Background to this inspection
Updated
6 October 2021
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 Care Act 2014.
Inspection team
The inspection was carried out by two inspectors 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 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 two working day’s notice of the inspection visit because we needed to be sure that the provider or registered manager would be in the office to support the inspection. We also needed to request records to review remotely and contact details for staff and people using the service.
Inspection activity started on 17 May 2021 and ended on 19 May 2021. We visited the office location on 17 May 2021.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection, such as notifications and information received from the public. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with one person who used the service and seven relatives via telephone about their experience of the care provided. We spoke with four care workers remotely via telephone, and spoke with the registered manager on our office visit.
We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including incidents and accidents records, were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records including a service improvement plan.
Updated
6 October 2021
About the service
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.