Kanmore House

People’s experience of using this service:

People felt safe and were protected from the risk of harm. Risks to people had been identified and managed appropriately. Staff had received safeguarding training and were aware of the action they should take if they suspected abuse.

Safe recruitment practices were in place and there were enough staff to meet the needs of people. People received care from a consistent team of staff.

Where required, people were supported with their medicines by trained staff, however some improvements were required to ensure the safe management of medicines. We have made a recommendation about the safe management of medicines.

Staff received appropriate training, supervision and support to enable them to fulfil their role and responsibilities.

People were supported to have maximum choice and control of their lives. People were consulted over their care and support needs and were actively encouraged to make decisions for themselves.

People were happy with the support they received from staff. Staff were kind and caring and treated people with dignity and respect. People's independence was promoted and, where possible, they were encouraged to do as much as they could for themselves.

Care plans were person centred and contained information on people’s preferences and how they wished to be cared for. Care plans were regularly reviewed to ensure they reflected people’s up to date care needs.

Systems were in place to check the safety and monitor the quality of the service and drive continuous improvement.

Rating at last inspection: Requires Improvement (report published 11 June 2018).

Why we inspected: This was a scheduled inspection based on the previous rating.

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

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

Our last inspection of this service in June 2017 highlighted a number of concerns and we imposed conditions on the service that they could not take on new care support packages without prior application to the Care Quality Commission. The service was previously rated Inadequate overall and placed in special measures.

The provider wrote to us to inform us of the actions they had taken since to improve the service. Significant improvements had been made since our last inspection, such as improved recruitment process and managerial oversight over the running of the service. We also received monthly reports from the local authority to evidence sustained improvements by the service with the support of the local authority. In addition, the willingness of the service to work with the Local Authority to make necessary improvements were required. The rating overall is requires improvement because the provider will need to demonstrate that their quality assurance and safety processes are robust enough to sustain good quality care delivery over time and independently of external support, and once the service increases the number of people they support.

The service is required to 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.

Staff delivered support effectively and care was provided in a way that promoted people’s independence and wellbeing, whilst people’s safety was ensured. Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people’s individual needs to be met adequately. Trained staff dispensed medications and monitored people’s health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People’s rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks. People were supported to identify their own interests and pursue them with the assistance of staff. Person centred social activities took place within the service.

Systems were in place to make sure that people’s views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals. The service was assisted to run effectively by the use of quality monitoring audits carried out by the manager, which identified any improvements needed and actions were taken. A complaints procedure was in place and had been implemented appropriately by the manager.

The inspection was completed on 14, 15, 20, 21, 28 and 29 June 2017. At the time of the inspection there were 12 people who used the service.

A registered manager was in place at the time of the inspection. 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 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.

There was a lack of provider and managerial oversight of the service. Effective quality assurance checks were not in place to enable the provider to assess and monitor the service in line with regulatory requirements or to improve the quality and safety of the service. The provider’s arrangements were not robust as they had not recognised the issues we identified during our inspection. Improvements were required by the provider to ensure that all staff employed by the service received effective training.

Proper recruitment checks had not been completed on all staff before they commenced working at the service and processes had not been operated in line with the provider’s own policy and procedures. Suitable arrangements were not in place to ensure that newly employed staff received suitable training opportunities, robust induction, formal supervision and an annual appraisal of their overall performance.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service. Steps to ensure people’s and others’ health and safety were not always considered and risk assessments had not been developed for all areas of identified risk.

Although people told us that they were kept safe, staffing levels were not always suitable to meet people’s needs. People told us that there had been no missed calls and staff had been punctual with times they were expected at people’s homes. People received their medicines at the times they needed them although not all staff had undergone training to carry out this task.

People spoke positively about the way staff treated them and reported that they received appropriate care. Staff demonstrated a good knowledge and understanding of the people they cared for and supported. People told us that their personal care and support was provided in a way which maintained their privacy and dignity. Although we found that people’s care plans did not contain relevant and current information to guide staff on the most appropriate care people required to meet their needs.

You can see what actions we told the provider to take at the back of the full version of the report.