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 wer

The inspection took place on 4 and 7 August 2017 and was an announced inspection. The manager of Citizenship First (Sheffield) was given 48 hours' notice of the inspection. We did this because the service is small and the manager is sometimes out of the office and we needed to be sure that they would be available. We also wanted the service to make initial contact with people who we had identified we would like to visit, to ask them if we could see them in their own homes.

The main office of the service is based in the centre of Sheffield. 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. At the time of our inspection the manager told us the service was providing personal care for 27 people.

Our last inspection at Citizenship First took place in April 2016. At that inspection we found three breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 17: Good Governance, Regulation 18: Staffing and Regulation 19: Fit and Proper Persons.

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 29 July 2017. We checked whether these regulations had been met as part of this inspection.

We found evidence at this inspection to show improvements had been made to meet the requirements of Regulation 19: Fit and Proper Persons. However, we found continued breaches in Regulations 17: Good Governance and Regulation 18: Staffing.

Their manager told us they had submitted an application to register with the Care Quality Commission (CQC). The previous manager had left the service in June 2016. A registered manager is a person who has registered with CQC 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 and associated Regulations about how the service is run.

Significant changes to the staffing at Citizenship First had occurred since our last inspection. The manager and members of the senior staff team had left the agency. The registered provider had put new management arrangements in place to support the operations and on-going improvement of the service. Most of the staff and most of the people we spoke with reported improvements to the service in recent months.

People's care records contained a lot of person centred information and detailed risk assessments. However, the records checked in people’s homes were out of date. This meant the information may no longer be relevant to the person and people were not always protected from risks. We also found that some people’s medication administration records required improvement. This showed the system in place to ensure an accurate, complete and contemporaneous record in respect of each person using the service required further improvement. We shared this information with the manager. They arranged for immediate action to be taken to ensure people had an accurate care plan in place.

We found the registered provider did not have adequate systems to ensure the safe handling, administration and recording of medicines to keep people safe. Not all staff had completed training in medicines so we could not be assured they were competent.

Registered providers must notify us about certain changes, events and incidents that affect their service or the people who use it. We found the registered provider had not ensured that CQC was appropriately notified.

We found that systems were not sufficiently embedded to assess, monitor and improve the quality and safety of the services provided in the carrying out of the regulated activity.

This was a continued breach of the Health and Social care Act 2008 (Regulated Activity) Regulations 2014. Regulati

We carried out this inspection on 15 and 18 April 2016. The provider was given 48 hours notice of the inspection taking place. We did this because the location provides a domiciliary care service and we needed to ensure that we could speak with staff and look at relevant records.

At the previous inspection on 16 October 2013 we found the service to be non-compliant in one of the outcomes we inspected at that time, ‘treating people with respect and involving them in their care’. During this inspection we found improvements had been made.

Citizenship First – 350 Glossop Road provides support to people over 16 years old with a learning disability. They support people to live as independently as possible in their own homes and also provide supported living accommodation. The agency office is based in Sheffield city centre. At the time of our inspection the service was providing personal care for 117 people.

It is a condition of registration with the Care Quality Commission that there is a registered manager in place. 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. There was a manager present during the first day of our inspection who told us they were going to register with the Care Quality Commission. The previous registered manager left the service in February 2016.

People told us they were satisfied with the support they received. One person told us, “I am very happy with the carers.” A relative said, “They are very good.”

We found that people were protected from abuse. Staff we spoke with had a clear understanding of safeguarding people and what to do if they suspected abuse.

Staff understood the need for the safe storage and administration of medicines. However medication administration charts were not regularly audited to check that medicines were administered as prescribed.

We saw and we were told that safe recruitment procedures were not always followed to ensure that all the required information and documents were in place before staff commenced employment to verify people employed by the service were suitable to work with vulnerable adults.

The manager told us they were aware of their responsibilities under the Mental Capacity Act, including the need to seek advice from the Local Authority where the movements of a person without capacity are restricted.

Support staff told us and we saw that supervisions and appraisals to support staff to undertake their duties were not regularly taking place.

There was no training record to verify what training staff had received, and no training policy to inform staff of what training was available and how to access it.

Support staff we spoke with were aware of people’s like and dislikes and how best to support the person to meet their care and support needs.

There was tension between support staff and managers regarding communication of rotas, staff changes and how best to support people receiving the service. Overall support staff morale was low.

Support staff we spoke with showed commitment to their jobs and compassion towards the people they supported.

People’s care records contained a lot of person centred information and detailed risk assessments. However we were told they were all significantly out of date. None of the care records we looked at had been reviewed since 2014. This meant the information may no longer be relevant to the person.

The manager showed us an up to date complaints policy and procedure that was to be shared with people who were supported by the service. We saw a record was kept of all complaints that were received, the response given to the complainant and any action taken to rectify the complaint.

People who were supported by the service and sta

We asked staff about how they provided care and support to people. They spoke with knowledge about people’s needs, and told us that they felt they understood how people should be supported in order to meet their needs. Staff told us that they felt they had sufficient time with people to ensure they could meet their needs.

We saw that the provider did not have appropriate arrangements in place for checking people’s capacity to consent to their care. Where people do not have the capacity to consent to their care, providers should take steps to ensure that they acted in accordance with people’s best interests. We did not see any evidence that formal best interest meetings had taken place in relation to people’s care.

The vast majority of staff had received training in abuse awareness and protecting vulnerable adults. There were resources available to all staff in relation to safeguarding. We asked staff members about their knowledge of safeguarding and they told us that they had received relevant training.

Appropriate checks had been undertaken before staff began work. We checked personnel files belonging to staff employed within the service. Each file contained evidence that the provider carried out background checks on staff. This included taking up references from previous employers, carrying out checks on people’s identities and undertaking a Criminal Records Bureau (CRB) or Disclosure and Barring Service (DBS) check.

The provider kept a record of complaints made and details of how they were addressed. We saw that where complaints had been received they had been dealt with in a timely manner. Staff we spoke with could describe the complaints procedure and were confident in their knowledge of how to raise concerns or make a complaint.

People told us that they were happy and satisfied with the care and support being provided. Comments made to us during this review included "New staff always have a mentor to ensure continuity and any issues with staff are quickly resolved" and "I’ve no problems." People said that their carers were reliable and professional. Comments made to us about staff included ‘Staff are fantastic and they ask you what you want to do" and "Staff are friendly and polite."

People told us the service was reliable and that staff were usually on time and stayed for the agreed length of time. People told us that if staff were going to be late someone always let them know. Comments from people using the service included "Always bang on time" and "Always ring you if they are going to be delayed." People said that they felt able to tell staff if they required any changes to the way in which they were cared for and would also happily talk to the manager of the service.

People who use the service said they felt safe and felt comfortable discussing concerns with staff and the manager of the service.