Purple Balm Exeter

Updated 16 June 2023

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 carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

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

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. The service was being managed by the nominated individual.

Notice of inspection

This inspection was announced.

We gave a short period of notice of the inspection to ensure staff would be available to support our initial office visit. Inspection activity started on 3rd April 2023 and ended on 19th April 2023. We visited the location’s office on 5th April 2023.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 staff including care staff, office staff and the provider, who was also the nominated individual. We received additional written feedback from 4 care staff. We visited 4 people in their homes and spoke with 6 people and 3 family members by telephone about their experience of the care provided.

We reviewed a range of records. This included people's care records and medication records. We looked at 5 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

We received feedback from 2 external professionals who worked with the service.

Updated 16 June 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Purple Balm is a domiciliary care agency. The service provides personal care to older and younger adults in Exeter, Newton Abbot and Plymouth areas who may have physical disabilities, learning disabilities or autism, mental health issues or be living with dementia. At the time of our inspection there were 89 people using the service.

Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

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

Service provision was monitored on a day-to-day basis, and staff practice monitored through spot checks, supervision, and feedback from people using the service. However, there were no formal auditing process in place to monitor the quality and safety of the service. This meant the failings we found during the inspection had not been identified or action taken to address them.

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; however the policies and systems in the service did not support this practice.

Staff received an induction, training and supervision to support them in their role. However, some staff told us they did not feel valued or supported. The service was registered to support people with a learning disability or autistic spectrum disorder, however relevant training was not provided which is a legal requirement.

Recruitment checks were carried out for staff before they started working at the service to ensure they were safe to work with vulnerable people. However we found some gaps in employment history, which the provider undertook to clarify.

People were at risk of receiving unsafe care because care staff could not access the detailed information in care plans on their hand-held devices. In addition, risk assessments were not always up to date.

There were systems in place to ensure the safe management of medicines, however improvements were needed to ensure peoples allergies were recorded on the computerised care planning system.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were at the centre of their care and were supported to be as independent as possible. Managers and staff empowered people to make their own decisions about their care and support. We received positive feedback from people and family members about the service provided and the positive outcomes people experienced.

People were supported by a consistent team of care staff and there were no missed visits. They told us, “The carers are so kind, trustworthy, happy, punctual and do what is needed. Office staff are lovely.”

People were protected from the risk of abuse and avoidable harm. Lessons learnt from accidents and incidents were used to prevent reoccurrences.

People were supported to live healthier lives, with staff supporting and contacting health care professionals when needed. Staff worked in partnership with other professionals to ensure people received the right support.

The provider was committed to continuing to learn and make the necessary improvements to the quality and safety of the service provided. They welcomed the feedback given during the inspection.

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

Rating at last inspection

The last rating for this service was good (published 6 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements.

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

Enforcement and Recommendations:

We have identified breaches in relation to the need for consent, governance and staff training.

Please see the action we have told the provider to take at the end of this report.

Follow up

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