Time Out Service

Time out service is a domiciliary care agency. It provides personal care to older adults living in their own homes. It is primarily a service that provides support to carers and part of a wider service provided by Age UK that also includes day care provision and signposting support. At the time of our inspection, there were 11 people who received personal care from the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal are. 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

People told us people they were happy with the care and support they received because they felt safe and all their needs were met by kind and caring staff.

People had access to healthcare services and were involved in decisions about their care. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take medicines safely.

People's care was planned and risks to their safety and wellbeing were assessed. The agency reviewed these plans regularly, involving people in these reviews and asking for their opinions. They delivered good quality care which had led to improvements in people's health and well-being.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

People and staff praised the managers of the service and agreed that they were approachable, knowledgeable, fair and did their job well. The staff team worked well together and supported the manager.

The staff team was committed to providing a high-quality service. They had undertaken training so that they were skilled and knowledgeable to effectively meet people’s needs. Staff understood their responsibilities to report any concerns.

Staff encouraged people to be as independent as possible and respected people’s privacy and dignity.

People received care and support from a small group of staff most of whom had worked for the agency for many years, which provided consistency.

People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well. Care plans contained information about each person’s individual support needs and preferences in relation to their care and we found evidence of good outcomes for people. When people did not have the capacity to make their own decisions, staff maximised their involvement and made decisions in their best interests, in accordance with legislation.

Recruitment practices were safe and relevant checks had been completed before staff worked at the service.

People confirmed the service did not miss any care calls and that staff were usually on time.

The managers of the service actively sought the views of people and their relatives about the running of the service and they dealt promptly with any concerns that people raised.

The provider had systems in place to monitor and improve the quality and safety of the service provided. There was a positive culture throughout the service. Staff told us they enjoyed working at the service and felt valued.

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More information is in the full report.

Rating at last inspection

At the last inspection we rated this service Good. The report was published on 22 January 2018

Why we inspected

We carried out a focused inspection of this service on 13 July 2022. This inspection was prompted by a review of the information we held about this service. This report only covers our findings in relation to the Key Questions safe, effective and well led.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Time out service on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information, we may inspect sooner.

At our last inspection in May 2017 one breach of regulation was found in relation to risk assessments and the service was rated as ‘requires improvement’ At this inspection we found that improvements had been made and the service was no longer in breach of this regulation.

The service had 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 service helped people to stay safe. Staff knew about abuse and how to report it and other incidents or accidents which took place. Risks to people were assessed and updated and there were systems in place to ensure there was enough staff to meet people's needs.

People were supported to take their medicines safely and in accordance with the prescribed instructions. Staff members received the training, support and development opportunities they needed to be able to meet people's needs.

People’s needs were assessed and care plans were developed to identify what care and support people required. People said they were involved in their care planning and were happy to express their views or raise concerns. When people’s needs changed, this was quickly identified and prompt, appropriate action was taken to ensure people’s well-being was protected.

People experienced positive outcomes because of the service they received and gave us good feedback about their care and support.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People’s views on the service were regularly sought and acted on.

Staff were motivated and proud to work for the service; as a result, staff turnover was kept to a minimum ensuring that continuity of care was in place for most people who used the service

Staff were respectful of people’s privacy and maintained their dignity.

The service followed safe recruitment practices and carried out appropriate checks before staff started supporting people.

The registered manager demonstrated leadership and a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service. We saw that regular visits and phone calls had been made using the service and their relatives to obtain feedback about the staff and the care provided.

The service worked in co-operation with other organisations such as healthcare services to deliver effective care and support.

The service listened and responded to people’s concerns and complaints, and used this to improve the quality of care. The service learnt lessons and made improvements when things went wrong.

Time Out Services is a domiciliary care agency providing personal care to people in their own home. At the time of our inspection there were 21 people who received personal care from the agency.

During our last inspection on 14 May 2016 we identified breaches of regulations relating to risk management, consent and person centred care.

The service did not have a registered manager. A manager was in place and was in the process of applying for registration. 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.

