26 and 30 November 2015
During a routine inspection
This inspection took place on 26 and 30 November 2015 and was announced. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. Our last inspection in August 2013 found the service to be meeting all the requirements of the Health and Social Care Act (2008).
Time 2 Care provides personal care to people living in their own homes in the Bideford area. At the time of our inspection there were 36 people receiving a service.
When we visited there was not a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The previous registered manager left in September 2015. The new manager was in the process of registering with the Care Quality Commission.
Staff were not suitably trained to administer medicines in line with legislation, guidance and as per the organisation’s medicines policy.
People did not always give consent for care and treatment and the provider did not act in accordance with the Mental Capacity Act 2005.
Staff did not receive on-going formal supervision and appraisals in order for them to feel supported in their roles and to identify any future professional development opportunities. However, staff felt supported by the management team and spoke positively about communication and how the management team worked well with them, encouraged team working and an open culture.
Staffing arrangements were flexible in order to meet people’s individual needs. Staff received training to deliver care effectively and competently.
Care files lacked personalised information for staff to refer to. For example, people’s likes, dislikes and preferences. This information would assist staff to know what kinds of things people liked and disliked in order to provide appropriate care and support. However, staff spent time informally getting to know people, but this had just not been written down. We spoke with the manager about the care files and they agreed they needed to be reviewed to ensure they captured people’s personal histories.
The service demonstrated some good management and leadership. Checks were completed on a regular basis to assess the quality and safety of the service people received. The manager informed us that when they came into post they had found care was really good, but there were limited systems in place to evidence the quality and safety. They were now in the process of developing more robust systems to evidence the quality and safety of the service. They explained these systems were at an early stage and would take time to embed.
People felt safe and staff were able to demonstrate a good understanding of what constituted abuse and how to report if concerns were raised. Measures to manage risk were as least restrictive as possible to protect people’s freedom.
People’s views and suggestions were taken into account to improve the service. They were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the right care and treatment.
Staff relationships with people were strong, caring and supportive. Staff were motivated and inspired to offer care that was kind and compassionate.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.