About the service:

Kalm Care provides care and support to people with mental health needs living. This service provides care and support to nine people living in three ‘supported living’ settings. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. Only two people living in the supported living schemes received support regulated by the Care Quality Commission. However, three people wanted to speak to us as part of the inspection. This inspection looked at people’s personal care and support if they were provided with a regulated activity.

People’s experience of using this service:

• People told us they felt safe, they liked living at the service and staff were kind to them.

• People told us they were treated with dignity and respect and received support in a way that suited them.

• Staff were competent to meet people’s needs and supported people in a person centred way.

• People told us they thought the service was well-led as did health and social care professionals, and we found this to be the case.

• The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection: The last inspection took place on 23 January 2018 and was rated ‘Requires Improvement’. There were three breaches of the regulations relating to safe care and treatment, recruitment and the failure to notify CQC of significant events. The report was published on 9 April 2018.

Why we inspected: The inspection took place as part of a schedule of planned inspections based on previous rating.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This inspection took place on 23 January 2018, and was unannounced. This was the first inspection of this service since they started to provide regulated activities in January 2017.

Kalm Care Ltd provides care and support to people with mental health needs living in two houses so that they can live 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. This was the first inspection of this service.

On the day of the inspection there were seven people living at the service across the two houses.

The service had a registered manager, which 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 told us they liked living at the service and mental health professionals were positive about the service offered to people they placed there. Although staff understood about the types of abuse that can occur, the registered manager acknowledged the service needed to be more proactive when incidents took place between people living at the service and consider that there may be safeguarding concerns.

There were gaps in the risk assessment process. Although there were some risk assessments in place for people, some lacked sufficient detail to provide guidance to staff in managing people’s risks. For some areas of risk there were no risk assessments in place at all to guide staff. Subsequent to the inspection the registered manager updated risk assessments to provide detail and put in place new risk assessments to fill the gaps.

The registered manager had reviewed medicines management prior to the inspection and identified some issues. Medicines management had improved by the time of the inspection but there were still some issues we identified with recording on medicine administration records, issues which had been identified earlier by the registered manager but still remained.

We identified issues with recruitment as up to date criminal checks were not in place at the time of the service being registered with CQC, although these had been obtained by the time of the inspection. We were not confident all checks had been undertaken to ensure staff had the right to work in the UK.

Staff received regular supervision and training and told us the registered manager was supportive. Mental health professionals told us staff and the registered manager had the skills and knowledge to carry out their roles.

People’s needs were identified and responded to well. The service was effective at working in co-operation with other organisations to deliver care and support. This included where people’s needs had changed, and where people needed ongoing healthcare support.

Care records were up to date and were reviewed annually and more often when people’s needs changed. There were quality audits in place and the registered manager was in the process of introducing more audits in line with the provider policy. The registered manager told us they were formalising new systems as part of the move to being a regulated service and they were not all in place as yet. The registered manager was keen to learn from incidents that took place and we could see evidence of this.

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 at the service supported this practice. Staff understood the importance of consent and people were supported to be as independent as possible. People signed their care records and were involved in planning their care.

We found the provider was in breach of three fundamental standards. These relat