Altogether Care

Who the service is for

Altogether Care provides support to younger and older people with a range of support needs including, people living with dementia, physical disabilities, sensory impairment and mental health needs.

Key findings

We carried out this assessment on 16 June 2026. This service was previously rated as good. We carried out this assessment to confirm whether the rating of good remains accurate. This report does not provide detailed information on areas where we found practice continues to meet a good standard. Instead, our findings focus on any areas where the service needs to improve or where we found exceptional practice.

Accidents and incidents were logged appropriately and reviewed on a monthly basis by the registered manager. These were analysed to identify if there were any themes or trends, and any updates or changes were shared with the staff team. Where risks had been identified for staff when providing support to people, risk assessments and guidance had been developed for staff on how to manage difficult situations. Environmental risks were assessed in people’s homes, with information available in people’s care plans of where specific utility points were in the event of an emergency.

The service had safeguarding systems and processes in place to ensure people were safeguarded from the risk of abuse. Staff demonstrated a good understanding of different types of abuse and understood their responsibilities to ensure any concerns were shared appropriately. One staff member told us, “If I had any concerns I would call the office, they would raise a safeguarding referral to the local team”.

We checked and found staff and management were working within the principles of the Mental Capacity Act 2005 (MCA). The management team were working with the Local Authority to ensure where immediate restrictions may need to be implemented, they had requested the necessary applications were made to the Court of Protection.

Staff were knowledgeable about their roles and responsibilities and had undertaken the majority of the required training. However, we identified all staff were either past their refresher date or had not received practical manual handling training. We did not see this had impacted on people. We shared this with the provider and sessions were booked for all staff to attend without delay.

Medicines processes were managed well which ensured people received their medicines as prescribed. Staff followed best practice and had knowledge and skills to manage medicines safely. Staff had received the appropriate training and had their competencies checked and reviewed by leaders.

Care was delivered by a consistent staff team which ensured continuity and good communication between team members.

People and relatives were encouraged to take part in reviews of people’s care plans and the delivery of their care. This was to ensure they remained satisfied with what care was being delivered and discuss any potential changes or amendments which may need to be made. A person shared an example of when they wanted their care call time to be amended to suit their morning routine, they told us action was taken and the call time was amended which was working better to suit their personal preferences.

Care plans were detailed and held the relevant information on how to support people based on their assessed needs, choices and preferences. Where additional guidance was required to support people’s clinical needs, these were in place. For example, catheter care. The records we reviewed, had appropriate monitoring and checks in place for people. Staff told us when people required changes with their support needs, this was shared with the registered manager, who liaised with the relevant external professionals to share the information, and care plans were updated accordingly.

Governance audits and spot checks were completed regularly by leaders of the service and there were systems in place to monitor the effectiveness of care delivery. These included live alerts which flagged missed calls, tasks, medicines and check in and check out times for calls. This enabled the registered manager and leaders to have an overview of call delivery, and if needed, act in a timely way.

There were clear visions and values promoted through the service. Staff told us there was a positive culture, where leaders offered support when needed with providing transport and advice. One staff member told us, “[Leader] helped us last night, they came out of the office and drove staff as they were walkers and who would have been late for calls”. All staff we spoke with, told us the registered manager and leaders promoted an open-door policy, and they could call into the office anytime for a discussion, and food and drinks were always available. Staff told us during hot weather, leaders ensured they had additional drinks and in difficult conditions during the winter months, transport was available for those who did not drive. The service operated an on-call system where leaders shared the responsibility to oversee the service delivery. Staff told us, leaders ensured at the end of each shift on call checked to make sure they had arrived home safely.

Staff spoke positively about working for the service, all staff said they felt supported in their roles and were offered opportunities to enhance their learning if they chose to. One staff member told us, “I love my job, management are really caring, the registered manager checks up on me regularly”. Another said “We are recognised for the work we do, we receive gift cards and wine, and the providers also buy gifts for our family members at Easter and Christmas. We have recently been given a bottle of wine to say thank you for working through the weekend when it was really hot”.