This comprehensive inspection took place on 11 and 12 June 2018 and was announced. The provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure the registered manager would be available for the inspection. It also allowed us to arrange to telephone and visit people receiving a service in their own homes. At the last inspection in September 2015 Bluebird Exeter was rated Good. At this inspection we found the service to be Outstanding overall.

Bluebird Care Exeter is a domiciliary care agency. It provides personal care to older adults and younger disabled adults in Exeter, and surrounding areas. The provider is W & S Flint Services Limited, a husband and wife team who run three branches of the agency in the Devon area, Exeter, East Devon and Exmouth. At the time of the inspection the Exeter branch provided personal care to about 100 people and employed 44 staff, known as Devon Bluebirds, supported by a team of nine office staff.

The inspection was carried out by an adult social care inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses services for older people.

The service had a registered manager. 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 and relatives praised staff as exceptionally caring and compassionate. People were partners in their care. Their views, experience and contributions were sought and valued. The agency had a strong, visible person centred culture. People were at the heart of everything they did, they were made to feel valued and that they mattered. The service went that extra mile to exceed people's expectations of the service. For example, the service was building on their wellbeing agenda. Staff, led by a ‘Wellbeing’ Ambassador’ organised a monthly wellbeing programme to get people out socialising, having new experiences and having some exercise. Feedback showed this significantly improved people's physical and emotional wellbeing and reduced their risk of isolation. One relative who had been struggling to cope said, “[Person’s name] went to armchair yoga. They came back smiling from ear to ear, we had something to talk about and I was able to have time to myself.” The service was also working with Age UK venues so people using Bluebird could meet other people and promote social inclusion. A new partnership with a local charity was offering discreet personal care, complimentary treatments, on-site library and laundry as a ‘Wellbeing Hub’. They envisioned getting away from the traditional ‘elderly day centre’ service and offering an empowering, inclusive experience for young and old focussed on a preventative, trusting agenda. Intergenerational experiences were promoted where people could enjoy spending quality time, sharing their skills and lives with school children in a meaningful way.

People were supported in innovative ways, to be proactively involved in making decisions about their care, treatment and support. For example, the provider undertook a 'Talk Care' campaign to promote a conversation about care that was positive, informative, open-minded and inclusive. They made a series of informative short videos of conversations with health and social care representatives such as the local hospice director of nursing and GPs, to highlight key things people needed to know about care. These included the importance of planning ahead for care, options for care, and simple explanations about lasting power of attorney, benefits and paying for care. These were posted on social media which enabled people and families to be better informed about care options and what

The inspection was announced and took place on 22 and 23 September 2015. Bluebird Care Exeter domiciliary care agency provides personal care and support to older people in their own homes in Exeter and the surrounding area. They also provide a live-in service . At the time of this inspection the agency was providing a personal care service to 87 people.

During our inspection the registered manager was present. 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 feedback we received from people was positive. Those people who used the service expressed satisfaction and spoke highly of the registered manager and staff. For example, comments included, “ The carers are very good. I can’t fault them”, “ The people they employ are nice and it’s very reassuring” and “There’s nothing wrong with this organisation at all. They’re all good. They come first thing, wash and dress me, give me my medicine and breakfast, then the same one will come back again at 11.30. They’ve been looking after me for five years and I’m really, really pleased.”

The service provided good support for people during end of life care. There was a specialist end of life nurse who co-ordinated care planning for those requiring end of life care. This included separate end of life care plans devised to use specialist skills when providing this care. The service focussed on providing community support and maintaining people’s independence at home. They also offered subsidised outings for people so they could enjoy trips out with care staff outside of allocated care provision. Other initiatives included introducing other opportunities for people receiving care using staff skills outside of the care sector such as hairdressing and massage therapies.

There was outstanding leadership and support from a well organised management team and co-ordinated office arrangement. This valued staff providing them with clear career pathways, training and rewards to encourage a stable and skilled staff team. Staff morale was good and staff felt proud to work for Bluebird Care. Bluebird Care had won various care awards and had set up a community grant where local charity and voluntary organisations could apply and receive monies to support their projects such as the East Devon Parkinson’s Support Group. The agency then matched people using the service to charities that could offer additional support if people wanted. There was ongoing investment in systems to further improve the service such as visit monitoring systems and leadership courses.

The safety of people who used the service was taken seriously and the registered manager and staff were well aware of their responsibility to protect people’s health and wellbeing. There were systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed. Where there were issues the service responded well, investigated and addressed them in line with their policies and procedures and drove forward improvements for the future.

The registered manager ensured that staff had a full understanding of people’s care needs and had the skills and knowledge to meet them. People received consistent support from care workers who knew them well. Some people commented that they sometimes had not met a care worker before who was visiting them although a weekly rota informed people which care worker would be coming. However, the service endeavoured to provide regular care workers where possible. Staff told us if they had not met someone before, which was not often, a supervisor would come out and introduce them if they asked. This generally happened when care workers were covering sickness or holidays.

People felt safe and secure when receiving care. They all trusted the care workers to have the skills to keep them safe. People had positive relationships with their care workers and were confident in the service. There was a strong emphasis on key principles of care such as compassion, respect and dignity. People spoke highly of the quality of care provided by the care workers. No-one had any complaints about any of the care currently provided.

People who used the service felt they were treated with kindness and said their privacy and dignity was always respected. People said if they preferred female care workers then that happened, for example. Everyone said their care workers treated them respectfully and kindly and took extra time to make sure their needs were met. One person said, “I did have a regular girl who was fantastic but she’s gone and now I’ve got [another care worker] who’ll bring the milk in and listen out for me in case I call out and need my pillows propping up.” People received a service that was based on their personal needs and wishes. Care plans were detailed and staff felt they had enough information to meet people’s needs, including up to date information recorded in daily records. Changes in people’s needs were identified and their care package amended to meet their changing needs. The service was flexible and responded positively to people’s requests where possible. People who used the service felt able to make requests and express their opinions and views. For example, one person said “I needed someone to came at a different time because I had to go to hospital and they slotted me in.” Another person said, “ I think [a supervisor] is coming next week as they come and reassess my needs. When I’ve asked for extra hours, they’ve been there and really helped me.”

The registered manager was very committed to continuous improvement and feedback from people, whether positive or negative, was used as an opportunity for improvement. The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service. The registered manager demonstrated strong values and a desire to learn about and implement best practice throughout the service. There was an organised office team with clear roles and staff were very happy working for Bluebird Exeter. They said they were fully supported and valued by the registered manager, provider and the office team. There was a programme of training, clear career progression opportunities and one to one supervision that enabled them to provide a good quality service to people. Staff consistently spoke about how they could provide good care and how much better Bluebird Exeter was to work for than other agencies they had worked for in the past.