Initial Care Services South East Limited

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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 found 3 breaches of legal regulations in relation to safeguarding, safe care and treatment and staffing. The provider’s safeguarding processes were not effective in recognising and acting on all safeguarding concerns raised by people. Risks to people were not always effectively identified, assessed and there was lack of robust guidance for staff how to support people around their specific risks related to healthcare conditions, skin integrity, behavioural support needs, safeguarding or environments in which care was provided. The provider did not have effective systems and processes in place to ensure staff competencies were appropriately checked and monitored, so they had appropriate skills and knowledge to provide safe and good quality care to service users. The provider’s systems and processes did not accurately identify and risk assess what support people needed with their medicines. Staff were overall recruited safely, and people’s care visits were provided as planned.

This service scored 31 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not effectively identify where lessons could be learnt. While the people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. Risks to people were overlooked and ignored. When people raised concerns about their safety, action was not taken. People's complex health risks were not robustly managed, which left people at risk of increased significant harm.

Opportunities to learn lessons to improve people’s safety and care experience could be missed. The registered manager told us about some improvements they had been making to the service since the last inspection, for example about staff recruitment. However, the registered manager was unable to explain how they ensured risks to people were not overlooked and that all concerns raised were appropriately reported and investigated. Hence, not all lessons learnt around safeguarding people with learning disability, were identified and actioned at the time of the assessment.

The provider did not have effective processes in place to identify lessons learnt from things that went wrong or people’s feedback. For example, not all lesson learnt and improvement needs in the service were identified as the governance processes were inadequate. Where people raised concerns to staff, these were not always appropriately addressed and investigated with action taken to ensure people were protected from harm.

While the people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. The provider did not ensure safe and effective management of changes in people’s care needs and effective communication with partners. This impacted people's safety.

Staff told us they would discuss any changes to person’s care with the registered manager and had access to the person’s care plans which would include all the information they required to support them safely. However, the registered manager told us they were informed by staff about some changes in people’s needs but did not verify that with people’s representatives or healthcare professionals at the time of the assessment and the care plan was not updated accordingly. Not all support strategies in place were appropriately consulted with healthcare professionals prior to implementation.

Partners told us they did not have any concerns around the care provided by the service but there were some inconsistencies in the information about the care the service provided to people in the community they held and what the service confirmed they were providing. This could put people at risk of not receiving care as they were assessed to receive by social services.

The provider’s systems and processes did not ensure they worked effectively with partners, including social services and healthcare professionals to adjust people’s care when people’s needs have changed. For example, the local authority was not informed in a timely way when people’s needs had changed to enable a review of care provided to them. Although the provider stated they delivered the care that was needed, there was limited assurance on how they worked with other partners involved in people’s care to ensure appropriate care reviews had happened and people’s information was up to date. The provider also failed to ensure up to date information on healthcare professionals’ recommendation was available for staff to support people well and included in the care plans.

While the people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. The provider did not always recognise when people raised safeguarding concerns to staff and failed to take appropriate action to report, investigate and action feedback to protect people.

The registered manager had limited understanding of their safeguarding responsibilities. For example, they explained that they did not report and investigate a safeguarding allegation made by a person to staff as the person made similar unfounded allegations in the past due to distress related to their other support needs. This put people at risk of not being listened to when they disclosed their safeguarding concerns due to assumptions being made around their experiences.

The provider’s systems and processes for safeguarding people from abuse and neglect were not used effectively. Although the provider had safeguarding and whistleblowing policies in place, they did not always follow them. For example, they did not report externally or act in a timely way to respond to a safeguarding allegation they were made aware of by staff prior to the assessment visit. This put people at risk of not being listened to when they raised concerns and at risk of abuse and neglect going undetected in the service with lack of robust and timely action being taken to protect people from harm. This was a breach of regulations in safeguarding.

While the people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. The provider failed to recognise, review and mitigate risks to people’s complex health conditions and personal care needs. This impacted on people’s safety.

The registered manager did not always recognise all risks involved in people’s care and the importance of assessing and addressing them to protect people which put people at risk. For example, they did not recognise safeguarding and specific healthcare risks for one person and could not explain clearly how they were addressing these risks in the support they provided. Staff told us they had access to people’s care plans, but these did not include clear and robust guidance on how to support people around their individual risks.