Some risk assessments did not take into consideration people’s health needs to reduce health complications and to ensure people were safe at all times.

People were protected from abuse and avoidable harm. People and relatives we spoke with told us they were happy with the support received from the service and they felt safe with staff. Staff knew how to identify abuse, the different types of abuse and how to report abuse.

There were systems in place for quality assurance. We discussed our concerns with risk assessments which had not been identified in the audits with the manager and chief executive who informed that quality assurance systems would be made more robust to identify issues. After the inspection the manager sent us evidence to demonstrate that their quality assurance system had been reviewed and revised.

Quality monitoring systems were in place and the recent results were positive. Results were analysed. However, we did not find evidence that an action plan had been created to continuously improve the service using the results of the surveys.

Staff had been trained on the Mental Capacity Act 2005 (MCA) and knew the principles of the act. Staff told us that they asked for consent before doing anything and people and relatives we spoke to confirmed this.

Medicines were being managed safely.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles. Spot checks were carried out on staff providing personal care and findings of the spot checks were communicated to staff.

Care plans were personalised and regularly reviewed to ensure people received the right care and support. People were assessed prior to receiving personal care to determine if the service was able to provide care and support to people.

People’s ability to communicate were recorded and staff were given guidance on how to appropriately communicate with people to ensure their care needs were met.

Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role.

Complaints had been investigated and appropriate action taken. People were aware of how to make complaints and staff knew how to respond to complaints.

People were encouraged to be independent and their privacy and dignity was respected.

Staff meetings were held regularly.

We identified a breach of regulation relating to risk management. You can see what action we have asked the provider to take at the back of the full version of this report.

Time Out Services is a domiciliary care service providing personal care to people in their own home. At the time of our inspection there were 11 people who received personal care from the agency.

During our last inspection on 14 October 2014 we found the service was meeting all the regulations.

The service did not have a registered manager. A manager was in place and is in the process of applying for registration. 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.

Some risk assessments were not updated to reflect people’s current needs and did not take into consideration people’s health needs. When a risk was identified it did not provide clear guidance to staff on the actions they needed to take to mitigate risks in protecting people such as falls and wandering.

People were protected from abuse and avoidable harm. People told us they were happy with the support received from the service. Staff knew how to report alleged abuse and were able to describe the different types of abuse. Two staff were not able to tell us they could’ Whistleblow’ to external organisations such as the CQC and local authority. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

We did not find evidence that people’s capacity had been assessed and if consent to care was obtained using the Mental Capacity Act 2005 principles.

Staff told us they were supported by the management team. However, although recent one to one supervision had been carried out, this had not been regular and not in accordance to the provider’s supervision policy. We found appraisal had not been carried out regularly.

Staff were being trained regularly. Although training had been provided in safeguarding and MCA, some staff were not aware on how to whistleblow and the principles of the MCA.

Service agreement forms had not been completed with people to ensure that people or relatives were involved in the decision making during the care planning process and agreed with the information on their care plan.

Some care plans were inconsistent and were not completed in full. We did not find that reviews had taken place to identify if people’s care and support needs had changed.

The manager told us people were assessed prior to receiving personal care. We did not see evidence that confirmed if people were assessed prior to being accepted to receive personal care, which reviewed important aspects such as their level of care needs, communication levels, health condition and if support could be offered.

People and relatives told us that staff communicated well with them. However, not all people’s ability to communicate was recorded on their care plans.

We found one spot check had been carried out and recorded. However, we did not find if further spot checks were undertaken and documented. There was no information on how often staff had received spot checks.

Quality monitoring systems were in place and the recent results were positive. Results were analysed. However, we did not find evidence that an action plan had been created to continuously improve the service using the results of the survey.

Quality assurance systems were in place. The latest audits identified most of the issues that we found during this inspection. An action plan had been created to address these issues with care plans, risk assessments and consent. The manager told us they were in the process of implementing these changes.

People were supported by suitably qualified and experienced staff. Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role.

