21 February 2020
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was carried out by one inspector.
Service and service type
Time Together is a domiciliary care agency. It provides personal care to people living in their own homes.
The service had a manager registered with the CQC. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection was announced; we gave the provider 48 hours’ notice of the inspection. This was because the service is small and we wanted to be sure the registered manager would be available to speak with us when we visited.
Inspection activity started on 18 December 2019 and ended on 20 December 2019. We visited the office
location on 19 and 20 December 2019.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used this information to help plan our inspection.
The provider was not asked to complete a provider information return before this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with two people who used the service, seven people’s relatives and received feedback from six health and social care professionals. We spoke with the registered manager, an assistant manager, two members of the provider’s ‘board of trustees’ and three care workers.
We reviewed two people's care records in full and two people’s in part, including their medication administration records and daily notes. We looked at two staff's recruitment, induction, training and supervision records as well as other records relating to the management of the service.
After the inspection
We continued to review evidence from the inspection and seek clarification from the provider to validate evidence found.
21 February 2020
About the service
Time Together is a domiciliary care agency providing personal care and support to people living in their own homes. The service specialises in supporting younger adults and older people with a learning disability or autistic spectrum disorder, mental health needs, a physical disability or sensory impairment.
Not everyone who used the service received support with personal care. The Care Quality Commission (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. At the time of our inspection 13 people were receiving support with personal care.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People received kind and caring support to meet their needs. Staff knew people well and how best to support them.
Whilst people benefited from a very caring and person-centred service, issues with staffing levels had impacted on the time available for managers to monitor the service and address governance issues. Some supervisions and appraisals had not been completed. Care plans and risk assessments needed to be reviewed and updated to include more information about people’s needs and risks.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Clear and complete records had not always been kept showing how people’s mental capacity to consent to their care had been assessed or in relation to best interest decisions. We made a recommendation about documentation in relation to the Mental Capacity Act 2005.
The provider had a board of trustees, who met regularly to monitor and check how the registered manager managed the service. The provider needed to develop and strengthen this approach as their auditing and monitoring of the service had not identified and addressed the issues we found. Although this had not impacted on people’s experience of using the service, the provider needed to improve how they monitored the service to make sure these problems did not start to affect people's care.
Staff were safely recruited and people praised the reliable staff who support them at the times they needed. Staff completed a training and shadowing to make sure they had the skills and knowledge to effectively meet people’s needs. Staff were trained to respond to any safeguarding concerns to help keep people who used the service safe. Medicines were managed and administered safely.
People were supported to make decisions and have control over their care and support. Staff promoted people’s independence and supported people to take part in activities and do the things they enjoyed.
Staff respected people’s privacy and supported them to maintain their dignity. Staff were carefully chosen to support individual people. Each person had their own team of familiar staff who knew them well. This helped people form meaningful relationships with the staff who supported them.
Staff understood people’s communication needs and provided accessible information to help people make decisions. The registered manager was developing an accessible copy of the provider’s complaints procedure. People felt able to speak with management if they needed to complain and praised the approachable and responsive way the registered manager dealt with any issue or concerns to improve the service.
There was a person-centred culture within the service. The registered manager was very approachable and responsive to feedback. They were committed to continually improving the service.
For more details, please see the full report which is on the CQC’s website at www.cqc.org.uk.
Rating at last inspection
The last rating for this service was good (published 28 April 2017).
Why we inspected
This was a planned inspection based on the previous rating.
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.