Innovative Start Ltd

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified two breaches of the legal regulations. The provider did not consistently protect people from abuse and improper treatment. They did not always identify allegations of abuse or make referrals in line with policy. The provider did not always assess risks to people's health and safety or mitigate them where identified. Risk assessments were incomplete and did not include risks we identified during our assessment. However, there were enough staff to ensure people’s safety and meet their needs. Staff received an induction, training and ongoing support to equip them with the skills and knowledge to provide care and support.

This service scored 22 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe in the presence of care staff, and this was confirmed by family members we spoke with. For some people a contributing factor was the relationship they had built with regular care staff. Comments from people and their families included, “I do feel safe and I am quite happy with my care”, “I am so well looked after now I am safe and content” and “generally speaking it’s pretty good and [person] is safe”. One family member disclosed a prior concern regarding a staff member’s conduct, we shared the concerns with the service and they commenced an internal investigation to mitigate potential risk.

Care staff understood their responsibilities to keep people safe and to report concerns to the management of the service. Care staff were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice. Care staff told us they received safeguarding training as part of their induction and refresher training. Staff advised people were not subject to any disproportionate restrictions, noting people were encouraged to be independent and make their own choices. A staff member explained any safety measures such as bed rails were agreed for use with people’s consent or in their best interests. Leaders acknowledged some improvements to processes were required in this area. The nominated individual advised they had scheduled additional safeguarding training for leaders to enhance their knowledge.

People were not routinely and consistently protected from abuse or harm. The registered manager and provider failed to ensure systems were in place for potential abuse or harm to be reported to the local authority safeguarding team. One person had informed their morning care worker the previous evening care worker had not supported them and had left their home unlocked. The person told the care worker the previous care worker did not respond to them calling for help. Daily records showed the previous care worker had recorded the person was not at home at the time of the call. However, this was not the case. Daily notes recorded the registered manager had been made aware. However, no safeguarding referral had been made to the local authority. Another person had been left at risk as the care worker had left their front door unlocked. The concern was raised as a complaint to the service and the management team were made aware. No referral had been made to the local authority. A third person was not visited when they were expecting to have support from a care worker. The management team were aware of this missed call, however, no referral to the local authority was made. This meant systems were not robust to ensure safeguarding referrals were identified and actioned when needed. This placed people at potential harm of abuse.

Continuity of staff deployment helped staff learn about people’s individual risks. For example, staff were able to describe how they observed for signs of seizures, how to encourage fluids and nutrition, monitoring for signs of health or skin deterioration, and assisting people who used mobility or moving and handling equipment. Staff told us they were encouraged to report risks or adverse events such as accidents and incidents, and stated they were kept updated when people’s support needs changed.

People were at risk of harm due to the poor management of risk. We found risks posed to people as a result of illness or disability and environmental risks were not routinely, robustly and adequately assessed. We found actions were not routinely undertaken to mitigate those risks and prevent people from harm. People who were prescribed anticoagulant therapy (blood thinning medication) did not always have a risk assessment in place to ensure staff knew what changes in people would indicate a deterioration in their health, or a sign of potential internal bleeding, for instance, bruising after a fall. People who were diabetic, did not routinely have guidance written for staff on how best they should be supported to manage the medical condition. This placed people at risk of harm. Risk assessments completed for supporting people move positions were not always completed fully. We found risk assessments written lacked detail about type of equipment used, who was responsible for maintenance and how staff should use the equipment. We found potential risks to people had been identified within care and support plans, however, no risk assessment on how staff should mitigate the risk of harm to them were written. For instance, we found, oxygen therapy, malnutrition, smoking, and self-neglect risk assessments were not routinely completed. The provider and registered manager failed to ensure they routinely assessed the risks to the health and safety of people and did all that was practicable to mitigate those risks.

People and their families told us they had been involved in decision making about keeping safe, with comments including, “I make my own decisions and we do talk about keeping safe here” and “They came over once and asked a lot of questions about [risks].” Most people spoke positively about the service’s approach to risk management. A person commented, “With the last agency I did get lot of pressure sores, since being with [Innovative Start] I have none” and a relative added, “They use a hoist and [person] feels safe.” A smaller number of relatives expressed concern about safety, with one relative advising, “[Staff] don’t check the equipment for safety…they do not notice if things are dangerous.”

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Robust recruitment practices were followed. This included a check for criminal convictions, written references and proof of identity. Appropriate additional checks were made where staff were recruited from overseas, such as residence permits. There were records of supervision and direct observations of competency, known as ‘spot checks’, to monitor the quality of care being provided. We found frequencies of spot checks and supervision varied. Training was provided for staff. This included essential learning such as safeguarding, moving and handling, first aid and medicines awareness. Staff meetings were held each month, to discuss, share and improve practice. Minutes of meetings showed staff were reminded of areas which included reporting concerns about people’s welfare, updating training, notifying the office if they were running late and reporting if people had less than a week’s supply of medicines. Staff care rotas showed in most cases staff received sufficient travel time, however we also noted some staff had 'back to back' visits within their care rotas which the provider agreed to review to ensure sufficient travel time was offered.

Most people and families spoke positively about staff punctuality and attendance. Their comments included, “Majority of the time they are on time”, “I have never had a missed visit and I get a call if they are [delayed]”, “They do come on time” and “The trouble is when they are late [person] is wet and so uncomfortable.” People and relatives told us they were supported by a team of regular consistent staff to help ensure people received continuity of care. A relative advised, “[Staff] are in a good routine with her care…the carers know what they are doing”. We received variable feedback about whether staff appeared well trained, particularly for more complex care tasks, with comments including, “Training does not seem to be great”, “When they do training there can be a language barrier and I need them to understand” and “I do feel confident that they are trained and know what they are doing.”

Staff we spoke with were satisfied required pre-employment checks were completed before they delivered care. Staff explained their induction consisted of e-learning, face to face training, shadowing and on the job training to equip them for their roles. Staff told us they received ongoing support through refresher training, supervision, staff meetings and spot checks. Leaders advised they followed a values based recruitment approach and supported staff arriving from overseas to understand cultural differences, such as traditional UK meal preparation. Staff indicated staffing levels were safe. Some staff felt rotas could benefit from improvement to enhance travel time and give staff more planned time off. However, most staff indicated rotas provided continuity of deployment and satisfactory travel time.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.