Time to Care Specialist Support Services Limited

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

The service was in breach of 2 legal regulations in relation to person centred care and governance and oversight.

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 always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Some staff, particularly agency staff, did not know people and did not engage with them in providing person-centred care. Care plans were not person centred. They lacked detail about people’s likes and dislikes and offered limited information about approaches to best support people, especially when distressed. People had not been actively involved in developing plans to ensure their needs and preferences were understood and met. There was limited evidence of managerial oversight of staff induction or care delivery to ensure a person-centred approach was applied.

One person who lived in an individual supported living service was supported by staff who knew them well and were able to deliver person centred care. Another person told us there had been some improvements in the last few months and they were able to go out more.

There were some shortfalls in how the provider understood the diverse health and care needs of people, so care was not always joined-up, flexible or supportive of choice and continuity.

There was limited evidence people, and their relatives, were involved in making decisions about their care. One person told us they were asked what they needed, but this had not always been reflected in up-to-date care plans. Care plans were developed in such a manner that details of people’s care had to be cut and pasted from one electronic document to another at the end of each month. In one area this had not been carried out for some people and therefore care plans for the most recent months were empty. This meant staff, and in particular agency staff had limited information about people’s care.

The high reliance on agency, together with limited induction and a lack of detail in care plans meant there were shortfalls in the provision and continuity of care.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

A relative said, “(Loved one) got a letter about safeguarding but they wouldn’t understand it. I didn’t receive a copy. It makes me suspicious that they are trying to hide something and not being open about it.” This showed information was not being shared with people in a format they would understand.

Care plans and care records had not been created in a way that enabled people to be involved in meaningful discussion and decision-making.

The nominated individual was aware of the Accessible Information Standard and said documents could be provided in different formats to meet people’s needs. An easy read complaints procedure was in place.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

Complaints and compliments had been logged. Lessons learned were not recorded. Surveys had been completed by some people, although there was no indication of when these had been completed, and no analysis or action had taken place. There was no comment from the nominated individual when we shared this feedback.

Some surveys shared with us related to feedback from people who were not in receipt of regulated activity.

Some people said they were asked about their needs and preferences; however, this was not always reflected in people’s care plans. A relative said, “Time to Care have never involved me, I’ve never been invited to any meetings, never updated about what (loved one) has been doing, their physical health or social activities. They never call me about anything.” Another relative said, “We get involved in monthly care reviews with (staff name). We give feedback and suggestions on things that could be improved.”

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

Staff did not fully understand people’s needs and had limited understanding of their conditions. Strategies to enable staff to effectively support people to access care were not in place. This meant there was a risk people were not always able to access the care and support they needed. One person told us they felt isolation and had withdrawn because they didn’t feel able to access the support they needed.

Some environmental adaptations were in place to meet people’s needs. A relative spoke with us about how the nominated individual had worked with them to secure a property that would meet their loved ones needs. They said, “The home is perfect, (person) rents it and it’s been amazing for them and for us.” Another relative who had visited the small complex of supported living services said, “At a recent visit, the staff member in charge didn’t know if there was a lift in the building, I found this very worrying.

Staff and leaders did not listen to information about people who were most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

People’s experiences were not equitable. One relative said, “(Person) gets out and about in the community, days out, swimming, shopping, meals out. They are never in!” Other people said they felt isolated, particularly those people who had more complex needs. A staff member said, “I don’t think everyone is supported fairly, personal opinions of people stick, and it negatively affects the support they receive.”

There were no robust support strategies in place to enable staff to actively engage people, so people withdrew and became more isolated and withdrawn. Individual obstacles and challenges were not robustly assessed and managed, so the equity gap widened due to a lack of knowledge and understanding of people’s needs. Staff had requested specialised training to enable them to support people. However, this had not been provided so frustration amongst people and staff built, which compounded the problem leading to poor outcomes for those people with the most complex needs.

People were not supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

There was no information in care plans to evidence that people were supported with goal setting or planning for the future. As a result, people’s preferences, values and priorities may not have been understood or respected which increased the risk that care delivered would not align with what mattered most to them. This lack of proactive planning also limited staff’s ability to provide timely, person‑centred support at crucial stages of people’s lives.