This inspection was announced and took place on the 24th and 25th October 2018. During our last inspection in November 2017 we found the provider to be in breach with Regulation19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Fit and proper persons employed. We found that the recruitment checks of prospective staff were not always sufficiently comprehensive and timely. This meant that people who used the service could not be confident that staff employed were suitable and safe to support them. The service sent us an action plan in January 2018 and told us that they had taken appropriate actions to address the breach and ensure that on all staff working with people who used the service had appropriate recruitment checks. During our inspection we found that the provider had taken the necessary steps to ensure safe recruitment practices were followed and all required recruitment checks were carried out prior to offering employment.

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

This service provides care and support within a Jewish framework to adults with learning disabilities and autism living in their own houses and flats in the community and in five ‘supported living’ settings, so that they can live in their own homes 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.

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

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was took place on 10 July 2014 and was announced, which meant the provider was informed two working days beforehand to ensure that key members of the management team would be available.

Kisharon Supported Living provides a supported living service to people in their own homes. Its services are primarily for adults with a learning disability. At the time of our visit, the service was providing personal care to three people in their own supported living scheme homes.

There was a registered manager 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 and associated Regulations about how the service is run.

At our previous inspection in October 2013, the provider was found to be meeting the required standards in the areas of respecting and involving people, planning and delivering care, recruitment, and the assessment and monitoring of service quality. However, the provider was not meeting regulations in relation to the management of medicines and supporting workers. At this inspection, we found that they had addressed our concerns, and we found no breaches of relevant regulations.

Feedback about the service from people, their representatives, and health and social care professionals was mostly positive. In particular, all three relatives and representatives felt they could recommend the service to others.

Staff knew people’s support needs and we observed positive interactions between people and staff. We saw staff being caring and respectful to people, and communicated effectively with them. People were supported to express their views, and were listened to. Staff placed value in people using the service, and were supported by a management team that promoted a positive, inclusive and empowering culture.

Systems were in place to help protect people from harm or abuse. Recruitment processes were robust, and there were ongoing checks of the suitability of established staff. The service had enough capable staff to support people and keep them safe. The service responded to people’s individual needs and preferences, and understood that by listening to people and aiming to meet their individual needs, the risk of abuse was reduced.

People were supported to maintain good health and address health concerns. They were supported to maintain a balanced and culturally-appropriate diet of their choosing, and so were protected against the risks of malnutrition. People were supported to participate in a range of varied and meaningful activities including employment and college courses.

We were assured that the provider was taking steps to ensure that the requirements of the Mental Capacity Act 2005 and associated codes of practice were being addressed.

Staff were guided to provide effective services to people. They were trained and supervised in support of this, which helped protect people against the risks of inappropriate care. There were systems in place to monitor the quality of the service. Where issues were identified, actions were taken to make improvements, which helped assure us that the provider aimed to deliver high quality care and support to people.

We spoke with five people who use the service, although due to some people’s complex needs we did not always gain people’s views clearly. We also spoke with two family members. People praised the service and the care provided. Comments included, “it’s a fantastic service” and “I couldn’t hope for anything better.” We found that care and support was planned and delivered in a way that was intended to ensure people's safety and welfare.

“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.

We spoke with three people who use the service. Everybody was happy with the quality of services provided, and everybody felt involved in making decisions about their care and support. Comments included, “I like it here, it’s a happy house” and “I’m happy here.” People told us they felt safe using the service, and that they could speak with staff if they had concerns.

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.

People who use the service generally spoke positively about it. A typical comment about the service was, “It’s good.” People told us about getting good support when needed, but that their choices, privacy and independence were also generally respected. There were enough staff, and people got on well with them. People generally felt safe with the services provided, and concerns cold be raised with the manager if needed.