On Time Care Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment and fit and proper persons employed.

This service scored 62 (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 proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff knew what incidents to report and how to report them.

The service investigated incidents thoroughly and shared outcomes with people and relevant stakeholders. We saw evidence of change as a result of incidents which had occurred.

The registered manager told us they received safety alerts from the government, local authority and CQC which informed them of upcoming risks along with themes and trends to ensure the provider could take appropriate action to mitigate these risks.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider had an admissions policy in place. The registered manager was able to explain the process including assessing people’s needs to establish if they could be safely supported by the provider, ensuring specialist equipment was available and staff had additional training if required.

People were consistently supported when they were distressed and there was a focus on planning for a good day and understanding what had caused people distress so positive changes could happen.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on protecting people’s right to live in safety, free from bullying, harassment, abuse, and discrimination.

Staff knew how to protect people from abuse and who they would report any concerns to both internally and externally.

The service shared concerns appropriately by following the correct process and ensuring these were reported to the relevant agencies.

The service did not always work well with people to understand and manage all risks.

People were assessed for risks of falls, risk of choking and risks relating to skin integrity. When risk had been identified some guidance was available for staff, however, sufficient information was not available to staff to enable them to safely support people.

Risks relating to people’s behaviour that could place themselves or others at risk had not been comprehensively assessed and robust mitigation plans were not in place to prevent risk of harm. This meant staff may not take appropriate action to prevent, identify and keep people safe when they became distressed or their behaviour posed a risk.

The provider took immediate action to update people’s risk assessments and care plans.

Staff were able to tell us what action they would take to try to minimise a person’s anxieties. Relatives told us staff kept their relative safe and they had the training to be able to safely support their relative. Relatives were confident staff knew their relative well and could support them through challenging times.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Health and safety and fire safety risk assessments were completed and checks made of equipment to ensure it was safe to use. Any concerns were reported to the management team or appropriate person for further action.

Staff attended regular fire training to ensure they could safely support people out of their homes in the event of a fire.

The provider did not follow safe recruitment practices. The provider’s recruitment policy did not detail satisfactory evidence of conduct or the reason for leaving previous employment related to health or social care, children, or vulnerable adults was required. We reviewed 2 staff members’ recruitment documents and found this information had not been sought for all previous care jobs. This meant the provider was not completed all required checks to ensure staff were of good character prior to offering employment. Following our inspection, the registered manager sent us updated documentation to show how moving forward they would ensure they were following safe recruitment practices.

The registered manager had a training matrix in place which evidenced staff had completed all their statutory and mandatory training and competency assessments. Staff had also completed training on how to support people with a learning disability and autistic people. However, staff supported some people who required staff to have additional specialised training such as how to support people who may display behaviours which challenged themselves and / or others. Not all staff supporting these people had this training. We spoke with the provider about this who told us, some staff were booked on this training over the next few months, however spaces were limited. They told us staff worked in 2’s and they ensured 1 of the staff members had received this training. We spoke with staff who told us how they would use re-direction techniques to support people who were becoming agitated. One staff member gave us examples of triggers they needed to be mindful of when supporting a person.

Staff and relatives told us there were enough staff. We reviewed call logs which evidenced staff were attending calls.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider had an up-to-date Infection Prevention and Control (IPC) policy. Staff attended IPC training and were able to confidently explain to us how and when they used personal protective equipment (PPE).

The service made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff received medication training, and their competency was checked to ensure they understood the requirements for the safe administration of medicines.

Staff told us they felt well trained and confident to support people to receive their medicines safely. Staff supported and involved people to manage their medicines and followed best practice guidance for administering medicines. Records showed people had received their medicines as prescribed. The staff team were proactive at reporting any changes to people’s medicines promptly.

The registered manager told us, they ask for annual health reviews for people and ask for psychiatrists to be involved where needed to discuss medicines to ensure people were only prescribe the medicines they needed.