Dial House

The registered provider of the service is V&J Billington Limited. The provider operates another branch of Bluebird Care in Wiltshire.

The inspection took place on 22 November 2017 and was announced.

There was a registered manager in place at the time of our inspection. 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.

People felt safe because staff understood their needs and any risks involved in their care. Relatives were confident their family members were safe when receiving their care and said staff made safety a high priority. They told us staff had highlighted any areas in which their family members may be at risk and implemented measures to reduce these risks.

There were sufficient numbers of trained staff employed to meet the agency's care commitments, including covering leave and sickness. The agency's monitoring systems helped ensure that people received a safe and reliable service.

There was a contingency plan in place to ensure people would continue to receive their care in the event of an emergency. People who would be most at risk if they did not receive their visits were prioritised to ensure that vulnerable people were protected. Accidents and incidents were recorded and reviewed to identify any actions that could be implemented to prevent a recurrence.

People were protected by the provider's recruitment procedures. The provider carried out checks to ensure they employed only suitable staff. Staff attended safeguarding training and understood their responsibilities in terms of recognising and reporting abuse. Staff had reported concerns when they believed people's safety to be at risk, which had resulted in positive outcomes for people.

Where people's care involved support with medicines, this was managed safely. Staff attended training in infection prevention and control and helped people keep their homes clean and hygienic. Staff wore appropriate personal protective equipment when providing personal care.

People's needs were assessed before they used the service to ensure the agency could provide the care they

needed. Rotas were planned to ensure people received their care from a small team of staff, all of whom had a good knowledge of their needs. People told us new staff were introduced to them before they provided their care. They said their care workers always stayed for the allocated length of their visits and had enough time to provide all the support detailed in their care plans.

Staff received the induction, training and support they needed to do their jobs. New staff attended an induction which included shadowing colleagues to observe how people preferred their care to be provided. Staff received regular refresher training and were supported through regular contact with their managers. This enabled them to seek advice when they needed it and to discuss their training and development needs.

People's care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff had received training on the MCA and understood how it applied in their work. People had recorded their consent to their care and told us staff asked for their consent on a day-to-day basis.

People told us staff prepared meals they enjoyed and knew their likes and dislikes. Relatives said staff knew their family member's preferences about the food they ate and any dietary restrictions. People's dietary requirements were discussed during their assessment and any needs related to nutrition and hydration recorded in their care plans. Staff attended training in nutrition and hydration in their induction and followed professional guidance where necessary to meet people's needs.

Staff monitored people's healthcare needs and responded appropriately if people became unwell. People's care workers supported them to maintain good health and liaised with healthcare professionals on their behalf if they wished. Relatives said staff were observant of any changes in their family member's health and highlighted any concerns they had.

People were supported by kind and caring staff. People had positive relationships with their care workers and enjoyed their company. Relatives said staff treated their family members with respect and provided care and support in a sensitive way. Staff supported people to maintain their independence and people were encouraged to be involved in planning their care. People's religious and cultural needs were known and respected by staff.

People received a service that was responsive to their individual needs. Each person had an individual care plan drawn up from their initial assessment which reflected their needs and preferences about their care. Care plans provided detailed guidance for staff and were reviewed regularly to ensure they continued to reflect people's needs.

People knew how to complain if they were dissatisfied and were confident their concerns would be taken seriously. Relatives who had complained were satisfied with the way their concerns had been investigated and resolved. The registered manager had taken appropriate action following complaints, using them as opportunities to improve the service people received.

The service was managed effectively, which ensured people received safe and well-planned care. People and their relatives told us that communication with the office team was good. They said they could always contact the office if they needed to and were satisfied with the response they received to queries or concerns. The provider sought feedback from people who used the service, their relatives and staff through annual surveys. Where people made suggestions for improvements, these were acted upon.

Staff told us the registered manager provided good leadership for the service and welcomed their ideas for

improvements. They said management support was available to them at all times and that they could seek advice when they needed it. Staff also valued the support provided by their colleagues and said they worked well together as a team to meet people's needs. Team meetings took place regularly and were used to reinforce key messages about people's care provision.

The provider's monitoring systems helped ensure people received consistently good care that met their needs. The office team had access to real time information about visit times and care provision, which ensured they could respond quickly to any problems that occurred. Care staff supervisors regularly observed staff practice at spot checks. Key areas of the service were checked regularly through audits carried out by the office team and the Bluebird Care quality manager.

The registered manager and staff maintained effective working relationships with other professionals involved in people's care, including district nurses and the local authority. Records relating to people's care were accurate, up to date and stored appropriately. Staff had received record-keeping training and the quality of recording was monitored by the office team to ensure records were maintained to an appropriate standard. The registered manager had notified CQC and other relevant agencies of significant events when required.

The five questions we ask about services and what we found