About the service:

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 inspection was announced and took place on 6, 9 and 10 April 2018.

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.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014. At our previous inspection on 21 and 24 November 2017, we found people were not protected from the risk of potential abuse. The service was rated as requires improvement and placed into special measures. After that inspection we received concerns in relation to management of the agency, the use of unskilled staff and an allegation of practices that caused injuries to a person who used the service. As a result we undertook this focused inspection to look into these concerns. This report only covers our findings in relation to those topics. 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

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 p

This inspection was unannounced and took place on 21 and 24 November 2017.

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

This inspection was announced and took place on 12 and 13 April 2017. Promises of Care Ltd provides personal care to people living in their own homes. At the time of our inspection the service was supporting 14 people, most of whom were living with dementia. This was the services first inspection since they registered with us.

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.