Purple Care TM

Purple Care is a domiciliary care agency providing personal care to people living in their own houses and flats. At the time of our inspection there were 20 people using the service.

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

Improvements to the quality and management of the service had been made. The provider and registered manager acted on previous concerns and implemented systems and processes to ensure people received safe quality care.

The provider and registered manager had developed a positive culture at the service. They were responsive to people, relatives and staff and endeavoured to address any concern raised.

People received care as planned and they were protected from the risks associated to their health and well-being. People felt safe and protected from the risk of harm and abuse.

Care workers were recruited safely with appropriate training provided to ensure they were competent to carry out their roles in line with best practice. Staffing levels were sufficient, and rotas were planned in advance, so people experienced continuity of care.

Care workers were compassionate and caring and delivered personalised care to people. People’s needs and wishes had been assessed and their care was delivered in a dignified and respectful way. Care workers understood the importance of delivering care how people wished.

People and relatives were involved in their care. Staff were supported by the provider with regular monitoring of their practice and were encouraged to develop their skills further.

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 this service was requires improvement (14 October 2021) and there were breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

Follow up

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

Purple Care is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection there were 90 people using the service, whose needs included mental health, physical disabilities, learning disabilities and dementia.

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

Staff did not always follow risk assessments and care plans, and this meant there was a risk people did not have their needs met and were at risk of avoidable harm. Staff were trained to support people with their medicines, however, due to an ongoing variance in call times for some people, people did not always get their prescribed medicine at the right time and there was a risk the time between doses may not be sufficient. Staff did not record the actual time medicines were administered and this meant there was no way of knowing the exact time the last dose had been given.

People did not receive their care and support at the agreed time on a frequent basis and this meant people could not plan their day or establish any routines.

Call times were often shorter than the agreed time and although the provider had addressed this with staff and taken the time to establish the reason for each short call, not enough action had been taken and this issue was ongoing The provider had not fully considered the impact and risk caused by short calls and staff not following care plans such as risk of malnutrition and risks associated with a lack of personal care.

Staff received training support and supervision. There was a known risk for one person displaying risky behaviours, however there was no risk assessment or care plan because staff had not alerted their managers about this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, people did not have their capacity to make decisions assessed so we could not be certain about people's capacity to make decisions. Where a person lacks mental capacity to make an informed decision, or give consent, staff must act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice.

People and relatives were not always confident to raise concerns or that their concerns would be listened to and resolved. The provider had quality assurance systems in place and had made some improvements regarding call monitoring and audit since our last inspection. However, the issues were ongoing and had not been resolved.

People and relatives told us they liked the staff and said they were kind and respectful.

Rating at last inspection

The last rating for this service was requires improvement (published 17 November 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment and governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Purple Care is a domiciliary care service, providing personal care to people in their own homes. At the end of the inspection they were providing personal care to 67 people. Purple care is registered to provide personal care to children and adults with a physical disability, learning disability or autistic spectrum disorder; dementia and mental health needs.

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

The provider had informed people, during the Covid-19 pandemic care calls would not be at a set time. This decision was not person centred and meant some people did not know when to expect their care which put them at risk of harm.

Office staff also provided personal care to people, they did not wear face masks whilst undertaking their duties in the office. This increased the risk of transmission of Covid-19. We have made a recommendation about this.

There had been no registered manager in post since June 2018, the provider was therefore responsible for the delivery of the regulated activity. A manager had been appointed but had not yet commenced their role at the time of the inspection. The locations rating of performance was not displayed at the location or on the services website.

Quality assurance systems and processes were not always effective. Audits of call times did not identify a significant variance in the delivery of some people’s call times. This meant no action had been taken to improve call times.

The electronic record keeping system enabled the management team to have a ‘live’ oversight of care delivery and to respond to alerts such as when medicines had not been signed for, care staff were late, or care tasks had been recorded as not completed.

People were supported by staff that had been safely recruited. Staff had a good knowledge of risks associated with providing people's care, including infection control. Staff had received adequate training to meet people's individual care needs, their competency was assessed before they gave people their medicines. Staff knew how to identify, and report abuse to keep people safe. Accidents and incidents were reported and reviewed. Measures were put in place to reduce risks to people.

People were not always supported to have maximum choice and control of their lives. People's preferences and wishes regarding their care delivery were not always respected. Staff supported them in the least restrictive way possible and in their best interests.

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 requires improvement (published 15 February 2020, updated 03 September 2020).

Why we inspected

We received concerns in relation to safe staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

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 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.

Purple Care is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection there were 47 people using the service, whose needs included mental health, learning disabilities and dementia.

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

Although there were enough staff deployed to meet people's needs, people did not always receive care from consistent staff who knew them well. Records showed, and people confirmed, staff did not always stay for the full duration of calls, times which had been assessed as required in order to ensure people's needs were met. Timings of calls could not be confirmed by records as these were not always accurate. People and relatives were not always confident to raise concerns or that their concerns would be resolved through sustained improvements.

