Timeswitch Care

On this page

• 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,treatmentand support achieved good outcomes and promoteda good qualityof life, based on best available evidence.

This is the first assessment for this service. This key question has been ratedrequires improvement.

This meant there were widespread and significant shortfalls in people’s care,supportand outcomes.

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 provider made sure people’s care and treatment were effective because they checked and discussed people’s health, care, wellbeing and communication needs with them.
The provider completed initial assessments and reviews of people’s needs;. People we spoke with told us they had been involved in care plan reviews. However, people's involvement was not always clearly documented. The provider has advised they plan to strengthen documentation relating to people's involvement in care reviews.
 

The provider did not always plan and deliver people’s care and treatment with them. They did not always follow legislation and current evidence-based good practice and standards. Although there was consideration of mental capacity in care documentation, this was not always embedded throughout care planning documentation.For example, where people had significant mental health needs, care documentation lacked important historical information, recognition of triggers, use of relevant tools such as behavioural plans and relevant mitigation measures to manage risk. However, we did not find any impact to people using the service. The provider took action and assured us they will make improvements regarding delivering evidence-based care, including a full care plan review for all people using the service.
 

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.
Robust systems and processes were not always in place to ensure staff worked well together. For example, staff had become aware of a person’s medication dosage being increased, however, this information was not relayed to leaders in the service, and as a result, the person’s medication records were not updated for a significant period. Therefore, there was a lack of up-to-date information provided from staff to leaders in the service. The provider received assessment information from the local authority, however, did not have important information in the service user’s care plan. This meant the provider did not have up to date and accurate oversight of people’s needs in the service. Staff and professionals, we spoke with did advise the staff team works well together.
 

The provider did not always support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

We reviewed people’s care records which did not always identify, up to date information as to how the service supported people to live healthier lives, for example, information regarding health needs. The inaccuracy of important health information in people’s care records, meant people’s health needs could not be appropriately identified, monitored and any risks mitigated. The provider did provide a “supporting people to live healthier lives” document, however, this information was not in people’s care plans. The provider did provide some evidence of supporting people to access the community. The provider has advised us how they will make improvements in supporting people to live healthier lives and have provided an action plan.
People we spoke with spoke positively regarding supporting people to live healthier lives. One relative told us, “[The carer] encourages physio exercises for [my relative].”
 

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

There was evidence of dates of review of care documentation had taken place. However, there was limited evidence as to what had changed as a result of the review, with only dates completed documented. There was no information as to the outcome of care documentation reviews, or whether there were any identified areas of learning or improvements required. There was also no documented evidence people were involved in reviews or their care. However, people we spoke with did advise us they had been consulted regarding their care. The provider put immediate actions into place following the concerns being raised and have provided an action plan as to how they will continue improvements.
 

The provider did not always tell people about their rights around consent or respect these when delivering care and treatment.
The service had consent documentation in place, however, appropriate consent considerations were not embedded throughout the service. Documentation was not always robust to be compliant with the MCA, 2005. For example, we identified practices were in place which restricted people’s liberty. Although the service did have some documentation in place regarding this, the information was contradictory and due legal process had not been followed, for example, a mental capacity assessment or best interest decision had not been completed. We spoke with staff regarding their understanding of MCA, 2005, and there was a significant lack of insight into the underlying principles of the legislation. The restrictive practices were also not clearly identified in people’s care plans. The provider has advised us how they will make improvements to documentation and staff training.