IECC CARE

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. At our last assessment we rated this key question Inadequate. At this assessment the rating has changed to 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.

The service continues to be in breach of legal regulation in relation to staffing. Improvements were needed to ensure staff arrived at planned and preferred call times and stayed for the agreed visit length. The provider’s approach to staff training, assessment, and competency needed to improve to ensure staff had the skills and knowledge to meet people’s needs.
 

This service scored 53 (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 positive culture of safety, based on openness and honesty. Where incidents had occurred and safeguarding matters raised, the management team had taken swift action to investigate and used the findings as an opportunity to put things right, learn from and improve outcomes for people. Staff told us they were able to raise safety issues and were confident these would be addressed. Comments included, “I feel confident to raise any safety concerns. I would report concerns to my manager or the office straight away. When there are incidents, learning is shared with staff through communication from management,” and “I feel very confident raising concerns, and I would escalate my concerns to my line manager. Learning is shared through training, supervision, and appraisal. Office staff come for both announced and unannounced spot checks on me and I have 1 on 1 chats with my line manager.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care. People’s care records reflected their initial assessment of needs had been used to formulate care plans setting out their individual needs, circumstances, ongoing care arrangements and expected outcomes. People and their relative’s generally considered safety and continuity was maintained across people’s care journeys, including when moving between different services. Comments included, “[Person] started using the service in March/April 2025, when they were discharged from hospital following an infection. Before admission to hospital, they were mobile and walking, but they came out of hospital with a catheter and couldn’t walk which is when IECC began care. IECC came here and spoke through all of [Person’s] needs. It was a comprehensive assessment.”

The provider and managers had a clear understanding of safeguarding systems, processes and practices to protect people from abuse. However, the provider’s own systems had not always identified the safeguarding concerns we found during our assessment of the service. People and relatives reported unprofessional staff behaviour, including inappropriate comments, rough handling, and poor knowledge of moving and handling equipment. Other concerns included inconsistent visit times, insufficient staff training, incorrect food preparation, and medication errors. Due to the concerns raised we made a safeguarding referral to the local authority. The provider took swift action to investigate the concerns raised to understand what went wrong and took action to prevent similar incidents happening again.

Staff told us they had completed safeguarding training and were committed to protecting people’s right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff knew what action to take if they identified or had an allegation of abuse reported to them. For example, 1 member of staff commented, “My understanding of safeguarding is protecting people from abuse, neglect, harm or discrimination. I would report any safeguarding concerns immediately to my manager or safeguarding lead.” However, despite this knowledge staff had not always identified and reported safeguarding issues we found during the assessment.
 

The provider did not always work well with people to understand and manage risks. Staff did not always have correct information to ensure they provided safe care to meet people’s needs. One relative told us, “Staff will ring and tell me about issues, [Person] had a ‘hypo’ whilst carer who was there. [Person’s] diabetes risk assessment says they can experience hypoglycaemia /hyperglycaemia, but not what symptoms staff should look for and what to do, luckily, [staff member] was here. They were aware of glucose tablets, but I am not sure all staff are aware, it’s not in their care plan.”

People’s care plans identified foreseeable risks, but some information was inaccurate, creating a risk of incorrect care. The providers care plan audits and spot checks were not always ensuring information about risks to people were accurate and up to date. This was of concern based on the feedback from relatives about the inconsistency in knowledge about people’s care needs between regular and stand in staff. For example, 1 person’s risk assessment for skin care contained information saying they could reposition themselves, however the overview of care, stated they needed support from 2 staff to reposition with the use of a slide sheet. The overview also stated they were waiting for occupational therapist (OT) assessment for a hoist and sling. This had not been updated since 2022. After the assessment the provider confirmed they had taken action to correct this error.
 

Environmental risk assessments were completed to determine whether people’s homes were safe for staff to work in. However, the provider lacked a formal system to identify, record and oversee safety checks within people’s homes. Although spot checks and welfare checks were undertaken in person or by telephone, these were not effective in identifying or escalating faults in equipment essential to the safe delivery of care. For example, in 1 person’s flat, a smoke alarm was repeatedly chirping, indicating a low battery. This person was permanently cared for in bed. There was no information to show how long this issue had been present or whether it had been reported. In another person’s home, the pump for a pressure relieving mattress was sounding an alarm indicating a pressure fault. The provider did take immediate action to address these issues which presented potential risks to people’s safety and wellbeing. The home care manager stated that equipment checks were carried out routinely and that staff used their initiative to report concerns. However, these issues had not been formally documented or reported through established systems to ensure risks were identified, escalated, and addressed promptly.

Staff were not always clear about their responsibilities regarding the premises and equipment. Relatives told us, staff did not always use equipment correctly to support safe care. One relative told us, “There was an occasion where the sling was left under [Person] in the chair, it’s not an in-situ sling. The occupational therapist had said not to leave it under them because of the air flow and to prevent them from slipping. I spoke to the carers about it.” Other comments included, “There was an issue with the turntable. They said they had not had training in how to use it properly,” and “On 1 occasion staff had put the sling on back to front. I pointed it out to them and it’s never happened again.”

