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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 therapists, GPs, chiropodists, district nurses and opticians.

People were supported to eat a healthy and varied diet. Comments from people about their meals included, “They come round in the morning and ask what we would like for lunch and if there is nothing I want they will find something else”, “I have an allergy and am always given lots of choice, I enjoy the food here”, “If I don’t like the choice of food I can choose something else that I would like” and “There is plenty of it and they can have seconds.”

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs in a timely manner. Staff knew how to recognise and report the signs of abuse. Staff were supported to develop the necessary skills to carry out their roles through a system of induction, training, supervision and staff meetings.

There was a positive culture within the staff team and the management provided strong leadership. There were opportunities for staff to raise any concerns or ideas about how the service could be developed. People and their relatives all described the management of the service as open and approachable. “It’s a very good home here, it has a good reputation”, “They run the home very well and the staff are all kind”, “It’s organised and they care” and “They are very good here. They get the right staff.”

There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The service had a suitable complaints procedure.

Further information is in the detailed findings below.

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 sought and they were able to share ideas on how to improve the service. For example people had said they were not keen on the wallpaper in the dining area. Their view was sought as to what they would like in its place and the dining room was redecorated. One person said “That’s how far they go; they go that one step beyond.”

People’s care and health needs were assessed prior to admission to the service. Staff ensured they found out as much information about the person as possible so that they could get to know the person, likes, dislikes, interests and their life story. This gave staff a very good understanding of their person and how they could care for them.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Where people did not have the capacity to make certain decisions the home involved family and relevant professionals to ensure decisions were made in the person’s best interests.

People’s care plans, identified the person’s care and health needs in depth and how the person wished to be supported by the service. They were written in a manner that informed, guided and directed staff in how to approach and care for a person’s physical and emotional needs. Records showed staff had made referrals to relevant healthcare services quickly when changes to people’s health or wellbeing had been identified. Staff felt the care plans allowed a consistent approach when providing care so the person received effective care from all staff. People told us they were invited and attended care plan review meetings and found these meetings really helpful.

There were sufficient numbers of suitably qualified staff on duty to keep people safe and meet their needs. People said, staff “responded quickly” when they requested support. “ The registered manager had recently purchased a nurse call system which monitored the time it took from the person requesting assistance and the length of time care staff took to respond. This showed calls for assistance were responded to within one minute. We saw staff were prompt to respond to people when they called for assistance.

Staff told us they were supported by managers. They attended regular meetings (called supervision) with their line managers. This allowed staff the opportunity to discuss how they provided support to people, to ensure they met people’s needs and gave time to review their aims, objectives and any professional development plans. Staff also had an annual appraisal to review their work performance over the year. Staff training was viewed as “essential” to ensure staff received up to date guidance to assist them in their care of people. Staff received a thorough induction when they started work at Kilmar House and fully understood their roles and responsibilities, as well as the values and philosophy of the service. People felt staff were skilled and competent to undertake their job.

We saw the home’s complaints procedure which provided people with information on how to make a complaint. People told us they had; “No cause to make any complaints” and if they had any issues they felt able to address them with the management team.

The registered manager promoted a culture that was well led and centred on people’s needs. The registered manager said they were “resident led” and consulted with people to ensure they were involved in how the service was run. People confirmed they were involved in decisions about their care and how the service was run. People were empowered by being actively involved in decision making so the service was run to reflect their needs and preferences.

There was a management structure in the service which provided clear lines of responsibility and accountability. There was a clear ethos at the home which was clear to all staff. It was very important to all the staff and management at the service that people who lived there were supported to be as independent as possible and to live their life as they chose. The registered manager had an effective system to regularly assess and monitor the quality of service that people received and was continuously trying to further improve the quality of the service.

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)