This inspection took place on 23 April 2018 and was announced.

Bluebird Care (East Hertfordshire) is a domiciliary care service that provides care and support to people in their homes. Not everyone using Bluebird Care receives the regulated activity of personal care. CQC only inspects the service being received by people provided with personal care. At the time of our inspection, Bluebird Care was providing personal care to 66 people.

At our last inspection on 15 May 2017, the service was rated requires improvement with breaches of regulation 12, 13, 17 and 18 Of the HSCA 2008. This was in relation to assessing the risks to the health and safety of the service users, proper and safe management of medicines, staffing levels. Systems and processes were established but not operated effectively to prevent abuse of service users and assessments to monitor and mitigate the risks relating to the health and safety and welfare of service users were not effectively completed.

At this inspection, we found that the provider had taken the required action to address these shortfalls and were meeting the required standards. The service has been rated good. However further improvement was required in relation to ensuring people received their calls at their preferred times.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Potential risks to people’s health and well-being were identified by staff and they knew how to manage these effectively and protect people from harm. Risk assessments were completed to keep people safe.

People told us that they were involved with their care and staff always asked for their consent when providing care.

People and their relatives told us that their family members were kept safe and well cared for when they were being supported by the service. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse.

Recruitment processes were robust and ensured staff employed to deliver care and support for people were of a good character and suitable to meet people`s needs safely.

People told us staff supported them to take their medicines. Staff were trained in safe administration of medicine practices and had their competency regularly observed.

People and their relatives were very complimentary about the abilities and experience of the staff that provided care and support. Staff received training and regular updates to ensure they were up to date with their knowledge and best practice guidance.

Staff supported people to stay safe in their homes, and people were supported to maintain their health and well- being. Staff developed appropriate positive and caring relationships with the people they supported and their families, and feedback from people was consistently positive about the service they received.

People and their relatives where appropriate were involved in the planning of the care and support people received. People's personal information was stored securely and confidentiality was maintained.

People told us that staff provided care and support in a way that promoted their dignity and respected their privacy. Staff were knowledgeable about people`s preferred routines and delivered care that was individualised to the person they were supporting.

People told us they felt that staff listened to them and responded to them in a positive way. People and their relatives knew how to raise concerns and they were confident that the manager would take appropriate action to address any concerns in a timely way.

People were asked to provide feedback about the service they received regu

The inspection of the office location took place on 15 May 2017. On 18 and 19 May 2017 we contacted people and relatives for feedback about the service they received. This was the first inspection under the new owners.

Bluebird Care (East Hertfordshire), provides personal care and support to people in their own homes. At the time of the inspection 80 people were receiving support with personal care. We gave the provider 48 hours' notice that we would be visiting the office to make sure that the appropriate people would be there to assist us with our inspection.

During the inspection we spoke with nine people who were being supported by the service, seven relatives, six members of staff and the provider. We looked at care plans relating to three people who used the service, three staff files and other information which related to the overall monitoring of the service.

The registered manager had left the service and the provider was fulfilling this role. The recruitment process to employ a registered manager had been started by the provider. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

Medicines were not always managed safely to ensure people were safe.

There was an electronic call monitoring system in place that was audited regularly to ensure people received their care calls at the agreed time. However, people did not always receive their calls on time and we found that people did not always know which staff member was coming to support them.

People who were being supported by the service and their relatives were positive about the skills, experience and abilities of staff who worked in people’s homes. Staff told us they had training and regular updates which helped them develop their knowledge and skills to support people effectively. Staff had regular supervisions and told us they felt supported. However staff had not received appropriate training on equipment used in one person’s home.

People felt safe and were happy with the care and support they received in their homes. Staff had received training in how to safeguard people from the risk of abuse and knew how to report concerns. However, safeguarding concerns raised by staff and documented in the accident and incident logs were not referred to the local authority to make sure that they were properly investigated.

Recruitment practices were safe and effective to help ensure that all staff were suitable to work with people in their own homes.

Care was provided in a way that promoted people’s dignity and respected their privacy. People received personalised care and support that met their needs. Staff were knowledgeable about people’s background histories, preferences, routines and personal circumstances.

Staff obtained people’s consent before providing personal care and support, which they did in a kind and compassionate way. People and relative’s we spoke with were positive about the staff and the way in which they delivered the care.

People were involved in the planning and reviews of the care and support provided. People’s personal information was securely maintained within the office.

When we last inspected the service on 05 March 2015 we found them to not be meeting the required standards in relation to regulations: 11, 12, 13, 15, 16, 18 and 19. At this inspection we found that they were meeting most of the required standards.

This inspection took place on the 13 August 2015 and was announced. We told the provider two days before our visit that we would be coming to make sure that relevant people would be available to assist us with the inspection. As part of the inspection process we telephoned staff and people who used the service to obtain feedback about their experience of the service.

Bluebird Care (East Hertfordshire), provides personal care and support to people in their own homes. At the time of our inspection we were told there were 63 people who used the service.

Care plans were personalised and included information about people’s life history and interests. People’s individual needs were assessed and were specific to people as individuals. Staff were knowledgeable about how to manage people’s individual needs and assisted people to take part in appropriate daily activities. However not all care plans had been updated with relevant information for people and staff.

People felt safe and staff were knowledgeable about how to protect people from the risk of abuse, accidents and incidents were monitored to ensure the appropriate action had been taken. There were regular quality assurance checks carried out to assess and improve the quality of the service. However, where audits for medicines had been done and problems found. These were not always investigated properly and remedial action were not in place.

Care plans were being updated. However not all care plans had been updated to provide good guidance to staff and make the care plan person centred.

The provider used safe recruitment practices. Staff were aware of their responsibility to protect people from harm or abuse.

Staff received regular training and supervisions. Staff had appropriate training to meet people’s individual needs. There were meetings held for staff to share information.

The staff were knowledgeable about the Mental Capacity Act (MCA) 2005. Staff also understood the importance of giving people as much choice and freedom as possible.

People told us that staff where required supported them with food and drink and staff had access to accurate and up to date information to help them meet people’s needs.

People and relatives told us, staff were kind and people appreciated the positive relationships they had with staff. People using the service were complimentary about the staff providing the service. Choices were given to people at all times and people’s privacy and dignity were respected and all confidential information about them was held securely.

The service was well led by a manager who promoted a fair and open culture. They encouraged staff to take responsibility and supported their professional development. The manager also had a support structure in place. There were regular supervisions and appraisals to support staff.