Walfinch Windsor & Maidenhead

Updated 19 June 2021

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector. An Expert by Experience contacted relatives of people using the service for their feedback. 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 flats.

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. The service had appointed a new manager who intended to submit an application to register and was being supported by the registered manager for a three-month period.

Notice of inspection

We gave a short period notice of the inspection to arrange consent for phone calls to people’s relatives at home ahead of the onsite inspection.

Inspection activity started on 13 May and ended on 1 June 2021. We visited the office location on 18 May 2021 and conducted a remote inspection meeting on 24 May 2021.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We contacted two healthcare professionals who were involved in people’s care and treatment. However, they advised us they did not come into contact with care workers as part of their role and could not provide us with any feedback. 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

The service told us three people were not able to communicate with us over the phone and another person did not wish us to contact them, which was confirmed by their relative. We spoke with four relatives about their experience of the care provided. We spoke with eight members of staff including care workers, the registered manager, the manager, and the nominated individual. The nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included three people’s care records and two people’s medication records. We looked at three staff files in relation to recruitment and staff training. 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 19 June 2021

About the service

Christies Care Windsor and Maidenhead is a domiciliary care service for people living in their own homes in the community. 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, five people used the service and four people received personal care.

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

The service did not identify or mitigate all risks to people, which meant staff may not know how to keep people safe. Systems to manage people’s medicines were not always fully implemented to make sure people received their medicines as prescribed. The service was not familiar with local authority safeguarding procedures. Staff were able to identify signs of abuse and told us they would report concerns to management.

Staff recruitment procedures were not robustly followed and placed people at risk of being supported by unsuitable staff. People's relative told us their family members received agreed levels of staff support on time. Infection prevention procedures were in place. Relatives told us staff wore appropriate personal protective equipment to reduce the risk of COVID-19 transmission.

Initial assessments were not holistic and did not capture relevant information about people’s needs or preferences. Staff did not always complete training to meet people’s needs prior to providing unsupervised care and support. Staff told us management supported them through their induction and felt prepared 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 and in their best interests; the policies and systems in the service did not always support this practice. Documentation did not consistently follow the principles of the mental capacity act code of practice.

Relatives felt their family members received caring and kind support from staff, with comments such as, “[Care workers] seem caring, they treat [my family member] with dignity” and “I can’t sing their praises highly enough, it’s good team work. They care for [family member] with kindness and respect, they understand [family member] has dementia”.

Care plans did not contain all relevant information about people needs, likes and dislikes. One relative said, “I don’t think they know [family member’s] likes and dislikes, if there was a bit more conversation, they might have understood their needs a bit more”. Some care plans contained detailed information about people’s background and hobbies.

The service understood the requirements of the accessible information standard to identify and take relevant action to meet people's communication needs. Care plans included information about how staff should adapt their communication. However, the full range of communication tools was not considered for one person with complex needs. We have made a recommendation in relation to the accessible information standard.

The service had not identified whether people had do not attempt resuscitate notices in place, which was important to ensure staff had the right information and to enable them to check such notices were appropriate and lawful.

The service had not always established robust systems to monitor the quality and safety of the service. Policies and procedure were not consistently up-to-date with relevant national guidance or professional standards. The deployment of the registered manager meant there had not been effective oversight of procedures and staff practice. The service had identified this previously and recruited a new manager who commenced 4 May 2021. The manager demonstrated a person-centred value base and knowledge of the regulations. They were responsive throughout our inspection and had already taken some action to mitigate risk prior to our inspection.

Staff and people’s relatives were consistently complimentary about the support and responsiveness of the nominated individual, who delivered a significant amount of care directly.

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 9 December 2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about staff training and lack of oversight by the registered manager. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, response and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The service has implemented a service improvement plan to address the concerns we found during our inspection.

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 person centred-care, safe care and treatment, good governance, staff training and fit and proper persons employed.

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.