Altogether Care - Care At Home Limited Christchurch

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Effective processes were in place to help protect people from harm, whilst respecting their preferences and promoting their independence. People felt secure with their care workers, who provided the support they needed to help them remain safe and comfortable. There were enough skilled and competent staff to provide people’s care. Staff were recruited following the necessary pre-employment checks. They had the training they needed to perform their roles safely and effectively. This included observing infection control precautions, administering medicines and assisting people who had impaired mobility. Staff knew how to report incidents, near misses and abuse, and were confident their managers would take appropriate action if they did so.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People said the service had acted on issues they had raised. Two people mentioned that although changes had been made in response, they did not hear directly back from the service about what had been done. The management team highlighted that it was their usual practice to inform people about what action they had taken.

Staff told us they felt confident to approach the management team with concerns or queries. The registered managers were familiar with the requirements of the duty of candour.

Staff recorded accidents, incidents and near misses. The registered managers kept logs of these. They reviewed each event to ensure necessary action had been taken for people's safety and welfare. They analysed events monthly to identify developing trends and any further action that might be needed as a result.

People experienced care tailored to their individual needs, which had been assessed thoroughly before their care package commenced. Collecting relevant information as part of detailed assessments had enabled the service to take on people’s care safely in complex situations, and to continue supporting them effectively.

Managers and staff recognised the importance of completing comprehensive assessments before people began receiving care, to enable truly person-centred care. Staff confirmed care plans contained the information they needed to provide safe care.

The service had received positive feedback from people’s health and social care professionals, in connection with the way staff and managers worked with them towards positive outcomes for people because their care needs were met.

Care plans held on the service's electronic care system were personalised, detailed and up to date. The system enabled key information to be shared with health and social care professionals where needed.

People told us they trusted and felt safe with their care workers. Comments included, “I have not had any occasion to feel unsafe”, “They are not bossy or pushy”, “They (staff) are always nice people” and “We feel really safe with the carers. They show us such respect and yes, dignity is maintained at all times.” People said they had been provided with information about who to contact if they were concerned about their safety with staff. For example, someone told us, “I would contact the number on the pack I have been given.”

Staff, including the management team, received regular training about safeguarding people and understood signs that indicated abuse might be happening. They knew how to report concerns about abuse.

The registered managers and staff were proactive and transparent in their contact with the local authority safeguarding team. They asked for advice in situations where care was not going as planned. Where necessary, they made safeguarding referrals promptly.

People told us staff provided the support they needed to help them remain safe and comfortable, whilst promoting their independence. Comments about this included, “They are good at giving [moving and handling] assistance” and “I am a little bit wobbly. Sometimes I forget where my stick is to support me, and they make sure I have got it with me when I move.”

The registered managers and office team had worked closely with professionals from a range of agencies to enable the service to continue supporting, safely and with the least possible restriction, people who sometimes became distressed in a way that presented challenges to those providing their care.

People's detailed, personalised, up-to-date risk assessments set out identified hazards, any support the person needed to manage these safely, instructions to staff about how to support the person accordingly, and what to do in an emergency with contact details of relevant persons and organisations. Areas covered by risk assessments included medication, risk of falls, skin breakdown, moving and handling, potentially restrictive practice such as sensors that triggered an alarm when the person got out of bed, health-specific issues, and activities outside the home.

People who needed equipment to assist them to move safely told us staff knew how to use this and did so competently.

Staff confirmed they had training in moving and assisting people and knew how to use any equipment people needed.

People had detailed risk assessments that identified and addressed environmental risks to people and staff, such as smoking, staff lone working and the use of closed-circuit television where people or their families had installed this. People also had risk assessments to instruct staff about the safe use of any specialist equipment, such as moving and handling equipment and bedrails. The service had a policy and procedures for business continuity, in the event of something such as severe weather that could challenge its ability to operate safely.

People felt staff had the necessary skills to provide their care, although they acknowledged some staff were new or less experienced. Comments included, “Occasionally I have had 1 or 2 who appear to be still learning on the job. I talk them through it, so they know what to do” and “Some are more experienced than others. Overall, they meet my needs.” People said they received their care calls, usually at the expected time, although a few said they did not receive a rota and varied appointment times. They reported receiving the care they needed, and most said staff stayed for the full time. Some people had a regular team of staff whereas others reported frequent changes in staff. Comments ranged between “Mainly the same people - odd 1 I don't know” and “Different people every day”. The management team recognised the benefits for people of consistent staffing. They remained focused on staff recruitment and planning to address this.

Staff told us the service supported them well through training and supervision, enabling them to perform their roles effectively. Comments included, “I’ve had all the training I need to go out and do my best, but life is all about learning and in my short time with the company I’ve learnt a lot”, “l have all necessary training needed to enable me to work effectively” and “I think I have all the training I need… I have supervision and spot checks at least once per 2 months, sometimes more often, especially with new clients. They are very supportive.”

The service operated safe recruitment processes that helped ensure it only employed people who were suitable to work in a care setting. Pre-employment checks included interviews, taking up references, ensuring candidates had the right to work in the UK, and undertaking criminal records checks, including obtaining barred list clearance from the Disclosure and Barring Service. New staff undertook computerised and face-to-face training in key topics. These included safeguarding, medicines and moving and handling. They shadowed existing staff on care calls for at least one shift or more shifts if needed. Their competencies were assessed before they were allowed to work alone. Staff received annual refresher training. All staff received training about learning disability and autism.

People told us they were satisfied with the way staff observed infection control practices. For example, a person using the service told us staff wore gloves and aprons and always had plenty of these.

Staff confirmed they had ready access to the necessary personal protective equipment (PPE).

The provider’s infection prevention and control policy reflected current guidance and legal requirements. Staff were required to undertake initial and annual refresher training in infection prevention and control, and in food safety. They had received this training.

People who received assistance with medication told us they received their medicines as needed. Comments included, “I take a lot of medication. They give it to me when I need it” and “I get it when I need it. They make sure I take my pills.”

Staff confirmed they received ongoing refresher training about the safe administration of medicines, following their initial training. The registered managers explained their process for monitoring that people’s medicines were given on time, and that medicines were recorded properly.

Medicines were recorded on an electronic system. Medicines administration records were complete and up to date. They contained a detailed description of each medicine and how it should be taken. Where people were prescribed medicines on an as-needed basis, there were clear instructions for staff to administer these safely. The electronic system flagged up to the office team if medicines were late being signed for. The registered managers oversaw regular medicines audits for assurance that medicines were being properly recorded.