Purple Care TM is a domiciliary care and supported living service which provides the regulated activity of personal care. This assessment only inspected the supported living service. Purple Care TM is a supported living service supporting adults with a learning disability and/or autism. At the time of our inspection, 7 people were living in their own flats or houses either in the local community or based at the provider’s office site on a farm. The assessment commenced on 23 September and ended 2 October 2024. This was the provider’s first assessment of the supported living service. This was a comprehensive assessment and included 34 quality statements. During the onsite inspection we spoke with the registered manager, the provider, office administrator, 9 care staff and additional feedback was received from a further 36 care staff through emails and telephone calls. We reviewed, in part, 6 people’s care records including their medicines administration records. We met 6 people using the service and observed staff engagement with people. We received feedback from 9 external health and social care professionals. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. Whilst the farm was situated in a rural area, people accessed the local community regularly and the environment met people’s individual care and support needs. People were supported as fully possible to have maximum choice and control. Independence and progression were supported and there was a positive approach to risk management. Staff demonstrated consistency and continuity in the care and support they provided. Staff had a kind, caring and supportive approach and clearly knew and understood people’s individual needs.
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Purple Care received a Requires Improvement rating following a focused inspection of safe and well-led domains, with two regulatory breaches identified: unsafe variance in care call times (Regulation 12) and ineffective governance systems (Regulation 17). The absence of a registered manager since June 2018 and inaccurate quality audit data were key leadership failures placing people at risk of harm.
Concerns (8)
criticalMissed or late visits: “One person had diabetes. Their breakfast call time varied by two hours and 17 minutes in one week during September 2020.”
criticalMedication management: “one person was prescribed medicines that needed to be given four to six hours apart... medicines were given significantly earlier than the prescribed recommendation.”
criticalGovernance: “Audits of call times were based on the time the provider had scheduled people's call for. Compliance data was inaccurate as call times varied.”
criticalLeadership: “There had been no registered manager in place since June 2018.”
moderateInfection control: “office staff did not wear face masks in the office, despite some of the staff delivering personal care to people.”
moderateRecord keeping: “The provider told us they had sought advice from professionals... The providers records contradicted those held by one healthcare professional.”
moderatePerson-centred care: “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.”
minorIncident learning: “Accidents and incidents had been reviewed by the management team... Further Improvements were needed to identify themes and trends.”
Strengths
· Safe recruitment checks including DBS and references were undertaken for all staff.
· Staff demonstrated comprehensive knowledge of safeguarding systems and knew how to report concerns.
· Electronic record keeping system provided live oversight of care delivery and medicine administration alerts.
· Staff were competency-assessed before administering medicines.
· Monthly MAR audits and daily medicine alerts ensured timely action on missed medications.
Purple Care, a domiciliary care service in Hinckley, was rated Requires Improvement overall at its December 2019 inspection, down from Good in 2018, with recurring failures in call duration compliance, inconsistent staffing, ineffective governance and audit processes, and poor complaints handling. Safe and Effective domains remained Good, supported by adequate safeguarding systems, recruitment practices and staff training, but caring and responsive domains suffered due to staff rushing visits and people feeling depersonalised.
Concerns (9)
moderateMissed or late visits: “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.”
moderateRecord keeping: “Timings of calls could not be confirmed by records as these were not always accurate.”
moderateMedication management: “We found several gaps in signatures on medicine administration records which had been audited in the last month. Audits showed medicine records had been signed off as compliant and had failed to identify these gaps.”
moderateGovernance: “Outcomes of audits were not clearly documented and there was no clear evidence that results of quality assurance checks were used to plan improvements to the service.”
moderatePerson-centred care: “Staff don't stay long because they've got somewhere else to go. They just want to get on to the next call. I feel I am invisible sometimes.”
moderateComplaints handling: “Record keeping in relation to complaints was inconsistent. Staff had not always clearly documented that improvement had been made and sustained in response to concerns.”
moderateConsent / capacity: “Assessments of people's capacity to make informed decisions about their health, care and welfare were not sufficiently robust or recorded clearly within their assessment and care plan.”
moderateCommunication with families: “A second relative felt the provider listened to their concerns and made assurances they would be looked into, but they never received a response in relation to their concerns.”
minorLeadership: “The service did not have a manager registered with the Care Quality Commission, although a manager had been appointed and was in post at the time of inspection.”
Strengths
· Staff had been trained in safeguarding procedures and the provider had effective safeguarding systems in place.
· Recruitment procedures were robust, including DBS checks and references from previous employers.
· Staff received infection control training and PPE was available and used appropriately.
· People's needs were assessed before starting the service, covering physical and mental well-being, preferences and communication needs.
· Staff received supervision, guidance and training including induction with online and face-to-face components.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
Purple Care TM received an overall rating of Requires Improvement, with Well-Led deteriorating to Inadequate, representing the third consecutive requires improvement rating and continued breaches of Regulations 12 and 17. Persistent failures in call time adherence, care plan compliance, medicines recording, and governance resulted in a warning notice being served for poor governance.
Concerns (11)
criticalMedication management: “Medicine administration records did not always record the exact time medicines were given... there was a risk the medicine would be less effective in managing the person's symptoms.”
criticalMissed or late visits: “provider's record of rostered call time and actual call times for 21 June 2021 recorded a variance to the rostered call time on 23 of the 59 calls for this day”
criticalCare planning: “Staff did not always follow risk assessments and care plans... staff did not follow the care plan regarding providing meals and encouraging personal hygiene and clean clothing.”
criticalGovernance: “The provider carried out audits and had identified shortfalls, but not enough action had been taken to address these.”
moderateConsent / capacity: “Assessments of people's capacity to make informed decisions about their health, care and welfare were not always completed.”
moderateSafeguarding: “Staff were not able to fully demonstrate they understood what safeguarding vulnerable adults means.”
moderateRecord keeping: “Staff were not routinely recording or monitoring the food and fluid intake for this person... There was no record of the amounts of food and fluid consumed or offered.”
moderateComplaints handling: “not all complaints had been formally recorded... Two people's relatives told us they had found staff at the office unhelpful when they raised concerns.”
moderatePerson-centred care: “Some people did not receive care and support that was person centred because staff did not follow the care plan.”
moderateIncident learning: “Staff did not always recognise or report risky behaviour in a timely manner so the risk could be assessed and managed appropriately.”
minorCommunication with families: “Two people's relatives told us they did not find the office staff helpful or approachable.”
Strengths
· Staff were kind, respectful and motivated, and people liked their care workers.
· Staff followed government guidance on PPE and had access to required infection control equipment.
· Safe moving and handling training was provided with competency assessments using hoists and slings.
· The provider worked with local authority and healthcare professionals to deliver packages of care.
· Risks in the environment were assessed and managed, and most recruitment checks were undertaken safely.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and RecruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experience
Purple Care TM, a domiciliary care agency supporting 20 people, improved from Requires Improvement to Good across all five key questions following a follow-up inspection. The provider addressed previous breaches of regulations 12 and 17 through better governance, improved call times, robust risk management and a positive person-centred culture.
Strengths
· Improvements made following previous inspection; no longer in breach of regulations 12 and 17
· Safe medicines management including PEG administration and electronic MAR records
· Safe recruitment practices including DBS, identity and right to work checks
· Sufficient staffing levels with improved call times and continuity of care
· Person-centred care delivered with dignity, respect and promotion of independence
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and management; Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough; access healthcare servicesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experience