Archived: Initial Care Services South East Limited

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. At our last assessment we rated this key question inadequate. At this assessment the rating has remained 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 was in breach of legal regulations in relation to good governance and notifying the CQC of events.

This service scored 29 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. We identified a closed culture at Initial Care Services South East Limited. (A closed culture is a poor culture in a health or care service that increases the risk of harm.)

At our last inspection, we found that there was not a strong structure for monitoring of quality and safety, and that learning and improvement was not undertaken. At this inspection we found the same concerns. There was a number of areas where improvements had not been made since our last inspection; this included the management of risk, oversight of safeguarding, medicines management and a lack of effective governance.
We found at this inspection that the registered manager did not have a clear vision for the service which was shared with staff. Although the registered manager told us that their values were to ensure people were respected, we found this was not always implemented as people’s right to make their own decisions and be involved in their care was not prioritised.

Leaders did not have the skills, knowledge, experience and credibility to lead effectively.

At the last inspection we found poor leadership at the service, which failed to drive improvements. At this inspection we found the same concerns. The registered manager demonstrated a lack of understanding when it came to supporting people with a learning disability or autistic people. We asked the registered manager about their understanding of RSRCRC and how they were complying with this statutory guidance. They were not aware of the guidance, and could not demonstrate how they incorporated it to ensure people’s independence, choice and human rights were upheld.

The registered manager did not understand their regulatory requirements. Services that provide health and social care to people are required to inform the Care Quality Commission, (CQC), of important events that happen in the service. This enables us to check that appropriate action had been taken. The registered manager had failed to inform the CQC when safeguarding concerns had been raised.

The registered manager did not always foster a positive culture where people could speak up and where their voice would be heard.

At our last inspection, we found that the culture of the service did not support freedom to speak up. At this inspection, we found the same concerns. Although staff told us they felt they could raise concerns if they needed to, processes to support and enable them to do this were not in place. For example, the safeguarding policy in place did not give any details of where staff could share concerns outside of the service (for example with the local authority safeguarding team). We asked the registered manager where staff could share concerns outside the service, and they told us, “They could reach out to [administrator], even they could speak with the family member if they are not happy about something.” This is not an appropriate place to escalate concerns.

The provider did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who worked for them. The registered manager did not ensure that staff had the guidance and information needed to ensure people received safe and effective care. Policies to ensure people’s equality and equity were prompted were not effective.
Staff told us that they felt registered manager treated them in a supportive and respectful way. Staff told us that the registered manager was supportive in relation to their culture and religious beliefs. However, the registered manager provided no evidence of how they actively embedded this into their policies or governance of the service.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate.

At our last inspection we found that there were no governance systems in place to check and improve the quality of the service. At this inspection we found some checks were being carried out, but they were poor and failed to identify where improvements were needed. The registered manager failed to ensure that records were accurate and complete and reflected events that occurred within the service. The providers safeguarding log was difficult to understand as it contained incorrect wording and did not clearly describe events that occurred at the service, for example when police attended the log stated ‘the carer informed me that, the came caem to the house and she was informed [that there had been an allegation of abuse],’ This had not been reviewed and corrected by the registered manager to ensure clear, accurate records were kept.

The registered manager failed to ensure there were effective checks and audits to ensure that the service improved. The provider did complete a series of checks, however these were not effective in identifying areas for improvements and driving positive change. For example, the provider had completed checks on recruitment files, however we found these were not complete, and did not constitute safe recruitment practices. The registered manager completed two checks of the care plan and failed to identify the lack of detailed guidance for staff in relation to health risks.

The provider did not understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not share information and learning with partners or collaborate for improvement.

At our last inspection we found that the provider did not work with other partners to provide joined up care to people. At this inspection we found the same concerns. People did not have hospital passports, or information to be shared with other organisations if they needed health support. The registered manager told us they relied on the relative(s) of people they supported to organise appointments or support them if they were to become unwell and need to go to hospital. Guidance within care plans was contradictory, as in some places it said staff were to support people to make appointments. The lack of clear guidance placed people at risk of not receiving the support they needed.

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people.

At our last inspection we found that there were not effective systems in place to learn and improve the quality of the service. At this inspection we found the same concerns. A number of concerns raised within this inspection had been highlighted within our inspection from 23 September 2024. This included a lack of understanding about supporting people with complex health conditions and ensuring staff had robust guidance to inform them how best to support people. As well as the providers understanding in relation to their obligations around medicines support and understanding around the MCA (2005). The provider failed to learn from passed concerns raised and improve governance systems to ensure compliance with the Health and Social Care Act 2008 (HSCA). The registered managers lack of understanding and ability to drive improvements at the service placed people at risk of avoidable harm.