We carried out a review of the data available to us about Justintime Healthcare on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Justintime Healthcare, you can give feedback on this service.
People’s experience of using this service and what we found
People received safe care and support because systems for assessing and managing risk were robust and staff knew how to safeguard people. One person told us they felt safe “all the time.”
Care plans included up to date and comprehensive individual risk assessments which gave staff the information they needed to maintain people’s safety. New and emerging risks including the effects of COVID-19 had been assessed.
Systems for the recruitment of new staff had been improved and were safe.
Improvements had been made to the systems for managing medicines and regular auditing meant these systems remained safe.
Clear processes were in place to prevent and control infection. The provider had been proactive in following government and local guidance in relation to managing the COVID-19 pandemic.
Staffing was well organised and appropriate to the needs of people using the service. Staff received the training and support they needed to care for and support people safely and effectively.
People’s nutritional needs and preferences were assessed, and plans put in place to make sure they were met.
People were supported to have maximum choice and control of their lives and the provider had made improvements in systems for assessing people’s capacity to make decisions. Staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Systems were in place to make sure peoples’ needs were assessed before they began to use the service. People were involved in regular reviews to make sure their care plans reflected people’s current and changing needs.
People were supported to access healthcare professionals. Advice from healthcare professionals was included in care plans.
People were supported to make decisions about their care and care plans reflected a person- centred approach.
People were treated with kindness and consideration and care was delivered in way which met people’s dignity and independence needs.
People were supported to follow their preferences in relation to their interests and lifestyles.
Complaints about the service were managed effectively. Systems were in place for learning lessons when something went wrong.
Robust quality assurance systems had been introduced and implemented to enable the provider to learn and implement positive change.
People, and their relatives, were unanimous in their feedback in relation to the improvements made at the service. One relative said, “They have really stepped up in terms of due diligence, I would give them ten out of ten.”
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 22 October 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 improvements had been made and the provider was no longer in breach of regulations.
This service has been in Special Measures since December 2019. 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
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
The overall rating for the service has changed from inadequate to good. 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 Justintime Healthcare on our website at www.cqc.org.uk.
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.
People’s experience of using this service and what we found
Recruitment practices remained unsafe, and we found the provider was still not following a robust process to ensure people were safeguarded from abuse. The safety of care and the management of medicines remained areas of the service we were concerned about. We saw improvement in the management of calls since the service began supporting fewer people, and we did not have concerns about the use of PPE during the Covid-19 pandemic.
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.
People’s consent to their care was still not well recorded. Staff induction and training remained areas of concern, however people told us they felt the care provided was beneficial to their overall health. We received good feedback about how people felt involved in their care and about positive relationships with staff members.
The care planning continued to lack a person-centred approach, however, people told us they discussed how they liked their support to be delivered. The provider had not acted to ensure people’s end of life wishes were understood and planned for, which was also highlighted in our last report. People knew how to raise concerns, and we found most complaints were dealt with appropriately.
There was a lack of evidence to show how improvement had been planned and monitored, and the provider remained in breach of regulations. People told us their experience of the service had improved, however systems and processes to measure and improve quality in the service still lacked rigour.
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 25 October 2019) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated Inadequate.
The service has been in special measures since 24 October 2019.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
We carried out an announced, comprehensive inspection of this service on 14 August 2019 and 2 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safeguarding service users from abuse and improper treatment, safe care and treatment, fit and proper persons employed, staffing, consent to care and treatment, person centred care, good governance, and registration regulation relating to submitting statutory notifications.
We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Justintime Healthcare 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 safety of recruitment, safeguarding of people from abuse, safety of care provided, induction and training of staff, supporting people to give consent to their care and treatment, making care person-centred, submitting notifications and the overall governance of the service.
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.
The overall rating for this service is ‘Inadequate’ and the service remains 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 6 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.
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.
Justintime Healthcare is a domiciliary care agency. It provides personal care and support to people living in their own home. On the first day of our inspection, 21 people were receiving this service. On the second day of inspection this number was 17 people and on day three this had reduced to 11 people.
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 and their relatives did not always feel safe and had raised concerns about care workers arriving late or missing care visits.
People were not protected from abuse and improper treatment. The registered provider was not always identifying safeguarding concerns, investigating them in a timely way and reporting them to the appropriate local authorities. These incidents were also not being reported to the Care Quality Commission (CQC).
Risk assessments were missing, lacked detail or contained general statements. Insufficient action had been taken by the registered provider to reduce the risk of harm to people.
The management of medication was not safe. We found gaps in the recording of medicines administration , lack of consistency in the instructions for one person who required crushed medication and protocols for the use of ‘as required’ medicines were missing. People who required support with their medication did not always have a medication care plan or risk assessment. We could not be sure all staff administering medication had an up-to-date medication competency assessment and the registered provider was not completing medication audits.
The recruitment of staff was not robust as up-to-date backgrounds checks had not been completed. Staffing levels were not sufficient to meet people’s needs as people, relatives and records we saw showed missed and delayed calls on a regular basis.
Staff were routinely asked to give care and support for people with specific health needs which they were not trained to provide. The registered manager said they provided staff with supervision, although staff told us this did not happen.
The registered provider was not completing mental capacity assessment s for people who lacked capacity to make certain decisions. 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.
People did not receive care and support that was person-centred. Care plans were not sufficiently detailed. There was an over-reliance on the assessments carried out by commissioners such as local authorities. End of life care needs were not assessed even though the registered manager told us most people required this support.
Management oversight was not evident over key aspects of the service. This demonstrated that systems to assess, monitor and improve the service were not sufficiently robust. We saw evidence of some complaints being responded to appropriately.
The registered provider was unable to demonstrate how people’s communication needs were met.
People told us their healthcare needs were met by staff who provided their care. We saw people’s care records did not always include contact details for healthcare professionals. People told us their dietary needs were met, although one person’s care records needed further detail around their diabetes.
People and relatives were mostly positively about the staff who provided their care. We were also told that care staff protected people’s privacy and dignity.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 13/09/2018 and this is the first inspection.
Why we inspected
This was a planned inspection based on the date this service was registered with the Care Quality Commission.
Enforcement
We have identified a total of eight breaches of regulation in relation to the recording of people’s mental capacity, a lack of person-centred care, the management of medicines, management of risks to people, protecting people from harm, oversight of the service, recruitment of staffing. We have also identified a breach of our registration regulations.
Please see the action we have told the provider to take at the end of this report.
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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
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 6 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.