Time to Care Specialist Support Services Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

The service was in breach of 1 legal regulation in relation to governance and oversight.

This service scored 32 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. They did not understand the challenges and the needs of people and their communities.

There was evidence of a closed culture. Staff were working with limited supervision and support from the management team, there were significant communication barriers and staff told us concerns were, at times, dismissed or not acted upon. One staff member said, “The wider organisational culture is poor, we don’t feel as though we are listened to and we rarely get a reply from the office.” The nominated individual said, “We are now logging concerns, in the past it may have been that staff didn’t get feedback on concerns."

Leaders did not demonstrate sufficient understanding of their regulatory responsibilities, including the statutory notifications they were required to submit to CQC. This lack of regulatory awareness contributed to weak leadership oversight and reduced assurance that the service was operating in line with legal and regulatory requirements.

Staff said they did not feel listened to by management. One staff member said, “Communication is horrific, most things are done by email and it’s very rare to get a reply. Service users are not a priority and there’s no consistency from the management team."

Staff did not feel they could speak up and that their voice would be heard.

One staff member said, “They don’t listen to us. People do well because of the support they receive then staff are moved so there’s no consistency. They don’t acknowledge our knowledge of people and that they need a consistent team of staff.”

The nominated individual explained that it was brought to their attention that staff were reluctant to raise concerns so they had introduced a process called “Your Voice” where staff could share feedback, either positive or negative and could do so anonymously if they wished. This had resulted in a mixture of feedback, for example praise for individual staff members as well as concerns about staff practice. Whilst feedback was logged there was limited evidence of any action having been taken and outcomes were not recorded.

Some staff shared with us that they felt there was a lack of confidentiality amongst the management team. The nominated individual was in the process of managing this.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for staff who worked for them.

Processes to promote workforce wellbeing included welfare checks and staff debriefs following incidents. However, there was no evidence of staff being supported to reflect and learn from incidents.

Staff felt the support from management and office staff was inconsistent, and they often felt undervalued due to a lack of visible leadership and on‑site engagement.

The provider did not have clear responsibilities, roles, systems of accountability or good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

Although some audits had been completed, staff told us these were conducted electronically and did not involve on‑site review.One staff member said, “Audits of care plans are done electronically, no one comes out on site.” The audit process had not been effective in identifying areas for improvement. We identified concerns in relation to care planning and risk management and staff support and training which had not been identified by the provider.

The nominated individual said, “The plan was that seniors were doing audits and the registered manager would check them every six months, but it wasn’t happening. I thought it was, but it wasn’t. This is concerning."

The nominated individual and acting manager told us they were already aware of some of the shortfalls before the assessment. There was limited evidence that timely action had been taken to drive improvements.

Additional support had been sought by way of appointing a consultant and an additional manager to support with implementing changes. An action plan, prompted by safeguarding and CQC concerns was being developed.

The provider did not always understand their duty to collaborate and work in partnership to ensue services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

Time to Care Specialist Support Services had been placed in the local authority organisational safeguarding procedure due to concerns about people’s care and the management of the service. They had received a range of feedback from local authority teams, but there was little evidence this had been acted upon in a structured, collaborative and transparent manner. The nominated individual said they attended various forums including Skills for Care and the Local Authority provider meetings. This provided opportunities to remain informed about sector developments and share learning.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people.

The failure to ensure robust governance and oversight meant there was a lost opportunity to learn and improve the quality of care provided for people.

There was no evidence of a lessons learned process following incidents or concerns. The nominated individual said, “We review incidents and behaviour charts and identify common themes and discuss them in meetings. We have regular meetings with the supported living services managers.” We gave the opportunity for the nominated individual to share details of these meetings with us, but they were not provided.