Innovations24 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

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

This is the first assessment for this newly registered service. This key question has been rated Requires Improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. However, lessons were not always learnt to continually identify and embed good practice.

Incident records reviewed confirmed the management team had taken immediate action to investigate and mitigate further risks. However, the provider’s systems and processes did not include an analysis of incidents, accidents or complaints for any themes, patterns and trends to inform any learning opportunities.

People were satisfied how any incidents, complaints or concerns were acted upon. Staff were aware of their responsibilities of reporting and acting on any accidents and incidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People received a face-to-face assessment before the service commenced. This meant any additional training and or resources needed to ensure people’s individual care needs were known, planned for and understood.

Important information about people’s individual care needs was shared with relevant professionals, such as ambulance crews and hospital staff, to support continuity of care. This helped reduce the need for people to repeatedly explain their circumstances.

People and their relatives told us they were involved in assessments and ongoing discussions about care needs and support.

Feedback from people, relatives and professionals also confirmed that care was provided by regular staff. This helped ensure consistency and continuity, as people were supported by staff who knew them well and had developed positive, trusting relationships with them.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

A review of the provider’s systems and processes found where safeguarding incidents, concerns and allegations had been raised, the management team had reported these to the appropriate external agencies, such as the local authority and the police. This included taking actions to ensure people’s immediate safety. However, the provider had not submitted notifiable incidents to us, the Care Quality Commission (CQC), as required. This information is essential for monitoring the quality and safety of services and helps ensure people receive safe and effective care. Following our inspection, the provider submitted the required notifications.

People and relatives were positive that staff provided safe care. People told us they had high levels of trust in staff, particularly with moving and handling. Relatives told us their family members appeared well cared for and safe. A relative said, “Oh yes [relation] feels safe with staff, and they look really well-groomed and well looked after.”

Staff had completed safeguarding training and had access to the provider’s safeguarding policies. We identified the provider’s policy did not correctly reflect the local authority contact details. We highlighted this to the management team who agreed to update the policy.

Staff were knowledgeable about what safeguarding means and their responsibilities in protecting people from abuse and avoidable harm. A staff member said, “Safeguarding is about protecting vulnerable people from abuse and harm, I feel confident to report any concerns and I feel that the management team would take action.”

At the time of the inspection, no person had a Community Deprivation of Liberty Safeguard (DoLS) in place that imposed restrictions on them for their safety.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

However, from reviewing a sample of people’s care records, we identified some examples where information was inconsistent, contradictory or lacked detail. For example, a person’s care records stated the person was independent with their medicines. This was contradicted by also stating the person had short‑term memory needs and required support with their medicines.

Another person had a catheter, and guidance for staff lacked detail about the correct position of the night bag. This is important to ensure the catheter drains safely, reduces the risk of infection, and prevents avoidable discomfort or harm. Care records indicated that people’s weights were being monitored. However, the records did not specify how this was carried out, how frequently, or which staff members were responsible. Without this information, it is not possible to confirm that monitoring was completed consistently or in line with people’s assessed needs.

No person had come to harm and staff knew people well, we concluded this was a recording issue. The management team agreed to amend guidance for staff to ensure it was sufficiently detailed and accurate.

People and relatives were confident that risks associated with care needs were safely managed. They confirmed care was delivered by staff who were competent and knew their care needs and any risks. A person said, “I feel 100% safe. I completely trust them [staff] when they're hoisting me around the house.”

Staff gave examples of the actions they took to support people with known risks. A staff member described how a person living with dementia could experience periods of emotional distress. They said, “I always show my name badge and my photo and introduce myself to support the person to recognise me. I always explain why I'm there and what I'm there to support the person with. I always give them time, it's important to make sure they are unrushed, sometimes I'll distract a person who's becoming anxious by singing or dancing and offering a cup of tea.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

An assessment of the environment had been completed to ensure staff were aware of important information to assist them an event impacting the environment and or premises. It also considered any known safety risks that may impact the person or staff.

Staff promoted people’s safety and independence by making referrals to external health and social care professionals for equipment, such as aids and environmental adaptations.

Staff felt safe working in the community. New staff shadowed experienced staff before working independently.

The provider had a loan working policy and an out-of-office procedure, staff could use to contact for support or advice. Staff confirmed this was helpful and supportive.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, some shortfalls were identified during this inspection. The management team were also taking action to make improvements in some areas.

The provider had identified what training staff were required to complete. However, the training matrix showed gaps. The management team told us of the actions they had taken to ensure staff completed training asked of them and this was ongoing. They gave us assurances of further action they would take.

The provider had safe staff recruitment procedures. These checks were completed before staff commenced, ensuring only suitable candidates with the right skills and experience were appointed. New staff received induction training, which included shadowing experienced colleagues. However, the procedure for Disclosure and Barring checks (checks on criminal history) was not sufficiently detailed. The management team confirmed they would review their policy and procedure.

Staff received support to discuss their work, training and development. The management team were taking action to increase the frequency staff received supervision. The registered manager completed staff competency assessments in medicines and moving and handling. These records showed a lack of detail of the actions taken to assess staff’s competency. The registered manager told us this was a further area of improvement.

There were sufficient numbers of staff to meet people’s care and support needs. Relatives were positive about the staff’s competency and ability in meeting and understanding their family member’s individual care needs.

People told us that if staff were running late, they mostly received a call advising them of this.

Most people said staff stayed for the full duration and did not rush. Some relatives noted that shorter calls could feel rushed if tasks were completed early, particularly at teatime, but longer calls were consistently delivered in full.

From a sample of daily care records reviewed, overall care calls were delivered within the expected time, and staff stayed for the correct duration. However, a lack of management analysis of care‑call data meant it was not possible to identify patterns, address delays, or ensure calls were consistently delivered in line with people’s assessed needs. Without regular oversight, the service missed opportunities to spot emerging risks or make improvements to scheduling and staffing.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff had received training in infection prevention and control (IPC). They had access to the provider’s policy and personal protective equipment (PPE). Guidance for staff about how to meet people’s care needs was reflected in infection prevention and control practice and requirements of staff.

The management team completed spot checks on staff to ensure they were providing care in line with expected standards and the provider’s policies. These records confirmed that checks included infection prevention and control (IPC) practices.

People confirmed staff wore appropriate PPE, including gloves, aprons and masks when required.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

However, the provider’s medicines policy and procedure were not fully adhered to. For example, PRN protocols (prescribed medicines administered when required) did not include essential information such as the maximum dosage within a 24‑hour period, the importance of maintaining 4‑hour intervals between doses, or the need to record the reason for each administration. Without this guidance, staff did not have the information they needed to administer PRN medicines safely and consistently. Emollient creams were a potential fire risk, but a risk assessment had not been completed. Administration of topical creams did not have a body map to confirm site of application.

No person had come to harm, and we concluded this was a recording issue. We discussed this with the management team who agreed to take action.

People and relatives told us support with prescribed medicines was safe and appropriate, including prompting, administering where required, and monitoring changes. Staff were reported to be observant and raised concerns when medication routines changed unexpectedly.