ILS24Health Care Limited

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• 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

A culture of continuous improvement was not fully embedded at the service. A breach of good governance was found at the last inspection of the service in 2022 and found again at this assessment. No effective and sustainable improvements had been made.

There was a lack of a consistent safety culture with regards to people’s care and the basic clinical tasks some staff were being asked to provide. The provider was not registered with CQC to support people with clinical care tasks and there was no clear vision, strategy or adequate processes in place to ensure this type of care was safe.

The provider’s governance processes were very limited and did not effectively monitor the quality of the service, identify, manage risks or drive up improvements. There was a lack of managerial oversight of people’s care which included the administration and management of medicines. Medicines management was unsafe and did not adhere to best practice guidance from The Royal Pharmaceutical Society, the Nursing and Midwifery Council or CQC. People’s daily care records contained gaps and anomalies that had not been explored to ensure people’s care and treatment was safe.

We did not find the provider or registered manager open to discussions about the shortfalls in people’s care or the improvements they needed to make. There were gaps in the knowledge of the provider and registered manager with regards to the health and social care regulations which impacted on the overall quality and safety of service delivery.

Staff felt able to speak up and raise any concerns related to the service, people’s care or their own employment and working life. All of the staff spoken with told us they liked working for the provider and registered manager and felt supported.

This service scored 36 (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 was not registered with CQC to support people with clinical care tasks and there was no clear vision, strategy or adequate processes in place to ensure this type of care was safe.

During our discussions with the provider and registered manager we found them to be defensive, with a lack of understanding of the shortfalls of the service and the action required to drive improvements. There was a lack of transparency or knowledge of some of the tasks staff were undertaking and a lack of managerial oversight of all aspects of service delivery.

Staff members told us morale was good and they felt supported.

There were limited processes in place to enable a shared direction and culture to be embedded. There were policies and procedures and staff meetings, but it was difficult to tell how the culture and vision of the service was promoted during these meetings, furthermore not all staff members attended.

There was limited evidence the culture of the service was focused on learning and improvement, with gaps in the training and development of staff.

Effective processes were not in place to identify and address shortfalls in service delivery in order to drive up and achieve improvements. Where improvements were required, the processes in place failed to ensure improvements were made.

The provider and registered manager did not demonstrate they fully understood the context in which good care, treatment and support should be delivered.

The registered manager when asked could not explain why the shortfalls identified during the assessment were found. They did not demonstrate an awareness of the issues or the reason why such shortfalls were a breach of the health and social care regulations.

Discussions about the service with the registered manager who was also the provider, were difficult. They were defensive and did not demonstrate a transparent and open approach to resolving the shortfalls found.

There were shortfalls in the care and treatment of some people. Staff were expected to complete basic clinical tasks they were not adequately trained, monitored to provide or registered with CQC to provide. The processes in place to assess, monitor and mitigate risks had not identified this as a serious risk to people’s safety.

There were processes in place to support staff including the manager to develop their skills, experience and credibility within the service. However, the quality of some of the staff training was poor and not provided by trainers equipped with the appropriate knowledge, skills, qualifications or experience to deliver staff training.

There were gaps in the knowledge of the provider and registered manager with regards to the health and social care regulations which impacted on the overall quality and safety of service delivery.

Staff felt able to speak up and raise any concerns related to the service, people’s care or their own employment and working life.

There were safeguarding and whistleblowing polices in place to guide staff on who to raise and report concerns.

Staff told us they were treated equitably and fairly. They told us the provider and registered manager was supportive and staff morale was good.

The provider had policies covering staff recruitment and selection, and equality, diversity and inclusion.

The registered manager could not explain why they had not complied with the conditions of their registration with CQC. They could not adequately explain what role and responsibility they had in ensuring compliance with the regulations. They were not able to demonstrate a clear understanding of the health and social care regulations, key areas of risk or best practice.

Staff members knew who the registered manager was and felt the service was managed well.

The audits in place to support good governance were inadequate. They lacked sufficient detail of what was audited and failed to identify any improvements to the service were required. This meant the shortfalls found at this assessment had not been identified or addressed.

Spot checks on staff practice and conduct were undertaken but there was a lack of managerial oversight with regards to people’s overall care. For example, where people required their health and well-being to be monitored for example, fluid input and output, pressure area care including repositioning, bowel monitoring and PEG management, there were no adequate governance arrangements in place to monitor the care provided by staff to ensure it was safe and in accordance with the person’s care plan and professional guidance given. This meant gaps and discrepancies in people’s day to day care had not been identified or acted upon.

The systems in place to manage medicines safely were inadequate. The registered manager had not recognised medicines management did not adhere to best practice guidelines issued by CQC such as ‘Medicines information for adult social care services – homecare’ and guidance issued by and The Royal Pharmaceutical Society. There were no adequate audits in place to monitor the administration of medicines or to ensure records kept in relation to medicines were accurate and up to date. This meant the serious shortfalls in medicines administration went un-noticed.

It was clear from the seriousness of the shortfalls found during this assessment that the governance and management of the service were inadequate

People did not provide any feedback in this area.

It was difficult to tell from people’s records how the service worked in partnership with other health and social care professionals, including the Local Authority to ensure people’s experience of care was seamless.

Staff members did not provide any feedback on how information was shared with partners. They told us they shared information between each other by documenting the care given at each visit.

Partners did not provide any feedback about how they worked in partnership with the provider to ensure seamless care.

The provider did not have a robust system in place to communicate with partners such as the local authority and other healthcare professionals involved in people’s care. For example, updated guidance from NHS partners had not been obtained when people’s PEG regimes had changed. The provider could not evidence any communication with NHS training providers to ensure staff received appropriate training in basic clinical care.

Staff members told us staff meetings were held and they received supervision in their job role.

A culture of continuous improvement was not embedded in service delivery.

The provider and registered manager did not demonstrate a good understanding of how to make improvements happen. At the last inspection in 2022, a continued breach of regulation 17, good governance was found. At this assessment, we found the same. This meant the provider and registered manager had failed to ensure necessary and timely improvements to the quality and safety of the service were made. Furthermore, since the provider’s inspection in 2022, the quality and safety of the service had declined further at this assessment. This clearly demonstrated the arrangements in place to ensure a cycle of continuous improvement was inadequate.

The provider’s quality assurance systems and processes did not enable the provider or registered manager to have a clear picture of how to make improvements happen, or to identify and address the shortfalls in quality and safety we found at this assessment and our previous inspection.