The inspection took place on the 26 and 27 February 2018 and was unannounced. The previous comprehensive inspection took place on 10 October 2015 and the service was rated as Good. In April 2017, Modus Care (Plymouth) Ltd was bought by Salutem, however the provider remained the same. Kanner Project provides care and accommodation for up to five people with learning disabilities who at times might display behaviour that others could be perceive as challenging. On the day of our visit four people were living in the service and each had their own self-contained living accommodation within the home. Modus Care (Plymouth) Limited owns Kanner Project and has three other services in Devon.
Kanner Project is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
In relation to Registering the Right Support we found this service was working towards doing all the right things, ensuring choice where possible and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism. 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.
The registered manager had left in July 2017 and was in the process of being de registered with the Commission. 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. Recruitment processes were underway for a new registered manager. Following the inspection we were informed by the regional manager that an appointment had been made and the new manager would start in April 2018. In the interim, there was an “acting” manager who was receiving support from another registered manager, the regional manager and the provider’s senior management team.
The provider’s governance systems at Kanner Project required improvement to assess, monitor and improve the quality and safety of the people living at Kanner Project and the staff supporting people. The provider was aware of the areas where improvement was required, however, people and staff remained at continued risk due to poor provider oversight at the time of the inspection.
The acting manager and regional manager promoted the ethos of honesty and admitted there were improvements to make. An action plan was sent to the Commission following inspection feedback.
Most people at the service were had very limited verbal communication skills. However, those able confirmed staff were caring and kind. We observed people looked happy and where able, engaged with staff. Professional feedback was positive about the staffs caring attitude. Staff demonstrated kindness and compassion for people through their conversations and interactions we observed. However, we saw people’s dignity was not always promoted. For example the language used was at times institutionalised, staff did not always knock on people’s doors and a greater awareness of the communal areas being people’s living space was required. People, where possible, and those who mattered to them, were not always actively involved in making choices and decisions about their care and treatment.
Staff understood what action to take if they were concerned someone was being abused or mistreated. Relatives confirmed they felt their loved ones were safe. However, there had been a number of incidents at the service over the past 11 months. We found these were not always analysed for themes, patterns and opportunities for learning. For example there were 28 incidents in February 2018 but there was no further analysis of the type of incident and any changes or improvements which could be made to reduce these. Although action had been taken to address previous safeguarding concerns this had been reactive and not proactive.
People’s care records were comprehensive but not shared with them in a format they were able to understand. Where people had a great deal of information about their care and treatment, care records were hard to navigate within the IT system the provider used. Reviews occurred with external professionals and people’s funding authorities but regular ‘in-house’ reviews of people’s care, goals and outcomes were not in place at the time of the inspection.
People and their relatives were encouraged to be part of the care planning process and to attend or contribute to discussions about care where possible. However, these discussions were not always well recorded or reflected in people’s care records. Some support plans were out of date so did not reflect people’s current needs. We also found end of life care plans required developing to reflect people’s needs at this time in their life.
Staff morale was mixed. Staff supervision and staff meetings had re commenced to address this. Staff were keen to develop the service and give people the best care.
Risks associated with people’s care and living environment were effectively managed to ensure people’s independence was promoted where possible. There was planned building work being undertaken and external contractors were mindful of their presence within the service. The service required refurbishment and plans were in place to improve communal areas such as the lounge, kitchen and staff areas. Plans were also afoot to address the heating within the service with quotes for this work being undertaken at the time of the inspection. These positive changes to the environment would support people and staff to feel valued and the service to have a more welcoming atmosphere.
People were asked for their consent to care and treatment where possible. Staff knew people’s individual communication styles well and had worked alongside speech and language professionals to develop skills in understanding and communicating with people. Some staff had attended training in sign language. Staff used their knowledge of people to assess their mood and needs by observing their body language, facial expressions and sounds which might indicate if they were content or anxious.
People were supported by consistent staff to help meet their needs in the way they preferred. However, it was not always clear if people were given a choice of male or female staff when they required support with personal care. Staff however told us where people had a preference this was known and respected.
The manager and provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken.
People received care from staff who had undertaken the provider’s essential training programme, but training to meet people’s specific, complex health needs or behaviours was not in place at the time of the inspection.
People’s human rights were protected because the acting manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards.
People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. However, there was a lack of choice available and staff shared concerns the budget was not sufficient. People were supported to access health care professionals to maintain their health and wellbeing.
Policies and procedures across the service were being developed to ensure information was given to people in accessible formats when required. However, at the time of the inspection these were not evident. Staff adapted their communication methods dependent upon people’s needs, for example using simple questions and information for people with cognitive difficulties and we were told information about the service would be available in alternative formats if requested.
People and relatives felt comfortable raising any concerns and felt confident these would be addressed promptly but there was not an easy read complaint process visible during the inspection.
We found the communal areas of the home were clean. Where possible people were encouraged to participate in laundry and household cleaning. This supported development of their daily living skills and a sense of value and contribution to the running of the service.
People’s medicines were well managed. People were given their medicines in their best interests following discussions with professionals and family who knew them well. We spoke with the acting manager about minor improvements which could be made to improve safety and these were promptly acted upon.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.