About the service: Koinonia Christian Care is a 'care home'. The home accommodates up to 39 older people with dementia or physical frailty across five adapted buildings. At the time of the inspection there were 39 people living in the home.

What life is like for people using this service:

•The provider lacked effective governance systems to identify concerns in the service and drive the necessary improvement. At times, there was a lack of clear and accurate records regarding people’s medicines, support and any potential risks posed to them. Accidents and incidents were not analysed sufficiently to ensure risks were reduced for people.

•The provider had not followed legislation that required them to act in an open and transparent way when people came to harm.

•Best practice guidance was not utilised in providing an environment that promoted the well-being of people who lived with dementia and we have made a recommendation about this.

•Despite this, people were happy living at Koinonia Christian Care and people told us they felt safe. People were supported by staff who were kind, caring and who mostly understood their likes, dislikes and preferences. People were positive about the activities on offer and people’s religious needs were met. People were cared for by staff who were well supported and received regular supervision to meet people's needs effectively.

•People and their relatives knew the registered manager and felt able to speak to them if they had any concerns. The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

Rating at last inspection: Good (Report published 13 August 2016)

Why we inspected: This was a planned inspection based on our last rating. At the last inspection the provider was rated as Good.

Follow up: The service has been rated as Requires Improvement and three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We will request an action plan from the registered provider about how they plan to improve the rating to good. In addition, we will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

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

The inspection took place on 30 June 2015 and 1 July 2016 and was unannounced.

Koinonia Christian Care is a care home without nursing that is registered to provide care and accommodation for 39 older adults. The home has a Christian ethos and people choose to live at Koinonia Christian Care for that reason. At the time of our visit there were 38 people living at the home. Some of the people in residence were living with dementia. The building consisted of five large Victorian terraced houses combined into one building. One of the houses was specifically designated for people living with dementia.

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.

We had previously carried out an inspection of Koinonia on 30 September and & 2 October 2015. At this inspection we found that the provider had met previous breaches of regulation and had met the warning notices issued, however we found additional breaches of regulations. At this most recent inspection we found that the provider had met these breaches of regulation.

Improvements had been made in recording information and ensuring that audits of practice had clear actions recorded and dates for completing these actions. We could see when actions had been completed and what was outstanding. Systems were in place to audit records so that if there were gaps these were identified and records were completed. The provider had a new electronic database for recording all information relating to people’s care which the registered manager told us had supported them and the team to organise and keep people’s records up to date. Risk assessments had been completed accurately to reflect risks that were current for people and therefore the appropriate actions needed to minimise these.

Improvements had been made in seeking and recording consent in line with the Mental Capacity Act (MCA). At this inspection we found that staff had received training in MCA and were knowledgeable about the principles of the legislation. People’s consent was being sought and where people had a lasting power of attorney in place a copy of this was in people’s care records. However some assessments regarding people who lacked capacity to make decisions in certain areas were still being completed so this remained an area of practice that needed to be sustained and embedded. We have therefore identified that this remains an area that needs improvement.

Staff were appropriately trained holding a Diploma in Health and Social Care and had received all essential training. Training was taking place on the day of our inspection. Staff told us they felt supported to carry out their roles and received and attended staff meetings. A new management structure was in place for carrying out regular and consistent supervision and this remained an area that needs improvement.

People were cared for by kind and compassionate staff. People told us how well the staff knew them. One person said “Staff are very kind and caring, willing to do anything to meet your every wish, desire or need, we really are spoilt”. People also told us they were treated with respect and dignity. One person said “I’ve never had to worry about my privacy or dignity the staff are very good”.

People could choose what they wanted to eat from a daily menu or request an alternative if wanted. People were asked for their views about the food and were involved in planning the menu. They were encouraged and supported to eat and drink enough to maintain a balanced diet. One person said “The food’s pretty good, I don’t have any complaints, and you’ve always got a choice. You can have extra drinks or anything outside of meal times.”

Care plans p

Thirty seven people were using the service on the day of our inspection. We looked at five outcomes during our visit: we looked at people’s care and welfare, how they were supported to take their medication, the cleanliness of the service, how staff were recruited and how the quality of the service was assessed and monitored. We spoke with nine people using the service, staff and the manager. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

We found that some aspects of the service were not safe because people’s assessments and care plans were not detailed enough to ensure their needs were met. Medication procedures were not followed and there was not a procedure in place for cleaning commodes. We have set compliance actions for the provider to tell us what they are going to do to improve these areas.

The manager was aware of the Deprivation of Liberty Safeguards and the implications of a recent court ruling. No-one was currently living at the service under the protection of the safeguards but the manager was in the process of making an application for two people who they felt would meet the criteria. This would ensure that any restrictions on a person’s liberty was in their best interests.

There were procedures in place for the recruitment of new staff and these were followed. Appropriate checks were completed before new staff started working at the service.

Is the service effective?

The service is effective as people’s needs are met. We spoke with nine people using the service who all spoke exceptionally highly of the manager, the staff and the service. All said they were receiving care and support which met their needs. One person told us, “By and large, it is excellent, any problems get addressed”. Another person said, “The staff are excellent, we all love them, nothing is too much trouble”. Other comments included, “I am very happy to be here”, “It is lovely to be here” and, “They are very good to us here”.

Is the service caring?

