Justintime Healthcare

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 legal regulations in relation to medicines and good governance.

This service scored 59 (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 had a positive approach to learning, with a culture based on openness and willingness to learn. People and relatives told us they knew how to raise concerns and felt confident appropriate action would be taken to address them.

Accidents and incidents were reported by staff, including near miss events. There was a complaints log in place which showed timely responses and the action the provider had taken to resolve any concerns or complaints. Most people and relatives told us they knew how to raise a concern and who to contact. The provider had recently upgraded their electronic systems which meant information was clearly collated to demonstrate lessons learned and action taken. We saw examples where details of events were shared with staff in team meetings and additional training and support had been provided.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, maintaining continuity of care when moving between services. The provider had a pre-assessment process in place which enabled them to gather relevant information prior to care being provided.

People’s needs were assessed before using the service. The provider worked with other agencies and people and relatives to gather information. Social care professionals told us they felt involved in the planning.

Improvements were required to safeguarding processes to ensure people's safety was maintained. Staff understood how top recognise and report poor care and abuse.

The provider had a safeguarding log in place. However, this did not evidence an overview of themes, trends or lessons learned from safeguarding events. One safeguarding report indicated a single event had taken place in relation to a medication error, when this had occurred several times. This meant we were not assured the provider had investigated this event fully. There were delays in submitting 1 safeguarding notification to CQC.

Staff had received safeguarding adults training and they understood how to raise concerns. Comments included, “Safeguarding is a procedure to prevent harm, abuse and neglect, child or adult.” The staff member told us about an event which they had referred to the registered manager when they had concerns about a person’s safety.

People and relatives told us they felt safe. Comments included, “They [staff] guide me and help me get around. I do feel safe.”

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

Risks were not always safely managed. This was because assessments did not always consider risks relating to people’s health, safety and medicines. Where risk management plans were in place, these were not detailed enough to ensure staff had all the necessary information to provide safe care and treatment. We found some assessments were not robust and key risk areas had not been fully assessed. For example, there were no detailed assessments relating to health issues, such as catheter care and complex health conditions such as Parkinsons Disease. Where people were at a high risk of falling, detailed risk assessments were not in place to advise staff. One person was at risk of choking and care plans were not detailed. There were no risk assessments to minimise the risk of harm to the person.

However, we found no evidence to suggest people had come to harm because of these concerns. This was because the staff we spoke with knew people well and were aware of people’s individual risks and how these risks should be managed.

The provider did not always detect and control potential risks in the care environment. The provider carried out a review of the environment as part of their initial assessment. However, this was not always detailed or reviewed regularly to inform staff about any issues relating to people’s homes. The provider sent us examples of completed risk assessments but we were not assured they were in place for everybody who they provided support and care for.

People did not always receive good continuity of care. The provider had a process in place to monitor call times. However, this was not always effective and we received mixed feedback from people and relatives about the consistency and timings of their calls. Whilst some people expressed their satisfaction, others were concerned call times did not meet their wishes and needs and this impacted on their wellbeing and plans for the day. We did not find any evidence of missed calls. The provider had recently upgraded their electronic systems, and was liaising with people and relatives, and they told us this meant monitoring and outcomes for people would improve. They were also supporting staff who wished to learn to drive and had some fleet cars available.

Staff recruitment was managed safely and the required checks were in place and completed, prior to staff starting work. Staff received an induction and had the opportunity to shadow experienced staff when they first started work. The training matrix indicated staff had undertaken mandatory and additional bespoke training and had their competency assessed, to ensure they were providing safe care and support. Regular spot checks were in place to monitor this.

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.

Processes were in place to ensure people were protected from the risk of infection. Staff received training in infection, prevention and control and understood what action they needed to take to keep people safe. People and relatives told us staff followed consistently good practice.

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

Medicines were not always managed safely. For example, one person was prescribed medication to be administered at a certain time and records indicated this had not been administered safely for 5 days in 1 week. This meant the person was at risk of harm and their symptoms deteriorating. We alerted the registered manager to this and they took action to mitigate the future risk, contacted the person’s doctor and made a safeguarding referral to the local authority.

One person had a handwritten Medication Administration Record (MAR) and this had not been checked and signed by 2 suitably qualified staff, which meant there was an increased risk of errors. One staff member’s signature on MARs was the same as a code used to identify somebody had not taken their medication. This meant medication audits could not determine if a person had taken their medication or not. We discussed this with the registered manager and they took immediate action to address this.

Where people had complex medical issues requiring high risk medication, care plans were not in place.

Staff had received training in how to administer medication safely and had their competency regularly assessed.