The Care Quality Commission
  • Services in your home
  • Homecare service

Archived: Simply Together Limited

Overall: Inadequate read more about inspection ratings

3 Constable Court, Barn Street, Lavenham, Sudbury, Suffolk, CO10 9RB (01787) 333001

Provided and run by:
Simply Together Limited

All Inspections

5 & 7 August & 2 September 2015

During a routine inspection

This inspection took place between 5 August and 2 September 2015. All visits were announced.

The service provides care to over 50 people who live in their own home.

There was no registered manager in place. 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.

The last registered manager had resigned from their position over a year ago and their replacement had been appointed but had not been registered with the CQC and they had also left the service. The regional development manager was managing the service at the time of our inspection and they informed us they had sought registration with the CQC to be the registered manager.

The provider had a safeguarding adults policy for staff that gave guidance on the identification and reporting of suspected abuse. Some staff we spoke with were aware of how to report suspected abuse. However with some staff we were concerned about their lack of written and spoken English. This view was shared by some people who used the service.

An assessment of people’s needs was carried out prior to the service providing care. This included risks to the individual receiving care and environmental risks. Risks reviews for some people were not up to date and hence did not reflected the current situation. Therefore we found that the provider had not ensured that people had been protected from the risks of unsafe care because people’s needs had not been appropriately assessed and reviewed. Care plans did not contain enough detail to enable staff to meet the individual needs of people. Where risks had been identified care staff did not always deliver care in accordance with the risk assessment management plans to keep people safe or ensure it was reviewed sufficiently and maintained up to date.

There were insufficient staff to support people safely and provide care for most of the visits. However we learnt that some staff worked from 06.00 to past 22.00 hours sometimes for 6 or 7 days per week. Although there were breaks between visits to people to provide care. Some staff told us at times they became very tired.

We found that people’s health care needs were assessed. However, people’s care was not planned or delivered consistently. In one case it was not clear whether the person required one to two staff for each visit. The provider had not ensured people were safe because they had not always provided care and support in accordance with people’s individual care plan and accurately assessed their need. This had been discussed with the local authority on a number of occasions but had not been resolved or clarified to the satisfaction of all concerned. By providing one member of staff instead of two staff, placed people and care staff at risk of physical harm.

When the service staff were running late or in danger of missing calls to provide care to people, the service did not have sufficient staff or robust back-up plans in place to deliver the care to people. The service had recently employed an additional team leader to assist the part-time team leader. At the time of the inspection the service lacked the capacity to respond to difficulties when the first line care staff struggled to complete their arranged duty visits to provide care to people.

We saw that some care plans had been reviewed, while others had not been reviewed, on a regular basis. A member of staff informed us this was being attended to and was the result of increased work resulting from new people using the service. Although the service was struggling to provide care to the existing people, it had continued to take on new care packages.

Care plans were written from a generic base and focussed mostly upon tasks, which did not reflect on the unique needs of each individual. The process for reviewing care plans did not make sure that people’s care was reviewed regularly and changes were not always recorded in peoples care or updated in a timely manner. This meant that the provider could not be assured that care staff had the correct information and guidance about how to care for people based upon their needs.

The manager arranged induction training for new staff. However we were aware that one member of staff experienced in care had provided care to people before they had completed their training with the service.

Staff had received training to provide medication safely and the service had medicine policies and procedures, but we found that staff were not attending at specific times to support people take their medicines.

People and their relatives gave positive feedback about the care staff that provided care. The service provided supervision and spot checks to support the staff, although records showed that this was not always as frequently provided as in line with the policy. Staff we spoke with considered they could raise matters as they happened with the service senior staff to be resolved. However staff and relatives and people using the service raised concerns about the general state and repair of the company vehicles that staff used. The manager told us about the arrangements for the cars to be checked over on a two weekly basis by appointed garages. However we learnt that one vehicle which had broken down was not removed from outside of a person who used the service home for over ten days which they found upsetting.

People and their relatives told us they were involved in the planning of their care and support. They felt that the service listened to their views at the initial assessment stage.

At the time of our inspection the service informed us there were no outstanding complaints, although we found the manager was not recording all complaints in the complaints log. The manager dealt with some complaints as they arose under the service safeguarding procedure. Although this meant that the manager was aware of issues this approach resulted in the complaints log not being an accurate record of complaints

The service had systems in place to monitor the quality of service. However, we saw that these were not always effective. As quality assurance systems had not been operated effectively, this meant the provider had not identified the concerns discovered during our inspection. Failure to assess and monitor the quality of the service meant the provider was unaware of areas that were inadequate and had not taken action to address them.

Although some people were content with the service they received and praised the individual care staff, other people did not feel the service listened to their concerns.

The management staff of the service had failed to keep appointments with the local authority staff to discuss aspects of care and concerns. There was no registered manager in place, the provider had only visited the service once this year and we could see no strategies for improving the service.

People had experienced missed and mistimed calls which led to them not being able to attend medical appointments. A relative informed us this had a big impact upon the person and left their relative feeling lonely

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and , if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service had demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in specials measures.

We found a number of 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 this report.

25 September 2014

During an inspection looking at part of the service

The purpose of this inspection was to check that improvements had been made following our last inspection on 6 June 2014 and 12 June 2014. At the time we had concerns that people's individual needs were not always being met as the care records lacked specific details care staff would need to deliver care safely. We found that that in most cases although an assessment of needs had been completed, these were not then translated into plans of care for staff to use. This meant that when new care staff started working at the service the records would not contain enough detail for them to understand people's individual needs and preferences. This could have resulted in poor care being delivered to people.

This meant that the provider was not meeting essential standards of quality and safety. We asked the provider to take action to address the concerns identified. The provider sent us an action plan and they told us the actions they would be taking to address the concerns identified within a reasonable timeframe.

