Time to Care Specialist Support Limited is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults, those who have a dementia related condition and people with learning disabilities. They also provide care and support to people living in four supported living settings, so that they can live as independently as possible.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Not everyone using the service receives the regulated activity of personal care; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

We last inspected the service in July 2017 and found five breaches of the regulations. These related to safeguarding people from abuse and improper treatment, need for consent, staffing, good governance and fit and proper persons employed. We rated the service as requires improvement.

Following our inspection, the provider sent us an action plan, which stated what action they planned to take to improve and meet the regulations.

At this inspection we found that action had been taken in certain areas, however, further improvements were required.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 and associated Regulations about how the service is run.

The operations manager was going to apply to become registered manager. This would allow the current registered manager to have a more strategic oversight of the management of the service as the provider.

Medicines were mostly managed safely. People and relatives told us that medicines were administered as prescribed. There were several medicines missing from one person’s medicines administration record which the provider addressed.

Safeguarding systems and processes had improved. No safeguarding issues were identified during our inspection. Staff were knowledgeable about what action to take if abuse were suspected. However, it was not clear which staff had completed safeguarding training from the training records we viewed.

Safe recruitment procedures were now followed. Suitable recruitment checks were followed to help ensure that staff were suitable to work with vulnerable people. The registered manager told us that recruitment was ongoing. Most people and relatives told us that visits were carried out on time and staff stayed for the agreed length of time.

Records did not always evidence how staff followed the Mental Capacity Act 2005. The registered manager told us that this had been addressed.

Records did not always evidence the training which had been undertaken. Although we were unable to ascertain the training which had been completed, the staff we observed were knowledgeable about areas such as moving and handling.

People's nutritional needs were met and they were supported to access healthcare services when required.

We observed positive interactions between staff and people who used the service. Staff promoted people's privacy and dignity.

An activities coordinator was employed. There was an activities programme in place which people could access if this was part of their plan of care and support.

An effective system to manage and respond to complaints was not fully in place.

The provider was not meeting all the conditions of their registration. When we register providers, we do so with conditions. Time to Care Specialist Services Limited had two registration conditions; to have a registered manager and t

Time to Care Specialist Support Limited provides personal care to people in their own homes. Staff supported two people receiving 24 hour support in two independent living services. They also supported 34 people living in their own homes in the North Northumberland area.

The provider also offered an outreach service to assist people to access the local community or other identified support to meet people’s social needs if this had been agreed as part of their plan of care. We did not inspect this part of the service because it was outside the scope of the regulations.

We have not inspected this service since the provider changed the service’s name and address in January 2016.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission [CQC] 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 and associated Regulations about how the service is run.

There was currently no nominated individual at the service, which is a person who the provider puts forward to oversee the management of the service. The previous nominated individual had left the service.

We identified shortfalls and omissions with regards to staff recruitment. We also found shortfalls with the recording and management of medicines.

There were safeguarding procedures in place. We found that one specific allegation had not been reported to the local authority in line with the provider’s safeguarding policy. In addition, the provider had not notified CQC of three safeguarding allegations in a timely manner. Not all staff had completed safeguarding training.

There was no evidence of induction training being completed. We found the records did not always evidence the training which had been undertaken or demonstrate that competency checks had been completed to ensure staff were able to carry out care safely and effectively.

Care plans and risk assessments were not always detailed and decisions made in line with MCA principles had not been recorded.

People's nutritional needs were met and they were supported to access healthcare services when required.

We observed positive interactions between staff and people who used the service. Staff promoted people's privacy and dignity.

There was a complaints procedure in place. The manager told us that no formal complaints had been received. However, it was unclear how many informal complaints and concerns had been received.

An effective system was not in place to monitor the quality and safety of the service. Following the inspection the manager told us that action had been taken to address the shortfalls and omissions identified.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.These related to the need for consent, safeguarding people from abuse and improper treatment, staffing [in relation to training], fit and proper persons employed and good governance. We also identified a breach of the Registration Regulations 2009 which related to the notification of other incidents.

Further information is in the detailed findings below.