Pure Life Homecare

Pure Life Homecare is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection the service was providing care for 30 people, including people with physical disabilities, learning disabilities and autism, mental health problems and people living with dementia. The service was provided in Canterbury and surrounding areas.

Not everyone using Pure Life Homecare receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

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

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.

The quality of service people received had improved since our last inspection. People told us they received the care and support that they needed.

Management of the service had improved. Since the last inspection the manager had registered with Care Quality Commission (CQC). The registered manager had oversight and scrutiny of the service and was receiving support from the provider. The provider and registered manager were both committed to improving and developing the service.

People told us the service was well managed. People, their relatives and staff spoke highly of the registered manager. They were described as 'very supportive' and 'approachable' and sorted out any issues they had. People and their relatives gave positive feedback about the service they received. People said they felt safe with the staff when they received care in their own homes. People told us they were treated kindly and compassionately by the staff.

People were protected from the risk of avoidable harm. When concerns were identified about people's safety, information was shared with appropriate stakeholders so investigations could be conducted. Risk to people health and safety where identified. The registered manager had ensured all risks associated with people and the service had been assessed and action taken to mitigate the risks.

People were supported with their health needs.The registered manager had oversight of incidents and accidents and lessons had been learnt when things went wrong.

Staff communicated effectively with people and each other to make sure people's needs were met in the way they had chosen. When people were unwell or needed extra support, they were referred to health care professionals and other external agencies. People received person-centred care that promoted their dignity

and independence. Staff followed infection control policies and practices to help protect people from any infection.

Staff knew their roles and were able to tell us about the values and the vision of the service. There were adequate quality assurance measures in place. The registered manager visited people and made calls to check people were happy with the service. Any complaints that were made were managed in the right way and people had been invited to suggest improvements to the service.

There were sufficient numbers of staff to provide the care people needed. People and their relatives said staff arrived when they should and stayed the allotted amount of time. They reported they had not had any missed calls. People said that they usually had consistent care from the same group of staff who had got to know them well. Staff received the training they needed to look after people in the way that suited them best Their competencies were checked by the registered manager to ensure staff had the skills to do their job well and effectively meet people's needs.

Staff received support, guidance and advice from the registered manager and provider. Learning needs were identified and staff had opportunities for personal development. The registered manager regularly worked alongside the staff team and checked that staff were working with people safely. All safety recruitment checks were completed before staff started working with people.

People were supported to express their views and make decisions about their care. 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. People's needs were assessed and reviewed to ensure care being delivered was up to date and reflective of their needs. People had care plans that provided detailed guidance for staff on the support and care that they needed on a daily basis. Care plans were specific and personalised. People were supported to do things they wanted to do.

People consented to their care and were supported by staff who were trained to fulfil their roles effectively. Staff were aware of the importance of good nutrition to people's health and wellbeing. Medicines were managed safely and people received their medicines.

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 9 March 2020). There were two breaches of the regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that people’s mental capacity be assessed and recorded, that staff had specialised training and people had information in format they could easily understand. At this inspection we found the provider had acted on any recommendations and made improvements.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well- led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

Follow up

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

Pure Life Homecare is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection the service was providing care for 34 people. including people with physical disabilities, mental health problems and people living with dementia. The service was provided in Canterbury, and surrounding areas.

Not everyone using Pure Life Homecare receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Since the last inspection the provider is no -longer involved with the franchise ‘Expertise Homecare’ and has changed its name to Pure Life. The legal entity of the service remains unchanged.

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

We found there were two breaches of regulations which had continued since our inspection in January 2019. Improvements had been made in some areas, but further improvements were needed.

People were not always fully protected from risks. Risks to people continued not to be fully assessed and there was limited guidance in place to make sure risks were kept to a minimum.

Governance and performance management systems were not always effective. The quality of information in people's care plans varied. The service was not always well led as systems to monitor the quality and safety of the service had failed to identify and address the areas of concern we found during the inspection.

People's care plans needed developing to show how person-centred care needed to be delivered in a way that people preferred and suited them best. There was a lack of guidance within care plans to support people with their medical and health conditions. There was no information in people's care records to show how the staff explored people's preferences and choices in relation to end of life care. Some people told us they were did not have access to their care plans. The manager had identified this shortfall and was addressing the issue. Other people and their relatives told us they were involved in and directed the planning of their care and support they needed.

Staff received mandatory training. However, staff had not received training to meet people's specific and specialist needs such as epilepsy, behaviours that can be challenging and end of life care and support. We have made a recommendation that staff receive the training they need to carry out their roles effectively and safely.

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. However, the procedure to assess people's capacity to make decisions was not always clear or completed accurately. We have made a recommendation to ensure peoples capacity is assessed in line with legislation.

There were enough staff deployed to give people the care and support that they needed. On the whole people told us they had the same team of staff who arrived on time. The manager was aware of this and new staff had been employed to make sure people received care from a consistent staff team,

Improvements had been made when new staff were recruited, and this was now managed safely to make sure only suitable staff were employed to provide care and support to people. Peoples complaints were now responded to in a timely way. People knew how to complain and felt confident they would be listened to. People received their medicines safely and as prescribed by their doctor. Lessons were learnt when things went wrong, and action was taken to prevent the risk of re-occurrence.

People's needs were assessed before they started using the service to make sure staff could deliver the care they needed. Staff were regularly supervised, and the manager checked that staff were undertaking their roles safely and effectively.

People were supported to access healthcare services when needed and were protected from the risks of developing infections. When staff prepared meals for people, they were supported to have a range of nutritious food and drink that they had chosen.

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 14 January 2019). The service remains requires improvement. 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 two regulations.

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches of the regulations at this inspection in relation to, the assessment of individual risk, and the monitoring of quality and safety.

