Date of Assessment: 12 to 28 January 2026. This assessment was prompted by a review of the information we held about this service and when the service was last inspected. Bluebird Care (Merton) provides care and support to people living in their own homes, including individuals living with dementia. At the time of our assessment, 40 people were receiving support with personal care. An assessment was carried out at a specialist service registered to support autistic people and people with a learning disability. At the time of the visit, no individuals from these groups were using the service. However, because the registration covers this specialist client group, we evaluated the service in line with the principles of Right Support, Right Care, Right Culture. This was a comprehensive assessment, and we reviewed all quality statements across the 5 Safe to Well-led key questions, identifying areas of good practice. The provider acted promptly on learning and improvement needs, including those identified during the assessment. They took steps to strengthen risk-assessment recording, ensure appraisal actions were followed up, and improve the clarity and detail of mental capacity assessments. The provider had a positive safety culture with effective systems in place to monitor incidents and learn from them. Safeguarding procedures were well understood and adhered to by staff. People’s medicines were managed appropriately, infection risks were controlled, and people consistently received reliable support from skilled staff. The provider assessed and regularly reviewed people’s needs, involving them in care planning and using effective electronic systems to ensure care was delivered consistently. Staff worked well together and maintained strong communication with healthcare professionals, supporting people to live healthier lives and ensuring timely referrals. Staff knew people well, treated them as individuals, encouraged independence, and responded promptly to their needs. The provider also promoted staff wellbeing through recognition and reward initiatives, helping maintain a positive culture that supported the delivery of person-centred care. The provider delivered personalised care that adapted quickly to people’s changing needs, supported by consistent staffing and clear communication with people and their relatives. People felt listened to and received information in ways that suited them. Staff ensured equitable access to support, helped people stay connected with their communities, and supported future planning, including end-of-life care delivered with dignity. The service was well led, with approachable and inclusive leaders who promoted a positive culture based on respect, openness and continuous improvement. Effective governance systems ensured oversight of quality, and staff felt supported to speak up, develop their skills and work collaboratively. Feedback from people, relatives and professionals was used constructively, and the provider demonstrated ongoing improvement, supported by stable staffing and clear, consistent processes.
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Bluebird Care (Merton) improved from Requires Improvement to Good overall, having remedied a previous breach of Regulation 17 by strengthening governance, audit analysis and continuous learning systems. All five key questions were rated Good, with people and relatives consistently reporting safe, personalised and respectful care from well-trained staff.
Concerns (2)
moderateGovernance: “the provider had failed to ensure their governance systems were effectively operated to monitor the quality and safety of the home care service people received”
moderateIncident learning: “outcome of the providers satisfaction surveys and audits...were not always analysed to identify emerging trends and patterns”
Strengths
· People told us they felt safe with their regular carers and staff arrived on time with office notification when running late
· Electronic monitoring system logged exact visit times and automatically flagged late, early or missed calls
· Electronic medicines records flagged missed or late medicine administration, with no recording errors found
· Staff completed training relevant to their roles including dementia, learning disability, autism and mental health awareness
· Provider improved governance since last inspection, creating new monitoring posts, daily manager meetings and quarterly audits
Bluebird Care (Merton) was rated Requires Improvement overall at its August 2018 inspection, with a breach of Regulation 17 due to ineffective governance systems failing to identify trends, drive timely improvements, or ensure care plans and end-of-life discussions were consistently completed. The four remaining key questions were rated Good, with staff demonstrating strong caring practices, safeguarding knowledge, and person-centred care delivery.
Concerns (6)
criticalGovernance: “Audits conducted of incidents and complaints were not effective in identifying patterns and trends.”
moderateCare planning: “Care plans for people using the service were not always regularly reviewed.”
moderateEnd-of-life care: “People were not always supported to express their wishes in relation to end of life care preferences.”
moderateMissed or late visits: “No they're not on time – always about 10 to 15 minutes late...They've been consistently late since Christmas.”
moderateIncident learning: “the nature of the incident was not always clear and the quality assurance audits completed were not used to identify any patterns and trends.”
minorCommunication with families: “office staff were not consistent in communicating lateness to people.”
Strengths
· Comprehensive risk assessments and medicines administration records with detailed staff guidance on each person's medicines, side effects and dosage.
· Staff demonstrated strong safeguarding knowledge and appropriate recruitment checks including DBS, references and employment history were in place.
· Staff received regular supervision and appraisal and were knowledgeable about infection prevention and control.
· People felt staff were caring, respected their privacy and dignity, and supported their independence and cultural/religious preferences.
· Complaints were investigated and responded to appropriately and in a timely manner.
Quality-Statement breakdown (17)
safe: Risk assessments and medicines managementGood
safe: Safeguarding and recruitmentGood
safe: Infection controlGood
safe: Incident and accident managementGood
safe: Timeliness of visits and office communicationRequires improvement
Bluebird Care (Merton) received a Good rating across all five key questions at its January 2015 announced inspection, with 60 adults receiving personalised domiciliary care. The service demonstrated strong safeguarding, staff training, person-centred care planning, and responsive governance, with no regulatory breaches identified.
Strengths
· People felt safe and reported consistent, familiar carers visiting their homes.
· Robust safeguarding procedures with staff trained in recognising and reporting abuse.
· Safe recruitment checks including DBS, references, and right-to-work verification.
· Staff received regular training including dementia awareness and manual handling.
· Regular one-to-one supervision and spot checks every six to eight weeks.
Bluebird Care (Merton) received a Good rating across all five key questions at its announced inspection on 17 December 2015, with no regulatory breaches identified. The service demonstrated strong person-centred care, effective governance and quality assurance, and a well-supported workforce.
Strengths
· People reported feeling safe and happy with the care received from staff
· Robust safeguarding procedures in place with staff trained to recognise and report abuse
· Individual risk assessments and risk management plans developed collaboratively with people
· Safe medicines administration supported by monthly MAR audits and staff training
· Thorough recruitment checks including DBS, references, identity and right to work
effective: Mental Capacity Act compliance and consentGood
caring: Dignity, respect and person-centred approachGood
caring: Cultural and religious needsGood
caring: Promoting independenceGood
responsive: Care plan reviewsRequires improvement
responsive: End of life care planningRequires improvement
responsive: Personalised care and complaints handlingGood
well-led: Quality assurance and governanceRequires improvement
well-led: Leadership vision and staff engagementGood