Together In Care

Updated 16 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

Both days of our inspection were carried out by 2 inspectors. Following our visit, an Expert-by-Experience and an inspector made telephone calls to people and their representatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

Both days of our inspection were unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service, including Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the Inspection

We spoke with 8 people who received a service and 8 relatives of people who received a service. We also spoke with 7 members of staff. We reviewed a range of records. This included 3 people's care records, as well as medication records. We looked at the recruitment of 7 staff members as well as records relating to the management of the service, including policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at further quality assurance records.

Updated 16 November 2022

About the service

Together In Care is a domiciliary care agency. It provides personal care to adults with a range of support needs in their own homes in the Kirklees and Calderdale areas. 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. On the first day of our inspection, 107 people were receiving a service, of which 89 were supported with personal care needs. On day two, 111 people were receiving a service and of those, 99 people needed staff to support with personal care.

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

Staff were required to work particularly long hours with limited days off. This placed people at an increased risk of harm due to the impact of staff working long hours. We received mixed feedback about the timeliness of call times. Call logs showed staff did not always stay for the full duration of their visit and travel time between calls was not allocated in some cases. Quality performance needed some improvement as these issues had not been identified and acted on.

The management of people’s medication was found to be safe. Feedback indicated people received their medicines as prescribed. Some recording issues were being dealt with at the time of inspection.

Risks relating to catheter management needed clearer recording. The registered manager was aware of this and arranging further training. However, a relative assured us staff had an understanding of responsibilities around catheter usage.

People and relatives consistently told us they felt safeguarded from the risk of abuse. They were largely complimentary about the care provided by staff. Recruitment checks had been carried out before staff commenced working.

We received mixed feedback from staff about the culture they worked in. The registered manager had signposted workers to agencies if they felt they wanted external support. Feedback was consistently sought from people and relatives. Staff spot checks were taking and staff received support through induction, training and supervision.

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.

We have made a recommendation about the provider reviewing information they hold in an ‘app’ to ensure confidential and sensitive information is not quoted.

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 the service at the previous premises was good, published on 31 December 2021.

Why we inspected

The inspection was prompted in part due to concerns received about staff working an excessive number of hours and the working culture some staff experienced. A decision was made for us to inspect and examine those risks.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Together in Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people not receiving a service which was consistently punctual and provided staff with sufficient travel time.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.