The inspection took place on 7 and 13 December 2018 and was announced.

Altogether Care is a domiciliary care agency. It provides personal care to people living in their own houses in the community. The service supports older adults, some of whom are living with dementia. At the time of our inspection visit, 37 people were using the service.

The provider is registered as an individual and therefore is not required by law to have a separate registered manager. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection, we found the provider had failed to notify us of a number of safeguarding issues involving people who used the service. Registered providers must, in accordance with their registration with the Care Quality Commission (CQC), notify us about certain changes, events and incidents, including safeguarding issues, that affect their service or the people who use it. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. At this inspection, we found the provider was now meeting the requirements of Regulation 18. They had taken steps to ensure all required statutory notifications were submitted to CQC within the expected timescales.

People felt safe receiving care and support in their homes from staff employed by Altogether Care. Staff had been trained in, and understood, their responsibility to protect people from and report abuse. The provider had safeguarding procedures in place to ensure the appropriate external agencies were informed of any abuse concerns. The specific risks associated with people’s care and support had been assessed, kept under review and plans developed to manage these. Staff confirmed they read people’s risk assessments and were kept up to date with any changes in risks to people and themselves.

People generally received a punctual and reliable service from Altogether Care, provided by familiar staff. The provider completed checks on prospective staff to confirm they were suitable to support people in their homes. The provider had systems and procedures in place to ensure people received their medicines safely and as prescribed. The provider had taken steps to protect people, their relatives and staff from the risk of infections, including the use of appropriate personal protective equipment by staff.

People’s individual needs were assessed before their care started to ensure the provider could meet these effectively. Staff received training to prevent people from experiencing any form of discrimination during the planning or delivery of their care. Staff and management worked effectively with a range of external health and social care professionals to promote people’s health and wellbeing. New staff completed the provider’s induction training to help them settle into their new roles. They then participated in a rolling programme of training to ensure they had the skills and knowledge needed to work safely and effectively. People had the support they needed to prepare meals and drinks, and any associated risks were managed. Staff helped people to seek professional medical advice and treatment if they were unwell. Staff and management understood and promoted people’s rights under the Mental Capacity Act 2005.

Staff treated people with kindness and compassion. People and their relatives were encouraged to express their views about the service provided and participate in decision-making that affected them. People’s individual communication needs were assessed and addressed to promote effective communication and support them in voicing their opinions. Staff promoted people’s rights to privacy and dignity, as part of which they protected their personal information.

People’s care reflected their individual needs and preferences. Staff followed people’s personalised care plans, which included information about their kno

The inspection took place on 31 January and 8 February 2018 and was announced.

The service was last inspected on 25 November 2015, when it was given an overall rating of Good.

Altogether Care is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older and younger adults, who may have dementia, mental health care needs, physical disabilities or sensory impairments. At the time of our inspection visit, 48 people were using the service.

The provider is registered as an individual and therefore is not required by law to have a separate registered manager. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s medicine administration records (MAR) were not always clear, accurate or complete. There was a lack of clear guidance for staff in relation to the expected use of people’s ‘as required’ medicines. The provider had failed to inform us of a number of safeguarding issues involving people who the service, although they had reported these to the local safeguarding team.

Staff had received training in, and understood, how to protect people from abuse and discrimination. The risks associated with people’s individual care and support needs had been assessed, recorded and plans implemented to manage these. People received a consistent and reliable service from Altogether Care from staff they were familiar with. Staff took steps to protect people, themselves and others from the risk of infection.

People’s individual care and support needs were assessed with their involvement, and care plans developed to achieve positive outcomes for people. Staff received training, supervision and ongoing management support to help them succeed in their roles. Where people needed support with meal preparation, eating or drinking, staff provided this, and any associated risks were recorded and managed. The provider and staff worked collaboratively with other organisations and community professionals to ensure people benefited from joined-up care and support. Staff helped people to access professional medical advice and treatment when they were unwell, and liaised effectively with the healthcare professionals involved in people’s care. Staff understood people’s rights under the Mental Capacity Act 2005, and supported their day-to-day decision-making.

Staff knew the people they supported well, and adopted a caring and respectful approach towards their work. People and their relatives were encouraged to participate in decision-making about the care and support provided. Staff actively worked to maintain and develop people’s independence.

People received care and support that reflected their individual needs and what was important to them. People’s care plans were individual to them, and were read and followed by staff. People and their relatives understood how to raise complaints or concerns about the service, and felt comfortable doing so.

The provider promoted a positive, open and supportive culture within the service. Staff felt valued and able to freely approach the management team for any additional support or advice needed. Staff understood how to raise any serious concerns about the way the service was being run. The provider’s quality assurance enabled them to assess, monitor and improve upon the quality of the care and support people received.

We found a breach of the Care Quality Commission (Registration) Regulations 2009.

We undertook an announced inspection on 25 November 2015. We gave the provider 48 hours’ notice of our intention to undertake an inspection. This was because the organisation provides a domiciliary care service to people in their homes and or the family home; we needed to be sure that someone would be available at the office.

The provider registered this service with us to provide personal care and support for people with a range of varying needs including dementia, who live in their own homes. At the time of our inspection 28 people received support with personal care.

There was a registered provider for this service. A registered provider is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives said they were well supported by the staff and the registered provider. People told us staff were caring and treated them with dignity and respect. Staff we spoke with recognised the different types of abuse. There were systems in place to guide staff in reporting any concerns.

Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s’ needs. People were supported to receive their medicines by staff that were trained and knowledgeable about the risks associated with them.

Staff really knew people well, and took people’s preferences into account and respected them. The registered provider was responsive to changes in people’s needs and shared information effectively.

Staff had up to date knowledge and training to support people. Staff were knowledgeable about ensuring people gave their consent to the support they received. They worked within the confines of the law which meant they did not treat people unlawfully. There were no applications to the court of protection to deprive people of their liberty.

People were supported when needed to eat and drink well. Relatives told us they were always involved as part of the team to support their family member. People and their relatives told us they had access to health professionals as soon as they were needed.

People and their relatives knew how to raise complaints and the registered provider had arrangements in place to ensure people were listened to and action taken if required. Staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service.

The registered provider monitored the quality of the service. She had systems in place to identify improvements needed. The registered provider was actioning the improvements identified.