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 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 in post. A registered manager is a person who is 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 2008 and associated Regulations, about how the service is run.

Staff were not always recruited safely. This was because the registered manager did not take all the necessary steps to ensure they knew the previous conduct of newly recruited staff. People did not always receive their medicines safely. We found staff were not following best practice guidelines when administering controlled drugs. We made a recommendation about this. The registered manager had not always taken steps to learn lessons when things went wrong to keep people safe. Some people and staff might be at risk because risks were not always being fully documented.

People’s needs were assessed before the service began, but we found some needs were not fully recorded. Newly recruited staff were supported with an induction, but progress was not always tracked in accordance with the registered provider’s guidelines. Staff were knowledgeable about the Mental Capacity Act, but records were not always accurate or up-to-date.

We found the registered provider had not always acted on complaints in a timely manner. This had a negative impact on the person making the complaint. People’s care plans did not always contain detail about their needs or preferences. This included how they wished to be supported at the end of their lives. People did not receive information about their care in an accessible format. People and their relatives told us they had not seen all of their care records because they were on a computer system which they did not know how to access. We have made a recommendation about this.

Governance systems were not always effective in making sure that shortfalls in service delivery were identified and rectified. The registered manager was unaware of the shortfalls in, for example, the recruitment procedures or care plans which we identified during our inspection. Not all the staff we spoke with were clear about what was expected of them. This was because job descriptions were not always changed when staff’s roles changed. Although staff were not supported with regular meetings or supervisions, they told us they felt supported by their manager and senior staff.

People were protected from abuse. Staff were knowledgeable about the types of abuse which could occur, and knew what action to take if they had concerns. People were protected by the prevention and control of infection. Staff had access to, and used, protective equipment, and received regular training which helped them keep people safe.

Staff received sufficient training in order to meet the needs of those being supported. Where people had specialist needs, additional training was provided. When required, people were supported to eat and drink enough to maintain a balanced diet. Staff worked across organisations to ensure people received joined up care and support. People were supported to live healthier lives. Senior staff ensured people had access to health professional support when needed.

Staff treated people with kindness and respect. People and their relatives told us that staff were compassionate and offered they emotional support when it was needed. People were supported to be independent. They were able to express their views and make decisions about their care. Staff took steps to make sure they treated people with dignity.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

We found additional shortfalls in the service in relation to which we have made recommendations.

This is the first time the service has been rated Requires Improvement.

Expertise Homecare is a domiciliary care service provided to people living in their own homes. The service currently provides support to people with a wide range of care needs, including both younger and older adults with physical disabilities and sensory impairment, learning disabilities and dementia and provides support to people with mental health needs, eating disorders, and people who misuse drugs and alcohol. At the time of the inspection 30 people were using the service.

A registered manager is currently in post and was present on the day of the inspection. 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 2008 and associated Regulations about how the service is run.

Everyone we spoke to said they felt safe when being cared for by the care staff of Expertise Homecare. There were clear risk assessments and equipment used was checked for safety and staff had training to make sure they were competent to use it. The registered manager and care staff worked closely with local health and social care professionals to support people’s health and wellbeing and make sure people were well hydrated and nourished. People had the help they needed to take their medicines and there were clear procedures to follow to assist them safely. When people were nearing the end of their life, the care staff worked alongside the hospice nurses to assist to make sure people were as comfortable as possible and had their wishes adhered to.

All care staff carried an encrypted electronic tablet that contained people’s care plans and all the information relevant to give each person the right care and support. Records were kept confidentially and could only be accessed on a need to know basis using a series of passwords.

There was an open and person centred culture based on the values of the organisation of trust, transparency, quality and support. The registered manager was known by everybody using the service because he visited people regularly and kept in touch. People and relatives told us that the registered manager was friendly, helpful and easy to contact. People praised the efficient communication between the registered manager and staff team, commenting that care staff were always well informed and if they wanted to speak with the registered manager he always had time for them. The registered manager gave care staff weekly updates and any changes regarding people’s care was sent to them by email as soon as possible and care plans reviewed and updated.

People said the care staff were reliable and always arrived at the time they said they would. People had a rota of times that they would receive care. Staff were on time and if they were going to be delayed would always call to let people know. Care staff explained that there was always plenty of time allocated to them to give people the care in the way they wanted. The registered manager explained that the company was expanding but they were doing this slowly to make sure they did not over-stretch the staff. He went on to say that they always checked the timings and staffing level was sufficient before offering a new care package.

People were full of praise for the caring nature of the care staff and the leadership of the service. Staff were recruited safely and received essential training at the beginning and were introduced to people by experienced care staff before they supporting people. Staff said they felt confident in their roles and the registered manager was always at hand if they needed any support. Staff said the training was good and included attending events and they had to experience some of the care as part of the training, for example, being hoisted. They said this helped them to empathise with the people they were giving care to.

People were listened to and received their care in the way they wanted from staff who treated them with dignity and respect. A relative commented, ‘We had an appalling experience before, Expertise is different it’s like chalk and cheese, they are responsive, interested, reliable and thoroughly pleasant nice people’.

There was a good system of evaluation of what was working well in the service and what could be improved. People, their relatives and care staff said they were asked what they thought of the service. People and relatives said they felt listened to and valued. Care staff said they felt appreciated and really enjoyed working for this company. Everyone we spoke with said they had no complaints but would feel comfortable raising any concerns if they needed to.

The registered manager and care staff always made sure people consented to their care and had a good understanding of the Mental Capacity Act (MCA) for people who may lack capacity. The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty

Safeguards (DoLS). For people who live in their own homes this is managed by the Court of Protection (COP). No applications had needed to be made.

The CQC had been informed of any important events that occurred at the service, in line with current legislation.