Butterflies Care & Support Ltd

Butterflies C\re and Support Ltd is a care agency. The service supports people receiving personal care in their own home. At the time of the inspection, three people were receiving support with personal care. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

There had been improvements to the quality monitoring processes at the service since our last inspection. However, these processes needed time to be embedded at the service to ensure the improvements could be sustained

People felt safe receiving care from the staff at Butterflies. Staff received up to date and appropriate training for their roles and there were enough staff to provide care in a timely and person-centred way. People’s medicines were managed safely, and staff supported people following the government guidelines in relation to reducing the spread of infection.

People were involved with their care, received care in a person centred way, and felt able to approach the management team with any concerns they had.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The rating at the last inspection conducted on the 25 November 2019 was Requires improvement (report published 16 March 2020) there were multiple breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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Why we inspected

We carried out an announced comprehensive inspection of this service on 25 November 2019. Breaches of legal requirements were found around safe care and treatment, staffing and governance. The provider was issued with a warning notice. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection undertaken in November 2019 for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Butterflies Care & Support Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service

Butterflies Care and Support Ltd is a care agency. The service supports people receiving personal care in their own home. At the time of the inspection, eight people were receiving support with personal care. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

Care records did not provide full guidance to staff and there was no documentation about medicines care provided to people. Staff had not received training or competency checks to ensure that they were skilled to care for people. The lack of guidance and staff training put people at risk of receiving unsafe care.

The safeguarding policy was not up to date and two out of the three staff checked had not received safeguarding training. One person had repeated bruising, but no investigation had occurred to consider the causes of this and ensure that this was not abuse. Incidents had not been recorded and investigated to ensure that they did not re-occur. People told us that they felt safe using the service.

People felt there were enough staff to support them and that staff arrived in a timely way. Staff followed guidelines to ensure they wore protective clothing (like gloves) and protected people from infection. Staff were safely recruited.

People were supported to have adequate food and fluid. Staff referred people to other professionals, however GP medical prescriptions were not always recorded. This put people at risk of not receiving medicines in line with professional advice.

People were not always supported to have maximum choice and control of their lives. Documentation did not guide staff in the least restrictive way possible and in people’s best interests. The policies and systems in the service did not support this practice.

People reported that staff were caring. They advised that they felt able to feedback to the service and request changes in the way their care was provided. However, formal reviews of their care were not completed and documented. This put people at risk of not receiving care in line with their preferences.

The registered manager was aware of people’s communication needs and used communication aids if needed. People’s ability to make decisions was not always assessed, and relatives signed consent on their behalf. This puts people at risk of not being supported to communicate their decisions.

The service did not support people with planned end of life care. There was a risk that people who had a sudden death, did not have their preferences followed. This is because people’s preferences had not been discussed.

The governance of the service had not made required improvements to the service. This has resulted in the service being rated ‘requires improvement’ for a second time. Action had not been taken to ensure staff were well trained. Care plans still required improvement. The registered manager and provider did not understand their regulatory responsibilities.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 January 2019.)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to regulation 12 (safe care and treatment) , regulation 17 (Good governance) and regulation 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

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.