Citibase Slough is a service providing care and support to people in their own homes. At the time of the inspection the service supported 12 people, and we were told everyone received support with personal care. The service provided both regular daily visits to people receiving personal care and at times provided live-in staff members providing a 24-hour support service. The service supported people in Surrey and Berkshire.
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.
People’s experience of using this service and what we found
People were supported by a service that was not well managed or monitored. The registered manager lacked sufficient knowledge of regulatory requirements, and audits were either not in place, or not effective to assess, monitor and drive improvement in the quality and safety of people’s support. The service had failed to inform the Commission of incidents and information they are required to, and we also recommend the provider develop their knowledge and approach in relation to the duty of candour, to ensure applicable incidents are identified and an appropriate response made.
Relatives described raising concerns and complaints to the registered manager regarding people’s experiences of care. Some people and relatives felt the registered manager was approachable and comments included, “We believe we have a good relationship with [registered manager’s name]” and “If I did have any concerns I would contact the office.” Some relatives felt issues remained unresolved or had worsened, with one relative advising, “I have phoned to speak about our concerns and the carers have been even worse… They don't have enough staff as even the office staff cover duties. We are never told when the carers are running late which is awful.”
We found risks to people using the service were not clearly identified and managed. We also identified concerns in relation to the safe management of medicines, concerns regarding staff testing for COVID-19 and a lack of oversight in relation to accidents and incidents. We recommend the service improve their organisation and record keeping in relation to staff COVID-19 testing. Some people told us they felt safe, but there was mixed feedback in relation to safe administration of medicines. Comments from relatives included, “They generally provide great care…There has not been an issue with medication” and “We have had to take back control for medication as wrong doses were being given.”
The service identified required learning for staff, however at the time of our inspection staff had not received training in subjects such as dementia, end of life care, and equality, diversity and human rights. We recommend the service seek advice from a reputable source in relation to staff training and ensure staff have access to regular supervision. The service assessed people’s needs, and carried out reviews of people’s care and support plans, although we found reviews were not always documented to evidence whether people and their families had been involved in reviews to make decisions about their care.
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; the policies and systems in the service did not support this practice.
Support was not always caring and person-centred. Some people and families provided positive feedback regarding their care, with comments including, “I am getting excellent care” and “The carers are all very, very good with my relative, there is one male carer who is very good and my relative enjoys his company.” A number of people expressed concerns regarding the impact of staff rushing to finish visits and not staying the agreed visit length. One relative commented, “Not all carers want to be here and rush in and out.” A person using the service added, “People have different attitudes, some will always be in a rush. They all treat me with respect and are caring and that is what I want and need.” We recommend the service develop their approach, to ensure people are consistently treated with dignity, respect and kindness.
Some people required support from healthcare professionals and the service liaised with families or made referrals to access support. The service also worked with local authorities and feedback from professionals generally indicated the service worked well in partnership with other organisations.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 28 August 2019 and this is the first inspection.
Why we inspected
This was a planned inspection following the service's registration with CQC.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.
Following our inspection visit the provider took some actions to mitigate risk, including reviewing medicines practices and submitting retrospective notifications of incidents to CQC.
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 care and treatment, recruitment practices, good governance, complaints, assessing people’s mental capacity to consent to care, and in informing the Commission of incidents and information they are required to.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.