Butterfly Days Limited

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• 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

We reviewed 4 quality statements under this key question; safeguarding, involving people to manage risk, safe and effective staffing, and medicines optimisation. At this assessment although we found concerns about safety were listened to, investigated and reported to the relevant authority where required, the provider had not always notified the Care Quality Commission when incidents occurred at the service. The provider submitted the relevant statutory notifications retrospectively after our onsite assessment visit. Improvements were needed to ensure all areas of the recruitment process were followed. We found gaps in staff employment history had not always been explored during the recruitment process. There were enough suitably trained staff to meet people’s needs. People’s medicines, where required, were being managed and administered by trained staff whose competencies were regularly undertaken.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and their relatives told us they felt safe with staff. A person told us, “I can trust them, made friends with quite a few of them.” A relative told us, “[Relative] always says, what would I do without them, [relative] feels safe with them.”

Staff told us they had completed safeguarding training and were able to give examples of a safeguarding situation. All staff spoken with were able to tell us how they would report any concerns within the organisation. However, some were less confident as to how they could report concerns to external organisations. We discussed this with the registered manager who advised us of actions they would implement to address this. Staff were confident the management and office staff would take appropriate action if concerns were raised.

The provider had systems in place to ensure safety concerns were investigated and action taken to ensure people’s safety. Records showed the provider had made/responded to safeguarding alerts to the local authority when necessary. However not all incidents which had occurred had been reported to the Care Quality Commission. The provider submitted the relevant statutory notifications required after our onsite assessment visit.

People and relatives felt that carers were aware of the risks associated with their care and knew how to keep them safe. Not everyone was able to recall being involved in a risk assessment but said that they had been asked about the care they were getting and asked if they needed additional support. A person said, “I am wobbly on my feet; the carers make sure my frame is nearby. I get phone calls from the manager to ask if I need more help.”

Staff knew people well. They explained people’s current needs and how the person wished to be supported. A member of care staff told us, “The care plans do have enough information provided to deliver the care that is required safely and to be person centred, the care plans are up to date.” The registered manager told us that when care plans were reviewed people and/or their relatives were consulted.

During the assessment we reviewed 5 people’s care plans. Some contained information regarding risks to people and guidance for staff about how to manage potential risks. Some risks had not been fully assessed, for example, where a person lived with diabetes there was no diabetes care plan for staff to support them safely. Where the service was recording people’s fluid intake there was not always information in the care plan as to why this was being done and their optimum fluid intake. The optimum intake is needed to enable staff to check people were drinking enough. The providers action plan included improving risk assessments in care plans.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were not rushed by staff and staff remained for the duration of the call time. Comments included, “Generally stay the full half hour, if everything is done, they’ll sit and chat always ask if there is anything else I want doing,” and “I have the same carers. I have had the same few for years, the newer ones don’t always stay in the job for long or it's a summer job. Always stay the full time sometimes longer if I need their help.”

Staff told us they received their rota in advance and had sufficient time to provide the care and support required. One member of staff told us, “On any visits that I have carried out there has been enough time allocated and I have not felt rushed in doing the tasks required.” Another member of staff said, “I have enough time to get to clients and the rota includes breaks.” The registered manager described their plans for developing processes to ensure there were always staff available to cover calls.

Systems were in place to ensure there were suitably qualified, skilled, and experienced staff and safe recruitment practices were followed. However, staff employment files were not well organised with information stored in different places. For example, employment history was not always recorded on the application form but on a separate curriculum vitae which was not in the file. This did not support effective assessment of applicants' employment history. Of the 6 recruitment files checked we found gaps in staff employment history in 4 files which had not been explored during the recruitment process.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People received their medicines when needed. A person said, “I’m prompted to take my medication, carer puts it in a dish for me, I count them and take them with a glass of water.” A relative told us, “Carers on the ball, if running short of medicines, they chase it up, has never run out. When [relative] had a water infection the carer made sure he took the medication and keeps him topped up with drinks.”

Staff told us they received appropriate training and had their competency checked by management to administer medication and felt confident to do so.

The provider had systems and processes in place for the safe management of medicines. Medicines were audited, and actions taken in the event of any errors or discrepancies being identified.