People and their relatives shared mixed views about staff. Where people received care from consistent staff, they spoke about positive, caring relationships. People who did not have consistency in carers spoke about staff rushing, not having time to talk with them and being focussed on getting to the next call. People told us this made them feel 'invisible'.

There were some systems in place to monitor the quality of the service however these were not effective in identifying areas for improvement. The provider had identified the issues we found during inspection and had begun to take action to bring about improvements.

People’s needs and expectations of care were assessed and used to develop a package of care, to support the person at home. People’s needs were met by staff who had the necessary skills but not always the detailed knowledge. Staff were supported through ongoing training and supervision to enable them to meet people's needs. Staff promoted people’s health by supporting them to take their medicine where required and by liaising with relatives and health care professionals in response to changes in people's health and well being.

People were supported to have maximum choice and control of their life and staff supported them in the least restrict way possible and in their best interests; the policies and systems in the service required further development to support this practice and develop staff understanding of mental capacity.

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 25 January 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Purple Care is a domiciliary care agency looking after people in their own homes. At the time of the inspection the service supported 60 people with their personal care. 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.

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

People were at risk of receiving poor care as the provider did not have adequate systems and processes in place to monitor the quality of the care people received. People were at risk of not being supported in a safe way as the provider did not have robust systems to assess people’s risks; they did not use evidenced based tools or follow best practice guidance to assess risks and plan.

People were at risk of receiving care that was not appropriate to meet their needs as staff did not receive adequate information and guidance they required to support people. People were at risk of harm as staff did not fully understand their roles and responsibilities to safeguard people.

People did not always receive their calls on time or for the allocated amount of time. People were not supported to have their medicines in a safe way. The provider did not have an adequate system to monitor medicines management or to monitor calls.

People were at risk of not receiving care and support in their preferred way as the provider did not effectively assess their needs and choices. Staff did not have appropriate training for all areas of care they delivered. People were not always supported to eat and drink in a timely way due to late calls.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible . However, there was a lack of understanding of the Mental Capacity Act and people’s capacity was not consistently recorded. We have made a recommendation about this.

People were supported to access healthcare services when required by caring and friendly staff who knew how to respect their privacy and dignity. People were not always involved in reviewing their care plans or in decisions about their care.

People did not always receive personalised care as care plans did not contain individualised information.

People felt that concerns raised were not always resolved adequately.

The provider did not understand their regulatory duties and responsibilities. The provider did not have adequate systems in place to assess, monitor and manage quality and safety of the service being provided to people.

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 25 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about poor care. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-Led sections of this report.

Enforcement

We have identified breaches in relation to safe care, person-centred care and the management of the service 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.

Since the last inspection we recognised that the provider had failed to notify CQC of incidents and deaths. This was a breach of regulation. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

Follow up

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 alongside the provider and local authority to closely monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager. The registered manager was also the registered provider. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons.’ Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

Experiences of the people using the service at the time of our inspection were mainly positive. Most told us they were supported by support workers that were kind and caring. The support workers we spoke with were enthusiastic about providing people with support that was based on their individual needs.

There was a culture within the service of treating people with dignity and respect. The registered provider sought people’s views about what mattered to them and acted on their feedback.

People felt safe. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and knew how to report them. There were risk management plans in place to protect and promote people’s safety.

There were enough support workers to make home care visits. The provider was continually recruiting more staff. Recruitment procedures were designed to ensure that staff employed were suitable for their roles. Staff were supported through training and supervision.

People were supported to have their medicines during home care visits.

Support workers who supported people with preparing meals were trained in food hygiene. People received enough to eat and drink and staff gave support when required.

There were arrangements in place at the service to make sure that action was taken and lessons learned when things went wrong and to improve safety across the service.

Support workers received an induction when they first commenced work at the service and in addition also received on-going training to ensure they were able to provide care based on current good practice when supporting people.

People were supported by staff to use and access a wide variety of other services and social care professionals. The office staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service. People were supported to access health appointments when required to make sure they received continuing healthcare that met their needs.

People were supported to have maximum choice and control of their lives and support workers supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were listened to, their views were acknowledged and acted upon and care and support was delivered in the way that people chose and preferred. Care plans provided support workers with detailed information and guidance about people's likes, dislikes, preferences and guidance from any professionals involved in their care. Care plans were regularly reviewed to ensure care met people's current needs. This helped to provide support workers with the information they needed to provide care that was personalised for each individual.

People, relatives and staff knew how to raise concerns and make a complaint if they needed to and there was a complaints procedure in place to enable people to raise complaints about the service. People also made compliments about the service.

The management and leadership within the service had a clear structure and the registered provider was knowledgeable about people's needs and key issues and challenges within the service. Staff felt supported and valued. The registered provider had systems in place to monitor the quality of the care provided and to ensure the values, aims and objectives of the service were met. Those systems included seeking and acting upon people’s feedback.

The registered manager was aware of their responsibility to report events that occurred within the service to the Care Quality Commission (CQC) and other external agencies.