Bluebird Care (Eastbourne & Wealden)

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence. At our last inspection we rated this key question requires improvement and the provider was in breach of the regulation need for consent. At this assessment, enough improvement had been made for the breach to be met, but the rating has remained as requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives were involved in the initial assessment before care delivery started. One person told us, “It was done properly, and they asked the right questions. It’s all working out really well.” A relative added, “Yes, I was involved. Most of our communication is done via telephone, email etc as I live two hours away. Adult social services have rung me to ask if we are happy to approve of [person’s] care package.”

Staff told us that they would recognise quickly whether someone’s needs were changing and report this to the office. They reported that at times they needed to chase the office to ensure matters were followed up. Staff reflected that they felt generally people’s care plans detailed people’s needs, but at times there was a delay in these being updated.

The provider did not have processes in place to effectively and regularly review people’s changing needs. A number of care plans viewed had incomplete or conflicting information within them. Daily notes and risk assessments were not always robust enough to provide clear guidance to staff. The provider was receptive to our feedback and implemented an action plan to address the discrepancies in people’s assessed needs.

People told us that their needs were met by staff who knew them well. This included supporting any specific dietary, cultural or religious preferences they had expressed.

Staff were able to recognise when people had changing needs which meant altering the care and treatment they required. Although staff were not explicitly involved in the use of the evidence-based tools, they were able to ascertain when a person was at risk, for example, of skin breakdown. Staff were able to demonstrate what they would do to report if they were concerned but were not always aware of what action would need to be taken to prevent risk straight away.

Processes were in place for nationally recognised tools to be used to support people’s needs. For example, Waterlow and Malnutrition Universal Screening Tool (MUST). However, these were not always robustly documented or reviewed as part of people’s care. These inconsistencies created a risk of information being out-of-date and providing inaccurate guidance for staff.

People were supported by care staff who worked well together. People and their relatives did not express any concern about the way staff worked between themselves and others. One relative told us, “They work well and I feel like I am well informed about what is going on, on a daily basis. Staff leave me notes which are really helpful.”

Staff worked well together, however, the communication between them and the office could at times be lacking. Follow up from leaders following concerns raised was not always robust. Staff reported that they did not always find team meetings useful and the minutes of these we saw were lacking detail of teamwork.

Whilst leaders had engaged with external professionals, it was not always evident that they had been transparent about concerns. Professionals told us that referrals were not always forthcoming, and this was an area that needed improving.

Processes were not robust to ensure effective working across teams and services. We found incidents had not always been consistently reported to appropriate agencies meaning additional support which could have been provided to the service was lost. Management did not have effective oversight of opportunities for team working, and documentation was not clear as to when external professional support had been requested or the outcome of this.

People were encouraged to live healthier lives. One person told us that they never used to eat breakfast, but this has since been encouraged by staff and was working well. A relative also said, “The district nurses are instructed by the GP to come and visit. They have previously come for a wound.”

Staff supported people to live healthy lifestyles where possible. However, this was at times hindered by documentation not being updated or containing conflicting information. For example, one care plan contained conflicting information about a person’s diabetes type. This conflicting information placed people at risk of potential harm. The management team were receptive to feedback and began updating care plans following our assessment visit.

The service did not have robust processes in place to identify risks to people’s health to prevent a deterioration in their wellbeing. For example, whilst the acting manager had implemented a new wound folder, this was ineffective as the information in this was lacking and it was unclear who had been referred for additional support, or how effective this had been. We were not assured that the service had systems to ensure people lived the healthiest lives they could.

People and their relatives felt that staff were regularly monitoring them to ensure good outcomes regarding their care. One relative told us, “[Person] ended up having open wounds and Bluebird care were very much on it. The district nurse came out and dressed the wound.”

Staff worked collaboratively to plan and deliver people’s care and achieve the best outcomes they could for people. However, due to conflicting information in care plans, it was not always possible for staff to robustly assess risks and ensure effective measures were quickly implemented to improve outcomes further.

The service did not have systems in place to robustly monitor people’s care and treatment, such as wound monitoring. They did not always ensure appropriate medical advice was sought and failed to ensure people’s care plans were updated to reflect any changes in their care needs. For example, we identified people who had developed bruising or skin damage, which had been documented, however, we did not see clear evidence of where the service had explored the cause, contacted professionals or implemented additional measures to prevent further risks to people’s skin.

People were asked for their consent before their care was delivered. One person had very specific elements of their care that they would not consent to, and this was clearly documented in their care plan. This was also well known by staff, and we saw from daily notes that it was being adhered to. Relatives spoke positively about how staff provided care with their loved one’s consent. One told us, “Very happy with all the reassurance they provide.”

Staff had completed training in the Mental Capacity Act 2005 (MCA). They told us of the importance of ensuring people’s consent was obtained before they offered any support. Documentation around consent and people’s capacity, especially that in the daily notes and care plans, needed to be more robust to ensure it was reviewed and up to date.

Processes were in place to gain people’s consent before their care package commenced, this was documented in people’s care plans. However, these were not always regularly reviewed to ensure the decisions made remained relevant. Improvements to care plans were needed to bring them up to date. People’s capacity had been assessed, and where needed, decisions had been supported in their best interests.