We carried out an announced inspection of the service on 13 November 2018. Butterflies Homecare is a domiciliary care agency. It provides personal care to people living in their own homes. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There were two registered managers in post who shared the role. 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. In this report when we speak about both the company and the registered manager we refer to them as being, ‘the registered persons’.

This was the second comprehensive inspection for this location. The service was previously rated overall ‘Good’. At this inspection the service was rated as overall ‘Requires Improvement’.

A process for checking the quality of care people received was in place. However these checks were not consistently documented.

There were enough staff on duty. People told us that they received person-centred care according to their wishes. Staff had received training and a plan was in place, however a system for providing core training and updates was not in place. Staff had received regular support but had not received supervision and appraisal.

There were processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Most risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their independence was respected. Medicines were managed safely. There were sufficient staff to safely meet people’s needs. Support was provided at the times people expected. Background checks had not been consistently completed before all new staff had been appointed.

Arrangements to prevent and control infection were in place.

Staff had not been supported to deliver care in line with current best practice guidance. Records were not consistently clear about people’s ability to consent to care.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive ways possible. People were helped to eat and drink enough to maintain a balanced diet. People were supported to access healthcare services so that they received on-going healthcare support.

People were treated with kindness, respect and compassion. They had also been supported to express their views and be actively involved in making decisions about their care. In addition, confidential information was kept private.

Information was provided to people in an accessible manner. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to improve the quality of care.

There was a registered manager who promoted a positive culture in the service that was focused upon achieving good outcomes for people. Staff had been helped to understand their responsibilities and to speak out if they had any concerns. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

This inspection took place on 5 October 2015 and was announced. Butterflies Care and Support Lincoln provides personal care in people’s homes to adults of all ages with a range of health care needs. There were 6 people using the service at the time of the inspection

At the time of our inspection 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 said they felt safe with the care they received. Arrangements were in place to ensure that people were protected.

People had risk assessments. Where risks had been identified there were plans to manage them effectively. Staff understood risks to people and followed guidance.

There was usually sufficient staff to provide people’s care. At the time of inspection the provider had two registered managers in post and two care staff. Recruitment checks ensured that people were protected from the risk of being cared for by unsuitable staff.

People’s care was provided by staff who were sufficiently trained and supported. Staff had received an induction when they started employment with the provider. Systems were in place to support staff and monitor their work.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA), where people lacked the capacity to consent to their care relevant guidance had been followed. People told us staff treated them with dignity and respect. People’s needs in relation to nutrition and hydration were documented. Care plans were personalised and people were supported to maintain their choices. Care plans were updated.

A system was in place to manage complaints however the provider had not received any complaints.

The majority of people told us there were good communications from the service office and they knew who to speak with. People’s feedback on the service was sought. Staff were encouraged to speak with the registered managers about any concerns they had about people’s care.

The manager informed us they had started to provide personal care for people in their own homes on 10 January 2014. At the time of our inspection care was provided by the two registered manager's who ran the service. They told us support was provided for six people in the community. Two of the people received help with their personal care needs.

Before we undertook our inspection visit we spoke with one person who used the service and a relative of another person who received personal support.

One person said, “I have no complaints. They are really good.” The person also told us, “They are well organised and I feel they have never let me down with my care.” The relative we spoke with said, “XXX gets help with washing and stuff like that. They are very reliable and I think they are the top ones in my book.”

Care records included an individual support plan. The plans were written in a way that promoted each person’s independence and respected their privacy and dignity.

We saw people’s needs were assessed and individual support plans were developed. Risk assessments were undertaken and measures put in place to minimise any risks identified.

Procedures were in place for safeguarding vulnerable adults. Staff knew how to respond if they suspected abuse.

We found the service was well led and systems were in place to assess and monitor the quality of service provision.