Promises of Care Stoke

Updated 4 March 2023

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 Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 on a specific concern we had about the providers systems to give oversight of the service and govern risks.

Inspection team

The inspection was carried out by 1 inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there was a registered manager in post, although they were on leave during the office inspection.

Notice of inspection

We gave the service 24 hours' notice of the inspection. This was because it is a small service and we needed to be sure that a representative of the provider would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

During the inspection, we spoke with 1 person and 5 family members who used the service, to ask about their experience of the care provided. We spoke with 7 members of staff, which included care co-ordinators, senior staff and care staff. We used technology such as video calls to enable us to engage with the registered manager when they returned from their leave, and electronic file sharing to enable us to review additional documentation.

We reviewed a range of records. This included 4 people's care records and multiple medication records. We looked at a range of records relating to the governance and management of the service.

Updated 4 March 2023

About the service

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 10 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

Governance processes failed to monitor safety and risks effectively to keep people safe from potential risk of harm. The provider had not learnt lessons from the previous inspection and had not safely monitored the care planning process, this placed people at continued risk of harm. Missing information within care records and the inconsistent documenting of people's care were identified during the last inspection, these concerns were found again during this inspection.

Risks to people were not always managed effectively to protect them from potential harm. Risk assessments did not always contain essential information to mitigate risks and identify safe ways of supporting people to reduce the risk of harm.

Medicines were not always monitored safely. Improvements were identified when administrating and monitoring time specific medicines and controlled drugs.

People and relatives told us the service had improved regarding staffing, time and duration of calls and communication. Staff told us the service had improved regarding support and leadership.

Staff received safeguarding training. Staff told us how they could recognise unsafe care practices and the action they would take to report poor practice.

Staff were recruited safely, the provider sought out references and carried out criminal record checks prior to their employment.

The provider used effective infection, prevention and control measures to keep people safe. The registered manager worked well in partnership with other health and social care organisations, to monitor people's health and improve their wellbeing.

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 10 May 2022). 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 insufficient improvement had been made and the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about missed calls, the timings of calls, staff competency, medicines management and risk assessments. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 not changed following this focused inspection and remains requires improvement, based on the findings of this inspection.

We have found evidence 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. The provider took effective action to mitigate some of the risks during the inspection.

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.

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 and will take further action if needed.

We have identified breaches in relation to the way people's care and risks were recorded and monitored, and a continued breach in relation to the governance systems at this inspection.

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