Time to Care Specialist Support Services Limited

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, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of 2 legal regulations in relation to governance and safe care and treatment, specifically care planning.

This service scored 46 (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 make sure people’s care and treatment were effective because they did not always check and discuss their health, care, wellbeing and communication needs with them.

People’s needs were assessed initially, including in relation to communication, mental health, medicines and nutrition. However, they were not robustly monitored. Care plans and risk assessments lacked sufficient detail in relation to the support people needed, and strategies to keep them safe.

There was limited evidence people, and their relatives, were involved in assessing needs. However, some relatives were complimentary and said they were kept up to date and informed of changes.

Monthly reviews had not been completed routinely, nor were they effective in reviewing people’s needs to make sure their needs were being met. Care plans were stored in multiple folders and documents, so it was difficult for staff to easily access information and understand people’s full and comprehensive needs.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider submitted information that stated they worked within an active support model of care and had policies and procedures in place. However, care plans lacked detail and reference to positive behaviour support. They did not include information on how to support people to be as involved as possible in their care.

One person ate a very rigid diet. There was no evidence external health professionals had been consulted in relation to strategies to broaden their intake to ensure they received a healthier, more nutritionally balanced diet. A risk assessment was not in place in relation to nutrition or the person’s routine around mealtimes.

The provider did not always well across teams and services to support people.

Staff told us about communication difficulties with the management staff and said communication was mainly by email and there were often delays receiving responses.

There was no evidence that referrals had been made to external professionals to seek guidance in relation to people’s dietary needs and preferences.

Staff described the benefits of consistent staff teams on people’s wellbeing. However, at times staff were moved to support elsewhere.

Relatives were complimentary of the staff. One relative said, “The staff team have really bonded with (loved one). They have time and patience; they all have a real connection.” Another relative said, “The staff have really taken the time to get to know (loved one), they have worked together to identify triggers, preferences and are always happy to help."

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence and choice.

Care plans contained limited information in relation to how to support people to live healthier lives, particularly in relation to dietary needs. Team meetings included discussions about people’s health and wellbeing. For some people concerns about dietary needs and mobility had been raised. Team meeting minutes did not document any specific action for staff to take to support healthier lives for people. For other people proactive strategies had been discussed in relation to distressed patterns of behaviour.

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.

Care plans had been robustly reviewed either routinely or following incidents to evidence improved outcomes and quality of life for people. Some people’s risk assessments had been developed in March 2022. An annual review was documented which stated, “no changes.” This did not evidence that outcomes were being monitored and support strategies developed to improve outcomes for people. In addition, risks relating to people’s specific conditions were not always detailed. These issues limited the provider’s ability to identify trends, make improvements and ensure people received effective care.

The nominated individual shared positive example with us of where people’s quality of life had improved considerably in relation to independence, communication and community engagement.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty.

Records did not always evidence how staff were following the Mental Capacity Act. One person’s care plan stated they received their medicines covertly and this had been authorised by the GP. There was no reference to this in the risk assessment nor was there a capacity assessment or best interest decision.