On Time Care Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. This is the first assessment for this service. This key question has been rated requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to good governance.

This service scored 57 (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 had a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, diversity and inclusion, and engagement.

However, although they understood the challenges and the needs of people; the care people received did not always reflect the service’s values and objectives as set out in their statement of purpose. People did not receive care that was always high-quality care or person centred.

The registered manager told us, “Our vision is to grow in the quality of care we deliver and through testaments and feedback from people we support. We want to make sure we are meeting their expectations and are compliant, and to treat every individual with dignity and respect. We need to make sure people are safe and well cared for and have a good quality of life. Making sure the staff have the right training in place and collaborating with other stakeholders effectively.”

Leaders understood the context in which they delivered care, treatment and support and strived to embody the culture and values of their workforce and organisation.

However, we found some regulatory breaches and quality statements requiring improvement in areas such as risk and recruitment records and monitoring. Leaders had not independently identified and acted on these issues prior to our assessment. This meant some development was needed in their skills and knowledge to lead effectively. The registered manager also required some support to further develop their knowledge of good practice guidance in relation to supporting people with learning disability and autism. Such as in relation to Stopping Over Medication of People with a learning disability and/or autism (STOMP). Which is an initiative to ensure people’s medicines are reviewed to ensure psychotropic medicines were not inappropriately prescribed or overused. As well as CQC’s ‘Right support, right care, right culture’ guidance to guarantee people with a learning disability and autistic people positive outcomes.

Following our inspection visit the registered manager had started working their way through service improvements. The registered manager told us they received ongoing support and development in their role.

Relatives knew who the registered manager was and spoke positively about them, 1 relative told us, “I know the registered manager. I don't need to speak to them much. I talk to the carers, but I've got their number and have been told to call them anytime.”

Staff members told us, the registered manager was visible, approachable, and supportive.

The service promoted a positive culture where people felt they could speak up and their voice would be heard.

People living in the services were asked for their views and were given the opportunity to speak up daily both informally, in review meetings, and through surveys.

We reviewed people’s daily notes and noted people spoke up, and their decisions and choices were respected. We reviewed people’s surveys where they were encouraged to speak up. This meant people’s voices were heard. The feedback received was positive, therefore, there were no action plans from the surveys.

The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

Staff felt supported to give feedback and were treated equally, free from bullying or harassment. They told us they had access to relevant policies. The registered manager gave us a couple of examples of how they had supported staff to be able to work more flexibly to aid with commitments in their personal lives or to manage health challenges.

The service did not always have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance, and outcomes.

Quality assurance audits had been completed, however, these systems and processes had not been effective in identifying the shortfalls we found at this inspection. Quality checks had not identified risks to people's health and safety had not been comprehensively assessed and risk mitigation plans were not sufficient to prevent risk of harm. Not all staff had the training to keep people safe when they became distressed. Recruitment practices which were not in line with legislation. Although the registered manager started making improvements, they required time to identify actions, make changes, and embed them into practice. The failure to have robust monitoring systems and process in place meant these risks had not been identified and action taken to keep people safe.

People did not always receive care and support in accordance with the principles of ‘Right care, right support, right culture’ guidance. Some people did not have up to date care plans in place, risk assessments, or PBS plans which contained enough information to support them safely. The failure to identify this put people at risk of harm.

The registered manager was able to confidently tell us how they ensured safe record keeping by following the principles of General Data Protection Regulation (GDPR).

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Professionals, staff, and the registered manager shared with us positive examples of collaborative working in partnership. One professional told us, “On Time Care Ltd work actively with me and the Intensive Support Team to understand the persons needs and to seek help and guidance to support the person.They have worked closely to understand the potential risks. People do not always have the opportunity to transition between one service to On Time Care Ltd due to the breakdown of the previous package of care, yet the provider has managed these times effectively and safely. On Time Care Ltd have been clear when they don’t feel that they can offer a service or are the right service for that person.”

The service strived to focus on continuous learning and improvement across the organisation and local system. However, we found some concerns during the inspection which we have highlighted throughout our report. Although the provider was motivated to learn and improve the service for people, their overall ambition was limited by the lack of effective risk and quality monitoring systems. This meant they were not always aware of shortfalls to enable prompt improvement and learning.

The provider was responsive during our inspection and told us they were taking learning from this inspection and would be sharing this across their organisation.

The registered manager shared with us how they had strengthened the skill set within their management team which they felt was a good improvement for the organisation.