Innovative Start Ltd

On this page

• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first comprehensive assessment for this service. This key question has been rated inadequate. This meant people were not safe and were at risk of avoidable harm.

The service remained in breach of legal regulations in relation to safeguarding, and safe care and treatment, and we found additional breaches of legal regulations in relation to staffing and staff recruitment.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a positive culture regarding learning from events to prevent harm to people. Lessons were not always learnt to continually identify improvements and ensure good practice. This included how a recent safeguarding incident was investigated by the provider. Managers were not able to demonstrate how they maintained oversight of accidents and incidents in order to identify any trends and themes. This meant it was not always clear how further risks to people’s safety were being mitigated. We found the provider had not always ensured action was taken and embedded from our previous feedback to ensure improvements were made since the last inspection. However, staff told us they were aware of the need to report and record accidents and incidents. We received mixed feedback from people and staff about the management of accidents and incidents. We found some accident and incidents had been reported. However, they were not always reported to external parties in a timely manner or investigated, to prevent a recurrence.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

We received mixed feedback from community professionals who have worked with Innovative Start Ltd. Positive comments included, “They always respond promptly and take appropriate actions.” The feedback we received confirmed that there had been a better level of engagement by the provider since our last inspection. One professional told us “This has (engagement) improved over the last 12 months.”

However, other community professionals told us “I have noticed a lack of knowledge regarding the processes and steps we follow as a local authority to arrange care packages, especially when cases are transferred between teams. For example, when a client is admitted to hospital” and “The (family) for the clients informed me she had difficulties in contact being responsive. They seemed to be very busy and unable to make a review date for many weeks.”

The provider did not share safeguarding concerns quickly and appropriately to ensure people’s lives improved and protected their right to live safety, free from bullying, harassment and abuse. The service failed to always recognise or act on allegations of abuse. For instance, we found the provider’s records showed missed care calls, late calls which affected when time-specific medicines could be given and verbal abuse, as examples. We also found the process to investigate an incident of unexplained bruising was ineffective and had not been thoroughly investigated. This meant people were at increased risk of harm. The provider had opportunities to provide us with the documentation we requested to demonstrate investigations had taken place. However, we were not provided with any evidence until after the assessment had ended. Although the provider was aware of these incidents, no safeguarding referrals had been made to the local authority, to screen for potential abuse or investigate it. This meant people were at increased risk of harm. People told us they felt safe, and staff told us they were able to recognise potential abuse. Comments from people included “I feel safe with them,” “Now I’m treated well,” and “I feel safe with them.” However, we found people were not routinely protected from abuse.

The provider did not always work well with people to understand and manage risks.

People were at increased risk of harm due to lack of effective management of risk. We found risk assessments were not routinely in place for all known risks to people. For instance, one person sustained burns which could have been avoided if appropriate measures had been in place. The provider had since addressed this.

People were protected from increased risks within their home, as the provider identified them and carried out a risk assessment to advise staff on how to support them safely. For example, we found there was a fire risk in one person’s home, which the provider had identified. Staff knew how to reduce this risk.

None of the people we spoke with raised any concerns about care workers leaving their homes in an unsafe condition.

People were not routinely supported by staff who had consistently been recruited safely or had received up to date training for their role and responsibilities. One member of staff had been in post since August 2024. However, the provider had not completed all the required safe recruitment checks. This had the potential to put people at an increased risk of harm.

Staff told us they were confident they had received all the suitable training required to undertake their role. However, this was not what we found. Staff said they were aware of how to recognise potential abuse, however we found this was not routinely the case, as there were incidents which had not been reported to the appropriate authorities.

We received mixed feedback about the punctuality of staff and the length of time they stayed with people. One person told us, “They come on time and stay as long as it takes to take me out.” However, other people told us, “I am diabetic and the carers only have a half hour window and I need to eat at a certain time”, “Nobody lets me know if they are going to be late”, “I do wish they could change this morning time” and “They won’t tell me what time they’re coming…it is happening a lot.”

There was insufficient supervision of care workers once they joined the company and then subsequently. For example, one care worker had been at the service since November 2023 and had only received supervision in December 2024 and a spot check in November 2024. Another care worker who started in September 2023 had only received supervision in December 2024 and a spot check in November 2024. A further care worker who started in February 2024 had only received supervision in November 2024 and a spot check in December 2024. This placed people at risk of harm from care workers who were not suitably supervised.

The provider assessed and managed the risk of infection. People told us care workers used personal protective equipment (PPE) when supporting them. Comments included, “I see gloves and handwashing in use. Not seen long painted nails,” “They wear PPE and always wash hands,” and “They all wear appropriate PPE.” No concerns were expressed about how infection control was managed in people’s homes.



There were policies in place for infection control practice and care workers undertook training to make sure they followed good practice.

People were at increased risk of harm due to poor management of medicine administration and training of staff. We found the provider’s process for assessing the competency of care workers to handle and administer medicines was not robust enough to measure their knowledge and skills. We found some people were administered non-prescribed medicines (homely remedies) by care workers. The provider had a policy to ensure these could be given safely. However, we found the policy was not followed and the medicines had not been authorised by a GP or pharmacist, to ensure they were safe to administer and would not interact with other medicines. A spot check form was in place to assess care workers’ competency whilst observing them working in people’s homes. This form did not contain any heading or prompt to check medicines practice whilst staff were being observed carrying out care. There was no mention of medicines practice in any of the completed spot check forms we read, although the people being supported did require assistance with their medicines. The provider had not followed good practice guidance to ensure care workers had the necessary skills and knowledge, which should include being observed handling medicines.

The provider told us, “In response to the feedback received, we have enhanced medication competency by increasing the frequency of medication competency assessments to every six months and introduced two unannounced spot checks per year for each staff member involved in administering medication.” We were unable to assess the effectiveness and sustainability of this change at this inspection.