those living with dementia. This assessment took place to follow up previous enforcement action we had taken. We found 3 on-going breaches in regulation in relation to safe care and treatment, safeguarding and governance. The service did not have robust quality assurance processes in place. Audits were lacking and those which had been completed, did not identify the concerns found during the assessment. Care plans contained conflicting or inaccurate information which placed people at risk of harm. Reviews had not been regularly completed and guidance to staff was not consistent. Risks had not always been documented in enough detail to ensure people were supported to minimise these. The service did not have a registered manager, and oversight from the provider was lacking. This led to the concerns identified at the previous inspection not being resolved. It was not always clear that appropriate referrals had been made to external bodies, such as the safeguarding team. We identified incidents which should have been reported and had not. Where referrals had been made to other professionals, such as district nurses, it was not always documented whether these visits had taken place, or what advice had been given for staff to follow. Although care plans contained conflicting information about care needs, they had been improved in relation to people’s personalised wishes. Consent was also clearly documented, and we saw evidence of staff delivering care in line with people’s wishes. Enough improvement had been made to meet the previous breaches in relation to need for consent and person-centred care. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/or appeals have been concluded.
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