Purely Care

Purely Care is a domiciliary care service providing support to people living with a learning or physical disability and, or mental health difficulties. They provide personal care and support to people living in their own homes. Not everyone who used the service received personal care. 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. At the time of our inspection the service was providing a regulated activity to 25 people.

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

The auditing and quality assurance systems in place required improvement, as they did not ensure accurate upkeep of full records and identify areas for improvement.

There was poor administration around the management, care planning and auditing of medicines. People’s health conditions which created risks, as well as communication needs, were not covered sufficiently in care plans.

Although staff understood the principles of the Mental Capacity Act 2005 (MCA) and supported people in decision-making, there were no records relating to this.

We have made a recommendation around end of life care planning, as this was not considered in the existing care plans.

People were supported by enough safely recruited, competent staff to meet their needs. People received their agreed care visits.

When incidents or accidents occurred, there was action to further mitigate risk or recurrence.

Staff supported people safely with eating and drinking when part of their support needs. Staff supported people to access healthcare and worked alongside other healthcare professionals if needed.

People’s needs were assessed prior to using the service and a care plan was developed.

Staff were kind and caring, and involved people and relatives in their care.

People knew how to contact the office and raise any concerns if needed. Complaints were investigated and responded to appropriately.

Staff were positive about working for the service and felt involved in the running of the service.

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 this service was Requires Improvement (published 23 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvements had been made and the provider remained in breach of one regulation.

The service remains rated requires improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service/We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least Good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Purely Care is a domiciliary care agency providing support to 35 people living with a learning or physical disability and, or mental health difficulties. It also supports older people including those living with dementia.

Not everyone who used the service received personal care. 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. At the time of the inspection 25 people were receiving personal care and support.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The systems in place to ensure people received their medicines safely did not always follow good practice. Risks to people’s safety were not always assessed and documented. Accidents and incidents were sometimes not properly documented or investigated. There were no missed calls by staff and most people and relatives spoken with told us they felt safe under the care of the service.

Some people felt staff required additional training to meet their needs and records did not assure us that all staff were appropriately trained. People received support with their eating and health needs. People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice

There was a person-centred approach to care but some people’s care records were incomplete. Reviews of care plans were not always undertaken regularly. Complaint management was poor. Staff did not routinely discuss people’s care wishes in the event of a health emergency.

Record-keeping and auditing required improvement to ensure effective quality management of care delivery. Feedback was received from stakeholders however there was no clear evidence that this this drove service improvement. Staff spoken with were positive about the working culture and most people and relatives commended the service.

People were supported by staff who listened to their views, and helped people make their own decisions. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection. We found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of the report.

There were five breaches of regulations relating to safe care and treatment, staffing, complaints management, governance, and notifications to the CQC. We have also made a recommendation about end of life care provision.

You can see what action we have asked the provider to take at the end of this full report.

Rating at last inspection

The last rating for this service was Good (published October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Purely Care on our website at www.cqc.org.uk.

Follow up

We will request an action and an improvement plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Staff received training to protect people from harm and they were knowledgeable about reporting any suspected harm. There were sufficient numbers of staff to provide care and support for people. Recruitment procedures ensured that only suitable staff were employed. Risk assessments were in place for people’s assessed risks and actions were taken by staff to reduce these risks. Arrangements were in place to ensure that people were supported and protected with the safe management of their medicines.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA). Staff were supported and trained and had an understanding of the principles regarding the MCA.

People were supported to access healthcare professionals and they were provided with opportunities to increase their levels of independence. Health risk assessments were in place to ensure that people were supported to maintain their health. People had adequate amounts of food and drink to meet their individual preferences and nutritional needs where appropriate.

People told us that their privacy and dignity was respected and their care and support was provided in a caring and a patient way.

A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People could raise concerns with the management team and care staff at any time and felt listened to..

There were quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. People and their relatives were able to make suggestions and changes in relation to the support and care provided and staff acted on what they were told.

There were links with the external community. There was a staff training and development programme and procedures were in place to review the standard of staff’s work performance.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:-

Is the service safe?

People using the service told us that they felt safe when the live-in carers stayed with them. The office environment was well equipped, secure and clean. There were sufficient numbers of care staff to ensure that people were provided with the live-in care and support they required.

Staff rosters revealed that sufficient numbers of live-in care staff were employed and that staff absence was covered. The provider demonstrated that they employed staff members that were suitable and had the skills, qualifications and experience needed to provide care and support to people living in their own home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs). The provider showed us that there had not been a requirement for a (DoLs) application to be made. Records, policies and procedures were held and relevant staff had been trained and knew how to ensure that, when needed, a (DoLs) application was submitted.

Is the service effective?

People told us they received the care and attention they required in a way that met their needs. Through speaking with staff we noted that they understood the care and support needs of each person they lived with. One person told us. 'The live-in carers I have stay with me are lovely and will do anything to help me. I only have to ask.' Staff had received training to meet the needs of people using the service.

Is the service caring?

People told us they were supported by staff who used a kind and attentive approach. They said that the live-in care workers were patient and encouraged people to be as independent as possible. People also told us that the staff did not rush them and that they were polite and respectful.

Is the service responsive?

Care and risk assessments had been completed before people used the service and when their needs had changed. A record was held of their preferences, interests and diverse needs. People told us that staff members consulted them and encouraged them to make their own decisions. People had access to planned activities that were tailored to their needs and choices.

Is the service well led?

All of the staff spoken with had a good understanding of the whistleblowing policy. Quality assurance processes were being further developed. Most people using the service and all staff said they had felt listened to when they made a suggestion or raised their concerns. People using the service told us that they were sometimes included in discussions about any planned changes to the live-in carer they were going to be provided with.

We also noted at this inspection that only one of the six staff members who should have received an appraisal at the time of the November inspection had actually been appraised.

This review established that improvements had been made. Dementia training for staff had been implemented and staff appraisals were up to date. This meant that the service was effective in ensuring that people were supported by staff who were suitably trained and appraised.

The service users or relatives told us that they or their family members were treated with consideration and respect. We were also told that staff respected people's belongings and homes. One relative told us that staff looked after their family member's home '.as if it were their own.'

Care plans were fully reviewed every six months or sooner if people's circumstances required. We noted timely reviews on each of the four care plans we looked at. Assessments of risk were made and plans were in place to reduce identified risks.

Systems were in place to ensure that prospective employees had been vetted and were suitable for their role. A training schedule was in place for staff. However due to the needs of several service users staff training was required in dementia so that people could be better supported. We also noted that staff appraisals were overdue.

Systems were in place to assess and monitor the quality of the service provided. However, we found that improvements could be made regarding the annual survey to obtain a more meaningful response in future.

Staff received training that was appropriate to their role. A carer told us they were always being offered training and that update training was provided each year. This included training about the safe handling and administration of medicines. Staff were supported in their role and were able to obtain guidance and support at any time.

People knew how to complain and felt able to do so. They told us they would be listened to and action taken if necessary. We saw that the service had a complaints procedure in place that was provided in any format or language as required. Complaint records showed that concerns were dealt with quickly and fully investigated.