Citibase Slough

Citibase Slough is a domiciliary care agency providing care and support to people living in their own homes. 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, nine people were receiving support with personal care.

The agency was the only location for Redbrick Care Limited, a private company.

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

Whilst the provider had assessed and planned for some risks relating to the health and care of people using the service, they had not assessed other risks. Where people had a healthcare condition, there was not always enough detail about this to ensure staff knew how to identify and reduce risks relating to these.

The provider had not always ensured risks were mitigated because they did not have detailed records in place regarding all aspects of managing the service.

People using the service and their relatives were happy with the care and support they received. They liked the staff who supported them and felt their needs were met. They were able to make decisions about their care.

The staff were well supported and had the training and information they needed to care for people safely.

The provider had made improvements throughout the service. These included better quality monitoring, improved record keeping and developing best practice. There were appropriate systems for dealing with and learning from complaints, incidents, accidents and safeguarding alerts.

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 and update

The last rating for this service was requires improvement (published 28 August 2021).

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

At this inspection we found improvements had been made. However, the provider remained in breach of some regulations where further improvements were still needed.

At our last inspection we recommended that the provider improve staff training and support, improve staff understanding of privacy, dignity and duty of candour and follow government guidance around preventing COVID-19 infections. At this inspection we found the provider had made improvements in all these areas.

Why we inspected

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

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

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 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.

Follow up

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.