Innovative Start Ltd

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.



This is the first comprehensive assessment for this service. This key question has been rated inadequate. This meant there were widespread and significant shortfalls in leadership. Leaders and the culture they created did not assure the delivery of high-quality care.



The service remained in breach of legal regulations in relation to good governance and notifying the Commission of events they were required to.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The policies and procedures at the service were written to promote a culture focused on learning and improvement. However, this was not delivered in practice. We did not always see that people’s care reflected high quality and best practice guidance. For example, in medicines practice and risk management. Staff meeting minutes did not refer to the visions, values and strategic goals of the service, which meant there was a lack of shared direction between managers and workers. However, the provider showed us changes they had made to meetings with staff to address this. Quality audits and action plans were designed to focus on learning and improvement but these did not identify the deficiencies we found during our assessment, such as continued breaches of regulations.

Leaders did not always embody the culture and values of their organisation. They did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.



The provider did not always ensure high quality leadership was sustained through effective and safe recruitment practices, as the full range of checks had not consistently been carried out.



Some staff who contacted us outside of the assessment process did not always describe leaders as capable and compassionate.



The provider and leaders were visible and contactable at the service.



Feeback from people who used the service included “I get a positive response from management. They listen, do what they say they’re going to do and are accessible.”

People did not always feel they could speak up and that their voice would be heard.



Staff were aware of what speaking up meant but some described a culture where this was not supported. One person told us “Speaking up is not a norm as many have faced victimisation from the management. The management is very rude and controlling, making it difficult to speak up.” Some other staff said they could speak up and issues would be resolved.



There was a raising concerns, freedom to speak up and whistleblowing policy in place. Staff also knew they could contact the Care Quality Commission if they had concerns.

The provider valued diversity in their workforce. They worked towards an inclusive culture by improving equality and equity for people who worked for them.



People were supported by a diverse group of staff. We were not made aware of any issues regarding discrimination in the workplace or of anyone who required reasonable adjustments due to disability.

The provider did not have clear systems of accountability or good governance. Quality of record keeping varied and did not always provide clear instruction or meet professional standards. For example, a care plan stated “when lifting or repositioning (name) it’s important to be cautious of your own safety. Use proper lifting techniques.” There was no explanation what these techniques should be. This put the person at risk of harm, as staff did not have all the relevant information to ensure they provided safe support.   Systems were not effective in ensuring medicines records met best practice standards. We found concerns regarding a photocopied sheet in place to record some people’s medicines. Transcribed information was not verified and was not always up to date. Information on dosage of medicines was inconsistent and there were incorrect instructions recorded for use of one person’s ‘as required’ medicine. Staff were administering one person’s cream, which the provider was unaware of. Records were incomplete regarding who worked at the service. There were discrepancies between a contact list for all staff and training records. This showed the provider had not kept accurate and complete records. We were not assured systems were effective in ensuring all staff had relevant training. Systems failed to ensure policies were followed. For example, there were policies to ensure spot checks and supervision took place. Some staff had not had a spot check or supervision within the policy timeframes or for a substantial period of time since working at the service. No spot checks at all were carried out in one specific area. Quality assurance processes had not ensured all required recruitment checks were in place for all staff at the service.   Systems were not effective to ensure we were notified of all relevant incidents, and that this was done “without delay”. We came across 12 incidents of abuse the provider had not told us about.

Since our assessment of the service, the provider had implemented three audits. We were unable to assess the effectiveness and sustainability of these changes at this assessment.

The provider did not consistently understand their duty to collaborate and work in partnership, to make sure services worked seamlessly for people. They did not always share information and learning with partners and collaborate for improvement. Appropriate referrals were not always made to external agencies when needed, such as the local authority.

Some of the people we contacted were supported to go out into the community as part of their care packages.

The provider did not put sufficient focus on continuous learning, innovation and improvement across the organisation. They did not actively contribute to safe and effective practice.



We saw some examples of making improvements and learning when things went wrong. However, the provider’s quality assurance systems were not used effectively to continuously improve the service. They had not consistently recognised risks to people’s care and ensured measures were put in place to prevent harm. Although the provider put an action plan is place following the inspection last year, learning had not taken place and there were continued breaches of regulations. During the assessment process, the provider could not always explain why things had not been achieved.



Staff had not been encouraged to develop their skills around improvement and innovation, such as through additional training or becoming champions, to share good practices.