People felt the staff cared about them, and we saw the caring way in which staff and the manager interacted with people. One person told us, “The staff have feelings for us”, another said they had some problems the previous day and staff had been, “good [with them] today, bless their hearts”. Throughout the day, we saw staff had a caring manner in the way they spoke with and supported people. As we walked around with the manager, they spoke with people about their individual needs, such as trying to source gluten free spaghetti.

Is the service responsive?

People felt involved with the service and had good relationships with the staff and manager. People told us the staff responded to their needs and requests. We saw some people’s needs had changed considerably since moving into the service and the care they received had changed to meet their new support needs. However, their care plans had not been reviewed and updated to ensure they always received care which met their needs. We have set compliance actions for the provider to tell us what they are going to do to improve.

Is the service well-led?

People felt the service was well led and spoke very highly of the manager. One person told us, “She [the manager] listens and acts. She has brought about a transformation”. Changes to the service had been made, both in response to non-compliance found during our last inspection and feedback from people using the service. However, there was not a formal system of quality assurance or auditing in place. We have set compliance actions for the provider to tell us what they are going to do to improve.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with five people who use this service, one relative and four members of staff. We found that people were happy living here and their care needs were met, especially with regard to their religious needs. One person told us "the food is good and I can have a cup of tea any time I like". Another person said "I can choose when to get up and I can have breakfast in my room". We saw staff treating people with dignity and respect at all times and one person told us "they're all very caring and willing to listen".

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People told us that they felt respected and involved by staff in this service. For example one person told us that, “I feel involved in this home and my views are listened to.” This showed us that people’s privacy, dignity and independence were respected.

People’s care and welfare needs were recorded in detail and were being met in line with people’s assessed needs. This meant that people experienced care, treatment and support that met their needs and protected their rights.

People told us that they felt secure in this service. This showed us that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Staff spoken with told us that they were up to date with their mandatory training and that they felt well supported by senior staff. Staff were able to outlined examples of the care and support that they provided for the people who were using this service. This meant that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We saw that the charity’s trustees carried out monthly visits to monitor for themselves the quality of the services provided to the people using this service. We saw action plans that resulted from these visits. This showed us that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

The inspection took place on 30 September 2015 and 2 October and was unannounced.

Koinonia Christian Care is a care home without nursing that is registered to provide care and accommodation for 39 older adults. The home has a Christian ethos and people choose to live at Koinonia Christian Care for that reason. At the time of our visit there were 39 people living at the home. Some of the people in residence were living with dementia. The building consisted of five large Victorian terraced houses combined into one building. One of the houses was specifically designated for people living with dementia.

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.

We carried out an inspection of Koinonia on 19 & 20 January 2015. Breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to good governance and the care and welfare of service users. We identified two further breaches of regulation in relation to supporting staff and safeguarding. After our inspection on 19 and 20 January the provider wrote to us to say what they would do to meet the legal requirements in relation to good governance, care and welfare, safeguarding service users from abuse, and supporting staff.

Following this we undertook a comprehensive inspection on 30 September and 2 October to follow up whether the required actions had been taken to address the previous breaches identified and to see if the required improvements as set out in the warning notice had been made. The report covers our findings in relation to those requirements. We found improvements had been made in some areas. However further areas for improvement were identified and two further breaches of regulation were highlighted in relation to the need for consent and the maintenance of accurate records.

People’s consent was not always being sought in line with the mental capacity Act 2015. Staff had not received specific training in this area. Consideration of someone’s capacity had not been given in areas such as having bed rails in place and no longer being able to self- medicate.

Records were not always accurately kept around care records, auditing the care provided and documenting action plans for continuous improvement. These are areas that require improvement.

Practice around safeguarding adults had improved. Staff had received up to date safeguarding training and the registered manager was aware of the multi-agency arrangements for safeguarding people from abuse. Staff were clear about how to identify whether someone maybe experiencing abuse and knew who to contact. A staff member said “Nothing like abuse would happen here I’m sure. We’re trained to deal with it if it happens though”.

Improvements in supporting staff had been made. Training and supervision were up to date and staff confirmed that this area had improved enabling them to provide better care and support for people.

Medicines were managed and administered safely and the correct policies and procedures were in place to support this. We observed medicines being given and saw that this was done accurately. Medicine management was regularly audited to identify any shortfalls in practice.

Improvements had been made in supporting people living with dementia. We saw caring interactions between staff and people living at the home. Staff had received training in dementia and strategies had been introduced to support staff to provide care. The registered manager was seeking outside support to continuously improve in this area.

People felt that they were cared for and that staff were kind. People valued the Christian ethos of the home. They told us that they felt respected and their dignity was upheld. They said that they were given choices around food, meal time and bedtimes and were supported to be independent. One person said “The staff are lovely and go over and above their duty to help us”.

People had access to healthcare professionals including GPs, community nurses and a chiropodist.

Improvements had been made in completing person centred care records that reflected the person’s individual needs, wishes and preferences. Peoples concerns were responded to and we were informed that friends of people living at the service had identified improvements at the home.

Improvements had been made in introducing systems and methods to monitor the quality of the care and support provided at Koinonia Christian Care. Audits of practice were being carried out consistently to assure the manager of the quality of service provision. Friends of a person living at the service who visited regularly said “Things have improved a lot”.

The manager told us that they were committed to the continuous improvement of the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the full version of this report.