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Inspection carried out on 17 May 2018

During a routine inspection

We carried out an unannounced comprehensive inspection of Kilmar House on 17 May 2018. Kilmar House is a ‘care home’ that provides care for a maximum of 15 adults. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection there were 12 people living at the service. The accommodation is over two floors in both the main house and the annexe. The annexe is joined to the main house via a corridor on the first floor and through an external door on the ground floor and is only used by people who are independently mobile. A shared lounge and dining room are on the ground floor and a smaller lounge on the first floor. The first floor is accessed by two sets of stairs one of which has a stair lift. There is also a passenger lift.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People received care and support that met their needs because there was a stable staff team who had the skills and knowledge to provide responsive and personalised care. People told us they were happy with the care they received and believed it was a safe environment. Comments included, “Yes definitely feel safe, because there’s always someone around and I can use the call bell”, and “They keep an eye on me and I feel sure they do all they can for me.”

We spent much of the inspection in the shared lounge and dining room observing and talking with people. There was a calm and relaxed atmosphere at the service throughout the day of the inspection visit. People and staff welcomed us into the service and were happy talk to us about their views of living and working there. We observed people had good relationships with staff and each other. People spoke positively about staff and their caring attitude. Comments included, “I’m happy that [person] is here. Staff know what they are doing”, “Everything is done for my relative, I don’t have to worry as I don’t live near and that helps me” and “I am very happy living here. I’m part of this family the family I never had.”

People's independence and wellbeing was promoted because staff had developed positive and meaningful relationships with people. People were encouraged and felt confident to make decisions about their daily lives. The culture in the service was one where there were no unnecessary rules or routines put in place to suit staff, rather than the people that used the service. People told us they made their own choices about their lives, commenting, “I was asked to change rooms and chose at that time not to”, “They ask me, never tell me”, “I choose how I spend my time doing what I choose to do. They suggest things like where to eat my lunch or whether or not I want to sit outside and I decide what I want to do.”

People’s care plans contained personalised information about their individual needs and wishes and people were involved in the planning and reviewing of their care. These care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

Incidents and accidents were logged, investigated and action taken to keep people safe. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. Risk assessments had been kept under review and were relevant to the care provided.

Safe arrangements were in place for the storing and administration of medicines. Staff supported people to access healthcare services such as occupational therapi

Inspection carried out on 9 January 2016

During a routine inspection

Kilmar House is a residential care home which provides nursing and personal care to adults. The service is registered to accommodate up to a maximum of 15 people. On the day of the inspection 14 people were living at the service.

The service is required to have a registered manager and at the time of our inspection there was a registered manager in post. 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.

We carried out this unannounced inspection of Kilmar House on the 9 January 2016. We saw people were happy living at Kilmar House. The atmosphere was friendly and relaxed and we observed staff and people using the service enjoying each other’s company. People’s comments included “Staff are marvellous”,” It’s terrific here,” and “I have stayed at other care homes but this one is the best.” When asked why they replied “Staff are so caring, it’s a family here.” Another person told us how much they had enjoyed Christmas and particularly enjoyed the registered manager’s children coming to the service and handing out the presents. The person said “We are as much a part of their family as they are ours. It was a big family occasion.” Another person told us that a staff member was going on maternity leave, they commented “I will miss her, she’s been like a mother to me. She’s going to bring her baby in to see me on my 80th birthday.” The registered manager said “We are led by the residents. The residents are part of our family.” The family theme came from people who lived at Kilmar House as well as from the staff.

People looked well cared for and their needs were met quickly and appropriately. People who used the service were complimentary about the care they received from staff who they felt were knowledgeable and competent to meet their individual needs. People commented “The staff are very patient, caring and kind.” People told us they were completely satisfied with the care provided and the manner in which it was given. At this visit we watched to see how people were cared for by staff. We saw examples of kindness, patience and empathy from staff to people who lived at the service.

