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Inspection carried out on 20 November 2019

During a routine inspection

About the service

Vijaykoomar Kowlessur (also known as Shenley Lodge DCA) is a supported living service providing personal care to five people with learning difficulties and mental health conditions. The service was operating in one supported living unit which was a terraced house which could accommodate up to five people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Improvements had been made to how staff were recruited with all required pre-employment checks now in place.

There was a system in place for auditing and monitoring the quality of the service. We received positive feedback about the registered manager and the way the service was run.

Staff received an appropriate range of induction and training to undertake their role.

Peoples health needs were supported, and staff alerted and involved relevant health professionals when necessary.

Medicines were managed safely.

People were provided with a varied menu that met their dietary needs and preferences.

Staff were kind and caring towards people. They respected people's dignity and privacy. People were encouraged to be independent.

Care plans and risk assessments were detailed and provided staff with information about people's individual support needs and guided staff in how they should deliver support safely.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 24 October 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 30 August 2018

During a routine inspection

This inspection took place on 30 August 2018 and inspection was announced.

At our previous inspection of this service on 22 and 23 May 2017, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the safe management of medicines. Due to the seriousness of the concerns, found we issued a warning notice to the provider and registered manager on 19 June 2017, requiring compliance with the Regulation by 5 July 2017. On 28 July 2017, we carried out a focused inspection to check if the provider had made the necessary improvements to how the service ensured medicines were safely managed. At this inspection, we found that medicines were safely managed and improvements made following the May 2017 inspection had been embedded and sustained.

Vijaykoomar Kowlessur provides care and support to five people living in one ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

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.

The provider did not always ensure robust recruitment practices were in place. References obtained did not always correspond with the staff member’s employment history and one staff member was employed prior to completion of required checks.

Staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Risks associated with people's care had been appropriately assessed. Staff had been given guidance on how to keep people safe in a person-centred way.

Medicines were managed safely and effectively and there were regular medicine audits in place. Staff had completed medication training.

There were sufficient staff available to ensure people received person centred care both at the service and in the community.

Staff received training to enable them to carry out their role. Staff received regular supervisions and an annual appraisal. Staff told us they felt supported in their role.

People were supported to have a balanced diet. People were consulted about menu choices.

All staff had received training on the Mental Capacity Act (2005) and staff understood what to do if they had concerns around people's mental capacity.

People are supported to maintain good health and have access to healthcare services. Referrals were made quickly when concerns were noted about people's health.

A complaints procedure was in place which was displayed. There was an incident and accident procedure in place which staff knew and understood.

There was evidence of audits for medicines and overall compliance. Issues identified were actioned promptly.

The registered manager was accessible to people and staff who spoke positively about them and felt confident about raising concerns.

We identified a breach of regulation relating to safe recruitment of staff. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 28 July 2017

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

At our previous inspection of this service on 22 and 23 May 2017, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the safe management of medicines. Due to the seriousness of the concerns found we issued a warning notice to the provider and registered manager on 19 June 2017, requiring compliance with the Regulation by 5 July 2017.

In addition, we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as a result of poor management oversight of medicines management and ineffective auditing processes. For this breach, we issued a requirement notice requesting that the registered provider submit an action plan to address the concerns. The action plan was submitted on 19 July 2017. On this inspection, we checked whether the registered manager and provider had completed the actions as identified on the action plan.

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 Vijaykoomar Kowlessur on our website at www.cqc.org.uk

A registered manager was 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.

At this inspection we found that significant improvements had been made to how the service ensured safe medicines management. We found that medicines stocks balanced with what medicines administration records (MARs) stated and medicines were stored safely and securely. With the exception of one administration of medicine, we saw that the administration of medicines was documented appropriately.

Measures were now in place to ensure that stock balances of ‘as required’ medicines were recorded accurately which was regularly checked by the registered manager as part of the auditing process in place.

The service had met the requirements and regulation identified in the warning notice.

Inspection carried out on 22 May 2017

During a routine inspection

This unannounced inspection took place on 22 and 23 May 2017. The inspection was carried out by two inspectors. This was the first inspection of the service since it registered with CQC in July 2016.

Vijaykoomar Kowlessur offers supported living services to people with learning disabilities. On the day of the inspection the service supported five men living in a single supported living location in Enfield, North London.

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.

Medicines were not being managed safely. We found that there were quantities of ‘as needed’ medicines that were unaccounted for. We found that some medicines were not being stored and disposed of safely. People's Medicine Administration Records (MAR's) were not always completed in full or accurately.

There were measures in place to monitor quality and safety of care. However, the audit systems in place at the service were ineffective, as they did not identify the significant concerns with medicines management which were found during the inspection.

All staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood what to do if they had concerns as regards people's mental capacity.

Detailed current risk assessments were in place for people using the service. Risk assessments in place were reviewed and updated regularly. The risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service.

Care plans were person centred and reflected what was important to the person. Care needs were regularly reviewed and updated to meet the changing needs of people who use the service.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff were also safely recruited with necessary pre-employment checks carried out. Staff had regular supervisions and annual appraisals.

People were supported to maintain good health and had access to healthcare services.

People were encouraged and supported to access the community and engage in a wide range of activities.

At this inspection we identified a breach of Regulations 12 and 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management and good governance. You can see what action we told the provider to take at the back of the full version of the report.