Purely Care is registered to provide personal care to people living in their own homes. There were 33 people receiving personal care from the service when we visited. A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received training to protect people from harm and they were knowledgeable about reporting any suspected harm. There were sufficient numbers of staff to provide care and support for people. Recruitment procedures ensured that only suitable staff were employed. Risk assessments were in place for people’s assessed risks and actions were taken by staff to reduce these risks. Arrangements were in place to ensure that people were supported and protected with the safe management of their medicines.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA). Staff were supported and trained and had an understanding of the principles regarding the MCA.

People were supported to access healthcare professionals and they were provided with opportunities to increase their levels of independence. Health risk assessments were in place to ensure that people were supported to maintain their health. People had adequate amounts of food and drink to meet their individual preferences and nutritional needs where appropriate.

People told us that their privacy and dignity was respected and their care and support was provided in a caring and a patient way.

A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People could raise concerns with the management team and care staff at any time and felt listened to..

There were quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. People and their relatives were able to make suggestions and changes in relation to the support and care provided and staff acted on what they were told.

There were links with the external community. There was a staff training and development programme and procedures were in place to review the standard of staff’s work performance.

We considered all of the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found:-

Is the service safe?

People using the service told us that they felt safe when the live-in carers stayed with them. The office environment was well equipped, secure and clean. There were sufficient numbers of care staff to ensure that people were provided with the live-in care and support they required.

Staff rosters revealed that sufficient numbers of live-in care staff were employed and that staff absence was covered. The provider demonstrated that they employed staff members that were suitable and had the skills, qualifications and experience needed to provide care and support to people living in their own home.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLs). The provider showed us that there had not been a requirement for a (DoLs) application to be made. Records, policies and procedures were held and relevant staff had been trained and knew how to ensure that, when needed, a (DoLs) application was submitted.

Is the service effective?

People told us they received the care and attention they required in a way that met their needs. Through speaking with staff we noted that they understood the care and support needs of each person they lived with. One person told us. “The live-in carers I have stay with me are lovely and will do anything to help me. I only have to ask.” Staff had received training to meet the needs of people using the service.

Is the service caring?

People told us they were supported by staff who used a kind and attentive approach. They said that the live-in care workers were patient and encouraged people to be as independent as possible. People also told us that the staff did not rush them and that they were polite and respectful.

Is the service responsive?

Care and risk assessments had been completed before people used the service and when their needs had changed. A record was held of their preferences, interests and diverse needs. People told us that staff members consulted them and encouraged them to make their own decisions. People had access to planned activities that were tailored to their needs and choices.

Is the service well led?

All of the staff spoken with had a good understanding of the whistleblowing policy. Quality assurance processes were being further developed. Most people using the service and all staff said they had felt listened to when they made a suggestion or raised their concerns. People using the service told us that they were sometimes included in discussions about any planned changes to the live-in carer they were going to be provided with.

We spoke with three people receiving support from Purely Care. One person said, “I have no grumbles at all.” Another person told us, “They look after me. All of the carers are okay.” We asked the person we visited whether staff assisted them when needed and whether they felt safe. They confirmed that they did.

The service users or relatives told us that they or their family members were treated with consideration and respect. We were also told that staff respected people’s belongings and homes. One relative told us that staff looked after their family member’s home “….as if it were their own.”

Care plans were fully reviewed every six months or sooner if people’s circumstances required. We noted timely reviews on each of the four care plans we looked at. Assessments of risk were made and plans were in place to reduce identified risks.

Systems were in place to ensure that prospective employees had been vetted and were suitable for their role. A training schedule was in place for staff. However due to the needs of several service users staff training was required in dementia so that people could be better supported. We also noted that staff appraisals were overdue.

Systems were in place to assess and monitor the quality of the service provided. However, we found that improvements could be made regarding the annual survey to obtain a more meaningful response in future.

We looked at records, spoke with staff and with two people. We also spoke with relatives or those acting on behalf of people. People told us they were consulted about what care and support they needed and we saw that they signed their care plans to show they had been involved and also agreed with the contents. One person said that the support they received was, "Everything you require". We were told that people were offered choices throughout the day and that staff, "Knew what they were doing". We saw that people's support packages were kept under regular review and changes made if necessary to ensure the person received the care they needed.

Staff received training that was appropriate to their role. A carer told us they were always being offered training and that update training was provided each year. This included training about the safe handling and administration of medicines. Staff were supported in their role and were able to obtain guidance and support at any time.

People knew how to complain and felt able to do so. They told us they would be listened to and action taken if necessary. We saw that the service had a complaints procedure in place that was provided in any format or language as required. Complaint records showed that concerns were dealt with quickly and fully investigated.