Bluebird Care (Stockport)

During our assessment of this key question, we found concerns around staff recruitment, gaps in staff training and supervision and the quality of care plan risk assessments. This has resulted in breaches of regulations related to safe care and treatment and staffing. You can find more details of our concerns in the evidence category findings below. There were systems in place to ensure people were safe and protected from avoidable harm, however not all of the processes were effective, and we found gaps in people's risk assessments. The safeguarding policy was not up to date. Staff training in safeguarding, moving and handling and medicines administration was not always up to date. People received their medicines as required, however, information on how to apply creams was not identified. There were enough staff to meet people's needs, however, staff did not always attend people's support calls as scheduled. Staff supervision was not planned and frequent. Staff recruitment was not always robust. Staff knew how to keep people safe, and people told us they felt safe with the staff who supported them. Following the on-site inspection, the provider told us about a number of improvements made to ensure people’s safety.

During our assessment of this key question, we found concerns around the quality and content of people's care records. You can find more details of our concerns in the evidence category findings below. The systems and processes in place did not always ensure people’s care plans were up to date which increased the risks to people of receiving inconsistent support. People's care records were not comprehensive and did not clearly identify if a pre-assessment had taken place, prior to people first receiving care from the provider. People told us they were involved in the assessment of their needs, however, one relative felt although care was reviewed, staff did not always follow up on any changes made to the support required. Care plans did not always identify if people had been involved in discussions about their care needs. The provider could not demonstrate how people's care was monitored and there was minimal evidence of lessons being learned and deficits in service provision being identified. Staff recognised the importance of understanding people's views and opinions. There was a process in place for staff to receive updates about people's care and support needs. Following the on-site inspection, the provider told us about a number of improvements made to ensure the service was more effective.

Staff respected people's privacy dignity and were described by people and relatives as being kind and caring. Staff understood the importance of delivering good quality care to people. Processes were in place to support the delivery of compassionate care, however, these required reviewing. Staff treated people as individuals and relatives felt staff knew people well. Staff were aware of different people's communication needs. Processes to support people’s choice and independence had not been regularly reviewed. People’s care plans were not consistently person-centred, however, care records completed by staff were detailed. Staff meetings, supervision and appraisal were not planned, regular and frequent. Staff were positive about changes made since our last inspection; however, it was unclear how any feedback provided by staff had been listened to, understood and acted upon by the provider. Processes were in place to support staff wellbeing, however, these required reviewing. Following the on-site inspection, the provider told us about a number of improvements made to staff support processes.

During our assessment of this key question, we found concerns around processes and procedures in place to support the delivery of person-centred care. The provider had not done everything reasonably practicable to ensure people received person-centred care, which was appropriate, and reflected their personal preferences. You can find more details of our concerns in the evidence category findings below. Staff training was not always up to date. There was no evidence of people's needs being assessed by the provider before they started receiving care, including people's communication needs, and no evidence of care plans being regularly reviewed. However, people and relatives told us they felt staff provided people with personalised care, which most people and relatives felt was meeting their needs. Staff told us they used technology to support people's communication needs. Most people told us they knew how to provide feedback, however, feedback provided was not always followed up by staff and there was no evidence of provider oversight regarding feedback provided, including complaints made. Staff told us knew who to contact if they had any concerns. Following the on-site inspection, the provider told us about a number of improvements made to processes to support person-centred care.

During our assessment of this key question we found the provider’s governance systems were not always effective, did not drive improvement and did not identify all of the shortfalls we found during this assessment. This has resulted in a breach of regulation relating to good governance. You can find more details of our concerns in the evidence category findings below. There was a lack of provider oversight in measuring the quality of care and support provided to people, for example there was a lack of provider quality assurance checks and audits. People’s risks were not always appropriately assessed, monitored and reviewed. There was some evidence of feedback being sought from people, however the gathering of feedback was mainly triggered by our assessment. There was no evidence of people’s feedback being continually sought, monitored and analysed, and no evidence of any learning or actions identified and carried out as a result. There was very little evidence of people, relatives, staff and partners being involved in developing the vision and values of the service. There was no registered manager in post and the provider was not consistently measuring the quality of care delivered to people. Staff meetings did not take place at regular and planned intervals, and staff supervision was not consistently completed. The provider had not ensured staff received the appropriate training to enable them to support people safely. Care plans did not contain all the necessary information to ensure people's needs were safely met. Processes in place to support learning and continuous improvement were not effective. Following our on-site assessment the provider told us about the steps they had taken to address the identified areas of improvement.