Archived: Simply Together Limited

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.

The majority of people we contacted told us they were always treated with respect. They were positive about the standard of care and support they received; " Cannot fault the care, girls are very nice and kind."

We looked at six support plans. These included full details of the person concerned including how they liked to be addressed. We found support plans were focussed on the person concerned. For example, one section was headed; 'My morning routine' and provided exact details of what care and support was to be provided and in what way. It included preferences for choice of breakfast, how the person preferred personal care to be provided and details of their medication. This enabled care workers to provide appropriate and effective care.

All of the people we spoke with said they felt safe and comfortable with their care workers; "They are very gentle and understanding" was what one person told us. This confirmed people were confident their safety and welfare were protected.

We found there was a robust and effective staff recruitment process in place. There were at least two references provided.There was evidence provided of the applicant's mental and physical fitness. This meant applicants who might not be considered fit to work in health or social care could be referred to the appropriate bodies for additional checks. We saw documentation which established the right of the person to work in the United Kingdom, together with a recent photograph which helped confirm the applicant's identity. We found all applicants were required to have an enhanced Disclosure and Barring Service clearance. This checked if any criminal convictions had been identified which meant the person would not be suitable to work with vulnerable adults or children. The evidence seen provided confidence appropriate checks were undertaken before staff began work.

We found there were systems in place which should have enabled people to feedback about the quality of the service they experienced. These included regular spot checks carried out by supervisors on care workers. There were also regular reviews of care support plans and telephone monitoring. This meant people who used the service, and their representatives were asked for their views about their care and support.

The provider told us they were aware of the importance of care workers being able to converse effectively in English. We were told all prospective care staff had a basic, recognised, verbal communication assessment before they were employed. Where a care worker's English was adequate but not strong, we were told they were paired with another carer, with better English language skills, until they improved. The provider may find it helpful to note a significant number of people we contacted or spoke with had concerns about the English communication skills of some care staff.

When we looked at care plan information we found it included details of how care was to be provided in line with people's expectations and preferences.

When we looked at training records for staff we found all new staff had undertaken a company induction training programme. They also had a 'shadowing induction' where they accompanied a more experienced member of the care staff team whilst they provided care. The records we saw showed care staff had received training in medication, manual handling, infection prevention and safeguarding. We found staff recruitment files recorded checks made and information received to ensure people were protected from the employment of unsuitable care workers. For example references were recorded and health checks made. Criminal Records Bureau (CRB) checks had also been undertaken.

People who received a care service told us they had been asked their views about their care. They were able to complete surveys from time to time to give their opinion about their service and how it could be improved.