This inspection took place on 30 August 2018 and inspection was announced.

At our previous inspection of this service on 22 and 23 May 2017, we found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the safe management of medicines. Due to the seriousness of the concerns, found we issued a warning notice to the provider and registered manager on 19 June 2017, requiring compliance with the Regulation by 5 July 2017. On 28 July 2017, we carried out a focused inspection to check if the provider had made the necessary improvements to how the service ensured medicines were safely managed. At this inspection, we found that medicines were safely managed and improvements made following the May 2017 inspection had been embedded and sustained.

Vijaykoomar Kowlessur provides care and support to five people living in one ‘supported living’ setting, so that they can live in their own home 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.

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.

The provider did not always ensure robust recruitment practices were in place. References obtained did not always correspond with the staff member’s employment history and one staff member was employed prior to completion of required checks.

Staff had completed training in safeguarding adults and demonstrated an understanding of types of abuse to look out for and how to raise safeguarding concerns.

Risks associated with people's care had been appropriately assessed. Staff had been given guidance on how to keep people safe in a person-centred way.

Medicines were managed safely and effectively and there were regular medicine audits in place. Staff had completed medication training.

There were sufficient staff available to ensure people received person centred care both at the service and in the community.

Staff received training to enable them to carry out their role. Staff received regular supervisions and an annual appraisal. Staff told us they felt supported in their role.

People were supported to have a balanced diet. People were consulted about menu choices.

All staff had received training on the Mental Capacity Act (2005) and staff understood what to do if they had concerns around people's mental capacity.

People are supported to maintain good health and have access to healthcare services. Referrals were made quickly when concerns were noted about people's health.

A complaints procedure was in place which was displayed. There was an incident and accident procedure in place which staff knew and understood.

There was evidence of audits for medicines and overall compliance. Issues identified were actioned promptly.

The registered manager was accessible to people and staff who spoke positively about them and felt confident about raising concerns.

We identified a breach of regulation relating to safe recruitment of staff. You can see what action we told the provider to take at the back of the full version of the report.

At our previous inspection of this service on 22 and 23 May 2017, the provider was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This regulation relates to the safe management of medicines. Due to the seriousness of the concerns found we issued a warning notice to the provider and registered manager on 19 June 2017, requiring compliance with the Regulation by 5 July 2017.

In addition, we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as a result of poor management oversight of medicines management and ineffective auditing processes. For this breach, we issued a requirement notice requesting that the registered provider submit an action plan to address the concerns. The action plan was submitted on 19 July 2017. On this inspection, we checked whether the registered manager and provider had completed the actions as identified on the action plan.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Vijaykoomar Kowlessur on our website at www.cqc.org.uk

A registered manager was in place. 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.

At this inspection we found that significant improvements had been made to how the service ensured safe medicines management. We found that medicines stocks balanced with what medicines administration records (MARs) stated and medicines were stored safely and securely. With the exception of one administration of medicine, we saw that the administration of medicines was documented appropriately.

Measures were now in place to ensure that stock balances of ‘as required’ medicines were recorded accurately which was regularly checked by the registered manager as part of the auditing process in place.

The service had met the requirements and regulation identified in the warning notice.

This unannounced inspection took place on 22 and 23 May 2017. The inspection was carried out by two inspectors. This was the first inspection of the service since it registered with CQC in July 2016.

Vijaykoomar Kowlessur offers supported living services to people with learning disabilities. On the day of the inspection the service supported five men living in a single supported living location in Enfield, North London.

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.

Medicines were not being managed safely. We found that there were quantities of ‘as needed’ medicines that were unaccounted for. We found that some medicines were not being stored and disposed of safely. People's Medicine Administration Records (MAR's) were not always completed in full or accurately.

There were measures in place to monitor quality and safety of care. However, the audit systems in place at the service were ineffective, as they did not identify the significant concerns with medicines management which were found during the inspection.

All staff had received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and staff understood what to do if they had concerns as regards people's mental capacity.

Detailed current risk assessments were in place for people using the service. Risk assessments in place were reviewed and updated regularly. The risk assessments explained the signs to look for when assessing the situation and the least restrictive ways of mitigating the risk based on the individual needs of the person.

We saw friendly, caring and supportive interactions between staff and people and staff knew the needs and preferences of the people using the service.

Care plans were person centred and reflected what was important to the person. Care needs were regularly reviewed and updated to meet the changing needs of people who use the service.

We saw evidence of a comprehensive staff induction and on-going training programme. Staff were also safely recruited with necessary pre-employment checks carried out. Staff had regular supervisions and annual appraisals.

People were supported to maintain good health and had access to healthcare services.

People were encouraged and supported to access the community and engage in a wide range of activities.

At this inspection we identified a breach of Regulations 12 and 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to medicines management and good governance. You can see what action we told the provider to take at the back of the full version of the report.