Citizenship First Ltd

Updated 20 November 2019

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of one inspector and one Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flat. This service also provides care and support to people living in eight ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service short notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used this information when planning our inspection.

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection-

We spoke with seven people who used the service and five relatives about their experience of the care provided. We spoke with six members of staff including the registered manager, head of service, development manager and care workers.

We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at eight staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 20 November 2019

About the service

Citizenship First is a is a domiciliary care agency. It provides personal care to people in their own houses and flats in the community and people living in supported living schemes. It provides services to people with learning disabilities. At the time of the inspection eight people in their own homes and 16 people in supported living schemes, were receiving support with personal care.

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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The care plans we looked at had been updated, however, other care plans still require updating to the new format. A plan was in place to complete this. We have issued a recommendation that the provider ensures all care plans are completed.

Peoples likes, and dislikes were recorded in people’s care plan and staff knew people and their preferences well. People’s communication needs were in their plans. People had a good range of activities in place and people were happy with what was on offer. There was a complaints procedure and people knew how to complain.

People spoke highly of the head of service who they said was approachable and supportive. The registered manager understood the regulatory requirements. People told us they thought the service was well led. New audit systems had been implemented. However, these required time to be embedded fully to ensure they were sustained and continued to drive improvements.

Medicines were managed safely. Staff were recruited safely, and there were enough staff to take care of people. Care plans and risk assessments detailed what care and support people needed to reduce risk to them. Relative’s told us they felt people were safe.

Staff received appropriate training, a plan was in place to ensure training was kept up to date. Staff were supported and felt supported by the management team. Staff received supervision. People’s needs were assessed, and outcomes recorded. People were offered a choice of food and drink. The service worked with other health care professionals. However, it was difficult to find outcomes for people's medical visits.

People and relatives told us staff were kind and caring. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems at the service supported this practice. People and relatives told us staff treated them with dignity and respect, they were involved with the planning of their care and their views were listened to.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (March 2019) and there were multiple breaches of regulation.

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 and the provider was no longer in breach of regulations.

The service has improved to good.

However, remains requires improvement in well led. This service had been rated requires improvement for the last three consecutive inspections, therefore the quality assurance systems and governance need to be embedded into practice.

Why we inspected

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Citizenship First on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.