On Time Care Ltd

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment, and support achieved good outcomes and promoted a good quality of life, based on best available evidence. This is the first assessment for this service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment were effective. They did not always ensure when people’s needs changed, guidance was up to date, and their changing needs were understood and supported by all staff.

One person’s communication care plan detailed they may become agitated when they were in pain. However, the plan did not detail how the person may present when they are in pain or what action staff should take. Therefore, staff may not always identify when the person was becoming unwell so appropriate medical intervention could be sought or concerns communicated to relatives.

The registered manager told us, they would update these documents to ensure they contained the relevant information.

Staff told us people’s views were sought using their preferred communication methods across various platforms including, during daily support and in review meetings.

People and those who knew them well were involved in their assessments and reviews. Where people could not participate or chose not to staff and those who knew people well were also involved to ensure their views and opinions were captured.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, this was not always in line with legislation and current evidence-based good practice and standards.

People’s care and support relating to their agitation and associated behaviour were not planned in accordance with nationally recognised positive behaviour support guidance. Staff monitored people’s weight if required and used nationally recognised tools appropriately to assess and monitor people’s needs. For example, Malnutrition Universal Screening Tool (MUST) and a clinical tool used to evaluate a person’s risk of developing a pressure ulcer (Waterlow assessment) were undertaken.

Staff ensured people had enough to eat and drink and people were supported to maintain relationships with family and friends.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

We sought feedback from professional’s who worked closely with the service. A professional told us, “On Time Care Ltd work well with other health professionals. They provide at least one update a week as to the person’s presentation and what activities they have participated in.They seek guidance when they are unsure or when they would like to introduce something new.They are polite and professional in all interactions.”

People’s goals, dreams and aspirations were discussed with them and always communicated so a consistent approach was maintained between services.

The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice, and control.

The service did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

One person’s care plan detailed they should be supported to maintain a healthy, balanced diet and the intake of sugary and high fat foods should be reduced. We reviewed this person’s daily food intake over a 4-week period and observed their daily meals were not healthy or balanced and they regularly ate sugary and high fat foods.

We spoke to the registered manager about this. Following our inspection, they told us they had worked with the person and put together a healthier menu, with emphasis on encouraging the person to become more involved in meal preparation to try to make the healthier food choices more fun for the person.

The service did not always effectively monitor people’s care and treatment to continuously improve it.

Review meetings took place with people to understand their goals and aspirations. However, the lack of detail in relation to for example, behaviour support meant people and their relatives could not always provide feedback on all aspects of people’s support to ensure care outcomes were positive and consistent, and met the expectations of people.

People were engaged to ensure they were able to make some choices about their lives.

The service did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

We reviewed mental capacity assessments which were not completed in line with the Mental Capacity Act 2005. There was only 1 mental capacity assessment in place which was not decision specific. There was no evidence of how the person had been involved in the assessment and how the provider had attempted to support the person to understand the decision. However, we did see evidence of people’s relatives being involved in the process.

We spoke with the registered manager about our concerns. Following our inspection, the registered manager sent us decision specific mental capacity assessments which included Best Interest meetings. These covered the required decisions, how the person was involved and input from their relative and other professionals.

A Deprivation of Liberty (DoLS) assessment had been completed and was waiting authorisation. When approved, this meant where restrictions were in place, these would be lawful.

Staff understood the importance of asking for consent prior to providing care and support. They told us they always sought consent from people before entering their rooms and they explained what they needed to do to support the person safely, before seeking their consent again.