The provider did not appropriately assess and mitigate individual risks to people. For example, people’s risks around specific healthcare conditions, skin care, moving and handling, or behavioural support needs were either not in place, or included out of date information. The risk assessments did not include clear guidance for staff on how to mitigate those risks when supporting people. This put people at risk of receiving poor care and avoidable harm. This was a breach of regulations in safe care and treatment.

While the people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. The provider did not appropriately risk assess environments in which care was provided to ensure people’s and staff’s safety.

The registered manager told us they looked at people’s house environments and any risks when they visited them. However, there were no records of spot checks or robust risk assessments being carried out at the time of the assessment visit. The registered manager updated their records following our feedback, but the measures proposed to mitigate risks were not always sufficient.

The provider did not have effective systems and processes in place to ensure people’s and staff’s safety in relation to the environment in which the care was provided. The business contingency plan had no details on identified service risks and plans on how any emergencies were to be managed at the point of the assessment visit. Staff were not provided with appropriate guidance and support on how to mitigate risks and how to respond to emergencies effectively, as the risk control measures were insufficient. This put people and staff at risk of avoidable harm. This was a breach of regulations in safe care and treatment.

While the people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. None of the staff had received appropriate training to meet people’s assessed needs. There was reliance on a small number of staff with limited assurances on cover available for any emergencies and staff absence. There was a lack of robust management oversight of staff’s competencies.

The registered manager told us they supported staff by keeping in contact with them on a day-to-day basis. However, they could not provide evidence of how they checked their practice when supporting people and how they assessed their competencies following e-learning that was provided for staff. They told us they were exploring opportunities for practical staff training in areas like first aid or moving and handling, but this was not provided to staff at all at the time of the assessment visit. Staff told us they completed training and observed other staff supporting people before starting to provide care themselves. Despite staff telling us they had found the training useful, none of the staff had received training which was essential to their role to ensure people received safe care. For example, staff had not received any practical training in first aid, moving and handling or medicines management. This placed people at increased risk of harm.

The provider did not have effective systems and processes in place to ensure staff competencies were appropriately checked and monitored to determine they had the skills and knowledge to provide safe and good quality care to people. Staff induction records did not include any information of direct observations of their practice and how their competencies were checked. Staff training courses were provided online only. Staff spot checks were carried out only once in a year, this included staff new to their roles. The lack of appropriate training and support for staff put people at risk of avoidable harm and receiving poor care and staff at risk of avoidable harm. This was a breach of regulations in staffing.

People and their relatives told us staff adhered to good infection prevention and control (IPC) and supported them to maintain a hygienic home environment. One relative said, “[Staff] always wear PPE (personal protective equipment) and take it into consideration. They always help with cleaning and with [person’s] bedding and clothing.”

Staff we spoke with had access to personal protective equipment they needed to follow good IPC practice and completed online training in IPC.

The provider ensured staff were able to adhere to good IPC practice and had access to required PPE. There was an infection prevention and control policy in place. However, the provider’s governance systems did not effectively address IPC as an area for quality and safety monitoring as there was no IPC audits or regular spot checks of staff practice.

While the people and relatives we spoke to expressed that they were generally happy with their care, our assessment found care did not meet the expected standards. The provider did not accurately assess or effectively manage the support people needed with their medicines.

The registered manager told us no people were supported with their medicines, but evidence we reviewed indicated people did receive some level of assistance. When this was the case, the registered manager could not explain how they assured themselves of staff’s competencies to support people and how they assessed people’s needs around their medicines in line with the national best practice guidance. Staff told us they supported people to take their medicines as prescribed. However, there was no evidence staff’s competence to do so was assessed.

The provider’s systems and processes did not identify accurately what support people needed with their medicines and did not always adhere to best practice guidance on supporting people in the community with their medicines. There was lack of appropriate review where staff were noting they were giving medicines to people who were assessed as independent with taking them. As a result, people’s care plans did not reflect their needs around medicines accurately and staff were not adequately trained and supported to help people with their medicines. This put people at risk of avoidable harm. This was a breach of regulations in safe care and treatment.