• Care Home
  • Care home

Archived: Kirkdale

Overall: Requires improvement read more about inspection ratings

Radcliffe Crescent, Thornaby, Stockton On Tees, Cleveland, TS17 6BS (01642) 611199

Provided and run by:
Cleveland Alzheimer's Residential Centre Limited

All Inspections

1 November 2017

During a routine inspection

We inspected Kirkdale on 1 November 2017. The inspection was unannounced. This meant that the staff and provider did not know we were coming.

Kirkdale is a single storey purpose built nursing home registered to provide care for a maximum of 38 people. At the time of our inspection there were 28 people using the service, all of whom were living with a dementia. The service was separated into two areas, Lavender accommodated those people who were more mobile and independent. People who required a higher level of support were accommodated on the Rosemary section. There was a spacious dining room for each area and a number of communal seating areas and lounges.

At the last inspection on 5 January 2016, the service was rated good. At this inspection we found some areas remained good however others required improvement.

The provider did not have a registered manager in place at the service. The position had been vacant since the previous registered manager’s contract ended on 18 August 2017. The provider had appointed an acting manager to oversee the day to day running of the service, however, at the time of our inspection no candidates had been interviewed for the permanent role.

Quality assurance checks and audits undertaken to monitor service delivery were not always effective and had not identified the issues we found during our inspection.

The service was in need of refurbishment and redecoration. The environment had some dementia friendly adaptation but this was in need of improvement to ensure all areas of the service reflected best practice. We have made a recommendation about this.

There were areas of malodour around the service, some areas were in need of deep cleaning and there were no hand washing facilities in dining areas. We have made a recommendation about this.

At mealtimes people were given sufficient to eat and drink but were not fully supported to make choices about their food. We have made a recommendation about this.

Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Appropriate recruitment procedures and pre-employment checks ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were in place and reviewed regularly.

People’s medicines were safely stored, correctly recorded and administered as prescribed by trained staff.

Staff received appropriate training and support. Training in equality and diversity was completed by all staff. Staff supported people in the least restrictive way possible in line with the principles of the Mental Capacity Act 2005 (MCA). Where people’s freedoms were restricted this was done following best interest assessments and the correct authorisation was obtained. People’s health and wellbeing was supported by appropriate access to healthcare professionals such as community matrons, the falls team and the dietician.

There was a calm atmosphere around the service. People were at ease with staff and relatives told us staff were caring. Staff treated people with kindness and compassion.

Staff demonstrated an understanding of people's needs and how they liked to be supported. People's religious and cultural needs were considered and access to religious support was available regardless of faith. Care plans were well organised, detailed and specific to people's individual needs.

We saw people enjoying a musical afternoon activity however the activity co-ordinator only worked at the service for two days and we did not see evidence of activities taking place on a regular daily basis. We have made a recommendation about the organisation of activities.

Complaints were investigated in line with the provider’s policy.

Relatives and staff felt the service was well managed. Staff described the acting manager as approachable and said there was an open culture. Records were well organised and easily accessible. Quality assurance checks and audits were undertaken to monitor service delivery.

One breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found during this inspection. You can see what action we told the provider to take at the end of this report.

15 January 2016

During a routine inspection

We inspected Kirkdale on 15 January 2016. This was an unannounced inspection.

Kirkdale is a 38 bedded nursing home, which provides support for people with dementia care needs. It is situated within Stockton in a purpose built building. Accommodation is on ground floor level and there is access to a secured garden. There are a number of lounges and sitting areas and two dining rooms.

The service has a registered manager who was on duty at the time of our visit. 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.

There were robust systems and processes in place to protect people from the risk of harm. Staff were aware of different types of abuse, what constituted poor practice and the correct action to take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety for people and staff was maintained. We saw accidents and incidents were closely monitored by the registered manager.

Staff told us that they felt supported. There was a regular programme of staff supervision and appraisal in place. Records of supervision were detailed and showed the registered manager and nursing team worked with staff to identify their personal and professional development.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. There was enough staff on duty to provide support and ensure that their needs were met. Staff were aware of the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were very positive interactions between people and staff. People told us they were cared for and supported in a very goodway. Relatives and visitors also praised the kind and caring staff team and we witnessed staff spending quality time in meanginful interaction with people. We saw that staff treated people with dignity and respect. Staff were attentive, observant, showed compassion, were patient and gave encouragement to people.

End of life care was care planned so that the person and their families were able to be involved in all decisions about their care and wishes at this time. The service was accredited with the GOLD framework (a national training and end of life accreditation programme).This showed the service was caring and open in ensuring people and their family were supported well at the end of their life.

People’s nutritional needs were met, with people being involved in decisions about meals and being supported in an environment that enabled people to eat in a calm and positive way. People who used the service told us that they got enough to eat and drink and that they could have different choices without a problem. Staff told us that they closely monitored people and we saw appropriate dietician or speech and language therapy was sought where required.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

Assessments were undertaken to identify people’s health and support needs. Person centred plans were developed with people who used the service to identify how they wished to be supported. People and their relatives told us they were fully involved in reviews of their care.

People’s independence was encouraged and we saw people being praised for carrying out any task for themselves no matter how small. The activity co-ordinator had developed innovative sessions for people who had dementia and people told us about the activities they enjoyed both in the service and the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People and relatives told us they knew how to complain and felt confident that staff and the manager would respond and take action to support them.

There were effective systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture and we saw the registered manager leading the shift by example.

8 April 2014

During a routine inspection

Are services safe?

The service had systems in place to assess risk and monitor health and safety. This included risk assessments related to the care of individuals and health and safety checks related to equipment and premises.

