Bluebird Care (Eastbourne & Wealden)

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. At our last inspection we rated this key question inadequate. At this assessment the rating has remained as inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care. The service was in breach of legal regulation in relation to governance at the service.

This service scored 32 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff had clear values and were aware of the direction the service wanted to take. They spoke of improvements already having been made since the previous inspection and the desire to keep moving in the right direction. The acting manager had developed a positive culture where staff felt they could talk to them. However, feedback on the effectiveness of this was mixed and staff would welcome more opportunity to have their say.

Processes to ensure improvements were paramount and effective were lacking. The provider recognised improvements were needed to ensure governance and leadership was more robust and effective in managing the day-to-day quality assurance of the service. This would ensure all actions identified in quality audits were followed through and sustainability was embedded into the service. The acting manager and supporting manager were not fully transparent with inspectors during the assessment. We also received feedback from professionals that some of the issues found during the assessment had not been reported and were said to be satisfactory by the management team rather than needing the improvements necessary. More robust oversight was required from both a manager and the provider to ensure improvement was made and embedded at the service.

Staff were clear about their roles and had the skills, knowledge and experience to perform their role. However, they expressed some concern that when matters were reported to the office or management, that these were not always robustly followed up. The acting manager and supporting manager were not clear on what matters should be reported to external agencies and we found examples of incidents which should have been reported to both the local authority and CQC but had not been. We were not assured the provider had good oversight of the service.

There was no registered manager at the service at the time of assessment. An acting manager had been appointed and was being supported by a registered manager from one of the provider's other services. There was no clear structure in place regards to who was responsible for doing what tasks and where tasks had been delegated, robust managerial oversight of these was lacking. The current leadership team had not acted in line with the integrity of the service and were not always transparent with the inspectors carrying out the assessment. Since the assessment the provider has appointed a new manager who was implementing an action plan to address concerns, however, these will take time to embed.

Staff feedback about being able to speak up was mixed. Some staff told us that they would be comfortable to contact the office or management to discuss concerns. However, some staff where not as confident that matters they raised would be robustly followed up. A staff member told us, “Sometimes the office needs to give the carers a bit more time to have their say. We should have more of an input because we are the ones out there looking after the clients. We should be heard.” The service had a whistleblowing policy however not all staff knew what this was.

Processes to enable staff to speak up were not always effective. There was a policy and process in place for staff to follow on ‘whistle blowing’. Staff knowledge of this was mixed. Staff meetings were being held. However, we reviewed minutes and saw they were task orientated with agenda items being discussed and minuted, there was no evidence of staff being given the opportunity to speak up. Supervision and spot checks were sporadic and there was no robust oversight of these to ensure they were consistently taking place and meaningful to staff members. The managerial team were developing a survey to send to people however this had not been sent out. Whilst we were verbally assured that people and staff were getting the opportunity to provide feedback, there was no formal record of discussions that took place following the calls and results were not always analysed for themes or trends.

There was a policy in place to protect staff from harassment and bullying and a focus on protected characteristics under the Equality Act. Staff did not report any concerns of bullying in the workplace and generally spoke positively about the acting manager and the support they received from the office.

Processes were in place to provide training to staff in equality and diversity. The oversight of whether this was completed and implemented in practice was lacking. Inspectors were provided with an out-of-date training matrix on the first day of the assessment. This was updated and provided retrospectively. The provider and acting manager had developed an inclusive workforce and recognised the value of diversity amongst the team.

Staff spoke positively about the acting manager. Comments included, “Things have changed and we now have new management and it is a lot better than what it was. Communication is so much better,” and, “Everything is fine. [Acting manager] is helpful and understanding.” Staff were not always sure of who was responsible for different tasks. For example, certain competency checks had been delegated to other staff members, but these were not robustly completed or documented, and staff told us they didn’t get feedback or know who to request this from.

Oversight and quality assurance processes were significantly lacking, which placed people at risk. Care plans did not contain accurate and up to date information nor were they reviewed regularly. This included risks to service users and clear guidance in service users’ care plans for staff. From the care plans seen on assessment, we found failings relating to documentation around mobility, skin integrity, accidents and incident, wound care, unexplained bruising, safeguarding processes, medicines and complaints. Governance and oversight had not been completed in accordance with Bluebird Care Policy- Record keeping and personal information. Some quality assurance tasks, such as medicine competency checks and audits, had been delegated. However, there was no managerial oversight of these, and documents could not be located during the assessment. They were believed to be in a staff members car. Accident and incidents were not analysed to look for patterns and trends, to prevent reoccurrence. There was no formal record for how the management team learnt from lessons following incidents. Staff meeting minutes did not include action plans completed to evidence how issues raised were to be addressed, dates to be achieved and if actions had been resolved or remained outstanding. Statutory notifications had not always been sent to CQC as required. Where audits had been carried out, they lacked detail and were mostly a tick box exercise and did not identify the shortfalls we found. This meant effective auditing arrangements were not in place to assess, monitor and improve the quality and safety of the service provided. The provider had not maintained oversight of the current enforcement in place and some of the on-going concerns had not been addressed. The provider was receptive to our feedback and put an immediate action plan in place to address the shortfalls in governance at the service. This will need time to embed.

People and their relatives felt staff worked well with partner agencies. One relative told of an incident where there loved one needed additional support, they said, “They have adapted the rota so someone can stay with [person] and make sure she is ok. We were short of prescription the other day and they sorted that. We work very closely with them.”

Staff were reporting matters to the office as appropriate, however, they reported needing to follow these up regularly to ensure action was taken. It was not always clear to staff in care plans or daily notes what external professionals were involved or who they would need to work in partnership with to ensure good outcomes for people.

The provider and managerial team did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. For example, appropriate referrals had not always been made to external health and social care professionals where this was required for people.

The provider did not have robust processes to ensure that referrals were made and followed up. We saw that not all incidents had been reported appropriately to ensure that steps could be taken to minimise reoccurrence and involve the correct partnership agencies. We were not assured that management were utilising the support available from external agencies, to ensure good partnership working and improved outcomes for people.

Staff feedback about learning and improvement was mixed. Some staff felt that there training was sufficient for them to undertake their role correctly. Others expressed that online training alone did not feel like it was enough. One staff member said, “I do appreciate that it is our own personal development and mandatory for the role, it’s just that there was a time where we were supported more with this in my opinion.” Staff told us they did not always receive regular supervision; we were not able to establish during the assessment if there was a schedule was in place for future planned supervision. Some staff meetings had taken place but the minutes for these were not robust and contained a list of agenda items and not a record of the meeting for anyone who had not attended, this meant all staff did not have regular one to one support or the opportunity to learn and improve their practice. The acting manager and supporting manager did not have robust knowledge of the on-going enforcement action being taken, nor the specific improvements which had been required following the previous inspection. The improvement plan following the previous inspection had not been robustly maintained. The provider had lacked oversight of this and had not ensured the concerns had been addressed.

Governance processes to manage accidents and incidents were lacking and ineffective. There was a lack of robust processes to ensure monitoring and reporting of wounds, unexplained bruising, accidents and injuries. This lack of oversight and analysis put people at risk of harm and opportunities to learn and develop were missed. A wound folder had been implemented and this contained photographs of substantial unexplained bruising to a person. This had not been documented on an accident /incident form and had not been referred to the local authority as a safeguarding concern. There had been no analysis into the cause of the injury meaning staff were unaware of how to prevent this occurring again.