Kisharon Langdon - Golders Green

Kisharon Supported Living Services provides specialised care and support to adults from the Jewish community with learning disabilities and autism. People live in their own houses and flats in the community and in three 'supported living' settings, so that they can live on their own as independently as possible. Kisharon Supported Living Services provides person centred care with the aim for people to become part of the communities in which they live. During the day of our inspection 19 people received personal care in the three supported living settings in their own flat and seven people received the regulated activity in their own or shared flat.

People's care and housing are provided under separate contractual agreements. Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support.

Not everyone using Kisharon Supported Living receives a regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

People's potential was recognised and valued. There were many good examples of schemes in how to involve people who use the service in community-based activities, including work schemes, voluntary and paid, to include people who used the service in the community and support people to gain greater independence and feel less isolated.

Staff were motivated and had pride in their work. They talked about people in a way which demonstrated they wanted to support them as much as possible and provide the best standards of care possible for everyone. Each person in receipt of care had supportive relationships with the members of staff in the team that supported them, and this had a positive impact on their overall health and wellbeing. It was clear that staff and people had similar interests, and this added to their commonality and helped develop their relationships and understanding of each other.

People and their relatives told us that they felt safe while they received support from staff at Kisharon. Staff understood their responsibilities to protect people from abuse and avoidable harm and to remain safe. There were procedures in place to manage incidents and accidents. Risks associated with people's support had been assessed and reviewed. Where risks had been identified control, measures were in place to protect people's health and welfare. Checks had been completed on equipment that people used and the environment to ensure they were safe. There were enough staff to meet people's needs. People received support with their prescribed medicines from staff who had completed training in how to administer medicines safely. Guidance was available to staff on the safe handling of people's medicines.

People who were able were fully involved in reviewing their care needs and support. Staff received regular training, appraisals and competency checks to keep their knowledge and understanding of people's needs up to date. Staff felt supported and received regular supervision meetings. Staff demonstrated good understanding of people's needs and were confident within their individual roles. People told us staff were caring and how their wellbeing had improved from the support they have received. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were passionate and proud to work at the service and felt valued and motivated. An experienced registered manager was in place and understood the importance of monitoring the quality of the service and reviewing systems to identify any lessons learnt. The service regularly consulted with people, relatives and staff to capture their views about the service.

Not everyone using Kisharon Supported Living receives regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager. This 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 the last inspection of this service, in July 2014, the service was rated ‘Good’. At this inspection, the rating changed to ‘Requires Improvement’.

There was positive overall feedback from people using the service, relatives and community professionals. Everyone recommended the service.

The service ensured good standards of overall safety, in terms of safeguarding, risk management, medicines, staffing levels and infection control. Lessons were learnt when things went wrong, as conscientious reviews were undertaken and new systems were set up as needed.

However, we found recruitment checks of prospective staff were not always sufficiently comprehensive and timely, and signs of unsuitability were not always given due attention. The provider’s governance systems had not identified this safety risk. The service sent robust action plans following our visits to demonstrate improved systems and that an audit of all staff recruitment checks was occurring.

People’s potential was recognised and valued. There were many examples of how people using the service received individualised support that helped them develop skills and independence. This included for household tasks, community travel, and vocational and paid work. People were helped to follow their interests, both at home and in the community.

There was a thorough approach to planning and coordinating people’s moves into the service. The service worked collaboratively to find effective ways to deliver joined-up support to people. Arrangements fully reflected individual circumstances and preferences, so enabling positive and successful outcomes.

People were treated with kindness, respect and compassion, were listened to, and were given emotional support when needed. The service supported people to be understood, including through technology or equipment to assist with communication. Trusting relationships with staff and managers were developed, including through people having a say on who worked with them.

The service supported people to undertake culturally relevant activities and to be part of the local community. A rabbinical adviser was employed to lead the service on actively supporting people to follow the Jewish faith. People were able to maintain and develop relationships with family and friends, for example, through cultural celebrations.

Staff had the knowledge and skills needed for their support roles, and received appropriate developmental supervision. In some cases, staff received specific training to meet the needs of people they worked with.

There was good liaison with healthcare professionals where appropriate. People were supported to eat and drink enough, and there was some support to maintain a balanced diet. However, there were some inconsistent support for ongoing healthcare within one scheme which we brought to the attention of the management team.

There was some very individualised work in support of helping people to undertake mental capacity assessments, to help establish if they could consent to specific care decisions when this was in doubt. However, further work was needed to complete the process for some decisions.

The service supported people to express their views and be actively involved in making decisions about their care and support. There was an emphasis on listening and understanding people as a means of helping them to develop.

The service had a clear vision for high quality care, and promoted a positive and inclusive culture that achieved impressive outcomes for people. The provider’s overall holistic approach, such as through day centres and dedicated employment services, supported people to develop and enabled equal life opportunities.

Systems at the service enabled sustainability and supported continuous learning and improvement. Where feedback had identified service delivery concerns, there was recognition and engagement to address matters. There was also much emphasis on incorporating best practice into the service, particularly through partnership working with other agencies.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

'They've a good way with her,' one relative said, explaining how the service had helped their relative to develop as a person. We found that people's privacy, dignity and independence were respected, and people were supported to develop independent living skills.

The provider had an effective system to regularly assess and monitor the quality of service that people received, and to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

We found that the provider had appropriate recruitment processes, to ensure that staff working with people were of good character. However, we found that training arrangements were not suitable for ensuring that staff delivered care and support to people safely and to an appropriate standard. This was because many staff had not received training on emergency first aid, fire safety or food hygiene.

We also found that medication arrangements did not always protect people against the risks associated with the unsafe use and management of medicines.

People confirmed that staff were respectful to them and listened to them. Comments included, 'they speak nicely to me.' We found that the support provided to people promoted their independence and community involvement.

We found, however, that some staff had been working with people before written references in relation to previous care employment had been acquired. This meant the provider's recruitment systems put people at risk of receiving care from someone who may not be of good character.

We also found that most staff had not received appropriate supervision and appraisal meetings in support of their responsibilities to deliver care to people safely and to an appropriate standard.