People were protected from abuse by the service's safeguarding procedures and related staff training. People were also protected by incident and accident analysis and monitoring, which helped to identify trends and any actions needed to maintain people's safety.

Safe recruitment procedures ensured that people were protected from unsuitable staff.

Are services effective?

People told us that they were happy with the care delivered. Comments made to us included 'The general care is fine' and 'I'm very happy with the care my (relative) gets.' We observed that people looked cared for and that staff were supportive.

The records we looked at also showed that people's needs were regularly reviewed. For example, people's weight was monitored and action had been taken when there was concern about someone's nutritional wellbeing, such aa staff fortifying their food and involving the doctor or dietician.

Are services caring?

We saw that staff treated people kindly and were caring in their approach. One relative told us 'They really try and are ever so kind.' Another said 'The staff are really nice.' Staff we spoke with demonstrated a good awareness of dementia care and were able to tell us how they tried to recognise and meet people's individual needs.

Are services responsive to people's needs?

People's needs had been assessed and care plans put in place which detailed people's needs and preferences. These records provided guidance to staff on what care and support was needed. Systems were also in place to provide information to other staff, such as the cook, so that people's needs and preferences could be catered for. The care records we looked at had been reviewed regularly and up dated if people's needs had changed.

Generally the service was responsive to people's needs. Some issues had been identified where the service had not been as responsive to individual needs as they could have been, but these issues were being appropriately addressed by the manager and other staff at the time of our visit.

Are services well-led?

The home had a registered manager, who was supported by the Trustees and the provider's administrative systems. Audits and checks were completed regularly to monitor the quality of service provision. There was also regular input from the Trustees, including visits to the service.

Relatives and staff told us that they felt able to talk to the staff and management and were listened to. One relative commented 'The home, the staff, the manager, I can't fault them.' One staff member commented 'I feel that I have a voice, let's say that.'

2 October 2013

During a routine inspection

We used a special way of observing people who lived at Kirkdale. This was because people's health conditions meant they were often unable to recall recent events, understand our questions or have meaningful conversations. Observations enabled us to have a better understanding of the experiences of people who used the service.

Relatives of people who used the service who we spoke with told us they were happy with the care and treatment being delivered by the service. They felt people's needs were met and there were enough staff on duty to do this in a timely manner. They were confident that changes in health were recognised and appropriate action taken. Staff communicated with other health care providers in a way that ensured that people received care that was coordinated and safe.

We found there were arrangements in place to seek people's consent for treatment. Staff were clear about the legal arrangement in place for people when they lacked the capacity to make complex decisions such as who had lasting power of attorney in place and whether this was for people's finances or care and welfare.

We found there were sufficient qualified and skilled staff in place to meet the needs of the people who used the service.

The service had a complaints procedure in place and relatives we spoke with were confident that if they had any concerns these would be dealt with appropriately and without concern about discrimination against their family member.

19 June 2012

During an inspection looking at part of the service

The visit took place because we were following up concerns raised at the last inspection in November 2011. Therefore when talking with people and observing practice we concentrated on these specific areas, in particular the choices on offer; what the care was like; and what people thought about the staff. During the visit we spoke with five people who used the service and six relatives. People and relatives told us that they felt the home provided an excellent service and thought the staff were very good at their jobs. People said 'The staff make sure people always have plenty of choice', 'Staff are purely resident focused and so always make sure the people are well looked after', 'It is lovely here', 'I have nothing but compliments about the home and staff' and 'The manager is excellent and when I have gone with any concerns she has always sorted them out'.

Most people who lived at the home had marked problems with their memory and found it difficult to think about recent events or at times to have a conversation. So we used a specific way of observing care to help to understand their experience called the short observational framework for inspection (SOFI).This involved spending a substantial part of the visit watching groups of people to see how they occupied their time; appeared to feel; and how staff engaged with them. We completed this type of observation in both units and various lounges.

From our observations and discussions with the people who used the service we found that practices had improved since our last inspection. Care staff effectively worked in ways that supported the people and treated individuals with humanity as well as empathy. Staff appeared to value and respect the people who used the service. We observed that staff continuously involved people in discussions and always sought their views. We saw that activities had been organised and the people appeared to find these enjoyable.

17 November 2011

During a routine inspection

Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people's experiences of living in the home and their interactions with each other and the staff. We call this the 'Short Observational Framework for Inspection' (SOFI).

We undertook two periods of observation in the lounge of the Rosemary Unit, during the morning and afternoon. We attempted to do similar observations in the lounge for the Lavender Unit. However, due to the complex needs of people in this unit, observation proved disruptive and unsettling for the people using the service, so we terminated any further observation within this lounge.

Although we were unable to carry out a formal observation in the Lavender Lounge, we did see that staff were engaging people in activities and spending time sitting and talking with people, whenever we passed through the lounge. Due to the level of dementia and frailty of people using the service in this lounge, there was a higher ratio of staff to people using the service than was observed in the Rosemary Unit. One person in the Lavender Unit had one to one support from a staff member at all times, which staff told us was to support the person and reduce the risk of a fall.

During our observation of the interactions with people in the Rosemary lounge, we saw that there was no activity ongoing and people would sit for long periods without any interaction from staff. Staff did spend time talking to and interacting with a small number of people in the lounge, but this focussed on those who were more able to react to staff or communicate verbally. For others, interaction with staff tended to be task orientated, for example, when the tea trolley came round. During the time we observed in the morning, three of the four people we observed were asleep or withdrawn for a long period of time. Clearly, during this time these people had no contact with staff or other people, which can have a negative affect on their mood. We saw this pattern of staff interaction repeated during the afternoon period of observation.

Overall, throughout our SOFI observation, we found that although people's needs were generally being met, support did not always enrich people's experience or meet people's mental, social and emotional needs.