Infinite Intermediate Care Limited

Infinite Intermediate Care Limited is a domiciliary care service. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection the service provided personal care to two people. One of the two people was receiving 24-hour care from the service. The service provides care to adults in Peterborough and surrounding areas.

People’s experience of using this service and what we found

The provider had systems in place to manage risks and keep people safe from avoidable harm. Staff followed good practice guidance to prevent the spread of infection and staff were trained to support people to take their medicines safely.

People liked the staff that cared for them. Staff were kind and caring and made sure people’s privacy and dignity was respected.

Staff received training, supervision and support so that they could do their job well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Effective systems were in place to monitor and review the service being provided. People and their relatives were asked their views on the quality of the service. The provider had a complaints policy in place which was provided to people and relatives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

As a result of the last comprehensive inspection this service was rated inadequate (report published 29 May 2021.)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We carried out a targeted inspection (report published 24 October 2021) and we found improvements had been made and the provider was no longer in breach of regulations. However, as it was a targeted inspection the rating was not changed.

This service has been in Special Measures since April 2020. During this inspection the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Infinite Intermediate Care Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Infinite Intermediate Care Limited is a domiciliary care service. At the time of our inspection the service provided personal care to two people. The service provides care to adults in Peterborough and the surrounding areas.

People’s experience of using this service and what we found

Action had been taken to ensure people received their medicines as prescribed. Staff had completed training and competency checks to ensure they had the knowledge they required to meet people’s needs. The providers recruitment policy was being followed to ensure that the right people were employed to work with vulnerable people.

The quality assurance systems were being followed to ensure any areas for improvement were identified and action was taken in a timely manner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (report published May 2021).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this targeted inspection to check enforcement action we previously took in relation to Regulation 12 Safe care and treatment, Regulation 17 Good Governance and Regulation 19 Fit and proper persons employed of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

CQC have introduced targeted inspections to follow up on enforcement action or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

provided personal care to two people. One of the two people was receiving 24-hour care from the service.

The service provides care to adults in Peterborough and surrounding areas.

People’s experience of using this service and what we found

Sufficient action had still not been taken in four out of five areas to make the required improvements as identified at the previous inspections. The provider had not always taken the action they said they would regarding safe administration of medicines, safe recruitment, staff training and competencies and governance.

People’s medicines were still not always managed safely. Not all staff had completed training in the administration of medicines and completed a competency assessment before they administered medicines on their own. This meant that people were at risk of not receiving their medicines as prescribed.

The provider’s recruitment procedure was not always followed so staff were sometimes employed before all required recruitment checks had been completed. Staff employed since the previous inspection had not completed all basic core training before working unsupervised with people. This meant that staff might not have the skills and knowledge necessary to meet people’s needs.

There continued to be a lack of oversight to ensure that where improvements were needed, they were made in a timely manner. This meant that not all of the required improvements had been made.

Risk assessments had been completed so that staff knew what action they should take to reduce risks to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Inadequate (published 21 January 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We undertook this targeted inspection to check if Regulations 11,12,17,18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Inadequate.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Infinite Intermediate Care Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe administration of medicines, following recruitment procedures, ensuring staff have the skills and training and are competent to carry out their roles and ensuring improvements made in a timely manner.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Infinite Intermediate Care Limited is a domiciliary care service. At the time of our inspection the service provided personal care to two people. One of the two people was receiving 24 hour care from the service. The service provides care to adults in Peterborough and surrounding areas.

People’s experience of using this service and what we found

Sufficient action had not been taken to make the improvements needed that were identified at the last inspection. The provider had not followed their own action plans to make the required improvements. There was a lack of oversight regarding the care being provided. This meant that people’s health and safety continued to be at risk.

People’s medicines were not always managed safely. The medication administration records contained numerous omissions for signing of medication administered and did not contain all of the relevant information required. Staff had not completed competency assessments for the administration of medicines to ensure they were following correct and safe procedures.

Care plans and risk assessments had not been updated when people’s needs changed. This meant that staff did not have access to current information about how people should be cared for.

Not all staff had completed training in the protection of vulnerable adults. The registered manager was still not aware of the correct procedure to follow if there was an allegation of abuse. Allegations of abuse had not been reported to the Care Quality Commission (CQC), as required.

