Kazlum Support Limited in Crediton, Devon has seen its overall rating drop from good to requires improvement, following an inspection by the Care Quality Commission (CQC) in February.
Kazlum Support is a supported living service which provides personal care to people living in their own houses and flats, and to people living in a supported living setting, so they can live as independently as possible. At the time of the inspection the service was providing personal care to 13 people. CQC does not regulate premises used for supported living.
CQC carried out an unannounced focused inspection to look at how safe, effective and well-led the service was, after receiving information of concern about a potential closed culture within the management of the service and allegations of abuse.
Following the inspection, the service was rated requires improvement overall and requires improvement for being safe, effective and well-led. Caring and responsive were not rated on this occasion. Previously it was rated good overall and good for all five key questions.
Amanda Stride, CQC’s head of adult social care inspection, said:
“When we inspected Kazlum Support Limited, we were concerned the service wasn’t encouraging people to be independent as possible and supporting them to develop and flourish by giving them choices and control over their own lives.
“Although staff understood how to protect people from poor care and abuse, they didn’t recognise their own behaviour could be abusive. Instead, staff decided they knew what was best for people and imposed restrictions on them, stopping them from spending their money on things, or from eating certain things, and limiting when they could use technology. Yet no assessments had taken place to determine whether this was in people’s best interests.
"Rather than supporting and encouraging people to live independently, staff were punishing them by withholding ‘treats’ - things people had bought with their own money - and making them apologise for behaviour staff felt was unacceptable. One person apologised for ignoring staff but was told sorry doesn’t mean anything and they would still lose a treat. In addition, people weren’t allowed to spend their day doing what they wanted, instead staff made them do tasks and follow house rules even when staff knew they preferred to do other things.
“When we pointed out staff were using outdated and degrading practices and institutionalised language when speaking to people, managers were defensive. The manager told us they’d reviewed all incident records, yet they hadn’t picked up on the fact staff were punishing people instead of encouraging them and hadn’t recognised this was abuse.
“The registered manager had little involvement in the day to day running of the service and staff said it could be difficult to raise concerns, as the managers were friends, which could make them feel like an outsider. All of this is indicative of a closed culture, which is when institutionalised practices are used and increase people’s dependence on the manager and staff.
“Following the inspection, we told the provider to make a number of improvements to ensure people receive safe care. We will continue to monitor the service to ensure that improvements are made and fully embedded.”
CQC found the following during this inspection:
- Leaders, and the culture they created, did not always support the delivery of high-quality, person-centred care. Governance processes were ineffective and did not hold staff to account, keep people safe, protect their rights or ensure good quality care and support. There were no audit and improvement tools in place, which impacted on people achieving good outcomes
- The provider, registered manager and manager were not alert to the culture of the service; the culture did not ensure staff truly valued and promoted people's individuality, protected their rights and enabled them to develop and flourish
- Although staff knew people well and communicated with them in ways that met their needs, people's support plans did not always contain enough information to enable staff to support them in a person-centred way
- The care and support model did not always maximise people's choice, control and independence and staff were not always supporting people in the least restrictive way possible and in their best interests. Written records indicated a culture which lacked respect for people, and indicated staff felt they knew what was best for the person and imposed that upon them
- Systems did not identify where people may have experienced abuse or been put at risk of harm, and it not been identified that some people had been subject to degrading treatment
- People’s care was not always delivered in line with standards, guidance and the law, and there were no clear pathways to future goals and aspirations in people's support plans, including teaching them skills
- People's rights under the Mental Health Act were not being protected. The service was managing people's finances on their behalf without the legal authority to do so
- People were subject to daily restrictions such as limited use of technology, restrictions on what they could spend their money on and restrictions around food. No mental capacity assessments had been completed in relation to these decisions
- The provider did not complete any formal quality checks and notifications weren’t always submitted to CQC
- The provider carried out an annual quality assurance exercise to gain feedback from people and their families with the aim of identifying areas for improvement. The most recent surveys were completed in 2021, however, no report of the findings was produced, and no action plan was developed as a result of the feedback.
However:
- Risks to people's safety were identified and assessed and people were supported to access the community safely. People's risk assessments were clear and up to date
- Support plans reflected a good understanding of people's physical health needs and included relevant information of people's communication support needs and contained good information about people's likes and dislikes
- Staff supported people to eat and drink enough to maintain a balanced diet and involved people in choosing their food and preparing and cooking their meals. People were supported to live active, healthy lives and take part in a range of activities, including physical exercise
- Systems were in place to ensure staff were recruited safely
- Appropriate measures were in place to reduce the spread of infection.
Full details of the inspection are given in the report published on our website.
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