Bluebird Care (Hook) provides domiciliary care services to people living at home. They currently provide personal care to 44 people. Each person received a variety of care hours from the agency, depending on their level of need.

The inspection was conducted between 5 January and 16 January 2016 and was announced. We gave the provider 48 hours’ notice of our inspection as it was a domiciliary care service and we needed to be sure key staff members would be available.

There was a registered manager in place. 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 and trusted the staff who supported them. Staff understood their safeguarding responsibilities and knew how to prevent, identify and report abuse. Staff recruitment practices were robust and helped ensure only suitable staff were employed. There were enough staff to support people; they were reliable and arrived on time.

Risks relating to the environment or the health and support needs of people were managed effectively and respected people’s independence. There were also systems in place, including a lone worker policy, to help ensure staff worked in a safe way.

Medicines were given safely by staff who were suitably trained and competent. There were plans in place to deal with foreseeable emergencies and all staff had been trained to deliver basic life support.

Staff were knowledgeable and received appropriate training to support people. They completed a comprehensive induction programme and the provider was focused on continually developing staff skills. Staff were appropriately supported in their work by supervisors and managers.

Staff followed legislation designed to protect people’s rights. Staff supported people in the least restrictive way possible and the policies and procedures of the service supported this practice.

Most people’s meals were prepared by family members, but staff encouraged them to maintain a healthy, balanced diet and took action when people were at risk of weight loss. Staff monitored people’s health and supported them to access healthcare services when needed.

The service delivered continuity of care to people by working in small teams that supported people within a specific area. People spoke positively about the relationships they had built with staff, which they valued and appreciated.

Staff used a variety of methods to communicate with people, including those living with dementia. People described staff as “wonderful”, “friendly” and “kind”. Staff were discreet and unobtrusive when working in people’s homes; they protected people’s privacy and involved them in decisions about their care.

The provider was committed to providing high quality care that put people at the heart of the service. People consistently told us they received highly personalised care and support that met their individual needs.

People’s experiences of receiving care were enriched because staff used the latest technology to ensure they were fully up to date with the person’s care needs before they arrived to provide care.

Staff worked proactively with healthcare professionals to achieve the best outcomes for people and responded promptly when people’s needs changed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. They were encouraged to remain as independent as possible.

The provider sought and acted on feedback from people to improve the service. There was a suitable complaints policy in place and people knew how to complain.

People consistently told us the service was well-led and said they would recommend it to others. Staff were motivated and enjoyed working at the s

At our previous inspection on 1 May 2014 we identified concerns that the provider was not operating the systems they had in place to monitor the quality of the care provided robustly, to ensure that they could identify areas that required improvement and take the necessary action.

The provider told us in their action plan of 8 July 2014 that they would have addressed our concerns by 30 September 2014. During this inspection, we saw evidence that the provider had taken positive action and ensured that they monitored the risk and quality of the service effectively.

We found since our last inspection the provider had reviewed their routine quality and risk monitoring systems and made adjustments to ensure they were robust. We found these systems had been implemented consistently to ensure the manager was monitoring the quality of the service effectively. This included the monitoring of routine care reviews, staff supervision, safety incidents and the duration of care visits. Where concerns had been identified we found that the provider had taken action to make the required improvements.

Bluebird Care (Hook) is a domiciliary care agency offering a service to people with a diverse range of care and support needs in their own homes. At the time of our inspection there were 80 people who use the agency. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People received the care and support they required to meet their needs and keep them safe. Risk assessments were in place to ensure care workers knew how to manage people’s individual risks. Staff had received appropriate training to deliver people’s care safely. There was no robust process for reviewing all the accidents, incidents, spot checks and audits across the agency, to help identify any themes, trends or lessons to be learnt. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. Care workers could describe how they would support people in line with their care plans and relevant professional guidance. People were assured that their care would be delivered. People and relatives confirmed that care visits were never missed.

Is the service caring?

Relatives and people who use the service consistently spoke of care workers treating them with consideration and kindness. One relative we spoke with told us ‘‘Staff are very attentive when they support my husband. When his morning routine is done you will often hear them chatting with him in the kitchen. They always keep an eye out so that he does not fall and are friendly and polite with both of us’’. Treating all people with dignity and respect formed part of the agency’s core values in service delivery. These values had been affirmed during care worker’s induction training.

Is the service responsive?

The agency responded appropriately to people’s changing needs. Records showed that care workers informed senior staff of any changes in a timely manner. The agency liaised with medical and other professionals to ensure people’s changing needs were met. People and relatives told us that they knew how to raise concerns with the agency and when they had done so their concerns had been investigated and resolved to their satisfaction.

Is the service well-led?

The provider had some systems in place to monitor the risk and quality of the service provided. Though they learned from incidents and complaints, routine monitoring systems had not always been implemented robustly to ensure that the provider could identify areas that required improvement and take action. People and relatives consistently told us that they had not had a regular review or an opportunity to formally discuss the quality of the care they received. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We spoke with five people who either used the service or represented someone who received a service and they told us they were happy with the care provided. One person said “my carer is wonderful she is more like a friend to me”. Another told us that they “have no complaints. Staff are very caring and cannot do enough for me”. Another said “The care staff are absolutely excellent. The office staff are really helpful too”. A relative told us “I’m pretty impressed. The staff are very clued up about dementia”.

The people we spoke with told us that care staff were always on time and always stayed for the right amount of time. One person told us that if staff were going to be late then they would telephone and let them know when to expect them. Staff told us that they always followed care plans which they felt contained adequate information.

The manager and staff were aware of their responsibilities regarding protecting people from abuse. People we spoke with told us that they had confidence in the care workers and the care they provided. They also said that they felt safe using the service. People we spoke with knew how to raise a complaint. One person said they would speak to their daughter in the first instance. Staff told us that they felt supported and the manager had processes in place to ensure that people were assisted and cared for by trained and experienced staff.