1 September 2022
During an inspection looking at part of the service
Together In Care is a domiciliary care agency. It provides personal care to adults with a range of support needs in their own homes in the Kirklees and Calderdale areas. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. On the first day of our inspection, 107 people were receiving a service, of which 89 were supported with personal care needs. On day two, 111 people were receiving a service and of those, 99 people needed staff to support with personal care.
People’s experience of using this service and what we found
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. We received mixed feedback about the timeliness of call times. Call logs showed staff did not always stay for the full duration of their visit and travel time between calls was not allocated in some cases. Quality performance needed some improvement as these issues had not been identified and acted on.
The management of people’s medication was found to be safe. Feedback indicated people received their medicines as prescribed. Some recording issues were being dealt with at the time of inspection.
Risks relating to catheter management needed clearer recording. The registered manager was aware of this and arranging further training. However, a relative assured us staff had an understanding of responsibilities around catheter usage.
People and relatives consistently told us they felt safeguarded from the risk of abuse. They were largely complimentary about the care provided by staff. Recruitment checks had been carried out before staff commenced working.
We received mixed feedback from staff about the culture they worked in. The registered manager had signposted workers to agencies if they felt they wanted external support. Feedback was consistently sought from people and relatives. Staff spot checks were taking and staff received support through induction, training and supervision.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
We have made a recommendation about the provider reviewing information they hold in an ‘app’ to ensure confidential and sensitive information is not quoted.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for the service at the previous premises was good, published on 31 December 2021.
Why we inspected
The inspection was prompted in part due to concerns received about staff working an excessive number of hours and the working culture some staff experienced. A decision was made for us to inspect and examine those risks.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Together in Care on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to people not receiving a service which was consistently punctual and provided staff with sufficient travel time.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.