Kazlum Support Ltd

About the service

Kazlum Support Limited is a supported living service providing personal care to 12 people at the time of the inspection. Support is provided to people with learning disabilities and autistic people living in their own houses and flats.

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

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

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 supported this practice.

People lived safely and free from unwarranted restrictions because the service assessed, monitored, and managed safety well. There were comprehensive risk assessments in place covering all aspects of the service and support provided.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so. People were not always able to comment on their safety. However, their body language while interacting with staff was relaxed and positive, which indicated they felt safe.

Medicines were managed safely. Infection control measures were in place. Health and social care professionals were regularly involved in people's care to ensure they received the care and treatment which was right for them.

There were effective staff recruitment and selection processes in place.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Staff provided care that was kind and compassionate. They were supported to reflect on their practice, to ensure it was person centred, and promoted people’s dignity and independence. With the support of a specialist in positive behavioural support (PBS) there were improved outcomes for people through more positive interactions with staff, and increased engagement in activities and the community.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

Governance processes were effective. They helped to hold staff to account, keep people safe, protect their rights and ensure good quality care and support.

People's equality, diversity and human rights were respected. The service worked hard to instil a culture of care in which staff truly valued and promoted people's individuality, protected their rights and enabled them to develop and flourish. Overall staff felt supported and valued by the management team promoting a positive and improvement-driven culture

People were supported by staff who had received relevant and good quality training. This included training in the wide range of strengths and issues people with a learning disability and or autistic people may have, mental health needs, communication tools and positive behaviour support.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 July 2022) At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focussed inspection of this service on 17 and 21 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person centred care; consent; safeguarding and governance.

We undertook this focused inspection to follow up on action we told the provider to take at the last inspection and confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kazlum Support Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kazlum Support Limited is a supported living service providing personal care to 12 people at the time of the inspection. It provides personal care to people living in their own houses and flats, and to people living in a 'supported living' setting, so they can live as independently as possible. People's care and housing are provided under separate contractual arrangements. The CQC does not regulate premises used for supported living; this inspection looked at people's care and support. Not everyone using the service received a regulated activity; CQC only inspects the service being received by people who are provided with the regulated activity of 'personal care', for example which includes help with tasks such as personal hygiene and eating. Where they do, we also take into account any wider social care provided.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

The supported living settings were near to the centre of towns and had access to the local community and amenities. Staff supported people to make choices about their daily lives and engage in activities, however, staff were not always supporting people in the least restrictive way possible and in their best interests. This meant the care and support model did not always maximise people's choice, control and independence.

People were supported by enough staff who knew them well, and staff communicated with people in ways that met their needs. People’s risk assessments were clear and up to date, however, people’s support plans did not always contain enough information to enable staff to support them in a person-centred way.

Right Care

Staff understood how to protect people from poor care and abuse but did not always recognise where their practice might be abusive or restrict people’s rights. People’s positive behaviour support plans did not always contain sufficient detailed information which led to staff sometimes working with people in inconsistent ways. People could take part in activities, pursue interests and live active lives. Staff and people cooperated to assess risks people might face.

Right Culture

The Provider, Registered Manager and manager were not alert to the culture of the service; the culture did not ensure staff truly valued and promoted people’s individuality, protected their rights and enabled them to develop and flourish. Management were defensive of practice which we highlighted as poor and outdated. Written records indicated a culture which lacked respect for people and indicated staff felt they knew what was best for the person and imposed that upon them. Concerns had been raised in advance of our inspection about a potential closed culture within the management of the service. Most staff told us they felt managers were open and approachable, however, some comments did indicate some elements of a closed culture.

The failure to meet the underpinning principles of Right support, right care, right culture, meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

Systems were not operated effectively to identify where people may have experienced abuse or been put at risk of harm, and it not been identified that some people had been subject to degrading treatment.

People were subject to daily restrictions such as limited use of technology, restrictions on what they could spend their money on and restrictions around food. No mental capacity assessments had been completed in relation to these decisions. People’s support plans referred to staff making decisions and taking action in people’s best interest, however, no mental capacity assessments or best interest decisions had been completed.

Peoples care was not always delivered in line with standards, guidance and the law and there were no clear pathways to future goals and aspirations, including skills teaching in people’s support plans. Staff completed regular training.

Governance processes were ineffective and did not hold staff to account, keep people safe, protect their rights or ensure good quality care and support. There were no audit and improvement tools in place, which impacted on people achieving good outcomes. The service did not always act on the duty of candour appropriately.

Where the service did identify an allegation of abuse, referrals to the Local Authority safeguarding team were made and investigations carried out. Risks to people’s safety were identified and assessed and people were supported to access the community safely. Systems were in place to ensure staff were recruited safely. Appropriate measures were in place to reduce the spread of infection.

Following our inspection, we made nine safeguarding referrals to the Local Authority that had not been identified by the service to ensure people were safely protected from harm.

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

Why we inspected

The inspection was prompted in part due to concerns received about the management and leadership within the service and the management of allegations of abuse. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Kazlum Support Ltd on our website at www.cqc.org.uk.

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 regulation in relation to safeguarding people from abuse, consent, person centred care and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

At the last inspection completed in August 2015 and Sept, the service was rated Good, although we found a breach of Regulation 11 of the Health and Social Care Act (2008) Regulations 2014. This was because the service was not operating within the requirements of the Mental Capacity Act (2005).

At this inspection, we found the service had addressed this and was now meeting all the regulations.

This announced inspection took place on 27 and 28 September 2017. The provider was given short notice because the location provides a domiciliary care service and we needed to be sure that someone would be in. We found the service was good in all domains.

Why the service was rated as good.

People looked calm and relaxed with staff who understood their needs and ways of communicating. Staff interacted positively with people and helped them engage in activities which they enjoyed and were meaningful to them.

There were sufficient staff to meet people’s needs. Staff had been recruited safely and were well trained and supported to do their job effectively. The management team valued staffs’ experience and ideas. Staff were encouraged to continue on-going learning through national qualifications and training to meet individual’s needs.

Care records were complete and up-to-date. They provided detailed information about people’s risks, needs and preferences. They also described how these should be met in care plans. Care plans were reviewed regularly and staff were able to describe how they worked with them. The person and their family were involved in developing the care plans. Medicines were stored, administered and recorded safely.

People’s relatives were confident and complimentary about the care provided. They said their views would be listened to and actioned if they had concerns or complaints, although they had not had to make one.

The service was well led by a registered manager/provider who had outlined the aims and objectives of the organisation. This included providing care which put the person at the centre, involved family and worked in a culture of openness and transparency. Staff felt they worked well as a team and described it as caring.