Butterfields Community Care

Updated 7 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was undertaken by two inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 36 hours' notice of the inspection visit because we wanted to make sure the registered manager would be in the office to support the inspection.

Inspection activity started on 11 March 2022 and ended on 22 March 2022. We visited the location’s office on 11 March 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included a review of notifications relating to safeguarding concerns or other incidents affecting the safety and wellbeing of people. We also reviewed the feedback on the home care providers’ website. We sent the provider an inspection poster with our contact details to circulate to people, relatives and staff to seek their feedback. We requested a range of information from provider about the ongoing monitoring of safety and quality. We obtained feedback from the local authority. We used all this information to plan our inspection.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection-

Due to the nature of the service provided, we did not receive direct feedback from people using the service. However, we received feedback from 11 relatives who shared their experience of the service provided. During the site visit we spoke with the registered manager, care manager and other office staff. We reviewed the care and support records of five people. We reviewed a range of other records, including medication records, two staff files in relation to recruitment and staff supervision, and a variety of records relating to the management of the service, including policies and procedures.

After the inspection –

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We received feedback from 26 staff members, including feedback from two ex-members of staff. We requested feedback from seven health and social care professionals and received feedback from four.

Updated 7 May 2022

About the service

Butterfields Community Care is a domiciliary care agency, which specialises in providing end of life care services for people in their own homes across Somerset. At the time of our inspection the service was supporting 54 people.

People are referred to Butterfields Community Care by Somerset Continuing Health Care (CHC) team following an assessment of their end of life needs. The service provides multiple day time visits and night sitting services, according to people's changing needs.

CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. All those currently using the service were receiving support with personal care.

People’s experience of using this service and what we found

The service was distinctive and innovative as it provided specialist end of life care to people living at home, who wanted to remain at home. People could be confident that at the end of their lives they would receive high quality compassionate care from skilled staff.

The service was planned and provided care in a way that met the needs of local people and the communities served. Commissioners of this service told us, “Butterfields have provided day and night care for our patients under the NHS Continuing Healthcare fast track funding for quite a while now. The agency has made some vast improvements and are dedicated to caring for end of life patients in Somerset. I truly believe that without the services of Butterfields there would be a significant unmet need for end of life care across Somerset”.

Care and support were tailored around people’s individual needs and preferences. People described an end of life service which was adaptable and flexible.

Feedback about this service was unanimously positive. The care and support provided to people and their families often exceeded expectations. Everyone we spoke with described staff as exceptionally kind, caring and very compassionate.

People were valued and as a result they felt very well cared for. Comments from relatives included, “I would like to express my sincere and grateful thanks to the Butterfield carers; their kindness and dedication to caring was absolutely wonderful” and “You could tell they really cared it wasn’t just a job to them”.

Staff felt equally respected and valued by the directors and senior management team. The provider was passionate about ensuring that they suitably rewarded staff employed at the service for their continuous contribution. All responses from staff were positive about their working environment. Staff displayed a high level of commitment and motivation for their role. All staff responding with feedback told us how much they loved their job and that it was a privilege to provide care at such an important time for people.

The provider promoted a positive culture that was person-centred, open, and inclusive. They had a clear vision for the service to make people's experience of end of life care the best it could possibly be. It was clear staff also shared that vision.

The service worked in partnership with health and social care commissioners to develop services in response to the changing needs of local people. One professional said, “Butterfields are the most proactive agency I know”.

People were protected from the risk of abuse because the provider was committed to ensuring people felt safe when receiving the service. The registered manager and staff team were very responsive to changing situations, especially where a person had been identified as being at risk. Risks to people’s health, safety and well-being were assessed, and measures were in place to reduce the risks.

The provider minimised risks to people by making sure only suitable staff were employed. Staff were deployed effectively to ensure people received the care and support they required.

People were safely supported with their medicines. Staff received training in medication administration and competency assessments were completed to ensure practice was safe.

The provider had arrangements to ensure people were protected by the prevention and control of infection. Infection prevention and control policies kept people safe and staff had received training in infection prevention and control.

People's needs had been assessed and documented. People received effective care and support from staff who had the skills and knowledge to meet their needs as staff received the necessary training to be able to work safely and effectively. Staff worked closely with social and healthcare professionals as well as other organisations to ensure people received a coordinated service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update - The last rating for the service at the previous premises was Good, published on 01 December 2020.

Why we inspected - This was a planned inspection. However, prior to the inspection we received concerns from ex staff members about their working conditions. We were not able to substantiate these concerns during this inspection. The feedback from all staff during this inspection was exceptionally positive.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.