Altogether Care - Care At Home Limited Salisbury

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (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 did not always consistently demonstrate a proactive, transparent, and positive approach to safety.

Staff listened to safety concerns and took steps to investigate and report incidents. However, learning from these events was not always embedded by leaders to drive continuous improvement. For example, although there was an incident tracker, it lacked essential details such as actions taken, follow-up requirements, and the outcomes. This was a shortfall in staff inputting the required information. These shortfalls meant the provider could not always evidence lessons were learned or that preventative measures were implemented. This increased the likelihood of recurring safety issues and reduced confidence that improvements would be sustained. We spoke to the provider on the day who acknowledged a shortfall in their systems. They assured us this would be reviewed.

However, the provider had ensured that all calls from people were logged and followed up, this was in the event of a complaint or a compliment.

Further medicines incidents were reported and the provider demonstrated lessons were learnt from these.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Staff told us about the importance of recognising people’s needs and ensuring these were communicated on to hospital environments. People were supported to review their own care plans when leaving hospital and helped to write and update their support plans. Ten out of twelve people told us they were actively involved with their care plans. Where people did not want to be involved, we saw evidence that the provider had consulted with relatives to ensure people’s care needs were met. This care planning ensured all care staff had a good understanding of a person’s needs to ensure continuity of care. One person told us “Following my discharge from hospital, the provider increased my visits so that I was able to get back on my feet in my own time”.

For people who were looking to start care from the service, the provider had thought about how people would feel and what support they would need to move between providers. Specific comments included “[The care planning documents] were in place from [previous care company] but Altogether have been brilliant – [previous provider] was not as thorough as Altogether Care”.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt secure in their homes and staff actively promoted their safety. Every staff member we spoke with demonstrated safeguarding principles and shared practical examples of how they protected people during care delivery. They spoke confidently about identifying signs of abuse and described the steps they would take to safeguard individuals.

All staff had completed safeguarding training, and records confirmed refresher sessions were booked for staff who required them.

People using the service and staff understood how to escalate concerns beyond the management team. People’s comments included “I know how to raise a concern and then if I am unhappy, I can raise it”. Staff described confidently that they would whistleblow if internal procedures failed.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people’s health, safety and welfare had been assessed and action taken to manage those risks. For example, people at risk of falls had a support plan and risk assessment in place with clear guidance for staff. Staff demonstrated a good understanding of the risks and ensured care plans were updated regularly with people when their needs changed. There were detailed and individualised risk assessments for people who had epilepsy. Another person experienced regular changes to their physical health and these changes were identified and assessed frequently to enhance the person’s safety.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider assessed people’s homes for risks and took action to ensure staff could safely deliver care in people’s homes. People had individualised environmental risk assessments which detailed hazards in their home. This included flammable emollient-based creams and how to safely support people in the event of an emergency.

People told us they felt safe in their home. Comments included: “I have a risk assessment for my creams because they are a fire hazard”.

People told us staff always left their property safely and secure.

The provider did not always make sure all staff received effective support, supervision and development. They did not always deploy staff effectively to ensure people experienced care from consistent staff.

People and relatives told us they did not always know who would be delivering their care. Care calls did not always take place on the agreed time, which left people waiting for personal care and time-sensitive medicines. At the time of our assessment, ten out of eleven people told us they had concerns around late or inconsistent visit times. Managers confirmed they were working to further reduce late visits by looking at factors such as rostering and traffic. However, the provider did not have a written plan to address and monitor their improvement.

Some people told us they had concerns over staff consistency. Comments included: “In the short time Altogether care have supported me, I had 8 different carers over the course of a couple of weeks” and “I never know who is going to come – I think they have staffing issues”. We shared this with the provider who made arrangements to review consistency.

We also found shortfalls in supervisions for staff. The manager had not been supervising staff in line with their policy. We spoke to the provider about this who assured us they would put a staffing structure in place to support the manager to catch up with supervisions.

Pre-employment checks had been completed for staff before starting work. New staff received an induction, including shadowing experienced staff. Staff told us they received regular training.

Staff had undertaken specialist training specific to autistic people. This meant staff were better equipped to understand people’s communication styles, sensory needs and preferred ways of receiving support. This enabled more consistent, person‑centred care and support.

People and their relatives told us the care was good and despite the shortfalls, overall they felt staff training and knowledge was good.

However, during the assessment we found the provider did not provide any training specific to mental health or drug and alcohol training despite staff supporting people with active addictions.

The provider assessed and managed the risk of infection and told us they would raise anything with appropriate agencies promptly.

Staff completed infection prevention and control (IPC) training and told us they had access to all the personal protective equipment they needed.

We saw evidence of completed IPC spot checks and staff spoke about the importance of maintaining hygiene standards. People confirmed that staff supported them safely and used personal protective equipment (PPE) when needed. One person said, “Staff are good, they always use PPE when supporting with personal care or medication” and “Staff wear PPE when they support me with showering and hair washing”. These statements reflected the provider’s commitment to maintaining a safe and hygienic environment.

Staff meeting records demonstrated leaders regularly reinforced the expectation for staff to maintain clean and professional uniforms as part of IPC standards. This was discussed to ensure good hygiene, reduce the risk of cross-contamination, and present a professional image when delivering care.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning their medicines support, including when changes happened.

We found staff were supporting people with creams and emollients but these were not listed on a body chart and there was limited information available which meant the provider could not be assured people had their emollients as prescribed.

People told us staff provided good support for them to take their medicines. Staff had completed training in the safe management of medicines and leaders regularly observed their practice through spot check visits. Competency checks ensured staff knew how to dispense and administer medicines safely.

People were supported to have regular reviews of their medicines with their doctor. The provider was working in line with “Stopping Over Medication of People” (STOMP) guidance. This ensured people were not prescribed more medicine than necessary.

Medicines errors were recorded and escalated in line with the provider’s policies and procedures. Each person had a medicines risk assessment which detailed guidance for how to support people and profiles contained information of any risks and allergies. This meant people’s medication profiles clearly defined what level of support they required with their medicines. This was in line with the National Institute for Care Excellence (NICE) recommendations of best practice. People had body maps for emollient application and references to the risks of flammable based emollients. Medicine Administration Records (MAR) showed all prescribed medicines, including topical creams, were administered as required. This meant people received the correct medicines at the right time, promoting safe care delivery.