Archived: Simply Together Limited

Updated 25 July 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of unsafe medicines management and the lack of reporting concerns to CQC. This inspection examined those risks.

The inspection took place on the 8, 9, 16 and 20 March 2017 and was an announced visit. The provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in.

The first two days of the visit to the office were conducted by one inspector, on the third day the same inspector was joined by another inspector. The last day of the inspection was based in the CQC office. Two experts by experience made telephone calls to people who were supported by Simply Together Limited and their relatives. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection the provider was not asked to complete a Provider Information Return (PIR). The PIR is a form that the provider submits to the Commission which gives us key information about the service, what it does well and what improvements they plan to make. We gave the provider an opportunity to share any future changes with us they had planned to make. We reviewed notifications and any other information we had received since the last inspection. A notification is information about important events which the service is required to send us by law.

We made 75 telephone calls to people and their relatives; we received full feedback from 47 of the calls made. While at the registered office we spoke with the director of the company, the director of care and the manager. In addition with spoke with the business development officer, the in house trainer and three locality managers. We also spoke with five care workers and the reception staff. We looked at 15 care plans, risk assessments and associated medicines records for people who were supported by the service and reviewed eight staff recruitment files. We cross referenced practice against the provider’s own policies and procedures.

Following the visit to the registered office we made contact with 25 staff, we received one reply.

We made contact with a further 10 people used the service and received one response.

We also contacted social care and healthcare professionals with knowledge of the service. This included people who commission care on behalf of the local authority and health or social care professionals responsible for people who were supported by Simply Together Limited.

Updated 25 July 2017

This inspection took place on 8, 9, 16 and 20 March 2017. It was an announced visit to the service.

We previously inspected the service on 21 May 2015. The service was rated good overall.

Simply Together Limited provides care and support to approximately 258 adults, older adults and children. The people supported have a wide range of physical and psychological disabilities; which includes learning disabilities and people living with dementia.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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. An application had been made to CQC for a registered manager.

We received mixed feedback from people about their experience of being supported by Simply Together. People told us they thought Simply Together was not well led, and did not provide a consistently good service. People told us there was a lack of consistency in care workers ability to effectively communicate. The overwhelming theme of negative feedback provided was regarding the quality of the care workers spoken English. People told us this had a direct impact on their well-being. Comments included “I have so many carers who do not speak English or even understand English e.g. not knowing the words ‘toes’ or ‘heels’ or able to hoist correctly,” “Carers don’t have a clue, can’t understand English or speak well ..I get very upset” and “I don’t have confidence in the carers’ abilities – they are unable to make a sandwich, boil an egg or make a cup of tea – I had to show them, because they could not speak English.” This was supported by what family members told us. People and their relatives told us they found it frustrating that many care workers could not communicate with them. The provider and manager were aware of the level of English spoken by some of the care workers and had supported them to attend English language courses. However they continued to send care workers who they had identified as not meeting a satisfactory standard to care for people in their own home. People told us this had a negative effect on their own well-being and satisfaction about the support provided.

In contrast, people who received care from regular care workers who had been working for the provider for some time were more positive. People told us “Both of my wife’s carers are excellent. We’ve had the same carer at night for years and the day carer has only changed four times. They have reasonably good English and they’re very good at getting my wife to understand them” and

“I’ve got two excellent carers at the moment and their English is good so we’re able to chat. Sunday is a bit iffy because they don’t work Sundays.”

People told us they did not always have confidence in the care workers and felt the training offered could be improved. One person told us “They’ve no nursing training, they’ve not had pad changing training and they’re no good with a wheelchair, would be better driving a tractor. Their training is virtually non-existent.” We acknowledged the provider and manager had identified the need to change the training to improve the skills of the care workers. The managing director felt it was advantageous the dedicated trainer was able to communicate with the care workers in their first language.

People were not always protected from abuse as staff did not always recognise situations which had the potential to cause harm or infringed people’s human rights. Where staff had informed office staff of events which met the safeguarding threshold, these were not always reported to the local authority or CQC. Incidents and near misses were not always reported by care workers to the office staff and therefore could not be investigated to prevent a similar future event.

The service did not always ensure that care workers always had the right skills and attributes to work with people. We noted some of the references for new recruits were very old which meant the service did not always have the most up to date information about new care workers. We have made a recommendation about this in the report.

People told us they were not routinely and consistency involved in decisions about their care and that care staff always sought consent from people The office staff had a good understanding of the Mental Capacity Act 2005 (MCA), however the provider’s own paperwork did not follow the core principles of the MCA and care workers we spoke with were unable to tell us their understanding of the MCA. However, they were able to tell us how they would always ask someone what they would like to wear for instance.

We received mixed feedback from people about how caring the care workers were. The lack of communication skills hindered effective relationships with people and care workers. Some people told us “On the whole, the carers are very good. They always clean up if water spills and they empty the bowl but to be honest, I wouldn’t stand any nonsense” and “They deal with my husband very well. He’s a lot calmer now because of them, and they’re very understanding of his needs and his memory loss.” Other people told us “They smoke in their cars and when they come in they reek. They sit on my bed because I don’t have a chair in my room and I can smell their smoke on my pillow. It’s very unpleasant” and “Most of the carers are very nice but they don’t always read instructions. They let themselves in because there’s a key safe, instead of knocking.”

People gave us mixed responses when we asked them if they felt the service was well led. We found the provider did not always ensure care workers were supported in their role. Care workers and office staff did not always received one to one meetings as regularly as the providers expected.

People told us care workers were often late and sometime they felt rushed by the care workers. We found care workers were working long hours, often starting work before 07.00and not finishing until after 22.00 They did have time off in the day, but often their working day involved a lot of travelling. We noted care workers were not always given realistic time frames to get from one person to the next.

People told us communication with the office was dependent on who answered the telephone call. We gave feedback to the provider and manager about what people had told us. The managing director and manager agreed to look into the reasons for the negative comments. The provider had made plans to change some of the systems used as they had identified improvements were required.

We noted the office had surveillance cameras at strategic places. The managing director told us this was to promote staff safety and people’s data held by the service. We asked for the policy which covered the use of cameras and how the information was stored. No policy was available which covered the full use of cameras. We have made a recommendation about this in the report.

We found there was a lack of engagement from care workers to communicate with us. We sent 25 emails to care workers and received one reply. We did receive information from ex-employees and from anonymous sources. We have made a recommendation in the report about team building.

We found breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.