During this inspection we reviewed the care records of five people who used the service to see if the required improvements had been made. We found that information that was contained within the assessment had been used to develop people's care plans and risk assessments. The up-dated care plans contained sufficient details such as mobility aids to be used and the number of staff required to deliver a person's care. Care plans and risk assessments were complete and up-to-date. They had been recently reviewed and updated where a person's care and mobility needs had changed. This meant that the required improvements had been made to ensure people's needs were assessed and care was planned and delivered in line with their individual care plan.

During our inspection on 6 June 2014 and 12 June 2014, we reviewed people's daily notes of care delivered by staff. We found that some of these records were illegible. Staff hand writing was poor and we were unable to gain information from these records because of the way in which staff wrote these records. This meant that these would not be usable for a staff member who needed to review care provided by the previous care worker to ensure continuity and note any changes that might have been recorded. This could place people at risk of receiving ineffective care.

During this inspection we reviewed the daily notes for five people and found that all of the notes had been written in single text rather than joined text. They were legible and contained sufficient details to enable the care workers to be able to identify any changes in previous care given. Records were legible and therefore they would be fit for purpose. This meant that the required improvements had been made to ensure that staff were able to ensure effective continuity of care.

During our inspection on 6 June 2014 and 12 June 2014, we saw that four staff files we reviewed did not contain the staff member's full employment histories. Staff are required to provide their full employment histories in accordance with Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. One staff file only contained one reference. The provider told us that they were sourcing an additional reference.

During this inspection we reviewed five people's personnel files. We saw that the provider had obtained an additional reference for the employee as identified in the inspection on 6 June 2014 and 12 June 2014. People's application forms contained no unexplained gaps in people's employment record. This meant that the required improvements had been made to ensure that the relevant employment checks had been made.

6, 12 June 2014

During a routine inspection

We received some information of concern and brought forward our planned inspection of this service. We undertook the inspection of Simply Together Limited at their Lavenham offices on 6 and 12 June 2014. At the time of our inspection the service provided personal care for 60 people within their own homes.

During the inspection we spoke with the registered manager, regional operations manager and one of the field care supervisors. After the inspection we spoke on the phone with eight care staff about their work. We also spoke with seven people who used the service and three relatives of people who used the service about the care that was being delivered. We inspected a sample of records at the service's office during our inspection.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the people who used the service were receiving safe and appropriate care and support. The people who used the service and their relatives spoke highly of the staff and the standard of care provided. From looking at records and talking to the people who used the service, their family members and staff we found that care had been provided in line with people's care plans. One person said about the service, "It's excellent." Another person said about the care staff, "Very cheerful. Always willing to do anything. They're very good."

People were safeguarded from the risk of abuse because the provider had taken steps to ensure that staff had the skills to recognise and respond promptly and effectively to any evidence or suspicion of abuse. The people who used the service told us that they felt safe and well cared for and their relatives told us that they had confidence in the service and staff. Staff we spoke with were able to tell us about the possible signs of abuse and how they would respond to any suspected acts of abuse.

People had mental capacity assessments on their care records to show their ability to consent to care and treatment and their general mental capacity to make every day decisions.

We had received some information of concern relating to staff moving and handling training and their ability to support people safely. From the inspection of training records, speaking to people and speaking to staff, we were unable to substantiate these concerns.

We found from inspecting staff files that care workers were regularly supervised whilst working to ensure that their work practices were safe. The care plans we reviewed contained risk assessments relating to people's care needs including their mobility needs and the general environment. Staff were able to tell us how they would respond in an emergency and had received safety training such as first aid and fire safety. This meant that people could be assured that the provider had taken action to ensure that staff had the skills necessary, were supervised and they had been provided with information needed to provide safe care.

We received some information of concern that staff were working on their own with people that required two staff members to support them safely. We found that there had been a few occasions where staff worked with family members with their agreement when a second staff member called in sick or was delayed.

Is the service effective?

We received some concerns about some of the care staff whose first language is not English and their ability to communicate with people effectively when delivering care. We were unable to substantiate these concerns.

All the people we spoke with told us that they benefited from continuity of care, usually having the same care workers and they valued this highly. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and knew people well. However, we did find that the care records lacked detail, although people's basic needs had been recorded. This might mean that staff did not have enough detailed information to deliver care effectively.

The provider had an effective recruitment process in place that safeguarded people from staff that were not suitable to work with vulnerable people.

Is the service caring?

We found that staff provided sensitive and compassionate care, with kindness, dignity and respect. All the people we spoke with made positive comments about the staff and the care provided. One person said about their care worker, "Ever such a kind person." Another told us about the care workers, "Kind and thorough. Very grateful for them." A person's relative told us that the care workers were, "Absolutely fantastic."

Is the service responsive?

Some of the people we spoke with told us about incidents where they were unhappy about a specific element of their care or the care worker that attended. They told us that either they or the regular care workers reported their concerns to the office who responded well.

The service responded to people's changing needs. Staff we spoke with told us that care plans were updated as people's needs changed. People were called or visited regularly to ensure they were satisfied with their care delivery.

Is the service well led?

We found that the service's quality assurance system which had been in place was robust and fit for purpose. Care staff received regular supervision, direct observations when on duty and the service held team meetings. People received regular quality monitoring calls or visits to ensure that they were satisfied with the service they received. People's care was reviewed during these visits.

The registered manager checked staff competencies and training on a weekly basis and this ensured that where staff required refresher training or supervision, it was arranged when required.

We received some concerns that care staff felt unsupported and did not have any time off. We reviewed care staff rotas and supervision records. We could not substantiate these concerns.