Bluebird Care (Eastbourne & Wealden)

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the service met people’s needs. At our last inspection we rated this key question requires improvement and the provider was in breach of the regulation person-centred care. At this assessment, enough improvement had been made for the breach to be met, but the rating has remained as requires improvement. This meant people’s needs were not always met.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People received care in a way which was personalised to them and met their needs and wishes. People spoke positively about staff getting to know them in order to provide person-centred care. One relative told us, “[Person] has plenty of time with carers. They do everything she wants, the way she wants and anything else for her before they leave.”

At the previous inspection, concerns were found with regards to the person-centred nature of people’s care plans and delivery. Improvements had been made at this assessment and care plans contained more person-centred information, for example, people’s likes, dislikes and life histories. This enabled staff to get to know people well and deliver care in a way that met people’s needs and preferences.

People and their relatives expressed confidence in knowing which staff were attending to them and when. One person told us, “They send us a timetable so we know who is arriving and what time they will be arriving.” A relative said, “Me and my sister know the staff who visit. They are good and kind and we have a good relationship with them.”

Staff knew people well. However, they did report that care plans did not always contain the most up-to-date information regarding a person’s care. Staff were made aware of changing needs due to messaging via an electronic application, however as documentation was inaccurate, there was a risk people would not receive correct care provision.

We received mixed feedback from professionals regarding the care provision at the service. Some professionals expressed concern about the lack of transparency when accidents and incidents occurred, which could impact on the continuity of care.

There were no effective processes in place to regularly review people’s changing needs. We found conflicting information in people’s care plans, daily notes and risk assessments. For example, one person’s care plan stated that mobilising should be encouraged, and the person could sit at a table for meals. However, the daily notes and risk assessment stated the person was ‘bed bound’ and mobilising could place them at risk of falls. This conflicting information could mislead staff and risk harm to the person. When a person had been referred to external agencies for additional support, the documentation regarding this was lacking. For example, we found in people’s daily notes that a referral was required to the district nurse for support with skin integrity, however it was not clear whether this referral was made or who was responsible for following this up. The lack of clear recording keeping placed people at risk of poor care provision and continuity.

People told us that if they had a specific need for the way information should be provided then staff did their best to achieve this. However, some people we spoke with told us that they were unsure how to access their care plan. Feedback from relatives was also mixed about information accessibility.

Staff knew people well and had effective skills in communicating with them to ensure needs were met. Staff told us if they identified a specific way someone wished to communicate then they would feed this back to the office.

Management did not always ensure information on people’s care was accurate and up to date. Whilst some processes were in place to provide information in an accessible way should it be required, for example large print leaflets, the incorrect information in some care plans created a risk of breakdown in communication.

People told us that they felt listened to and able to raise concerns with staff. Relatives advised if they had any concerns, they would contact the office. One relative said, “I raised the concern with the office, and it was dealt with in a manner I felt was fair. I feel comfortable raising issues with [acting manager] or the service. I’m always listened to, taken seriously and it’s always acted upon.”

Staff had good rapport with people and gave time to listen to any concerns they may have. However, when speaking with some staff it was evident that knowledge around what would be a complaint and what would be a potential safeguarding matter was lacking. Some staff told us that they had to be persistent with the office to ensure people’s voices were heard.

Some measures were in place to gather feedback or allow people to have their say. However, there was no robust or consistent programme to ensure this was done regularly. The documenting and analysis of people’s feedback was poor, meaning opportunities to drive improvements were missed. People’s care was not reliably reviewed and as such, not everyone was given the option to be listened to. The provider maintained a complaints log however we identified some matters which had been addressed as complaints but were not in this folder, and as such, we could not be assured that complaints were being robustly dealt with.

People told us that they were supported by staff to access additional care and treatment should this be required. Many people had the support of their relatives to also do this, but relatives spoke of confidence in requesting additional help with this from staff when required.

Staff were able to recognise when a person may require access to an external agency. This was reported to the office if there was not a representative of the person to follow it up. However, the action then taken by leaders was sporadic and not robust enough to ensure people had relevant access.

Whilst staff supported people to access external services, professionals told us that they were unclear whether all matters were being referred as appropriate. Without this transparency, people were placed at risk of not receiving the support they required.

Systems and processes were not robust to ensure people received equity in access to care. Matters of concern had not always been referred to external agencies by the management team which led to it being unclear whether people received the support they required. For example, daily notes advised that a person was awaiting a visit from a health professional, but there was no follow up. It was not clear whether the visit took place or what action the service by taking to best support the person going forward.

People who had protected characteristics or who were most likely to experience inequality in their care experiences were supported appropriately by staff to minimise discrimination.

Staff engaged well with people, and they spoke about people they supported in a respectful way. Staff had undertaken equality and diversity training.

Processes were in place to promote equity, and any protected characteristics had been detailed in people’s care plans. Documentation did not always reflect robust working arrangements with external health and social care partners, and as such, positive outcomes for people were not routinely monitored.

People and their relatives felt able to express their wishes for the future if needed. One relative told us, “[Person] is receiving palliative care, we do have nurses coming in once a week. [Staff] keep my relative calm. We have good relationships with the staff and all the staff members are very supportive. The communication has been very good, and we are really pleased.”

Staff knew people well and this included any future wishes that they had. Staff had completed end of life training to guide them with supporting people at this time of their life, as and when this was required.

Systems to robustly document people’s end of life wishes were not in place. Care plans did clearly document whether a person had a do not attempt cardiopulmonary resuscitation (DNACPR) in place and where this was kept. However, they lacked any information of wishes people may have expressed in terms of planning their future.