Time to Care Specialist Support Services Limited

Time to Care Specialist Support Services Limited is a homecare service that provides personal care and support or enablement to people with learning disabilities, autism or related conditions and/or people with physical or mental health needs. 10 people received support for a regulated activity at the time of the inspection.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People who used the service had their needs assessed before they began receiving care. They had appropriate plans in place to aid in living independent lives and were involved in decisions and reviews about their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: The staff providing care were well trained to do so and quality checks were carried out to ensure that standards were being met. People we spoke to had positive experiences of using the service. We saw evidence of staff working with partner organisations to meet the needs of people who used the service.

Right Culture: There was a positive culture for the people who use the service. Staff who worked there benefited from the strong support from the management team, including values checks at supervisions and feedback calls from the registered manager and human resources (HR). Staff that we spoke with spoke positively about their roles and about providing care to people who used the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (report published 31 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service and the time that had passed since our last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Time to Care Specialist Support Services Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Time to Care Specialist Support Services Limited provides personal care and support or enablement to people with learning disabilities, autism or associated related conditions and/or people with physical or mental health needs. 17 people received support at the time of the inspection, including people within four independent supported living settings. Only six of these people received personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People received a good, safe, caring and responsive service, but other aspects required some further improvement.

At the last inspection staff had not always received support sessions. Although a plan had been in place, some staff had still not received an appraisal or regular supervision.

There were enough, consistent staff to support people. The provider had suitable recruitment and training procedures in place. The provider updated some of their recruitment processes during the inspection, after discussion.

Medicines management was generally good. Any minor issues noted, were addressed during the inspection.

Accidents and incidents were recorded and monitored, and any lessons learnt shared with the staff teams.

People were kept safe from abuse. Staff had received training to protect people and knew how to report any concerns appropriately. Risks people faced had been assessed and the provider was reviewing information to ensure it was all up to date and relevant.

People had access to food and fluid which met their dietary requirements.

Staff treated people in a gentle and caring manner. The care delivered was centred around the people receiving support and they were helped to remain part of the community in which they lived where ever possible.

Complaints were recorded and managed in a timely manner with outcomes noted.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain skills and become more independent.

Audits and checks were in place but were behind in some cases. Management were working through the backlog caused by changes in previous management.

We have made one recommendation regarding the formatting of policies and procedures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 29 November 2018) with breaches of two regulations. The service has remained as requires improvement, but progress was noted, and they are no longer in breach of any regulations. However, further time was needed to fully embed improvements in the effective and well led areas.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Not everyone using the service receives the regulated activity of personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

We last inspected the service in July 2017 and found five breaches of the regulations. These related to safeguarding people from abuse and improper treatment, need for consent, staffing, good governance and fit and proper persons employed. We rated the service as requires improvement.

Following our inspection, the provider sent us an action plan, which stated what action they planned to take to improve and meet the regulations.

At this inspection we found that action had been taken in certain areas, however, further improvements were required.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The operations manager was going to apply to become registered manager. This would allow the current registered manager to have a more strategic oversight of the management of the service as the provider.

Medicines were mostly managed safely. People and relatives told us that medicines were administered as prescribed. There were several medicines missing from one person’s medicines administration record which the provider addressed.

Safeguarding systems and processes had improved. No safeguarding issues were identified during our inspection. Staff were knowledgeable about what action to take if abuse were suspected. However, it was not clear which staff had completed safeguarding training from the training records we viewed.

Safe recruitment procedures were now followed. Suitable recruitment checks were followed to help ensure that staff were suitable to work with vulnerable people. The registered manager told us that recruitment was ongoing. Most people and relatives told us that visits were carried out on time and staff stayed for the agreed length of time.

Records did not always evidence how staff followed the Mental Capacity Act 2005. The registered manager told us that this had been addressed.

Records did not always evidence the training which had been undertaken. Although we were unable to ascertain the training which had been completed, the staff we observed were knowledgeable about areas such as moving and handling.

People's nutritional needs were met and they were supported to access healthcare services when required.

We observed positive interactions between staff and people who used the service. Staff promoted people's privacy and dignity.

An activities coordinator was employed. There was an activities programme in place which people could access if this was part of their plan of care and support.

An effective system to manage and respond to complaints was not fully in place.

The provider was not meeting all the conditions of their registration. When we register providers, we do so with conditions. Time to Care Specialist Services Limited had two registration conditions; to have a registered manager and to manage the regulated activity of personal care from the location address in Alnwick. At this inspection, we found that the provider was also running the service from another location in Ashington. This location was not registered as a condition with CQC, which meant the provider was not meeting the conditions of their registration. We spoke with the registered manager about this issue. Following our inspection, she submitted an application to add the Ashington location as a condition of their registration.

The provider had not notified CQC of a serious injury. This omission meant an effective system was not in place to ensure that all notifiable incidents were reported to ensure CQC had oversight of all notifiable events to make sure that appropriate action had been taken.

The provider had strengthened their quality assurance system. However, it had not identified the shortfalls we identified with the MCA, training, complaints and medicines management.

The provider sought to work in partnership with others. The provider hosted the North Northumberland Registered Manager’s meetings in collaboration with Skills for Care. They had also been a finalist in the National Learning Disabilities Awards after being nominated by a member of the public.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.These related to receiving and acting on complaints and good governance. We also identified a breach of the Registration Regulations 2009, which related to the notification of other incidents.

Further information is in the detailed findings below.

The provider also offered an outreach service to assist people to access the local community or other identified support to meet people’s social needs if this had been agreed as part of their plan of care. We did not inspect this part of the service because it was outside the scope of the regulations.

We have not inspected this service since the provider changed the service’s name and address in January 2016.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

There was currently no nominated individual at the service, which is a person who the provider puts forward to oversee the management of the service. The previous nominated individual had left the service.

We identified shortfalls and omissions with regards to staff recruitment. We also found shortfalls with the recording and management of medicines.

There were safeguarding procedures in place. We found that one specific allegation had not been reported to the local authority in line with the provider’s safeguarding policy. In addition, the provider had not notified CQC of three safeguarding allegations in a timely manner. Not all staff had completed safeguarding training.

There was no evidence of induction training being completed. We found the records did not always evidence the training which had been undertaken or demonstrate that competency checks had been completed to ensure staff were able to carry out care safely and effectively.

Care plans and risk assessments were not always detailed and decisions made in line with MCA principles had not been recorded.

People's nutritional needs were met and they were supported to access healthcare services when required.

We observed positive interactions between staff and people who used the service. Staff promoted people's privacy and dignity.

There was a complaints procedure in place. The manager told us that no formal complaints had been received. However, it was unclear how many informal complaints and concerns had been received.

An effective system was not in place to monitor the quality and safety of the service. Following the inspection the manager told us that action had been taken to address the shortfalls and omissions identified.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.These related to the need for consent, safeguarding people from abuse and improper treatment, staffing [in relation to training], fit and proper persons employed and good governance. We also identified a breach of the Registration Regulations 2009 which related to the notification of other incidents.

Further information is in the detailed findings below.