People had choices during mealtimes and staff assisted with meals in accordance to people’s preferences.

There was a formal complaints procedure with response times. People were aware of how to make complaints and staff knew how to respond to complaints in accordance with the service’s complaint policy.

People were supported with accessing health care provisions, when required.

People were encouraged to be independent and their privacy and dignity was maintained.

Staff meetings were held regularly.

We identified three breaches of regulations relating to risk management, consent and person centred care. You can see what action we have asked the provider to take at the back of the full version of this report. After the inspection the manager submitted an action plan acknowledging the findings and listing actions that they will be taking to make improvements to the service.

Below is a summary of what we found. The summary describes what the representatives of people using the service and staff told us, and the records we looked at. There were 12 people using the service at the time of our inspection, the majority of whom had dementia. We spoke with six representatives [family members] of people who used the service and five care workers. We also spoke with the registered manager and the home care organiser. We looked at five care records and six staff records.

Is the service safe?

One family member told us, 'the staff are more than kind. I know if I weren't here, my relative would be safe in their hands.' There was a member of the management team on call at all times in case of emergencies. The provider ensured their staff had the skills and experience needed to support those who used the service. Care workers were trained in safeguarding awareness, infection control and food hygiene. They were able to demonstrate their knowledge in these areas to us.

Is the service effective?

We spoke to family members of those who used the service and were told they were happy with the care provided. This was confirmed in the results of the most recent satisfaction survey done in June 2014. Staff told us they understood people's care and support needs and said they referred to the support plan at all times. One family member told us, 'the staff and the support they offer have been a lifeline for me. My relative would be in a home without them.' Staff had received training to meet the needs of the people whom they supported. We saw how a spot check done by the registered manager resulted in new equipment delivered, which meant a safer environment for the person and the care worker.

Is the service caring?

We were told how respect for the dignity of the person was observed and how permission was sought before any personal care was given. Before a service started, an assessment of the persons needs was carried out and a care plan was developed to meet those identified needs. The home care organiser told us, 'by slowly building up the relationship with the person [and the care worker], there is a better chance of ensuring a good match.' A family member told us, 'the assessment was wonderful. They showed real interest in my relative and me and tried to understand what we worked for us.' Another told us, 'I always feel the staff are there to help me.' It was clear from speaking with staff they understood people's care and support needs and how to deliver them. They spoke with a depth of knowledge and understanding of those whom they supported.

Is the service responsive?

People's needs had been assessed prior their support package started. The registered manager told us, 'care workers follow the care plan.' Records confirmed people's diverse needs and care and support had been provided, which met their wishes. A family member told us, 'everyone is different and the agency accommodates that by providing an individualised service.' During our inspection, we observed how a request for additional support hours later in the same day was accommodated.

Is the service well-led?

Staff had a good understanding of the philosophy of the service. They told us they were clear about their roles and responsibilities. Quality assurance processes were in place. We saw completed quality assurance forms of those who used the service. Care workers told us the management team were available to them at all times. One worker told us, 'the managers always seem to have time and a smile for me, I don't know how they do it.' A relative said, 'I really appreciate the fact the manager regularly rings me to check I am happy with everything. I seem to speak to her almost daily.'

The provider told us that care plans were reviewed annually or sooner if a person's situation changed. We looked at provider records and saw that they had a system for checking when care plans were due for their annual review.

We spoke with seven relatives of people using the service. They said that they felt their relatives were safe. One relative told us, 'I wouldn't think twice about leaving my relative with the care worker.' This view was shared by other relatives.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Relatives we spoke with told us that staff had the necessary skill and training required to do the job. The provider had an induction programme for new care workers which ran for up to three months depending upon the previous care experience.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The provider undertook a carer's survey in June 2013 which showed that 81% of respondents rated the service as 'very good.'

People confirmed that the service regularly contacted them to seek their opinions about the quality of the care being provided. They were consulted about how people's needs would be met. They were able to contact the office at any time and would be listened to by staff.