The provider did not make sure there were enough qualified, skilled and experienced staff. We received consistent feedback from people and their relatives, about unreliable visit times and inconsistent experiences of care. Families and people described disorganisation, unreliability of visits, including missed or late calls, and carers leaving early. Relatives and people told us, timing of visits changed daily, and they never knew when staff were going to turn up. One relative commented, “They’re [staff] always turning up late.” We reviewed the providers call logs for the period 06 January to 31 January 2026. This covered 7763 calls for 47 people. Of 7763 visits, 5536 were delivered within 15 minutes, with an average lateness of 4 minutes. 1614 calls were more than 15 minutes late, including 733 which were more than 45 minutes late. There were 172 short calls where less than half the planned time was delivered. Out of 8699 calls, 2807 had no travel time factored in between visits adding pressure on staff to get to their next client.

Where people had a regular, experienced member of staff, feedback was generally positive, however, when regular carers were absent and were covered by stand-in staff, people and relatives told us standards often declined. Several families reported seeing a high number of different carers, which they felt impacted on consistency and familiarity, including poor communication due to language barriers and a lack of training. Relatives told us, some staff arrived without sufficient knowledge of people’s needs, especially brain related injury and dementia. Review of the training rota reflected 4 out of 48 staff had completed acquired brain injury training in March 2025. The home call visit log from 20 March to 20 April 2026, reflected 7 staff had visited a person with an acquired brain injury, none of whom had completed this training.

The staff training matrix and staff recruitment files identified concerns regarding the provider’s approach to staff training, assessment, and competency assurance. Records showed several staff had completed multiple online training courses within a very short timeframe, typically over 2–3 days, with no systems in place to assess learning, understanding, or competency. One member of staff had completed 21 training courses in a single day, including fire safety training. There was no follow-up assessment, supervision, or observation to verify staff knowledge or to ensure they were suitably qualified, skilled, and experienced to carry out their roles safely and effectively. Training was largely completed as part of a certificate of achievement for the care certificate. The care certificate is a set of standards developed for the health and care support workforce, to ensure all support workers have the same introductory skills, knowledge and behaviours to provide compassionate, safe and high-quality care, in their workplace settings. While the care certificate provides an important foundation, it is not a substitute for statutory training, nor does it remove the employer’s responsibility to ensure learning is embedded and competencies are assessed in practice.

Review of staff files found robust and safe recruitment practices had been implemented to ensure staff were suitably experienced, and able to carry out their role.

The provider had clear policies in place outlining the arrangements to protect both staff and people from the risk of infection. The infection prevention and control (IPC) policy clearly defined the responsibilities of both registered managers, who held overall accountability for ensuring safe working practices were implemented and maintained. This included promoting high standards of basic hygiene and ensuring universal infection control procedures were followed through staff induction, training, supervision, and team meetings. People and their relatives told us, overall staff adhered to good standards of hygiene and wore the appropriate personal protective equipment (PPE). One person told us, “Staff wear masks, gloves, and aprons. Pads go into outside bin, this was previously a problem, however I raised it with staff, and they now take them out to bin.”

Staff demonstrated a good awareness of the IPC policy and consistently described how they followed guidance in practice. One staff member told us, “We use PPE when required and follow infection control guidance. PPE is available and disposed of safely. I am aware of the IPC policy and follow guidance on cleaning and safe waste disposal.” Another staff member said, “We always have full PPE. I have completed my food safety training through eLearning, and my manager carries out spot checks. I wear PPE during personal care, meal preparation, medication administration and house cleaning. We dispose of waste in the correct bins, empty and replace bins regularly, and always have enough PPE available in the office.”
 

The provider did not always ensure the safe management of people’s medicines. Relatives raised concerns about inconsistent medicines administration. One relative told us, “They don’t watch [Person] take their pills and I have found them on the floor. One morning staff didn’t arrive till gone 11am and they’d put [Person] to bed at 6pm, so they had no breakfast and no pills.” This indicated people were at risk of missing prescribed medicines. Staff had completed medicines training and had their competency assessed. One staff member demonstrated knowledge of safe medicines practice, describing the “right person, right medicine, right dose, right route and right time,” and awareness of people’s right to refuse medicines. However, despite this knowledge, medicines were not consistently managed safely in practice.

A review of medication administration records (MARs) identified staff had not consistently signed MAR charts to confirm medicines had been administered. For example, 1 person had been prescribed a course of penicillin for an infection, but there were no staff signatures on 10 and 11 February 2026 to confirm whether the medicine had been given. Failure to complete prescribed antibiotic courses increases the risk of infection recurrence and antibiotic resistance. For another person, the MAR showed a prescribed medicine to reduce inflammation had been amended from 1 tablet to 3 tablets. This amendment was not supported by 2 staff signatures, which is recommended good practice to ensure the accuracy and safety of changes to medicines records. Where medicines were prescribed on an “as required” (PRN) basis, such as paracetamol, staff had not consistently completed the MAR chart. Records did not clearly document the rationale for administration, the dose given, or the time administered. This meant there was no assurance PRN medicines were being used appropriately.