Promises of Care

Promises of Care is a domiciliary care service providing personal care and support to people living in their own homes. At the time of our inspection there were 31 people using the service. 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

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.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Some people experienced inconsistency in the timings of their support calls. People were supported by staff who knew how to identify and report concerns and there were systems in place to safeguard people from harm. Risks were assessed and management safely and people received their medicines as prescribed. Staff follow guidance to reduce the risk of cross infection and PPE was available for their use. Staff had been safely recruited.

People’s needs were assessed prior to them receiving care. Staff received training to ensure they were able to meet people’s needs. People were supported to manage and maintain their health. 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 and relatives spoke positively about how they were treated by staff. People felt staff supported them with kindness and dignity.

People received care in line with their current needs. Any changes to people’s needs were recorded in care plans and shared with staff to ensure people received responsive care. People’s communication needs had been considered and staff were aware of how to support people’s communication so they were able to express their views and experiences. People knew how to raise concerns and there was a complaints process in place which included learning from concerns and events.

People, relatives, and staff had been asked for their feedback about their experiences. The management team then took action to address any concerns raised about people’s care and support. Improvements had been made to the governance arrangements which meant management oversight had increased which had improved the quality of care people received. Staff and the management team worked in partnership with other agencies to ensure people’s need were met.

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 2 September 2022).

At our last inspection we recommended that the provider ensured that where people have a specific medical condition they seek training from a reputable provider and check the effectiveness of that training with their staff. At this inspection we found staff had now received training relating to people’s medical needs and had the knowledge required to safely support people.

Why we inspected

This inspection was prompted by a review of the conditions applied to the provider’s registration.

Follow up

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

Promises of Care is a domiciliary care service providing personal care and support to people living in their own homes. At the time of our inspection there were 13 people using the service. 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

Systems were in place to check the quality of the service, but they were not always effective. Medicine audit and daily logbook audit documentation was thorough but was not always completed accurately to ensure recording errors were identified. Staff knowledge regarding a specific medical condition was inconsistent.

Clear documentation was in place to guide staff how to meet people’s needs. Documentation was in place to enable staff to manage risk to people. People and their relatives told us they felt safe and staff understood how to keep people safe. People and relatives told us the registered manager was approachable and took action to resolve issues where needed. Staff told us they were well supported by the registered manager and were listened to and encouraged to discuss their views regarding the service. The provider had been proactive in making improvements to the quality of the service people received.

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 16 June 2021). 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.

Why we inspected

We carried out an announced focused inspection of this service on 3 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

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 of Safe and Well Led which contain those requirements.

The inspection was also prompted in part due to concerns received about compliance with conditions, concerns around staffing, missed and late care calls, medicines management and staff not following care plans and risk assessments. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report.

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

Recommendations

We have made a recommendation that the provider implements training and undertakes staff competency checks around a specific medical condition.

Follow up

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

Promises of Care is a domiciliary care service providing personal care and support to people in their own homes. They were providing a service to 25 people at the time of inspection. 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 not being provided safe care and treatment. Risks to people’s safety and health were not assessed or mitigated which exposed them to the risk of harm. Medicines were not given as prescribed and the guidance for staff was not effective leaving people at risk of their health deteriorating. Staff were not always wearing personal protective equipment as required and no risk assessments were completed for people or staff in relation to Covid-19.

We found significant concerns about the management of the service. Their systems were either not in place or not effective to assess, monitor, and improve the quality and safety of the service. The systems had failed to ensure risks were properly assessed, documented and mitigated. The provider had failed to ensure care staff had guidance in place to provide safe care and treatment to people.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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 (published 12 June 2019) and there was a breach 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 enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

The inspection was prompted by risk information we held about the service, 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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 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 breaches in relation to people’s safe care and treatment, managing risks to people's safety; governance and oversight of the service at this inspection.

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

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 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.

Promises of Care is a domiciliary care agency. It provides personal care to people living in their own homes in the community. Promises of Care provides a service to older people, people living with dementia, people living with physical disabilities, adults with learning disabilities and people living with sensory impairments. At the time of the inspection, 20 people were using the service for personal care.

