Walfinch Windsor & Maidenhead

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.