14 February 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’
This inspection took place on 24 and 25 October 2018 and was announced.
We gave the service 48 hours’ notice of the inspection visit because it is a supported living service and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.
This inspection was carried by one adult social care inspector and two experts by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses supported living services.
Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. In addition, we reviewed information that we held about the service, including statutory notifications, serious incidents and safeguarding information that the provider had notified us of within the last 12 months. We contacted the commissioners of the service, local authority and visiting clinicians, to obtain their views about the care and support delivered by the service. We used the information that they provided us with to inform the planning of our inspection.
During our inspection we visited two supported living schemes and spoke with eight people who were supported by the service, seven relatives, four members of staff, two supported living managers, the registered manager and the day opportunities manager. We observed the care and support during visits to supported living schemes and we reviewed a range of records related to people's care and the management of the service. This included looking at four people's care records Including financial records), four staff files (including recruitment, training and induction records), four people's medication administration records and other company-based records related to quality assurance and the general operation of the service.
We gathered further feedback about the service from three healthcare professionals who worked closely with the service. We reviewed all the information that we gathered prior to, during and after our inspection, and used this information to form the basis of our judgements and this report.
14 February 2019
This inspection was announced and took place on the 24th and 25th October 2018. During our last inspection in November 2017 we found the provider to be in breach with Regulation19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Fit and proper persons employed. We found that the recruitment checks of prospective staff were not always sufficiently comprehensive and timely. This meant that people who used the service could not be confident that staff employed were suitable and safe to support them. The service sent us an action plan in January 2018 and told us that they had taken appropriate actions to address the breach and ensure that on all staff working with people who used the service had appropriate recruitment checks. During our inspection we found that the provider had taken the necessary steps to ensure safe recruitment practices were followed and all required recruitment checks were carried out prior to offering employment.
Kisharon Supported Living Services provides specialised care and support to adults from the Jewish community with learning disabilities and autism. People live in their own houses and flats in the community and in three 'supported living' settings, so that they can live on their own as independently as possible. Kisharon Supported Living Services provides person centred care with the aim for people to become part of the communities in which they live. During the day of our inspection 19 people received personal care in the three supported living settings in their own flat and seven people received the regulated activity in their own or shared flat.
People's care and housing are provided under separate contractual agreements. Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support.
Not everyone using Kisharon Supported Living receives a regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
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.
The service had a registered manager. 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.
People's potential was recognised and valued. There were many good examples of schemes in how to involve people who use the service in community-based activities, including work schemes, voluntary and paid, to include people who used the service in the community and support people to gain greater independence and feel less isolated.
Staff were motivated and had pride in their work. They talked about people in a way which demonstrated they wanted to support them as much as possible and provide the best standards of care possible for everyone. Each person in receipt of care had supportive relationships with the members of staff in the team that supported them, and this had a positive impact on their overall health and wellbeing. It was clear that staff and people had similar interests, and this added to their commonality and helped develop their relationships and understanding of each other.
People and their relatives told us that they felt safe while they received support from staff at Kisharon. Staff understood their responsibilities to protect people from abuse and avoidable harm and to remain safe. There were procedures in place to manage incidents and accidents. Risks associated with people's support had been assessed and reviewed. Where risks had been identified control, measures were in place to protect people's health and welfare. Checks had been completed on equipment that people used and the environment to ensure they were safe. There were enough staff to meet people's needs. People received support with their prescribed medicines from staff who had completed training in how to administer medicines safely. Guidance was available to staff on the safe handling of people's medicines.
People who were able were fully involved in reviewing their care needs and support. Staff received regular training, appraisals and competency checks to keep their knowledge and understanding of people's needs up to date. Staff felt supported and received regular supervision meetings. Staff demonstrated good understanding of people's needs and were confident within their individual roles. People told us staff were caring and how their wellbeing had improved from the support they have received. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Staff were passionate and proud to work at the service and felt valued and motivated. An experienced registered manager was in place and understood the importance of monitoring the quality of the service and reviewing systems to identify any lessons learnt. The service regularly consulted with people, relatives and staff to capture their views about the service.