Assessment activity started on 22 May 2024 to 24 June 2024. Citibase Slough is a domiciliary care agency registered to provide personal care to people in their own homes. The service provides support to people of all ages and different abilities. At the time of assessment, the service provided care to 20 people who received personal care. The inspection was prompted in part due to concerns regarding staff training, policies not being accessible for staff and concerns regarding peoples care plans. The reasons for inspection was to also look at the previous breaches of regulations to assess whether the service has improved. We did not assess all quality statements at this inspection. We looked at 4 key questions: Safe, Effective, Responsive and Well-led. For those areas we did not assess, we used the ratings awarded at the last inspection to calculate the overall rating. The last rating for this service was requires improvement (published 25 October 2022). At this assessment we found improvements had been made and the provider was no longer breaching any regulations and has now improved to a rating of good. Systems were in place to help protect people from the risk of harm. Staff were recruited safely and trained appropriately to ensure they were competent for their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s care and support plans reflected their range of needs. Staff told us they felt supported by their colleagues although some staff told us that they were not confident or comfortable to raise some issues with management. Systems were in place to monitor aspects of the service and quality of care provided continuously.
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Citibase Slough, a domiciliary care agency supporting nine people, was rated Requires Improvement overall, with continuing breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to incomplete risk assessments and record-keeping. Improvements since the last inspection led to Effective, Caring and Responsive being rated Good, with positive feedback from people, relatives and staff.
Concerns (5)
criticalCare planning: “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.”
criticalCare planning: “the risk management plan gave only basic guidance which did not include proactive strategies. There was no assessment or guidance for managing the risks for the other person.”
criticalGovernance: “The provider's systems had not always identified, assessed or mitigated risks to people's safety and wellbeing.”
moderateRecord keeping: “The provider's systems did not always ensure that accurate and complete records were in place.”
moderateIncident learning: “some of the information in care records was unclear and needed more detail for staff to fully understand their needs, information about the medicines people were prescribed and capacity to make choices.”
Strengths
· Improvements made in medicines management with clear records, training, and monthly audits
· Safe recruitment processes and sufficient staff to meet people's needs; staff arrived on time
· Staff well trained (Care Certificate) and well supported with regular supervision
· People and relatives gave positive feedback about caring, respectful staff
· Personalised care plans with regular reviews and good communication support including translation
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choicesGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies and supporting access to healthcareGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships and follow interestsGood
responsive: End of life care and supportGood
well-led: Continuous learning and improving careRequires improvement
well-led: Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsGood
well-led: Duty of candourGood
well-led: Promoting a positive, person-centred culture; engaging people and staffGood