Archived: Care Promise

Care Promise provides personal care to people who wish to remain independent in their own home across the Durham area. The service could be provided to people with a wide range of needs covering; learning disabilities or autistic spectrum disorder, older people, physical disability, sensory impairment or younger adults. At the time of our inspection there was one person using the service.

When we visited the service on the 6 September 2016 we found that the provider could not demonstrate that fire risk assessments had been completed to ensure people’s health and safety.

We issued a requirement notice to the registered manager to send us a report (action plan), within 28 days, to explain how they intended to mitigate the risks in relation to health and safety and fire safety and address the breach of regulations. The registered manager sent this report to us promptly and we were satisfied with how they intended to address the issues we found.

There was a registered manager in post. 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.

On this visit we spoke with the registered manager. They explained the checks they carried out to ensure fire risks were considered and reduced. We saw improvements the service had made around fire risk assessments.

During the inspection we also saw improvements had been implemented by the registered manager in recording quality assurance checks, including monitoring fire safety on an on-going basis.

The service had a registered manager. 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.

The person who used the service told us they felt safe and well supported by staff.

Staff had received training in safeguarding. We found staff recognised signs of abuse and understood what actions to take if they thought people were unsafe.

There was a process for managing accidents and incidents to ensure the risks of any accidents re-occurring would be reduced.

Staff employed by the registered provider had undergone a number of checks to ensure they were suitable to work in the service; however we found that references on file were not originals and did not have signatures.

Fire risk assessment policies were not being followed and staff did not have clear instructions about what to do in the event of a fire.

Staff had received regular support through supervision and appraisal to enable them to care for people. Mandatory training needs were met but we found that evidence of additional training was required for more specialised tasks.

We saw that the person had person centred support plans that reflected their needs and were reviewed regularly. Support plans reflected the person’s needs and preferences.

Individual support plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. We found in some case these did not demonstrate that risks had been fully assessed.

The care records showed us that people’s health was monitored and health care professionals were involved where necessary for example: their GP, district nurse or social worker.

We saw a compliments and complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to advocacy services and safeguarding contact details if they needed it.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. Any applications must be made to the Court of Protection.

The service adhered to the requirements of the Mental Capacity Act. This meant people’s capacity to make decisions had been assessed. Where required we found decisions had been made in people’s best interests involving their family members and other professionals.

We found the person who used the service, their representatives and healthcare professionals regularly asked for their views about the service.

We found that spot checks were being introduced but had not previously been used to ensure staff were completing tasks in an appropriate way. Some checks were made on the safety and quality of the service as part of the care review process.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People's relatives told us they were happy with the care their relative received. One person told us "my relative has been a client of the service for many years and I am very happy with the care they receive". Another person told us "the care is excellent, my relative and the family get on very well with the care workers."

We looked at the care records of people and found there was a system in place to ensure people consented to their care. People had an assessment of their care needs before they started using the service. A care plan was then implemented to ensure staff knew how to deliver care safely and effectively.

The service had suitable staffing arrangements to ensure people's needs were met. The staff had been appropriately trained and knew how to identify and report any concerns of abuse.

Records relating to people were stored securely where only people who had been authorised could access them.

People told us they always had the same team of staff coming to their home. One person said 'I have a rota so I know who is coming'.

People told us they felt able to say if they were unhappy. One person said "If I have a problem it's soon sorted out". Other comments included "They always leave their telephone numbers" and "If I have any problems I would speak to the manager".

Staff were knowledgeable about people and were able to explain, with examples, about how they would promote people's independence and choice. We spoke with four members of staff and asked them how they made sure people they supported were treated with dignity and respect. One member said 'I always make sure people are covered and blinds and doors are closed'; another said 'I give them space when they want to be alone and let them decide what they want to do, it's entirely up to them'.