About the service 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.