People’s experience of using this service:

People were not always supported by a sufficient number of staff to ensure calls were on time and they received care they needed safely. Assessments and care plans were not always reviewed as people’s needs changed. People’s dignity was not always respected. People were not always provided with personalised care. Complaints and concerns were not addressed consistently. Audits were in place but did not always monitor the service effectively.

Medicines were administered safely. Systems were in place to protect people from abuse and staff understood them. Risk was managed and reviewed to ensure people were kept safe.

People were supported by staff who were appropriately trained and had the skills to provide effective support. People were supported to access health professionals when needed.

People and their relatives were encouraged to be involved in making decisions about their care. People were supported by staff who promoted their independence.

People’s end of life wishes were considered when needed.

People and staff told us they found the management team approachable. The management team worked with other professionals and sought ways to improve the quality of the service.

The service met the characteristics of Requires Improvement in all areas; more information is in the full report.

Rating at last inspection: At the last inspection, the service was rated Good (last inspection report published on 11th May 2018).

Enforcement: A breach of regulation was identified during this inspection. You can see what action we told the provider to take at the back of the full version of the report.

Follow up: We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.

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

This service is a domiciliary care agency. It provides personal care to people living in their houses and flats in the community. It provides a service to older adults and younger disabled adults. At the time of the inspection the agency was providing a service for five people.

The agency had a registered manager who was also the registered provider who was present on the day of our inspection visit. Throughout this report we have referred to them as the 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 2008 and associated Regulations about how the service is run.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

At our previous inspection in January 2018, we found that the provider’s governance was ineffective in promoting safe and effective care. At this inspection we observed the provider had taken significant action to review and improve their governance to ensure people received a better standard of care. Systems and practices were now consistent to ensure people and staff had a say in the running of the agency. The review of equality, diversity and human rights reduced the risk of discrimination to both people who used the service and the staff.

The provider had taken action to ensure people using the service were safe and staff were aware of their responsibility of safeguarding them from the risk of potential abuse. Risks to people were managed effectively and action was taken to reduce the risk of further accidents and incidents. People were cared for by sufficient numbers of staff who had been recruited safely. Where people required support to manage their prescribed medicines they were assisted by skilled staff. Systems and practices helped to reduce the risk of cross infection.

People and other professional’s involvement in care assessments ensured their preference in relation to their care and support were identified and met accordingly.

People were cared for by skilled staff who had access to one to one [supervision] sessions to support them in their role. New staff were provided with an induction to ensure they were appropriately assisted to understand their role and responsibility. Where required people were supported to eat and drink sufficient amounts to promote their health. People’s consent to care and treatment was obtained by staff and where an individual lacked capacity to make a decision, staff explained what they intended to do before they assisted them. The provider worked with relevant healthcare professionals to ensure people’s healthcare needs were met. The provider also offered a service to assist people to attend medical appointments if and when required.

People were supported by staff who were caring and understood the importance of preserving their right to privacy and dignity. People’s involvement in their care planning ensured their specific needs were met the way they liked.

People were aware of how to make a complaint and could be confident their concerns would be listened to and acted on.

The provider informed us they were not currently providing end of life care for anyone.

At this inspection we found the provider had not taken sufficient action to improve the quality of the service and people remained at risk. The risk to people was not managed effectively as staff did not always have access to detailed information about how to reduce the risk of harm to them. The inappropriate use of personal protective equipment placed people in danger of cross infection. The service remains rated as requires improvement and remains in special measures.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This service is a domiciliary care agency. It provides personal care to people living in their own home. It provides a service to older adults, younger disabled adults and children. On the day of our inspection visit to the office the agency was providing a service to six people. All of these people were receiving personal care.

The agency had a registered manager who 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The risk to people was not managed effectively as staff did not always have access to detailed information about how to limit risks. The inappropriate use of personal protective equipment placed people in danger of cross infection. The provider had not taken any action to ensure people were not placed at risk of discrimination.

The provider had not taken any action to improve the governance with regards to monitoring the quality of the service provided to people. People therefore, remained in jeopardy of receiving a service that did not meet their specific needs.

Since the previous inspection the provider had taken action to improve the management of accidents and to reduce the risk of a reoccurrence. The provider had also reviewed medicine practices to ensure staff had an understanding about how to support people to take their medicines safely. People were cared for by sufficient numbers of staff who had been recruited safely.

