Archived: Altogether Care LLP - Wareham Care at Home

Wareham Care at Home is registered to provide personal care to people living in their own homes. At the time of the inspection the service provided personal care and support to 61 people living in their own homes in the Wareham and surrounding areas.

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.

At the previous inspection the service was also providing a live-in carers service. The live-in carer service was now delivered from one of the provider’s other registered locations.

People’s experience of using the service and what we found

People expressed dissatisfaction they no longer received rotas and therefore did not always know who was coming and at what time. Since December 2018, following consultation with local authority commissioners, the service had introduced two hour visit windows. This had been communicated to people by letter at the time. We raised this with the management who immediately scheduled telephone calls and visits to people to discuss their concerns and look for a mutual resolution.

People told us they felt safe. Staff had an improved understanding of the risks in people’s lives and how to work alongside them to minimise the risks. When risks were identified information was shared appropriately and in a timely way. Additionally, staff demonstrated knowledge of the signs and symptoms people could be showing should they be experiencing harm and abuse and how to raise concerns internally and to external agencies.

Since the previous inspection care plans had been improved. These were now more personalised and contained detailed information to help staff get to know people well and meet their needs competently. This included advice on particular conditions. Staff received an induction, competency assessments and a consistent programme of spot checks to ensure they were delivering care in line with best practice standards.

Since the previous inspection quality assurance systems had also been improved and now provided sufficient oversight of service delivery. Staff undertaking audits had received appropriate training.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and considered these consistently when supporting people. 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.

People and relatives felt staff were kind, caring and respectful. One person said, “I’m well pleased with the way things are going. They (staff) are very good.” A relative had fedback that the care provided to their family member was ‘second to none.’

Staff felt supported, motivated and valued by the registered manager. The office and staff team said communication had improved between them and told us they got on well. The registered manager had helped create a friendly, vibrant and open culture at the service.

The service understood the benefits to people of close liaison with other agencies and organisations such as GPs, fire service, hospital discharge team and local housing associations. The service had recognised the part they could play in maintaining and improving people’s health and 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 20 October 2018) and there were multiple breaches of regulation. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous 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.

Altogether Care LLP Live in Service – Care at Home is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of the inspection they were providing personal care and support to 77 older adults living in the general geographical area of Wareham.

The service supported people who received care from live in carers. Live in carers, lived in people’s home for periods up to nine months at a time. At the time of the inspection there were 20 people receiving this service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Individual risks to people were not always identified to ensure measures were in place to help keep people safe and prevent harm. There were inconsistencies in how staff reported accidents and incidents. This meant there was a risk that appropriate action would not be taken by the service to, identify themes, learn lessons and prevent future occurrences taking place.

People told us they received their medicines safely. However, management of people's prescribed medicines required improvement to ensure people received their medicines in a safe way. Care plans, Medicines Administration Records (MAR) and daily records showed conflicting information about people's medicines. Systems around auditing records in regards medicines were not being thoroughly undertaken, to ensure any errors or shortfalls were addressed.

People told us they felt consulted in regards choice and decision making. The registered manager told us information had been gathered in regards consent for people who lacked capacity to consent. However, we found these decisions were not documented in peoples’ care records.

There were policies and procedures in place to help keep people safe from abuse. A safeguarding procedure with the information staff would need to follow if they had concerns about people was available, and staff told us they would be confident to raise concerns. People told us they felt safe and knew who they would talk to if they did not.

People told us they had regular staff to support them who were on time, and received a rota in advance which informed them who would be visiting them. They told us staff stayed their allocated time and treated them with dignity and respect.

Care plan records did not always provide the person centred information necessary for staff who did not know a person well to continue to provide the same good quality care as regular staff.

Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

People were supported by staff who respected their individuality and protected their privacy. Staff understood how to advocate and support people to ensure that their views were heard and told us that they would ensure that people’s religious or other beliefs were supported and protected.

Staff had undertaken training in equality and diversity and understood how to use this learning in practice.

The provider had systems and procedures in place designed to enable them to seek and document people's consent to care. However, although the provider told us best interest decisions had taken place there were no records in place to identify the discussions or outcomes.

People were protected from the spread of infection by staff who understood their role in infection control and used appropriate Personal Protective Equipment (PPE).

Environmental risks inside and outside people's homes were documented to keep people and staff safe from hazard.

People were supported to have enough to eat and drink. People’s preferences for meals were well known and staff offered people choices about what they ate and drank.

Quality assurance systems in place did not ensure that improvements we identified during our inspection were always effective. The registered manager told us, “Communication had not been taking place as it should”.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which are listed in other areas of our report.