People felt safe living in the home, commenting “I feel safe here, they (staff) make sure they protect me.” We saw throughout our visit people approaching staff freely without hesitation. We saw positive relationships between people and staff had been developed. Staff were aware of how to report any suspicions of abuse and had confidence that appropriate action would be taken.

People’s preferences in how they wanted to spend their day were sought, listened to and respected. A wide range of activities were provided including arts and crafts and visiting entertainers. Visitors were made welcome and were able to visit at any time.

We heard of examples where the staff team had responded to people’s needs in a caring and creative manner. For example one person missed their chickens, so the registered manager brought some to keep in the garden. The person and staff visited the chickens in the garden regularly. Another person wanted to sit and watch the traffic but it was not safe to do this in the services doorway, so the service erected a bench at a safe distance so that the person could watch the traffic. A person came to the home with no possessions or clothing, had neglected their health and had no contacts in the local area. The service supported the person to buy clothes and to take pride in their appearance and helped them get to know the local area. The person told us “It’s terrific here, staff have been so kind and I’m so grateful. It’s the best place.”

People were asked for their views at residents meetings. People told us their views were constantly sou

During a check to make sure that the improvements required had been made

We carried out a follow-up review of Kilmar House after our inspection on 11 October 2013 when we identified areas where the provider was not fully compliant.

Our previous inspection found care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare.

The Commission had received an action plan from the provider, which detailed how they intended to address the areas of concern.

We asked the provider to tell us, with supporting evidence, how they had complied with the outcome identified as non-compliant at the last inspection.

We did not visit the service or speak with people who used the service on this occasion.

At this inspection we found accurate records about people�s health and social care needs were maintained.

Inspection carried out on 11 October 2013

During a routine inspection

We spoke with people who lived at Kilmar House, the provider, care staff, housekeeping staff and the cook.

People who lived at Kilmar House were complimentary about the care and support they received and told us they thought the staff were respectful and treated them with dignity and respect. Peoples comments included, �I think they do extremely well�, �cosy and comfortable� and �we are very well looked after�. One person told us the food was �plain but wholesome�.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that ensured people's safety and welfare.

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment.

The provider had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service, and others.

Accurate records about peoples health and social care needs were not always maintained.

Inspection carried out on 13 September 2012

During a routine inspection

We reviewed all the information we hold about this provider, carried out a visit on 13 September 2012, observed how people were being cared for, talked with people who used services, talked with staff, and checked records.

We spoke to people who lived at Kilmar House and all the comments we received were positive. One person told us, �I am happy here, the staff are very good, this is a good home�. Another person told us, �We are never left on our own, if we go out for a walk somebody always comes with us�. A third person told us �I couldn�t be served better, it�s like a five star hotel�.

We spoke to a relative of a person that lived at Kilmar House. They told us they were satisfied with the care provided and they were informed of the progress concerning the person they were visiting.

We also spoke to a visiting physiotherapist who told us that she had a very good working relationship with the home.

Inspection carried out on 24 January 2012

During a routine inspection

People told us that staff were very kind and helpful. They told us that they felt treated with dignity and respect and that all of their needs were being met by the staff. They told us that they could choose how they spent their day and felt able to make choices about their lives.

One person said 'I have no complaints, the staff are all very kind'.

Another person told us that 'If you use the call bell, they always come'.

The cook on duty told us that people using the service could have a choice of two menu options each day or anything else they preferred.

People using the service told us that the food was very good. They told us that they had a choice for each meal and that snacks were available if they wanted them. One person told us 'They keep trying until they find something that you want to eat'.

One person told us that 'when you send your clothes to the laundry, they come back proper lovely'.

People told us that, should they have any complaints, they felt able to speak to the staff or the manager and their concerns would be addressed.

Staff told us that they felt supported by the management of the home and that they felt able to raise any concerns. They told us that communication at the home was very good and this supported them to provide a good and consistent standard of care.

Reports under our old system of regulation (including those from before CQC was created)