safe:Insufficient evidence to rateeffective:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted follow-up inspection of Infinite Intermediate Care Limited found insufficient improvement across four of five previously identified breach areas, with ongoing regulatory breaches in medicines management, recruitment, staff training, and governance. The service remains Inadequate and in special measures, with continued enforcement conditions in place.
Concerns (7)
criticalMedication management: “Staff still had not received training and competency assessments before administering medicines to people unsupervised. This meant that people may not receive their medicines as prescribed.”
critical
Staff training
: “Staff were not completing their induction, core training and competency assessments as set by the provider before working with people unsupervised.”
criticalStaff competency: “For the three members of staff who had been employed since the previous inspection; the registered manager was not able to produce a medication competency assessment however they were administering medicines unsupervised.”
criticalGovernance: “The provider's governance systems had failed to identify that the recruitment procedure had not always been followed and action had not been taken to request missing information.”
criticalLeadership: “Although the areas for improvement had been identified during previous inspections and discussed with the registered manager, action had still not been taken to make all of the required improvements.”
criticalSafeguarding: “New staff had sometimes been employed before all of their recruitment checks were returned. Care staff had been employed before their criminal records checked were returned and were working alone.”
moderateRecord keeping: “Handwritten entries to the medicine charts had not included the name of the person making the entry and it had not been countersigned by another member of staff.”
Strengths
· Risk assessments were now in place for risks such as bed rails, diabetes and choking, meaning staff had information needed to care for people safely.
· Mental capacity assessments and best interest decisions were now in place where needed, with families involved in decisions.
· People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.
Quality-Statement breakdown (5)
safe: Using medicines safelyInsufficient evidence to rate
safe: Staffing and recruitmentInsufficient evidence to rate
safe: Assessing risk, safety monitoring and managementInsufficient evidence to rate
effective: Ensuring consent to care and treatment in line with law and guidanceInsufficient evidence to rate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInsufficient evidence to rate
Infinite Intermediate Care Limited, a sole-provider domiciliary care agency, was rated Requires Improvement overall at its first inspection due to breaches of Regulations 11 and 17, including failures in Mental Capacity Act compliance, inadequate care plan detail, outdated staff training, and lack of governance oversight. The service was rated Good for caring, reflecting strong, compassionate relationships between the registered manager and the people she supported.
Concerns (6)
criticalConsent / capacity: “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.”
criticalGovernance: “The provider did not have adequate oversight of the service to ensure that people were provided with a high-quality, safe service.”
moderateCare planning: “one person's care plan contained no information about the continence aid they used or the aids they used to help them drink independently.”
moderateRecord keeping: “people's care plans did not consistently record these. This meant that if new staff provided people's care, they would not have sufficient guidance.”
moderateStaff training: “the registered manager told us they received their last training in August 2017, 15 months earlier. This meant they may not be up to date with legislation and best practice.”
moderateLeadership: “there was no-one else involved in running the service and there was no other oversight of the registered manager's practice.”
Strengths
· Relatives described very positive relationships with the registered manager, with one saying they would give her '11 out of 10'.
· Medicines were administered safely and in line with prescriber's instructions.
· Infection control procedures were in place and personal protective equipment was used consistently.
· The registered manager knew people well, respected their dignity and independence, and promoted person-centred communication including use of objects of reference.
· No missed care calls reported; registered manager described as always on time.
safe:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted inspection of Infinite Intermediate Care Limited found that the provider had remedied previous breaches of Regulations 12, 17, and 19, with improvements made in medicines management, recruitment, and governance. The overall rating remains Inadequate as the service is in special measures and only specific concerns were reviewed rather than all key questions.
Concerns (3)
criticalMedication management: “the provider had failed to ensure that people received their medicines as prescribed. This was a breach of regulation 12 (Safe Care and Treatment)”
criticalStaff competency: “the provider had failed to ensure staff were recruited safely and they had the right knowledge and skills to meet people's needs. This was a breach of regulation 19”
criticalGovernance: “the provider had failed to ensure areas for improvement were identified and action was taken in a timely manner. This was a breach of regulation 17 (Good governance)”
Strengths
· Safe recruitment practices were being followed and checks completed to ensure new staff were suitable to work with vulnerable people.
· Staff had completed induction training and medicines administration training with competency assessments before administering medicines unsupervised.
· Effective quality assurance systems were in place with regular audits to identify issues and take timely action.
· People, relatives and staff had been asked for feedback to enable improvements to be made.
Quality-Statement breakdown (3)
safe: Staffing and recruitment (Regulation 19 – Fit and Proper Persons Employed)Insufficient evidence to rate
safe: Using medicines safely (Regulation 12 – Safe Care and Treatment)Insufficient evidence to rate
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirements (Regulation 17 – Good Governance)Insufficient evidence to rate
Infinite Intermediate Care Limited improved from inadequate to Good across all five key questions, exiting Special Measures. Minor areas for development included adding detail to care plans and finalising an emergency evacuation plan for a 24-hour care recipient.
Concerns (2)
minorCare planning: “The care plans would benefit from being more detailed so that any new staff are aware of people's preferences.”
minorSafeguarding: “the registered manager stated that they were in the process of putting together an emergency evacuation plan for someone they provided 24 hour care”
Strengths
· Safe recruitment practices and induction training in place
· Staff trained and assessed competent in medicines administration
· Effective infection prevention and control with appropriate PPE use
· Staff respected dignity, privacy and learnt key phrases in a person's first language
· Registered manager committed to person-centred culture and continuous improvement
Quality-Statement breakdown (19)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood