Bluebird Care (Eastbourne & Wealden)

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulations in relation to safe care and treatment and safeguarding.

This service scored 56 (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 spoke positively about the care they received from staff. They did not raise any concerns about the learning culture. One person told us, “We can’t fault them at all, they have been very good to us and very good to me. They are concerned about how I am as well. They go above at times when I am not well and sort this out amongst themselves.”

Staff felt supported however they told us that they did not always get feedback from leaders. Staff told us that they would be confident in raising any concerns with the office but did not always hear of any outcomes following this.

The service did not always ensure that there was a positive learning culture. Risks to people were not always used to learn and improve. There was no robust managerial oversight regarding accidents and incidents. Inspectors found that not all issues documented in daily notes were reported on an accident and incident form, then not all incidents had been reported to the appropriate external agencies. Incidents were not effectively analysed for themes and trends, meaning learning opportunities were missed.

People did not voice any concerns about safe systems, pathways or transitions. Many people who used the service were supported by their loved ones to access external support agencies as needed.

Staff were able to demonstrate what they would do if they felt a person needed support from another service. Whilst they believed that matters were appropriately dealt with by office staff, the documentation around this was lacking, meaning opportunities to ensure safe transitions in care could be missed.

The service had been engaged with the local authority to gain support in driving improvements. However, this had become more sporadic. Feedback we received from professionals who worked with the service was mixed. Some professionals told us that the management team were not always fully transparent regarding any issues which may be on-going.

Systems were not robust to enable safe pathways and transitions between services for people. Documentation was poor, meaning it was difficult to know whether referrals had been made, or whether external professional visits had taken place. For example, we saw in one person’s care file that a visit was due from a paramedic practitioner. There was no recording following this to detail whether the visit took place or what guidance had been given to staff to ensure the professionals advice was followed. This also risked visits not being completed and follow up not being arranged to keep people safe. Managerial oversight of engagement with external professionals was lacking and the responsibility of ensuring referral were effective was unclear.

People and their relatives told us that they felt safe in the presence of staff. Comments included, “Yes, I do feel confident with them and safe with them,” “[Staff] make [person] feel safe and put them first for everything. I haven’t got a bad word to say about them they are brilliant”, and, “When [person] is on their walkie, staff walk behind them, so they do feel really safe with them.” People were aware how to raise any concerns should they need to and felt staff listened to them well.

Staff had completed safeguarding training and demonstrated knowledge of how to recognise signs of abuse. However, some staff were unclear on the distinction between a safeguarding concern and a complaint. Some staff members stated that they would refer the person to the complaints procedure. This increased the risk of concerns not been reported and action not being taken. One staff member said, “Yes, we would talk to the safeguarding member of staff in the office. If we don’t feel like we have been listened to, then we would follow the trail of people we need to report to. We also have the whistle-blowing procedure to follow.” However, we found that when staff had reported concerns to the office, these were not always robustly documented or followed up.

Safeguarding processes were not robust or effective to ensure concerns were identified, reviewed and referred to other agencies when required. For example, one person had sustained a number of unexplained bruises which had not been referred to the local authority as a safeguarding concern. Another person had not been supported correctly with their nutritional needs, this led to serious risk to their health. Whilst this had been addressed as a complaint by the acting manager and some actions taken, no accident/incident form had been completed, and this had not been referred to the local authority as a safeguarding.

People felt that their needs were being met in a safe way. Relatives also spoke positively about staff and how they managed risks to their loved ones. One relative explained to us that their loved one was finding mornings difficult and could find being supported with personal care distressing. They told us that the care call was increased in length, in order to give the person more time to be supported safely and effectively. The relative added, “[Staff] are doing what they can and doing it really well.”

Staff did know people well however some care plans lacked guidance and contained conflicting information. For example, one person who was living with diabetes had conflicting information in their care plan as to which type this was. This placed the person at risk of avoidable harm. This was rectified by the acting manager during the assessment. Staff told us they spent time getting to know the people they supported.

There were no robust processes in place to manage and minimise risks to people. Where issues had been identified, these had not always been clearly documented and it wasn’t obvious what action had been taken to minimise further risks. For example, one person had an area of skin breakdown, this had deteriorated from when it was first noted. There was no body map or measurements documented. Information in notes and daily records was inconsistent to demonstrate who, if anyone had called a district nurse and who was responsible for following this up if no visit had taken place. There was a lack of managerial oversight to ensure care plans were up to date and contained accurate details of people’s needs and the risks associated with them.

