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Inspection carried out on 7 March 2019

During a routine inspection

About the service

Kanner provides care and accommodation for up to five people with learning

disabilities. 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.

People’s experience of using the service

People using the service benefitted from caring, dedicated staff. People living at Kanner were unable to verbally express their views to us but we observed they looked comfortable and at ease with staff. Relatives told us their family members were treated with kindness, compassion and respect.

People were placed at the heart of the service and involved in decisions as far as possible. People’s family, professionals and advocates told us people’s care was individualised.

People’s care was provided safely. The staff team were consistent, staff knew people well and supported them to move safely around the service if needed, and when they were out of the home.

People’s medicines were well managed.

People’s risks were known and managed well, promoting independence as far as possible. Positive behavioural support plans were in place for staff to follow to support their care of people.

People were protected from discrimination because staff knew how to safeguard people. Staff knowledge of people meant they were alert to signs of change which may indicate someone was not happy.

People lived in a service which had a positive culture and was led by a committed registered manager and staff team.

Kanner had worked hard to develop good relationships with local professionals supporting people’s care for example the local authority, commissioners and learning disability service.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (The last report was published 8 August 2018). At this inspection the overall rating had improved.

Why we inspected:

This was a planned inspection to look at improvements the service had made following the previous rating. At this inspection we found improvements had been made. People’s risks relating to their health needs and the environment were known and care planned. Incidents were recorded and monitored for any themes and to reduce the likelihood of a reoccurrence. The environment had improved for people and staff working at the service. Maintenance was on-going to promote safety. The leadership at the service was stable. Monitoring of the service to ensure the quality and safety of people was undertaken.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Inspection carried out on 2 July 2018

During an inspection to make sure that the improvements required had been made

We carried out an unannounced comprehensive inspection of this service on 26 and 27 February 2018. Breaches of legal requirements were found. We served a warning notice on the registered provider. Warning notices are part of our enforcement policy and tell the provider where they were not meeting their legal requirements. They told them they had put this right by 1 June 2018. This was because the systems in place to monitor the quality of the service were not effective. After this inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to the Regulation 17 breach in Well-Led.

We undertook this focused inspection on the 2 and 3 July 2018. We undertook this focused inspection to confirm that the provider now met the legal requirements of good governance (Regulation 17). The first day of the inspection was unannounced. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kanner Project on our website at www.cqc.org.uk.

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 five 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.

The registered manager had left in July 2017. A new manager had been appointed and was going through the Commission’s process to become the registered manager for Kanner Project.

At this inspection we found there had been improvement in establishing systems and processes to help ensure compliance with the regulations. These required time to embed.

Leadership and governance of the service had improved. The service was working collaboratively with the local authority improvement team, new audits were being implemented and the manager, regional manager and senior team were were monitoring the quality of service provision closely, through a service improvement plan. The registered manager had also started attending forums where best practice was discussed.

We could not improve the rating for Well-Led from the existing rating because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Inspection carried out on 26 February 2018

During a routine inspection

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

Inspection carried out on 10 October 2015

During a routine inspection

The inspection took place on 10 October 2015 and was unannounced. Kanner Project provides care and accommodation for up to five people with learning disabilities who displayed behaviour that could be perceived as challenging to others. 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.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. The registered manager is also the registered provider. Registered providers 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.

We met and spoke to people during our visit. People were not able to fully verbalise their views and used other methods of communication to tell us their views, for example by using pictures and symbols. We therefore spent time observing people for short periods.

During the inspection we observed people and staff relaxed in each other’s company and there was a calm atmosphere. A relative commented; “No one else could do a better job.” One staff said; “Enjoy being here and happy working here.”

A relative said they believed their relative was safe living in Kanner. All staff agreed that they felt people were safe living in the service. Staff knew people well and had the knowledge to be able to support people effectively.

Staff understood their role with regards to ensuring people’s human rights and legal rights were respected. For example, the Mental Capacity Act (2005) (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) were understood by staff. Staff had undertaken safeguarding training and had a good knowledge of what constituted abuse and how to report any concerns. Staff described what action they would take to protect people against harm and were confident any incidents or allegations would be fully investigated.

People’s medicines were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received appropriate training and understood the importance of safe administration and management of medicines. People were supported to maintain good health through regular access to health and social care professionals, such as GPs and dentists. People were supported by Modus Care behavioural support teams. Staff acted on the information given to them by professionals to ensure people received the care they needed.

Care records were comprehensive and personalised to meet each person’s needs. Staff fully understood people’s individual complex behavioural needs and responded quickly when a person required assistance. People were involved as much as possible with how they liked to be supported. People were offered choice and their preferences were respected.

People needed a minimum of one to one staffing at all times, with some people requiring two or three to one staffing. Staff agreed there were always sufficient staff to meet this requirement. Staff had completed appropriate training and had the right skills and knowledge to meet people’s needs. New staff received an induction programme. People were protected by safe recruitment procedures.

People living in the service could be at high risk due to their individual needs and additional support was offered when needed. People’s risks were well managed and documented. People lived active lives and were supported to try a range of activities. Activities were discussed and planned with people’s interests in mind.

People enjoyed the meals provided and they had access to snacks and drinks at all times. People were involved in food shopping and preparing snacks and meals when possible.

People did not have full capacity to make all decisions for themselves, therefore staff made sure people had their legal rights protected and worked with others in their best interest. People’s safety and liberty were promoted.

Staff described the registered manager as being very supportive, very approachable and very hands on. Staff talked positively about their roles.

There were effective quality assurance systems in place. Any significant events were appropriately recorded, analysed and discussed at staff meetings. Evaluations of incidents were used to help make improvements and ensure positive progress was made in the delivery of care and support provided by the service. People met with staff on a one to one basis and staff knew people well and used this to recognise if people seemed upset. Feedback was sought from relatives, professionals and staff.

Inspection carried out on 15 February 2014

During a routine inspection

We met with five people who lived at Kanner Project, spoke with five staff and looked at people's care records and staff files.

We found that Kanner Project ensured the correct legal processes were followed where people did not have capacity to consent to aspects of their care and treatment. This ensured their human rights were protected and care and support provided was in people's best interests.

People's needs were assessed and their care planned according to their needs. Health and social care professionals and family where appropriate were involved in people's care.

People received a healthy, nutritious diet. Referrals to dieticians were made to support people to eat a well balanced diet when required.

Staff regularly had one to one meetings with their manager or a senior colleague and the staff team felt supported. Staff had access to an on-going training programme to support their professional development.

There was a complaints policy and process in place at Kanner Project. There had not been any complaints over the past twelve months for us to review.

Inspection carried out on 12 January 2013

During a routine inspection

We used a number of different methods to help us understand the experiences of people using the service because the people had complex needs which meant they were not able to tell us their experiences.

We met all four people who used the service and one relative. We spoke to six staff members on duty and checked the provider's records. We also spoke to the registered manager by telephone. We spoke to staff about the care given, looked at the care records of two people. We looked at other records pertaining to them and observed staff working with them for short periods.

Each person had their own living area, which included a lounge and bedroom with en-suite, separated from each other but each person was able to share the communal lounge and kitchen.

We saw that staff treated people with consideration and respect. For example, we observed staff knocking on doors; they supported people to meet with us, and introduced us to people living in the home. We observed that the staff responded to people with patience and understanding at all times.

We saw and heard staff speak to people in a way that demonstrated a good understanding of people's choices and preferences. They demonstrated a good understanding of what kinds of things might constitute abuse, and knew where they should go to report any suspicions they may have had.

One relative spoken with said, “They help us support X when we come for a visit”.

Reports under our old system of regulation (including those from before CQC was created)