Archived: Krinvest Head Office

Krinvest Head Office was previously inspected in March 2018. During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to: staffing; fit and proper persons employed; safeguarding service users from abuse and improper treatment; safe care and treatment; receiving and acting on complaints and governance arrangements. We also found that an offence had been committed under the Care Quality Commission (Registration) Regulations 2009 as the registered person had not notified the Commission of incidents or allegations of abuse.

Following the last inspection, the registered provider was placed into special measures by CQC. The registered provider was asked to complete an action plan to confirm what they would do and by when to improve the five key questions we ask. They are: is the service safe, effective, caring, responsive and well led.

At this inspection we found that the registered provider had taken action to address the breaches identified at the last inspection and made enough improvements to be taken out of special measures.

Krinvest Head Office provides care and support to people living in supported living settings, so that people can live in their own home and reach greater autonomy, social integration and independence.

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.

At the time of the inspection, the service was providing the regulated activity of personal care to six people with complex mental health and social care needs who were living in their own homes in Warrington and Liverpool. The service is provided by Krinvest Limited and coordinated from an office in Warrington.

The service did not have 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.

Since our last inspection, the registered provider had appointed a new manager for the service who had applied to register as the manager of Krinvest Head Office with the Care Quality Commission. During the second day of our inspection we noted that the manager attended a site visit from a registration inspector employed by CQC. We received confirmation on the same day that that the new manager’s application had been approved and that they would be registered as the manager of the service in due course.

We found that people's needs had been assessed and planned for. Records contained information on the holistic needs of people using the service, their care and support plans, risk assessments and crisis management plans.

Support plans and supporting documentation had been audited, updated and reviewed to ensure they contained personalised information about people’s needs, their short and long-term goals and the required interventions by staff. This information helped staff to be aware of how to provide effective support and keep people safe.

People told us that they received care and support from staff and other health and social care professionals who treated them with dignity and respect and were responsive to their needs.

People were encouraged to maintain a healthy diet subject to people’s individual choice and preferences. Likewise, people were supported to access routine health care appointments when required.

We found that staff responsible for administering medication had been provided with medication training so that they understood how to support people to manage their medication safely. We identified that further action was needed in regard to checking the information recorded on medicines administration charts (MAR) and the development of risk assessment processes for people who may chose to self-administer their medication.

Upon completion of our inspection, the manager provided us with evidence to confirm that a risk assessment had been completed for a person who managed their own medication. Furthermore, we received confirmation that a system had been introduced to check and counter check the information recorded on MAR was correct. This practice helps to safeguard the health and wellbeing of people using the service.

Staff recruitment records and systems had been reviewed to ensure staff were appropriately recruited and suitable to work with vulnerable people. A programme of staff training and development had also been established which was subject to ongoing review and development. Staff also benefitted from regular supervision and support from the manager.

The registered provider had developed a policy and obtained guidance for staff relating to the Mental Capacity Act 2005. Staff had completed training in this topic and understood the importance of this protective legislation.

An accessible complaints procedure had been developed and people had been provided with a copy of the complaints procedure for reference. People told us that they knew how to complain in the event they needed to raise a concern.

Safeguarding policies and procedures were in place and systems had been developed to ensure oversight of any safeguarding incidents, action taken, lessons learned and outcomes. Records confirmed that any safeguarding incidents were managed correctly and reported to the local authority's safeguarding team in accordance with local policies and procedures.

A comprehensive range of management information and quality assurance systems had been developed to enable improved oversight and scrutiny of the service. This involved seeking the views of people who use the service and staff.

Following completion of the service user survey, a summary report was produced which indicated that four people (65%) had completed a survey. All participants reported that they were happy with staff and that staff arrived on time and stayed for as long as they should or were needed for. Areas for development included activities, involvement in writing care plan and risk assessments, contact with the office and engagement with management. An action plan was included within the summary report and this provided details of action the provider proposed to take to improve the experience of people supported by the supported living service.

The registered provider had notified the Care Quality Commission of reportable events and incidents in the service in accordance with statutory requirements.

This service has been in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

This was the first inspection of Krinvest Head Office since the service was registered in January 2017.

This service provides care and support to people with complex mental health and social care needs living in eight ‘supported living’ settings, so that people 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.

At the time of our inspection, the service was providing ‘personal care’ to nine people who were living in their own homes in Knowsley, Halton and Warrington.

The service is provided by Krinvest Limited and coordinated from an office in Warrington.

The service did not have 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 Chief Executive Officer and the Business Development Director (referred to collectively in this report as the Senior Management Team) had taken over the interim management of the service in the absence of a registered manager and a deputy manager for the service.

Prior to our inspection the Commission received information of concern from whistle-blowers who raised concerns regarding the operation of the service.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to: staffing; fit and proper persons employed; safeguarding service users from abuse and improper treatment; safe care and treatment; receiving and acting on complaints and governance arrangements. We also found that an offence had been committed under the Care Quality Commission (Registration) Regulations 2009 as the registered person had not notified the Commission of incidents or allegations of abuse.

We identified that there had been no proper scrutiny or monitoring of the service by the provider which had led to significant failings within the service.

There had also been inappropriate admissions into the service and people did not always receive a reliable person-centred service that was responsive to their needs.

Recruitment practices were not safe as staff had not always undergone the necessary checks required prior to commencing employment. Furthermore, staff had not been appropriately inducted, trained and supervised to undertake their roles and responsibilities. This placed the welfare of people using at risk.

Records relating to the people using the service had not always been accessible to staff and were in need of development and review - to ensure staff had access to up-to-date and accurate information on the people they cared for.

Systems to safeguard people from abuse, to notify CQC of reportable incidents and to respond to concerns and complaints were ineffective and not robust.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.