This service is a domiciliary care agency. It provides personal care to people living in their own home. It provides a service to older adults, younger disabled adults and children.

On the days of our inspection visit the agency was providing a service to 12 people. All of these people were receiving personal care.

The agency had a registered manager who 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our previous inspection on 12 and 13 April 2017, the provider was rated inadequate and was therefore placed into special measures. We issued a warning notice so the provider was aware of the areas where improvements were needed to ensure people received a safe and effective service. The provider submitted an action plan on 30 June 2017, to tell us what action they would take to improve the service and to comply with the regulations.

We undertook this inspection to check whether improvements had been made and found the provider had not taken sufficient action to improve the service provided to people or to ensure their safety.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, they will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Quality assurance monitoring systems remained ineffective to reduce the risk of people receiving inappropriate care and support.

People remained at risk of harm because the provider had not taken sufficient action to ensure people were appropriately supported to take their prescribed medicines.

The risk of potential abuse to people had not been managed effectively because the registered manager failed to recognise abuse and to take appropriate action to safeguard them. Risk management was ineffective to monitor accidents and to avoid a reoccurrence.

Staff’s practices needed to be improved to promote hygiene standards to reduce the risk of cross infection as the inappropriate use of personal protective equipment placed people at risk.

The provider was unable to demonstrate how they worked with other relevant healthcare professionals to ensure people received a safe and efficient service. However, staff were able to recognise when people required urgent medical attention and acted on this promptly. Action was needed to ensure all staff were aware of how to support one person with their meals to reduce the risk of choking.

People’s dignity was not always maintained as their decision to have staff of their preferred gender care for them was not always respected. However, people were involved in planning their care and in most cases care was delivered by individual staff members in a kind and caring manner.

Complaints were not always managed effectively as staff did not always share people’s concerns with the registered manager to enable them to address them.

Assessments and care planning of people’s needs did not include equality, diversity and human rights to ensure the service was specific to the individual.

People were cared for by staff who received one to one [supervision] sessions and who had access to training to enhance their skills. However, skills learnt by staff were not always put into practice to ensure people received the appropriate care. New staff were provided with an induction to support them in their role.

The provider had taken action to reduce the risk of missed calls to ensure people received consistent care and support. There were sufficient numbers of staff provided who had been recruited safely to meet people’s assessed needs.

People’s consent was obtained before staff assisted them with their care needs. The registered manager demonstrated a better understanding of when a mental capacity assessment needed to be carried out to determine a person’s ability to make their own decision.

We found a number of breaches of the Health and Social Care Act 2008 regulations. You can see what action we took in response to these breaches at the back of this report.

There was a registered manager in post at the time of the inspection who was also a company director. 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.

People’s medicines were not always given as prescribed or managed in a safe way. Risks to people had not always been accurately identified, assessed or managed and not all staff were aware of people’s specific risks and how to manage them. People were not always supported by staff that had been safely recruited. Most people told us their calls were often late and they had occasionally experienced missed calls.

The principles and application of the Mental Capacity Act was not always understood and followed where people lacked capacity to make decisions for themselves. People who were supported with food and drink were not always supported by staff who understood their specific dietary requirements.

Staff understood the importance of treating people with kindness, dignity and respect, however not all people and relatives we spoke with could confirm this.

People’s care plans were not always kept up to date and staff were not always aware of people’s specific needs or preferences. People knew how to complain, however the provider was not always appropriately managing complaints received.

The service was not well led. Not everyone we spoke with told us they would recommend the service to others. The provider had not returned the PIR we requested. The provider was not always safely recruiting staff. There were not sufficient systems in place to ensure people were provided with safe and effective care that met their needs. Systems that were being used to monitor the quality and consistency of the service were not effective at identifying the required improvements. People’s feedback was not always used to drive improvements.

Staff received an induction to their role and the registered manager had recently signed up to an online training tool to enable staff to access training to meet people’s specific needs. People were asked for their consent before care and support was provided. People were supported by staff who knew what action to take if they identified a deterioration in a person’s health. People were encouraged to make day to day decisions about their care and support and were supported to maintain their independence.