Time to Care Specialist Support Services Limited

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. At our last assessment we rated this key question good. At this assessment the rating has changed to 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 3 legal regulations in relation to safe care and treatment, specifically care planning and risk management: staffing and governance.

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. Staff raised concerns but felt they were not always listened to. Lessons were not always learnt to continually identify and embed good practice.

Incidents were documented and some debriefs took place. However, there was no evidence of reflective practice and lessons were not learned to continually identify and embed good practice.

Some staff meetings had taken place, which evidenced discussion and learning in relation to some people’s care needs. Staff meetings had not taken place consistently for all 4 people who were supported with domiciliary care. Staff told us, “Team meetings are about every 6 months, they can be helpful but we rarely get responses to any concerns.”

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.

People, and appropriate others were not fully involved in developing care plans and risk management plans. The care planning system was not robust. Care plans and risk assessments did not always include the information staff needed to keep people safe. For example, one person’s care plan stated staff must be rigid with the persons routine, however there was no routine documented. Risk assessments had been completed in 2022. Reviews were documented annually however they did not include any information on the effectiveness of the measures in place to mitigate risk.

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 provider did not always share concerns quickly and appropriately.

Most safeguarding concerns were documented. Action taken in response to safeguarding concerns was not always documented, nor was there evidence of learning from concerns to drive improvement and mitigate future risks.

Multiple recording systems meant the system was disorganised. The acting manager told us they were developing a new process.

The provider did not work well with people to understand and manage risks.

There was no evidence in care records that people or relatives were involved in managing risks. Staff did not have clear or consistent guidance on how to manage risks relating to people’s specific conditions. Key information about the use of rescue medicine to manage one person’s health condition was missing.In addition, there was conflicting information in a person’s risk assessment and care plan about whether staff were trained and permitted to administer rescue medicine. This lack of clarityshowed measures to mitigate risks had not been appropriately understood or managed. There had been insufficient oversight to ensure records were accurate and up to date, which placed the person at potential risk of harm.

The acting manager confirmed that some staff had attended appropriate training in epilepsy and the administration of rescue medicines.

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

We did not identify any concerns in relation to the environment.

Staff were not always sufficiently qualified, skilled and experienced to meet people’s needs. The provider did not always make sure staff received effective support, supervision and development.

A range of staff training was provided. However, some completion levels were low, including face to face based first aid training and fluid and nutrition awareness. The acting manager confirmed that staff had received specialist training in relation to epilepsy. However, there was no evidence any staff had completed training in care planning and risk management.

Supervision meetings had taken place, although not in line with the provider’s policy. Staff commented on a lack of support from the management team and one staff member said communication was mainly by email and it was rare to receive a response.

Recruitment procedures were inconsistent. For example, full employment histories were not always present and/or gaps in employment were not explained. Not all references correlated with previous employment history. Right-to-work checks and DBS checks were completed prior to staff starting work. A new recruitment checklist had been designed to monitor and manage pre-employment screening and on-boarding processes. However, this had not been fully embedded.

People had their own core team of staff who provided their support. One staff member said, “We rarely use agency staff and tend to cover for each other. There are times when staff are removed from someone’s team to support elsewhere which can have an impact on people’s wellbeing. We have raised this before, but we don’t feel listened to, and it still happens."

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.

No concerns were raised in relation to infection prevention and control. Staff had completed training and one staff member told us, “We have access to the PPE we need for personal care."

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

There were gaps and inconsistencies in the oversight of medicines management. Risk assessments were not reviewed in a way that demonstrated whether identified risks had changed over time. Audits lacked sufficient detail or follow‑up actions to ensure issues were addressed. Relatives spoken with did not raise any concerns around medicine management.