The provider’s recruitment procedure continued to not be followed. This meant not all of the required pre-employment checks had been completed to ensure staff were suitable to work with vulnerable people. Not all staff had completed the training as required by the provider to ensure they had the skills to carry out their roles. Action had not been taken to ensure that staff were competent to carry out their roles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (report published 01 April 2020) and there were multiple breaches of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service was rated requires improvement as a result of their first inspection and inadequate for the last inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We planned to carry out a targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We inspected and found there was a concern with safe use of medicines, safe recruitment, infection control procedures, staff training and risk assessments, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We did not inspect the other key questions. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Infinite Intermediate Care Limited on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to a lack of oversight of the service, safe recruitment, safe use administration of medicines, risk assessment, training and competency of staff and notifications to the commission at this inspection.

We asked the provider for assurances that they would take immediate action to ensure that people received their medicicnes as prescribed. We were not confident that the providers response was adequate to ensure people's safety. Therefore we urgently imposed a positive conditions on the provider stating that they could not provide a service to any new people.

We also urgently imposed a positive conditon on the provider to make the necessary changes to ensure safe administration and monitoring of medicines. This inlcuded the provider sending information to the Commission on a weekly basis about the action they had taken to comply with the regulation.

Follow up

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Infinite Intermediate Care Limited is a domiciliary care service. At the time of our inspection the registered manager provided personal care to two people. The provider had employed staff to provide care to one other person for four weeks since our last inspection. The service provides care to adults in Peterborough and surrounding areas.

People’s experience of using this service and what we found

The service was not well led. At the previous inspection we told the provider there was a lack of oversight of the service to ensure that it was being managed safely and in line with current good practice. The registered manager had supplied an action plan after the previous inspection. However, they had failed to make the necessary improvements. The service was not well managed, and the registered manager had failed to recognise their responsibility to ensure that the service delivered high quality, safe care to people. The registered manager had not carried out any quality monitoring or audits that may have identified the improvements needed.

People’s health and welfare was at risk because procedures and policies to keep them safe were not being followed. Risk assessments had not been reviewed to reflect any changes and did not include all relevant information for staff to keep people safe. Medicines were not well managed. Staff had not completed medication administration training since working for the service and had not had their competency assessed by someone trained to do so. People did not always receive their medicines in line with good practice, the provider’s policy, or the manufacturer’s instructions. People’s care plans did not contain enough information about their medicines or how they should be administered. The medication administration charts did not include all the required information and contained multiple errors. Checks of medication administration records had not been recorded.

The registered manager had not carried out the required checks to ensure staff were suitable, prior to them providing people’s care. The provider’s recruitment policy had not been followed when recruiting new staff. New staff recruited in 2019 had not received the training they required since working for Infinite Intermediate Care Limited and they had not been assessed as competent to carry out their role effectively.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. There were no records that decisions made on behalf of people were made in their best interests by people who had the legal authority to do so.

Care plans did not include all the information staff needed to be able to support people safely or in the way the wanted. Only the registered manager was providing care at the time of our inspection visits and she knew both people who received care really well. However, if a new staff member had to support people, the information was not available to enable them to do this safely or in the way the person preferred.

The feedback we received about the service was very positive. The registered manager knew both people well and liaised with their relatives about their care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 January 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained, and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection we have identified breaches in relation to keeping people safe from harm and avoidable risks, management of medication, safe recruitment, staffing, consent, and monitoring of the service and making improvements where necessary.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This is the first inspection of this service since it registered with the Care Quality Commission. This announced inspection took place between the 2 and 8 November 2018. There were three people receiving the regulated activity of personal care during this inspection. All care was provided by the registered manager.

This service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how they run the service.

The registered manager was also the sole director of Infinite Intermediate Care Limited. This meant there was no-one else involved in running the service and there was no other oversight of the registered manager’s practice. The provider did not have sufficient oversight of the service nor were there adequate systems in place to ensure that people received a high-quality service and were kept safe.

Where people did not have the mental capacity to make decisions, processes had not have been followed to protect people from unlawful restriction and unlawful decision making. Not all potential risks to people had been managed to ensure that the risks were minimised. Care plans were not sufficiently detailed guidance on how to meet each person's individual needs.

People were supported to manage their prescribed medicines safely. There were processes in place to reduce the risk of infection and cross contamination.

There were enough staff to ensure people’s needs were met safely and in a timely manner. The registered manager had very good relationships with people and their relatives. The registered manager knew the people she cared for well and understood, and met, their needs.

People were supported to have enough to eat and drink. People were assisted to have access to external healthcare services to help maintain their health and well-being.

The registered manager worked in partnership with people’s relatives who were fully involved in making decisions about their family member’s care and support. They were involved in the setting up and review of their or their family member’s support and care plans.

People were treated kindly and were made to feel that they mattered. The registered manager respected and promoted people’s dignity and independence. People’s suggestions and concerns were listened to and acted upon. The provider had a complaints process in place but had not received any complaints.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.