Timeswitch Care

On this page

• 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 people were not always safe and were at risk of avoidable harm.

This service scored 53 (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 did not always have a proactive and positive culture of safety based on openness and honesty. They did not always document concerns about safety, investigation or report safety events. Lessons learnt were not documented to continually identify and embed good practice.

There was a lack of documentation such as recording of and analysis of accidents, incidents and falls. We were advised by the service; there had been no recent incidents or concerns. However, following review of care records, we identified recent police incidents which had not been documented as incident reports, or notified to the Care Quality Commission(CQC).Furthermore, there was no evidence of appropriate systems in place to support the oversight of concerns, or the function to review and analyse patterns or trends. As a result, there was no evidence staff were provided with feedback or guidance to prevent reoccurrence or opportunities for learning. We were advised team meetings took place to discuss areas of learning, however, lessons learnt were not fully documented. Therefore there was little documented evidence staff were provided with opportunities to improve safety and reduce future risks for people. However, we did not find any impact to people using the service. The service has provided an action plan on how to improve their learning culture, including a full review of staff support.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We identified important information, was not always present in people’s care records, for example people’s health needs. Although some aspects of people's health were documented, important medical conditions were not detailed in care documentation. Where people lived with diabetes, care documentation did not identify who held overall responsibility for the administration, monitoring and oversight of people’s diabetes. For example, whether the GP or community diabetes team was responsible for reviewing and completing regular blood test monitoring. The service did not always document this important information in people’s care plans. This created a risk of people being supported without their health needs being fully identified. The service did not always keep clear, contemporaneous records, which placed people at risk of harm, as relevant up to date information was not available for staff to effectively assess, monitor and mitigate risks to people. However, we did not find any impact to people using the service. The provider gave us assurances and provided an action plan on how to improve their safe systems and transitions, including full care plan reviews.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately, however, these actions were not documented.

The provider did not always have robust systems and processes in place to safely monitor and mitigate the risk of abuse to people. We spoke with professionals who worked with the service, who advised they had been provided with safeguarding information appropriately. However, concerns were not documented by the service, with relevant actions or mitigating measures in place. Staff had completed safeguarding training, however, could not demonstrate a full understanding of identifying and reporting on safeguarding concerns. The provider did not notify CQC regarding any safeguarding or police concerns. The lack of meaningful or reliable analysis of incidents creates a risk that concerns are not identified or responded to. However, we did not find any impact to people using the service. People we spoke with did not raise any concerns regarding their safety using the service.

The provider took action following the concerns raised to strengthen safeguarding training, policies and procedures.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We were not always provided with accurate information as to how the service works with other professionals to manage risk. However, a professional told us the service did appropriately involve them and the police regarding recent incidents and said this was well managed by the service. As there was not always accurate information in people’s care records, the provider could not always identify opportunities to involve relevant professionals appropriately. For example, people living with a stroke or dialysis. Therefore, staff would not be able to identify where appropriate support from other professionals may be required. People we spoke with did not express any concerns regarding involving relevant professionals to manage risk.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider did complete environmental assessments; however, documentation did not always contain important environmental information. For example, where environmental safety mitigation measures were put in place to keep people safe, such as areas of people’s homes made inaccessible for people’s safety, care documentation lacked important information as to how decisions about environmental safety had been reached and associated risks. There was also at times a lack of detailed information regarding people's mobility needs. Care documentation lacked a fully detailed environmental assessment for people to be provided with safe care where risks were identified and documented relating to the care environment.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

We reviewed staff records as part of our assessment. We found there was a lack of systems and processes in place to ensure safe staffing, for example, a lack of interview documentation and character references. Staff had completed training relevant to their roles, however, training did not meet all mandatory requirements for adult social care providers, for example, a lack of learning disability training. Supervision and appraisal documentation evidenced staff also did not receive regular supervision, although staff did receive regular appraisal. Staff provided mixed feedback as to whether there had been regular supervisions, and whether these had been documented by leaders. The provider gave us assurances on how they will improve their recruitment and staffing processes including re-training for staff. People we spoke with provided positive feedback regarding staff. One relative told us, “The carer communicates really well [with my relative].”
 

The provider 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 infection, prevention and control (IPC) policy in place, and staff had completed relevant training. People we spoke with advised us staff wore the correct personal protective equipment, (PPE) whilst being supported. One person told us, “The carer always wears apron and gloves.”
 

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not always involved in planning.

The service had relevant policies and procedures in place to support the safe management of medicines. However, upon review of people’s medication records, we found the service did not follow these policies and procedures to ensure safe management of medications. For example, medicine administration records (MARs) charts were not clear or accurate. We reviewed peoples records for those medications given ‘as required’. There were no protocols in place with relevant detailed information as to when the medication would be administered. The providers topical medicines policy advised best practice was for administrators to identify the area the cream or emollient was to be applied using a body map, and to detail the method application and amount. This information was not in place in people’s medication records. We reviewed daily records and identified several people were given medication amounts not in accordance with their care plans. Further investigation found the service had not appropriately updated people’s medication care plans.

There was a lack of managerial oversight and capacity to ensure the staff teams followed their own policies and procedures. However, we did not find any impact to people using the service. The provider took immediate action to rectify the concerns raised and has advised us how they will make improvements to their medicines management, including a full medications management investigation. People we spoke with did not express any concerns regarding medication management.