Altogether Care

Updated 16 January 2019

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.

This inspection took place on 7 and 13 December 2018 and was carried out by one inspector.

We gave the provider 48 hours' notice of our intention to undertake an inspection. This was because the provider delivers a domiciliary care service to people in their own homes, and we needed to be sure that someone would be available in the office.

Before the inspection visit, we reviewed the information we held about the service, including any statutory notifications received from the provider. A statutory notification is information about important events, which the provider is required to send us by law. We also contacted the local authority and local Healthwatch for their views on the service.

During our inspection visit, we spoke with five people who used the service, seven people's relatives and six community health and social care professionals. We also spoke with the provider, one senior care staff and three care staff.

We looked at a range of documentation including four people's assessment and care records, three staff recruitment records, medication administration records, staff training records and records associated with the provider’s quality assurance processes.

Updated 16 January 2019

The inspection took place on 7 and 13 December 2018 and was announced.

Altogether Care is a domiciliary care agency. It provides personal care to people living in their own houses in the community. The service supports older adults, some of whom are living with dementia. At the time of our inspection visit, 37 people were using the service.

The provider is registered as an individual and therefore is not required by law to have a separate registered manager. 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.

At our last inspection, we found the provider had failed to notify us of a number of safeguarding issues involving people who used the service. Registered providers must, in accordance with their registration with the Care Quality Commission (CQC), notify us about certain changes, events and incidents, including safeguarding issues, that affect their service or the people who use it. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. At this inspection, we found the provider was now meeting the requirements of Regulation 18. They had taken steps to ensure all required statutory notifications were submitted to CQC within the expected timescales.

People felt safe receiving care and support in their homes from staff employed by Altogether Care. Staff had been trained in, and understood, their responsibility to protect people from and report abuse. The provider had safeguarding procedures in place to ensure the appropriate external agencies were informed of any abuse concerns. The specific risks associated with people’s care and support had been assessed, kept under review and plans developed to manage these. Staff confirmed they read people’s risk assessments and were kept up to date with any changes in risks to people and themselves.

People generally received a punctual and reliable service from Altogether Care, provided by familiar staff. The provider completed checks on prospective staff to confirm they were suitable to support people in their homes. The provider had systems and procedures in place to ensure people received their medicines safely and as prescribed. The provider had taken steps to protect people, their relatives and staff from the risk of infections, including the use of appropriate personal protective equipment by staff.

People’s individual needs were assessed before their care started to ensure the provider could meet these effectively. Staff received training to prevent people from experiencing any form of discrimination during the planning or delivery of their care. Staff and management worked effectively with a range of external health and social care professionals to promote people’s health and wellbeing. New staff completed the provider’s induction training to help them settle into their new roles. They then participated in a rolling programme of training to ensure they had the skills and knowledge needed to work safely and effectively. People had the support they needed to prepare meals and drinks, and any associated risks were managed. Staff helped people to seek professional medical advice and treatment if they were unwell. Staff and management understood and promoted people’s rights under the Mental Capacity Act 2005.

Staff treated people with kindness and compassion. People and their relatives were encouraged to express their views about the service provided and participate in decision-making that affected them. People’s individual communication needs were assessed and addressed to promote effective communication and support them in voicing their opinions. Staff promoted people’s rights to privacy and dignity, as part of which they protected their personal information.

People’s care reflected their individual needs and preferences. Staff followed people’s personalised care plans, which included information about their known preferences. People and their relatives understood how to raise complaints with the provider, and felt comfortable doing so. Staff and management worked collaboratively with community healthcare professionals to ensure people received person-centred care as they approached the end of their lives.

All of the people and most of the relatives we spoke described positive dealings with the management team. Staff felt well supported, valued and were clear where to turn for any additional support and advice needed. People, their relatives and staff were encouraged to be involved in the service and put forward their ideas and suggestions. Health and social care professionals spoke very positively about their working relationships with staff and management, and their willingness to take on board any recommendations made. The provider’s quality assurance systems and processes enabled them to assess, monitor and improve the safety and quality of the service.