Together In Care was rated Requires Improvement overall, with breaches of Regulation 18 identified due to staff working excessive hours with insufficient travel time between calls, increasing risk of harm to people. While people felt safe and medicines were managed appropriately, governance systems failed to detect punctuality and staffing issues, and record-keeping gaps in risk assessments and care plans were identified.
Concerns (8)
critical
Staffing levels
: “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.”
criticalMissed or late visits: “Rotas did not account for sufficient travel time to enable care visits to be punctual. Staff did not always stay for the full duration of their visit.”
moderateGovernance: “Quality assurance systems had not identified issues around the timeliness and duration of care visits which we found at this inspection.”
moderateRecord keeping: “One person had a risk of falls, but this wasn't reflected in their risk assessment. The same person's continence care plan did not refer to their catheter.”
moderateIncident learning: “Although we had been assured by the provider that staff were not working potentially unsafe hours, records and feedback showed staff working long hours with limited days off.”
minorCare planning: “One person's care plan showed they were living with dementia. We looked at their mental capacity assessment and saw this recorded the person as not having this condition.”
minorCommunication with families: “We identified two people were named in the provider's WhatsApp messaging group used by staff to communicate key messages.”
minorStaff competency: “Feedback from some relatives showed staff were not always skilled in carrying out household tasks such as making porridge and managing boxed medication.”
Strengths
· People and relatives consistently expressed they felt safe when staff provided care.
· Recruitment checks had been carried out before staff commenced their employment.
· Staff received safeguarding training and knew how to recognise and report abuse.
· People received their medicines as prescribed and staff were trained and assessed as competent in medication management.
· Staff consistently wore PPE to care visits, managing infection control risks suitably.
Quality-Statement breakdown (11)
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
Together In Care received a Good rating across all five key questions at its first CQC inspection in December 2021, with inspectors finding safe staffing, person-centred care, and effective governance systems in place. Two recommendations were made regarding PRN medicines guidance and recruitment record-keeping, and the registered manager was reminded of their CQC notification obligations for safeguarding referrals.
Concerns (3)
moderateGovernance: “Referrals were being appropriately made, however not all had been notified to CQC.”
minorRecord keeping: “a full work history had not been taken for each member of staff”
minorMedication management: “The guidance to staff on when a person may or may not need their PRN medicines could be improved.”
Strengths
· People felt safe and staff had received safeguarding training; concerns were acted upon appropriately.
· Sufficient staffing levels with timely call delivery and good travel time between calls.
· People received medicines as prescribed and staff competency in medicines administration was checked.
· Effective infection prevention and control practices with adequate PPE supply.
· Detailed, person-centred care records including risk assessments and life history information.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
Good
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships; end of life care and supportGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirements; Continuous learningGood
well-led: Engaging and involving people using the service, the public and staffGood