Archived: Kadima Support UK Limited No 333

Updated 22 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the registered provider was 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.

The inspection took place on the 22 and 23 October 2015. The inspection was unannounced on the first day and we told people who used the service and the staff team that we would be coming back on the second day.

The inspection team consisted of an inspector and a specialist professional advisor, who was a registered mental health nurse.

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.

Prior to the inspection we reviewed information contained in the PIR along with other information we held about the home. This included notifications of significant incidents reported to CQC.

We spoke with three people who used the service, three support staff and the registered manager. We spoke with one relative during the inspection and the relatives of three people after the inspection. We observed the support and care provided to people in the communal areas and looked around the premises. One person showed us their bedroom.

We reviewed three care plans and the accompanying risk assessments. We also looked at a variety of documents including the safeguarding policy and procedure, the whistle blowing policy, medicine administration record (MAR) sheets, four staff records, health and safety records, and quality assurance audits.

We contacted health and social care professionals with knowledge of this service in order to find out their views about the quality of the service. We received feedback from eight professionals and used this shared information to assist our inspection.

Updated 22 December 2015

The inspection took place on the 22 and 23 October 2015. This was the first inspection of the service since it registered with the Care Quality Commission on 17 October 2014, having been previously owned and managed by a different provider. Kadima Support UK Limited No.333 is registered to provide care and accommodation for up to 10 people with mental health problems. At the time of the inspection one person was in hospital and there were two vacancies. All of the people using the service were male.

The premises had 10 single occupancy bedrooms which provided en-suite facilities. There was a communal sitting room and dining room, kitchen, bathrooms and shower rooms. The rear garden included an in-door meeting room with gym equipment.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were not in place to audit the rigorousness of staff recruitment, including the recruitment undertaken by the previous provider. There were sufficient numbers of staff rostered on each shift to meet people’s identified health and social care needs.

People told us they felt safe living at the service. Staff had received safeguarding training and there were policies and procedures in place to protect people from the risk of abuse or harm. Staff understood the signs of abuse and knew how to report any concerns about people’s safety and welfare.

Care plans included regularly reviewed risk assessments, which provided information about how to uphold people’s safety while supporting their wishes to make their own choices and decisions, and be as independent as possible.

People were supported to take their medicines as prescribed and arrangements were in place for the safe management of medicines.

Suitable checks were conducted to ensure that the premises were safely maintained. People were provided with a spacious, clean and comfortable home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. Procedures and guidance were in place in relation to MCA and staff understood their legal responsibilities.

Staff received appropriate mandatory training, for example food hygiene and fire safety, as well as other training about how to meet the specific social, physical health and mental health needs of people who used the service. There was an annual appraisal system in place and regular formal supervision was provided, although some supervision sessions were not held as one-to-one meetings.

People were supported to experience a balanced diet and were encouraged to participate in menu planning and food preparation. Beverages, snacks and fruit could be accessed as required.

Staff were well informed about people’s medical and health care needs, and how to support people to meet these needs. People told us they always received the level of support they needed to meet their health care needs, for example, staff attended appointments with them to provide emotional support if requested or provided assistance to follow-up guidance from a healthcare professional.

People told us that staff were supportive, caring and kind, and treated them with dignity and respect. We observed positive interactions between people and staff throughout the inspection, for example staff asked people if they had enjoyed their outing if they had been to a club, sports activity or café.

People were provided with opportunities to take part in activities which interested them. These activities were diverse and included art groups, bingo, visiting relatives and friends, monthly meals out with staff, shopping trips and sports.

People’s needs were identified in their care plans and were regularly reviewed by their allocated member of staff known as a key worker, and the registered manager. People’s health care and social care needs were also reviewed in their meetings with health and social care professionals. People were involved in planning their care and relatives told us they were invited to contribute to care planning meetings and reviews, in accordance with the wishes of their family member.

The complaints policy was given to people and their relatives, and displayed at the premises. People and their relatives confirmed they knew how to make a complaint and expressed their trust in the registered manager’s ability to conduct a thorough and fair investigation.

People and their relatives told us the service was well managed. We also received complimentary remarks about the management of the service from health and social care providers, who told us the registered manager was knowledgeable and committed to the people who used the service. The provider had notified CQC about significant events including safeguarding concerns, incidents and injuries in a timely way.

We have made one recommendation for the provider to audit the quality of recruitment conducted by the previous provider.