KEPA Care Solutions Limited

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified two breaches of the legal regulations in relation to safe care and treatment, and the need for consent. People's capacity to consent to key decisions about their lives had not been assessed or considered. The registered manager failed to ensure that principles of the Mental Capacity Act (2005) were complied with, and therefore people's human rights were not upheld. People's needs were not robustly assessed, and key information considered when supporting people to choose their homes. As a result people who were not suitable to live together, did so, which caused a chaotic living environment.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People's needs had not been fully assessed before they moved into their home. One person's care plan detailed that they should not live with the opposite gender, however despite this they did. The registered manager did not consider how this may impact this person and the other person living with them. There was no risk assessment to inform staff of this risk and give guidance on how to reduce or mitigate this risk. We identified a high number of incidents between these people.

Staff and the registered manager told us they knew people well and understood their needs. However, we idented that people did not have care and support plans that were personalised, holistic and strength based. People's care plans did not highlight their strengths or detail any goals or aspirations people were working towards.

Processes to assess people's needs were not robust. People's needs had not been regularly reviewed, and action taken to address any changes to people. Within one house staff told us, and incident records confirmed that people were not suitable to live together. Although the registered manager told us they had identified this, there was no action plan or evidence of what they had done to address this. There was a lack of understanding and assessment of people's needs who could show high levels of distress. All of the care plans we reviewed detailed that people could show high levels of distress, however the registered manager had not sought the support of a positive behaviour support (PBS) expert to write a comprehensive plan to inform staff how to best support people and reduce their distress. None of the care plans we reviewed had PBS plans, despite them all showing high levels of distress, which sometimes resulted in safeguarding incidents.

We did not look at Delivering evidence-based care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

People had not been empowered or included to make decisions about their care and support. Staff told us that in one home, a person who did not live there, attended frequently, sometimes daily as part of 'outreach respite.' The people who lived in that house had not been asked for their consent to this person attending their house frequently. The registered manager told us that not all people living in the house had the capacity to consent to the person going to their house for outreach respite support. A capacity assessment and best interest meeting had not taken place for these people. Staff and the registered manager showed a lack of respect to the people living at this house, and failed to consider that they were bringing a stranger into people's home, without their consent, and with no consideration about the person using people's utilities and home.

Although staff told us they understood the principles of the Mental Capacity Act (2005), they had not always been adhered to. Staff understood their responsibilities to ensure that people made less complex decisions about their lives, for example what to do or what to wear. However, staff had failed to identify and report that people's capacity around more complex decisions had not been assessed, or appropriate processes followed. The registered manager told us they understood the principles of the MCA but could not explain why appropriate processes had not been followed. There was a lack of understanding, and advocacy for people's rights from staff and the registered manager. The registered manager was not open and honest with us about the packages of care they delivered, relating to ‘outreach’ ‘respite’ and ‘day services.’ The registered manager had not considered it was inappropriate to run day centres / respite care in people’s houses and had not been open and honest about the number of occasions this occurred. During the assessment they told us about one location where this occurred, and despite us requesting clarification from them, they failed to inform us of another 2 locations where they provided respite / day services in people’s house. This demonstrated a complete lack of regard for people’s rights.

Processes were not in place to assess people's capacity and ensure the Mental Capacity Act (2005) was complied with. Staff and the registered manager did not demonstrate best practice around assessing mental capacity, supporting decision-making and best interest decision-making. For example, people who lacked the capacity to make decisions about medicines, best practice was not followed and there were not safe processes and guidance for staff to follow around medicines. People had not been consulted when restrictions had been placed on them. For example, one person had a seizure mat put in their bedroom to alert staff if they were to have a seizure. The registered manager told us the person could not consent to this restriction; however they had not completed a capacity assessment or best interest meeting. One person's support plan stated that staff were to link arms with them whilst out to 'ensure they are closely monitored and supervised.' It also stated the person could 'make an attempt to escape from arm link.' The registered manager told us this person did not have capacity to consent to staff holding them when out. The registered manager also confirmed that there had been no capacity assessment around this, or best interest meeting. An incident report for another person stated that staff were 'holding them whilst walking back to the house.' Likewise this person was not able to consent to this restriction, and there had been no capacity assessment, or best interest meeting to agree to this. Following our assessment, the provider sent us some capacity assessments - however these did not include all areas of people's lives, for example the decision to have someone come into people's house for a day service has not been considered or assessed, and the use of physical intervention had not been assessed.