Background to this inspection
Updated
22 March 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 12 and 17 December 2018 and 4 January 2019 and was announced. We gave the service 48 hours’ notice of the inspection visit because the registered manager is often out of the office supporting staff or visiting people. We needed to be sure that they would be in.
The inspection team was made up of two adult social care inspectors.
Prior to the inspection visit we gathered information from a number of sources. We looked at the information received about the service from notifications sent to the Care Quality Commission by the registered manager. We had also received a provider information return (PIR) from the provider, which helped us to prepare for the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection, we visited one person using the service and one relative of a person using the service in their homes. We also reviewed, with their permission, their care and medicine records which were kept at their home. During the inspection, we contacted four relatives of people who used the service. We spoke with three relatives by telephone.
We visited the service's office and we met and spoke with the registered manager, the administrator, the development manager, the recruitment officer, two assistant managers and two support workers.
We spent time looking at written records, which included four people's care records, six staff records and other records relating to the management of the service such as training records and quality assurance audits and reports.
Updated
22 March 2019
The inspection of Citizenship First took place on 12 and 17 December 2018 and the 4 January 2019. We last inspected the service on 7 and 8 August 2017. At that time the service was not meeting the regulations related to staffing and good governance and was given an overall rating of requires improvement. This was because staff did not receive appropriate support, training, supervision and appraisal, the service had not maintained an accurate, up to date record in respect of each service user and quality assurance processes were not effective.
The provider sent us a report of the actions they would take to meet the legal requirements of these regulations. The provider stated they would be compliant by January 2018. At this inspection we checked to see if the necessary improvements had been made and we found continuing concerns relating to staffing and good governance.
Citizenship First is a domiciliary care agency registered to provide personal care for people living in their own homes, flats and specialist housing. Not everyone using Citizenship First receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. They are registered to provide personal care to people over 16 years old with a learning disability. They support people to live as independently as possible in their own homes in the Sheffield area.
At the time of the inspection Citizenship First were supporting 26 people with the regulated activity.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy
There was a manager at the service who was registered with the Care Quality Commission (CQC.) A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At the last inspection we found issues with risk management. At this inspection we found continuing issues with risk management. Care plans did not always contain sufficient information, up to date and relevant information to provide direction for staff, and information about how to reduce risks.
At the last inspection we found the records checked in people’s homes did not always correspond with the records kept at the office. At this inspection we found people did not have corresponding records in their home. This meant care workers may not have access to important information about how best to support people and keep people safe.
At the last inspection we found systems were not sufficiently embedded to assess, monitor and improve the quality and safety of the service provided. At this inspection we found the quality assurance framework was not sufficiently robust and did not give the registered manager and the provider effective oversight. Audits were not always effective in identifying and addressing the issues we found on inspection and accurate records were not always kept.
The registered manager and registered provider failed to monitor and improve the quality and safety of the service and had not taken action following our last inspection to meet the continuing breaches of the regulations in line with their action plan.
This was a continued breach of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. Regulation 17: Good Governance.
At the last inspection we found staff had not received sufficient support, training, supervision and appraisal necessary to carry out the duties they were employed to perform. At this inspection we found continued concerns. The provider did not have adequate oversight of staff training and development. Staff competency checks, in respect of medicines, had not been carried out in line with National Institute for Health and Care Excellence (NICE) guidelines and staff had not always completed the necessary training the providers organisational policy required.
We have made a recommendation that the service consider the National Institute for Health and Care Excellence (NICE) best practice guidelines on ’Medicines management for people receiving social care in the community’ and take action to update their practice accordingly.
This was a continued breach of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. Regulation: 18 Staffing.
The provider kept records of accidents and incidents, but these were not always analysed to identify any ongoing risks or patterns and to identify what required improving.
At the last inspection we found the provider had not notified us about certain changes, events and incidents that affect their service or the people who use it. At this inspection we found the provider had submitted all the necessary notifications.
People we spoke with gave mixed comments about the care workers who regularly supported them. They told us their care workers were ‘kind’ and ‘caring’, but sometimes ‘lacked direction’ and were ‘lazy.’ There were mixed responses from people about regular and consistent staff.
Staff had undertaken training in safeguarding vulnerable adults from abuse and could explain their roles and responsibilities about keeping people safe. Staff were clear who they would report any concerns to and were confident action would be taken to address their concerns.
Staff recruitment procedures were thorough and ensured people’s safety was promoted. The provider had undertaken all the checks required to make sure people employed at Citizenship First were suitable to work with people who may be vulnerable due to their circumstances.
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. Staff were aware of the importance of seeking consent from the people they supported and told us people had capacity to make decisions about their care for themselves.
There was a complaints procedure in place. There was a mixed response from relatives when we asked if they felt listened to when they raised any issues with managers.