People told us they felt safe in their home with care staff. People and their relatives felt staff treated them and their environment with respect. Those who needed support with keeping their environment clean and tidy, were helped to do this by staff.

Staff showed an awareness of the potential environmental risks in people’s homes. The provider had a lone working policy which was followed by staff. Where staff provided ‘live-in’ care, they took time to familiarise themselves with the environment to promote their and the person’s safety.

Processes were in place to assess and monitor any risks associated with a person’s environment. For example, individual care plans included any potential hazards in the home. Some people were supported with creams which were known to be highly flammable. These were documented in the care plan along with the potential fire risk. Other environmental factors had also been considered, such as whether people had pets and where utility shut off points were.

People and their relatives spoke positively about staff and reported that staff knew them well. People felt that staff supported them well and did not raise any concerns about lack of training.

Feedback from staff about the training and support they received was mixed. Some staff found the online training offered was easy to engage with, however, others commented that they preferred face to face training as this was more beneficial. Spot checks and supervisions were not provided consistently, and when they were given, they weren’t always documented fully. One staff member told us, “I can’t remember the last time someone did a spot check on me or supervision. They keep having a changeover in the office they are always so busy. You do get time to sit with them and discuss your customers with them, but you don’t always get the feedback.”

Processes to monitor staff skills and knowledge were not robust. There was no oversight of effective staff meetings, supervision and training. The management team had not ensured they had maintained oversight of staff training as this task had been delegated to a member of office staff. During the assessment, inspectors were shown an out-of-date training matrix. Although some training had been completed by staff, this was not documented. Supervision for staff was sporadic and often the spot checks done in a person’s home were used to discuss any issues instead of a private space. This could prevent staff from being able to speak freely. Staff were recruited in line with the provider’s policy and appropriate checks had been completed.

People and their relatives did not have any concerns in relation to infection prevention and control. They were supported to keep their home environments clean and tidy where appropriate and needed. One relative told us, “[Person] is always clean. We know that they are well looked after.”

Staff had completed training in infection prevention and control (IPC). When competency checks were undertaken, IPC was considered as part of these. For example, staff were observed with their use of personal protective equipment (PPE). Staff had access to a plentiful supply of PPE which they could collect from the office as and when needed.

The provider had an infection prevention and control policy in place which was up to date and relevant to the service. Staff were aware of this policy and followed it appropriately. Infection prevention and use of personal protective equipment (PPE) was considered as part of spot checks of staff in people’s homes.

People and their relatives spoke positively about the way staff supported them with medicines. Relatives told us that they were happy with the support staff give their loved ones to keep them safe with medicines. One said, “Yes absolutely. We have been able to get [person’s] medicines in a blister pack. They have morning, evening and teatime medicine to take. Sometimes they refuse but most of the time it is working out very well. The staff have some of their strategies they will use to try and get [person] to take their medicine.” Another commented, “Yes, they are always given medicine at the correct time of day.”

Staff had received training to administer medicines. Competency checks had been completed however the documenting of these were inconsistent. Staff also told us that they didn’t always receive constructive feedback following a check. Some staff spoke about frustrations in communicating with the office about medicines. One staff member told us, “Sometimes when you are running short on medications and it comes close to the client running out, you make [the office] aware and they say they will sort it, but you have to give them a little bit of a nudge and have to repeat this couple of times until they sort it.”

There were no robust systems and processes in place to safely manage medicines. Records were sporadic and not always securely stored or available. It was not clear how management oversight of medicines had been maintained. Some medicine care plans lacked information. Whilst side effects of medicines were documented, such as increased risks of bleeding or bruising if someone is on a blood thinner, it was not explicit about what action should be taken if there were concerns. We found one person on blood thinning medicines had unexplained bruising and it was unclear what action had been taken to address this. Some medicine records had gaps in them, and it was not clear why these had occurred. Competency checks and some medicine reviews had been delegated by the acting manager to a member of office staff. The acting manager told us the documentation relating to medicines reviews were likely being stored in the staff member’s car. This posed a risk of confidentiality breaches and could have led to learning opportunities to address any errors being missed.