Altogether Care - Care At Home Limited Salisbury

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

This service scored 61 (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 had a shared vision and strategy aimed at promoting transparency, equity, equality and human rights, diversity and inclusion, engagement, and an understanding of people’s needs and the challenges within the local community.

However, we found the provider had not achieved their aims for all people. Everyone using the service had not received person centred care of a high quality.

Staff told us since the new manager’s appointment, there was an emphasis on the provider’s values of compassion, competence and communication. The provider was in the process of embedding their newly defined mission statement into everyday practice. Staff confidently and positively spoke about the organisation’s goals and described how it shaped their approach to care. Comments included “The mission is to deliver good quality care”.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation.

We identified a breach of legal regulations and concerns relating to records and governance. Leaders had not independently identified or addressed all these issues before our assessment and some development in leadership was required.

Staff described leaders as approachable. Comments included “I can talk to managers about any issues I have.”

Managers had qualifications in health and social care and had undertaken training in line with Right support, right care right culture. Leaders did not always receive regular supervision but did have access to ongoing training to maintain their skills, including updates in safeguarding, governance and leadership development. They had an open and honest approach to our findings and feedback and were committed to making immediate changes.

The provider had policies covering supervision, training and workforce development, and managers’ training records showed they were up to date with mandatory learning. The manager was in the process of registering with the Care Quality Commission.

The provider fostered a positive culture, however not all people felt they could speak up and their voice would be heard.

The provider ensured that staff surveys were provided, however the response to these surveys was below 50%, This meant that the provider could not be assured that all staff views on speaking up were gathered.

Leaders told us they promoted equity, diversity and human rights and they ensured these principles were reflected in policies and in practice. The registered office had speaking up posters and information on how to complain, including how to raise concerns openly. Staff in the office told us they would speak up if they needed to.

We spoke to staff, Three staff told us they felt empowered to challenge poor practice and areas for improvement and were confident their voices were heard. One staff member told us “Quite a few of us reported to the manager that a few ways we did things were not working. They changed it”.

However, some workers told us staff on sponsorship are treated differently. Comments included “We do not always feel like we can speak up because we get told we are sponsored workers” and “I have raised concerns regarding breaks and travel time but have not been listened to”.
This meant there was a proportion of staff many of whom were more likely to experience inequality who did not feel confident to speak up or feel that their voices would be heard.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Feedback from staff on equality and diversity was mixed. Some staff told us they were treated with dignity and respect and that when they did experience discrimination from people, colleagues were supportive. Other staff told us workers on sponsorship were treated differently; this was around expectations that staff on sponsorship were available to work every weekend while non-sponsored staff were not. ‘Inequality in learning and development was also mentioned by staff we spoke to. Comments included “Non sponsorship staff have received support with further qualifications while sponsored staff have not. The provider informed us that equal access to further qualifications is hindered by the national eligibility criteria set by the government under the apprenticeship levy’.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. The provider was in breach of legal regulations relating to good governance.

Leaders did not have systems in place to support safe and effective oversight of the service. During the inspection we identified shortfalls in staff supervision, mental capacity assessment, audit effectiveness, inequalities experienced by sponsored staff and non-sponsored staff, visit timings and consistency of staffing had not been identified by the provider. Therefore, prompt action had not been taken to improve care for people.

Although governance systems were in place, and monthly reports were generated, the monthly reports did not always identify that complaints and concerns had been followed up. This meant systems were lacking in oversight from the manager and any end of month reports would only show information from what was inputted by staff. It did not pick up that information was missing from logged concerns and complaints because leaders had not reviewed it.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement.

This included a situation where a person had recently been admitted to hospital. At the point of discharge from hospital, the provider ensured they had open communication channels with the hospital discharge team and ensured that increased support was authorised by local authorities before recommending care and support for people.

The provider told us they worked with a range of other professionals to help make sure people received continuity in their care. The provider had a tracker to document contact with the Local Authority. This ensured requests for support from the local authority were well documented and followed up.

The provider understood the importance of accessing the community and supported people to find events and gatherings that were of interest to them. For example, 7 out of 12 people told us the provider supported them to attend current interests outside of their home environment. This meant people maintained a social life and the risk of social isolation was reduced. People told us this impacted positively on their well-being. Comments included “I am lucky my staff help me with anything I need, and this includes going out” and “Leaving the house is important to me – staff know this and help me plan what I want to do, when I want to do it”.

The provider did not always focus on continuous learning, innovation and improvement across the organisation and local system.

The service aimed to promote continuous learning and improvement across the organisation and local system. However, during the inspection we identified several concerns, which we highlighted throughout this report. Although the provider was motivated to learn and improve, they were limited by the lack of effective risk and quality monitoring systems. This meant leaders were not always aware of shortfalls and could not consistently act promptly to drive improvement.

The provider responded quickly to the issues we identified during the inspection and began implementing improvements. For example, they took immediate action to review supervision of staff and assured us they would develop a system of oversight to ensure complaints and concerns were better documented, including reviewing visit times and inconsistencies. The manager informed us they would develop a new improvement plan based on the findings from our inspection.