ReadyCQC, a weekly field guide to CQC home-care regulation

Inspection report · 2022-02-18

Framework: KLOE · 16 pages · 97 KB · PDF

Requires improvement

safe: Requires improvementeffective: Requires improvementcaring: Goodresponsive: Requires improvementwell-led: Requires improvement

Bluebird Care (Bradford North) was rated Requires Improvement overall following a November–December 2019 inspection, with breaches of Regulations 12 and 17 identified around unsafe medicines management, inadequate risk assessment, and ineffective governance and quality assurance systems. Caring was rated Good, with people reporting kind, respectful staff, but significant concerns remained across safe, effective, responsive and well-led domains.

Concerns (9)

criticalMedication management: “People did not always get their medicines as prescribed. One person was prescribed a medicine which should have been administered with a four-hour gap between doses. However, the electronic records showed this was not the case.”
criticalIncident learning: “Individual accident and incident reports were not monitored by the management team to determine if there were any lessons to be learned. This meant when things went wrong there was no evidence of learning.”
criticalGovernance: “Electronic audits were not recent. For example, the last medication audit was completed in December 2017. Care plans and care notes were not audited.”
criticalPerson-centred care: “Risks to people were not appropriately assessed or managed which placed them at risk of harm. For example, one person's skin care plan stated they had previously suffered a pressure sore. However, there was no risk assessment.”
moderateCare planning: “People's care plans were basic and lacked guidance around how to support people, for example, one person's plan stated they needed help with washing and dressing but there was no detail about how support should be provided.”
moderateMissed or late visits: “People's agreed visit times were inconsistent and staff arrived at times that were not always suitable to the person. For example, some people received medicines at the wrong time.”
moderateRecord keeping: “The care system was not set up to accurately record which staff had written and updated people's care plans and assessments. One person's name was used against all documentation.”
moderateLeadership: “Members of the management team did not fully understand how to operate the electronic care system which meant records were not set up currently and data was not checked.”
minorEnd-of-life care: “There was no information in people's care records to show how the service had explored people's preferences and choices in relation to end of life care.”

Strengths

· Staff were recruited safely with appropriate checks carried out to ensure suitability.
· People told us staff were kind, caring and treated them with respect.
· Staff completed induction and annual refresher training and received annual appraisals and quarterly supervision sessions.
· Systems were in place to prevent and control infection, with staff completing training and having access to PPE.
· People were supported to have maximum choice and control of their lives in the least restrictive way possible.

Quality-Statement breakdown (20)

safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
effective: Staff support; induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement

Inspection report · 2021-10-30

Framework: KLOE · 19 pages · 91 KB · PDF

Requires improvement

safe: Requires improvementeffective: Goodcaring: Goodresponsive: Requires improvementwell-led: Requires improvement

Bluebird Care (Bradford North) was rated Requires Improvement overall following a January 2016 inspection, with two regulatory breaches identified: unsafe medicines management (Regulation 12) and failure to maintain accurate records and monitor service quality (Regulation 17). While people reported kind, caring and reliable staff and the service performed well on effectiveness and caring, significant gaps in medication administration records, outdated care plans and absent governance systems undermined safe and well-led care.

Concerns (8)

criticalMedication management: “In four people's records we found gaps on the MARs which meant there was no way of knowing if the medication had been given as prescribed.”
criticalRecord keeping: “Some care records were significantly out of date and did not reflect people's current needs.”
criticalGovernance: “There were no systems in place to review daily records of care and medication records once they were returned to the office.”
moderateCare planning: “The person's care plans were not up to date. A message had been sent to care staff on 23 December 2015 which stated the person was staying in bed until lunch time.”
moderateIncident learning: “More minor incidents were not consistently recorded. We found examples of more minor incidents and complaints which should have been logged.”
moderateComplaints handling: “There was no complaints log in place detailing the number of complaints received within the last year, which made monitoring for any trends or themes difficult.”
moderateSafeguarding: “We found one example where a concern identified by staff was not recognised as safeguarding by the service... it had not been reported to the local authority safeguarding team.”
minorSupervision / appraisal: “One new staff member had six checks done since October but another had not had any who started at the similar time.”

Strengths

· People consistently reported feeling safe, treated with dignity and respect, and cared for by kind and caring staff.
· Staff received face-to-face training from a recognised provider including the Care Certificate on induction, with regular refresher training.
· Safe recruitment procedures were in place including DBS checks and references.
· Service proactively reduced care packages to match available staffing, demonstrating responsible capacity management.
· Service liaised effectively with external health professionals such as GPs and district nurses.

Quality-Statement breakdown (19)

safe: Medicines are managed safelyRequires improvement
safe: Safeguarding systems and processesRequires improvement
safe: Staffing levels and safe recruitmentGood
safe: Risk assessments and environmental safetyRequires improvement
effective: Staff training and competencyGood
effective: Staff supervision and appraisalGood
effective: Mental Capacity Act complianceGood
effective: Nutrition and hydration supportGood

Inspection report · 2021-01-31

Framework: KLOE · 17 pages · 267 KB · PDF

Bluebird Care (Bradford North) delivered broadly positive care to 102 people, with good safeguarding practices, person-centred care planning, and dignified staff conduct evidenced throughout. Key weaknesses centred on inadequate monitoring and communication of late calls, absence of central incident-trend analysis, and incomplete roll-out of specialist training in dementia and end of life care.

Concerns (5)

moderateMissed or late visits: “When they are late the office said they would contact me and let me know. But this isn't happening I have to make numerous calls to find out when they are coming.”
moderateIncident learning: “There was no analysis of late calls to look for themes and trends, and late calls were not identified if staff failed to ring the office.”
moderateGovernance: “There also was no central collation or analysis of these incidents which meant that the organisation may have missed opportunities to understand the frequency of these incidents.”
moderateStaff training: “some staff had received specialist training in some subjects such as dementia care or end of life care, however most staff had not”
minorComplaints handling: “73% of people were happy with the way the agency and its staff respond well to any complaints or concerns raises, and 25% disagreed that the agency responded well to complaints”

Strengths

· Prior breach of Regulation 23 remedied: all new starters now complete an accredited five-day induction based on Skills for Care Standards before working in the community
· 100% of questionnaire respondents felt safe from abuse and the Local Authority Safeguarding Team had no concerns about the provider
· Detailed, person-centred care plans with risk assessments held both in people's homes and the office, enabling consistent staff awareness
· Staff demonstrated sound understanding of the Mental Capacity Act and dignity and respect practices, verified through spot checks
· Strong multi-disciplinary working with health professionals; 100% of surveyed healthcare professionals said they would recommend the service

Inspection reports (5)