Altogether Care - Care At Home Limited Salisbury

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

Care managers assessed people’s needs before they started using the service to ensure needs could be met. Staff told us they received good information about people’s needs. Comments included “Care plans have all the information” and “[Assessments] are helpful, because we often find that people’s needs are different to what we are told they are”. There were detailed care plans and staff developed risk assessments in partnership with people, so they could take positive risks.

There were frequently updated and reviewed care planning documents which changed in line with people’s needs. For example, one person was supported through care planning that adapted responsively to their changing needs. The provider worked closely with healthcare professionals including occupational therapists and the person’s family to regularly review and update their care plan. One person told us “Staff offered to speak to the district nurse and to a GP for me, which was really useful and the impact of this meant I received better care”. This meant the person’s needs were assessed regularly so that they received effective support when they needed it.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

People told us staff provided good support for them to undertake their daily lives. One person said, “[Staff] even do the hoovering, it’s not what they are paid to do”. Other comments included “Staff plan my care with me on the day” and “They sit and talk with me and always stay the full visit”. Relatives commented: “[Relative] likes their staff, and it is clear they are well trained in supporting [relative] with all aspects of their care”.

People’s care plans were developed in partnership with them and included tailored dietary recommendations based on their health conditions. Several people were at risk of diabetes and we saw records of conversations with people regarding what steps they could take for a healthier life. Care records contained details of people’s needs and preferences and how to support them in line with their likes and dislikes.

Staff completed regular training in nutrition, moving and handling, dementia and end of life care to ensure their knowledge was up to date. This meant staff could deliver care in line with national guidance. However, some areas such as mental health and stroke awareness had not been completed by the provider. The provider told us they would look at additional training for staff.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people joined the service.

We saw evidence of the provider working with the adult social care team including social workers and GPs. Speech and language therapists (SALT), and the district nursing team had engaged with the service to ensure people’s changing needs were assessed. For example, the provider supported a person’s family with a district nursing team and both organisations worked together to ensure continuity of care. This meant the person care needs were met and tasks were shared between providers.

During our assessment, we overheard several telephone calls where the provider was working with the local authority to support new referrals. We spoke to leaders who told us this was an important part of their roles as it ensured a collaborative working approach which was holistic to the person.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

People had health reviews and care records contained details of how to support people and what people could do for themselves. For example, where people were recommended to maintain a healthy lifestyle, they were supported to access the community with staff, go for walks and plan their own menus which staff assisted with.

The provider did not always monitor all aspects of people’s care and treatment to continuously improve it. They did not always ensure outcomes for people were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

For example, managers routinely requested updates from other services involved with individuals. We saw managers requesting support from the adult social care team and from people’s GPs. People confirmed this with comments including “My carers help me make appointments I need” and “Altogether care organised for the district nursing team to come and help”.

People were involved in reviews about their support. One person told us “They’re good. They know what I need and they ask me regularly if anything needs to change support wise” and “I have had input in reviewing my care plan”.

However, none of the service reviews contained opportunities for people to comment on the times of their care or to comment on late or missed visits. Three people we spoke to told us they had not been contacted for feedback. Comments included: “Management never call or email to get feedback” and “I have not had the opportunity to share my experiences as part of a survey”. This meant people were not always given accessible or proactive opportunities to share their views, which limited the provider’s ability to improve people’s experiences of care.

We saw records that welfare checks by telephone had taken place for several people where managers had identified wellbeing concerns. This demonstrated a proactive approach to monitoring individual’s wellbeing to support improved outcomes.

Managers told us they regularly checked care records and completed observations to make sure support was provided in a person-centred way.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Managers told us every person had capacity to consent to their care arrangements. However, care records showed some people’s mental capacity could fluctuate and no further information was available for staff. Of the 5 staff we spoke to, 3 were unsure who had capacity to consent.

Records did not always show how decisions had been make in relation to arrangements about people’s medicine storage and ongoing supervision. This meant the provider could not assess whether people’s rights had been upheld.

However, staff told us how they would ask people for their consent. For example, if personal care was required, all staff told us they would ask before providing support. People told us “[Carers] are good, they always ask for consent before doing anything that involves physical contact” and “For me, it signifies that while people are here to do a job, it makes me at ease and allows me to be seen as a person”.