The dates of assessment were from 29 April 2025 to 28 May 2025. We visited the office on 29 April 2025 and 6 May 2025. The assessment was commenced due to emerging concerns about the quality of the service. Justintime Healthcare is a domiciliary care service, providing care and support for people living in their own homes. At the time of our assessment the service was supporting 33 people with 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. The service was also registered for Supported Living services but was not providing anyone with this support at the time of our assessment. The overall rating at this assessment is requires improvement. We identified 2 breaches of regulation in relation to safe care and treatment and good governance. There was a lack of consistent oversight of the service and auditing processes were not always effective in identifying shortfalls. Medicines were not managed safely. Risks relating to people’s health, safety and welfare were in place, but they were not always robust and some key areas had not been assessed. Care records were not always detailed or person-centred. Call times were not always consistent. Staff were recruited safely and had the support, skills and training to carry out their role. Improvements were required to how safeguarding events were logged and lessons embedded, but the provider had made referrals to the local safeguarding authorities and staff understood how to report abuse and poor care. The provider had systems in place to get feedback about the quality of care including regular telephone calls, surveys and reviews. The provider had recently invested in new technology and had a Service Improvement Plan in place and responded promptly to our feedback throughout the assessment. We have asked the provider for an action plan in response to the concerns found at this assessment.
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Justintime Healthcare was rated Inadequate overall and placed in special measures, with eight breaches of regulation plus a registration breach covering safeguarding, risk, medicines, recruitment, staffing, consent, person-centred care and governance. Late and missed visits, unreported safeguarding allegations and absent management oversight created widespread risk to people, although staff were generally described as kind and respectful.
Concerns (19)
criticalSafeguarding: “Allegations of abuse had not been recognised as reportable and were not investigated... As part of this inspection we raised eleven safeguarding concerns with the relevant local authorities.”
criticalMissed or late visits: “Yes, many times they have not turned up and many times they have been late.”
criticalMedication management: “Gaps were seen in the recording on MARs making it difficult to establish whether people had received their medicines.”
criticalCare planning: “Risk assessments were either missing, or where available, lacked detail or contained general statements.”
criticalStaff training: “Staff were routinely asked to give care and support for people with specific health needs which they were not trained to provide.”
criticalStaffing levels: “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.”
criticalConsent / capacity: “There was no assessment of capacity and record of best interest's decisions in these cases.”
criticalPerson-centred care: “Individual care plans we looked at were task focused and there was little information about individual risks, goals, skills and abilities.”
criticalEnd-of-life care: “Care plans we looked at did not contain an assessment of people's end of life wishes to ensure their preferences were met during this important stage of their life.”
criticalGovernance: “There were no systems in place to assess, monitor and improve the quality and safety of the service provided.”
criticalLeadership: “Management oversight over key aspects of the service was not evident. Recruitment, rota management, person-centred care and management of risk were poorly managed.”
criticalStaff competency: “The staff training matrix showed that only three out of 17 staff had their competency to administer medication checked.”
criticalOther: “Recruitment procedures did not protect people from the risk of unsuitable staff being employed. One staff member's file showed they did not have a new DBS check when they joined the service.”
moderateSupervision / appraisal: “We saw some evidence of staff supervision, although staff told us they had not received this support.”
moderateCommunication with families: “There was insufficient evidence to demonstrate that the service had identified people's communication needs.”
moderateComplaints handling: “On the third day of our inspection, we saw this was not recorded in the complaints log.”
moderateIncident learning: “Records of accidents and incidents were maintained, but these were not used to inform and update people's risk assessments.”
moderateRecord keeping: “We looked at daily notes for one person and found a week of recording was missing from June 2019.”
moderateCultural competency: “Where people had specific requirements relating to their religious or cultural needs, this was not recorded in their care plan.”
Strengths
· Most people and relatives reported positive relationships with care staff who were kind, caring and respectful
· Staff supported people to maintain privacy and dignity in their own homes
· Infection control was suitably managed, with staff wearing gloves and aprons
· Some evidence that complaints were being responded to appropriately
· People reported staff asked for consent before providing care
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff working with other agencies; supporting access to healthcareNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
responsive: Planning personalised care; End of life care and supportInadequate
responsive: Meeting people's communication needsInadequate
responsive: Improving care quality in response to complaints or concernsNot rated
well-led: Managers and staff being clear about their roles, understanding quality, risks and regulatory requirements; duty of candour; continuous learningInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Working in partnership with othersNot rated