Promises of Care Stoke

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 15 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

In response to the governance and auditing concerns raised during the last inspection, the provider developed a new care co-coordinator role to assist with the monitoring and auditing processes. The registered manager was keen to develop a culture of improvement, partnership working and transparency.

The provider monitored the quality of care and support provided to people, involving the person, their families and other professionals as appropriate.

The provider completed regular audits of the care plans, risk assessments and medicine administration. Improvement were identified and acted upon in a timely manner.

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 December 2022).

At our last inspection we found breaches of the regulations in relation to a lack of oversight and governance of risk within the service. The provider was made aware of our concerns and the improvements which were required to be completed by 20 January 2023.

At this inspection we found improvements had been made and the provider was now meeting this regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.

Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

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 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.

Promises of Care is a domiciliary care agency providing personal care to adults with a range of support needs in their own homes. At the time of the inspection there were 19 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

Based on our review of safe and well-led, we found people were not always protected from harm and staff did not consistently document all aspects of people’s care. People were not always supported by consistent staff who effectively met their needs. The provider audits in place were not always effective in identifying missing information or areas for improvement. The provider did not ensure all staff shared a culture of achieving positive outcomes for people.

Staff received training in relation to infection, prevention and control considered essential for their role. Accident and incidents were recorded, and lessons learnt were shared with staff. Staff received regular competency checks to confirm they worked safely and in accordance with the provider’s policies and procedures. People, their relatives and staff received opportunities to provide feedback and engage in the service. The provider worked in partnership with others to make changes to the service.

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 good (published 26 April 2021).

Why we inspected

We received concerns in relation to the monitoring of risks associated with people’s care. 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 changed from good to requires improvement based on the findings of 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. Following the inspection, the provider had taken some action to mitigate the risks. This included investigating the concerns raised and identifying changes made to minimise the risk of them happening again.

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 safeguarding and good governance 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.

Promises of Care is a Domiciliary Care Agency (DCA) providing younger and older adults, some of whom may have dementia, with a varying level of personal care needs. Staff provided care to people living in their own homes. At the time of inspection, the service was supporting four people. 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

Effective systems were not always used to ensure staff were recruited safely at the service.

We made a recommendation about the safe recruitment of staff.

People who use the service felt safe with the care staff. During the pandemic, where possible, regular care staff have been completing care calls.

Relatives told us they were confident that their relatives have been kept as safe as possible.

People told us that staff wore PPE (personal protective equipment) when coming into their homes.

Medicines were handled safely by the service.

Staff received supervision throughout the year in the office and had spot checks in the community.

There had been problems with staff being very late for calls in the past, but recently the provider employed staff from the local area and the lateness of care calls was no longer an issue.

People’s care plans outlined their communication needs and advised staff how people liked to communicate.

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.

The registered manager effectively used quality assurance systems to ensure and evidence they had reviewed the service provision to identify any issues or trends.

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

Rating at last inspection

This service was registered with us on 24 June 2019 and this is the first inspection.

Why we inspected

This inspection was carried out due to the length of time the provider had been registered with CQC without receiving a formal rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.