Archived: Time2B Ageing Gracefully Ltd

Time 2Be Ageing Gracefully is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection there were three people receiving support from the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

There were continued failings in management oversight of the service. The provider had not made improvements despite previous regulation breaches and enforcement action at previous inspections.

The provider did not ensure safe staff recruitment. Not all staff had undergone appropriate recruitment checks prior to working with vulnerable people.

The provider did not keep records of all staff employed by the service. Staff rotas did not reflect who was attending care visits.

The provider did not adequately assess risk for all people using the service.

Medicines were not safely managed. Not all staff received training in medicines administration.

People were not always receiving care from staff who were competent, skilled and experienced. There was a risk that people were receiving care from staff who had not received training to meet the needs of people. The provider did not keep appropriate records of training.

Most people and relatives told us they found staff caring and kind.

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 24 March 2021) and there were two breaches of regulations. This resulted in two warning notices being issued against the provider and registered manager related to safe care and treatment and good governance of the service.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 11 December 2020. Breaches of legal requirements were found.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements related to the warning notices. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Time 2Be Ageing Gracefully on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing, recruitment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Time2B Ageing Gracefully Ltd is a domiciliary care agency providing personal care to people living in their own homes. At the time of the inspection there were two people receiving support from the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People had been using the service for a number of years and knew staff well. Relatives were very positive about the quality of care for people and the support given by care staff that visited.

Whilst there has been improvement in the service since the last inspection, we continued to find concerns with medicines management, risk assessments and the overall governance of the service. Medicines were not well managed or documented appropriately. Risk assessments failed to provide guidance to staff on managing people’s risks. There were insufficient quality assurance systems in place to monitor the quality of the service.

People received a continuity of care and had the same care staff visiting them. Staff understood their responsibilities around safeguarding and how to report any concerns. Staff recruitment procedures had been updated and staff had received appropriate checks to ensure they were safe to work with vulnerable people.

Staff received supervision, annual appraisals and training to support them in their role. This included training around COVID-19 and appropriate use of Personal Protective Equipment. 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. People were supported, where necessary, to access healthcare.

People and relatives were able to provide feedback on the service through written surveys. Relatives said they also felt able to contact the director at any time to give feedback or raise concerns.

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 inadequate (published 30 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made. However, enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 30 April 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the safe, effective and well-led key questions which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has improved to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Time2B Ageing Gracefully Ltd on our website at www.cqc.org.uk.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment, around adequate risk assessments and medicines management and good governance concerning oversight of the service and record keeping.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Time 2B Ageing Gracefully Ltd is a domiciliary care agency providing personal care to three older adults living with dementia in their own homes in North London and Hertfordshire at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

There were continued failings across the management and oversight of the service. The provider had not made improvements following our last inspection.

The provider did not adequately assess risk for all people using the service.

Medicines were not safely managed. Staff had not received medicines training. Medicines Administration Records had not been completed appropriately and did not list all medicines people had been prescribed.

The provider did not ensure safe staff recruitment. Not all staff had undergone appropriate recruitment checks prior to working with vulnerable people.

People were not always receiving care from staff who were competent, skilled and experienced. There was a risk that people were receiving care from staff who had not received training to meet the needs of people. The provider did not keep appropriate records of training. Staff did not receive regular documented supervisions or appraisals.

People's care preferences were not appropriately recorded. Care plans were basic and were not always reviewed on a regular basis.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

We received positive feedback from relatives who told us staff were caring and responsive to their needs. They told us they found the provider accessible and responded to any queries they had.

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 5 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified repeated breaches in relation to safe care and treatment, the employment of fit and proper persons, staffing and good governance at this inspection. We also identified a breach of regulation in relation to person centred care.

We are mindful of the impact of COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

Follow up

We have discussed with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

•Time2B Ageing Gracefully Ltd is a domiciliary care agency.

•It provides a personal care support service to people with a mental health condition, an eating disorder, learning disabilities, autistic spectrum disorder, dementia, physical disability, sensory impairment, people who misuse drugs and alcohol, older people and younger adults in their own homes.

•At the time of the inspection, it was providing personal care support to four people.

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

People’s experience of using this service:

•Risks to people’s health, care and mobility needs were not always appropriately assessed and mitigated. Risk assessments were not appropriately completed which put people at risk of potential harm.

•There were gaps in staff recruitment checks and we could not be assured if they were safe to work with people who were vulnerable.

•The provider lacked systems to ensure the safe management of medicines.

•People were not always supported by staff who were appropriately trained. Staff were not provided with regular supervision to do their job effectively.

•The provider lacked robust and effective systems and processes to ensure the quality and safety of service.

•Not all people's care plans were person-centred.

•People and relatives told us they felt safe with staff and found them reliable. Staff knew how to safeguard people against harm and abuse. They were provided with sufficient personal protective equipment to prevent the spread of infection.

•People’s needs were assessed before they started receiving care and they told us their needs were met.

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

•People and relatives told us staff were caring and treated them with dignity and respect. They were involved in the care planning process and reviews. People's independence was encouraged and maintained.

•People and relatives knew how to raise concerns and they told us they the service was responsive.

•People and relatives told us they were happy with the service and the provider was approachable.

•Staff told us they felt supported and were involved in continuously learning and improving care.

Rating at last inspection:

•The service was registered by CQC on 7 March 2018. This is the service’s first inspection since its registration.

Why we inspected:

•This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

•This is the first time this service has been rated Requires Improvement.

Enforcement:

•We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around safe care and treatment, staffing, fit and proper persons employed, and good governance. Details of action we have asked the provider to take can be found at the end of this report. We made recommendations in our inspection report, which we will follow up at our next inspection.

•You can see what action we told the provider to take at the back of the full version of the report.

Follow up:

•We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good.