We carried out a review of the data available to us about Kilvie House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Kilvie House, you can give feedback on this service.
Kilvie House is a residential care home providing personal and nursing care for eight people. People who live at the home have learning and physical disabilities. At the time of the inspection, there were eight people living at Kilvie House.
The home met the characteristics that underpin the Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.
There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear anything that suggested they were care staff when coming and going with people.
People’s experience of using this service and what we found
Some of the people living in Kilvie House had a profound learning and physical disability and therefore did not communicate verbally. In order to understand their experiences, we observed staff interactions with people over the course of the inspection.
Staff were caring and attentive to people. People and staff were comfortable in each other's company. People were at the centre of the service and everything that they do.
People received safe care. Staff understood safeguarding procedures. Risk assessments were in place to reduce and manage risks within people’s lives. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out. People had access to other health and social professionals. Safe systems were in place to ensure that people received their medicines as prescribed.
Staff were trained to support people effectively. Good communication was in place in the form of daily handovers, team meetings and one to one supervision.
Staff continued to provide people with daily choices on what they wanted to eat, wear and choice in respect of activities. Staff knew people really well and were responsive to changes in body language, gestures and their nonverbal communication.
Staff were very caring and provided people with care tailored to their needs promoting their rights to an ordinary life. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The provider had quality assurance systems in place to monitor the running of the home and the quality of the care being delivered.
There was an open and transparent culture within the service. Complaints, accidents and incidents were analysed, action was taken to reduce the risk of them happening again.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
Good (report published April 2017)
Why we inspected
This was a planned inspection based on the previous rating.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
There was a registered manager in post. They were registered with us in November 2016. They had worked at Kilvie House as a team leader for seven years prior to the role of 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.
Some of the people living in Kilvie House had a profound physical disability and therefore did not communicate verbally. In order to understand their experiences we observed staff interactions with people over the course of our inspection. Staff were caring and attentive to people.
At the last inspection, the service was rated Good. At this inspection we found the service remained Good.
Why the service is rated good:
People’s rights were protected in respect of any restrictions. Since the last inspection, systems had improved to monitor applications for Deprivation of Liberty Safeguards. This included making prompt applications prior to their expiry date.
People were treated in a dignified, caring manner, which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process.
People remained safe at the home. There were sufficient numbers of staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to receive care with minimum risk to themselves or others. People received their medicines safely.
People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes.
People continued to receive effective care because staff had the skills and knowledge required to effectively support them. People's healthcare needs were monitored by the staff. Other health and social care professionals were involved in the care and support of the people living at Kilvie House. Staff were proactive in recognising when a person was unwell and liaised with the GP and other health professionals. Relatives commended the staff on their ability to recognise when a person was not well and the actions taken to address this.
The home continued to provide a caring service to people. People, or their representatives, were involved in decisions about the care and support they received. Staff were knowledgeable about the people they supported. People were treated with kindness and there was a happy atmosphere in the home.
The service remained responsive to people's individual needs. Care and support was personalised to each person. People were assisted to take part in a variety of activities and trips out.
The service continued to be well led. There had been a change of management to the service since our last inspection. Relatives and staff spoke positively about the commitment of the new manager. They told us the registered manager was open and approachable. The registered manager and provider had monitoring systems, which enabled them to identify good practices and areas of improvement.
There was a registered manager in post. They had managed the service for the last five years. 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.
Some of the people living in Kilvie House had a profound physical disability and therefore did not communicate verbally. In order to understand their experiences we observed staff interactions with people over the course of our inspection. Staff were caring and attentive to people.
People were treated in a dignified, caring manner which demonstrated that their rights were protected. Where people lacked the capacity to make choices and decisions, staff ensured people’s rights were protected by involving relatives or other professionals in the decision making process. The registered person had not ensured that appropriate applications had been made in respect of the Deprivation of Liberty Safeguards and these had not been monitored effectively in respect of expiry dates.
People living at Kilvie House were supported by a team of staff that included a nurse. Nurses were available 24 hours a day to ensure people’s nursing care needs were being met. All team members described a team that worked together to meet the needs of people. Sufficient numbers of staff supported the people living at the service. Staff had received appropriate training to enable them to support people effectively. Staff were supported by the registered manager and had regular one to one sessions with a senior member of staff. Team meetings were organised monthly enabling staff to keep up to date, discuss the running of the home and the welfare of the people they supported.
People had a care plan that described how they wanted to be supported in an individualised way. These had been kept under review. Care was effective and responsive to people’s changing needs. Staff were knowledgeable about the people they supported and spoke about people as individuals. The essential lifestyle care file would benefit from a review to ensure they were in a logical sequence enabling staff to access information that was current promptly. People were supported to maintain contact with friends and family and take part in activities both in the home and the local community.
People had access to healthcare professionals when they became unwell or required specialist equipment. Feedback from health and social care professionals was positive in respect of the staff’s approach to people and delivery of care. Staff were proactive in recognising when a person was unwell and liaised with the GP and other health professionals. Relatives commended the staff on their ability to recognise when a person was not well and the actions taken to address this.
People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures. Systems were in place to ensure people were safe including risk management, checks on the equipment, fire systems and safe recruitment processes. Suitable arrangements were in place to ensure people received their medicines safely.
Systems were in place to ensure that any complaints were responded to. People’s views were sought through an annual survey that was completed by a representative from Milestones Trust.
The staff, the registered manager and representatives from Milestones Trust completed regular quality checks on the systems that were in operation in the home to ensure they were effective. Staff were committed to providing care that was tailored to the person.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
We observed a midday meal and saw staff supported people in a respectful and caring manner. We saw that people were relaxed, and staff were supportive and patient, and explained and reassured people when necessary.
We were assisted by the registered manager and a senior member of staff during our visit. They demonstrated their understanding about people's needs and how people consented to their care. We were given information that helped us understand about people's experiences of living in the home, the arrangements for giving people their medicines and how the quality of service was monitored.
People and their families were encouraged to be involved in how the service was run and had been asked for their views.
We spoke with the majority of the staff team during our visit. This included the registered manager, a team leader and several support staff. They demonstrated that they had developed positive relationships with people and were knowledgeable about their individual care needs.
We looked at various records kept at the home. People's needs had been assessed and support plans had been developed where we found detailed individual information about how people should be cared for. We found some information that had not always been signed and dated. Written guidance for staff relating to when an individual's medication should be given had not been recorded. However, this was updated immediately.
We looked at other records to ensure that people's safety was being maintained and how staff had been trained to meet people's needs. Some staff told us that although they always had informal support from senior staff they had not always received regular formal supervision.
Health and safety and management audits had been carried out regularly to help monitor the quality of the service.
We saw staff use a friendly banter to coax people and their laughter indicated that they enjoyed this approach. It was noted that members of staff did not always follow the care plans, for example, the care plan said staff needed to sit to the left of the person and we saw staff sitting to their right. We also observed that staff did not always tell people where they were going or what they were doing before being moved to another location.
We spoke to a relative present during our visit and we were told that whenever they visited the home, they were greeted politely by the staff. Their views about the home were sought through annual surveys and they felt able to approach the staff with complaints. They said the staff took an interest in the welfare of their family, they were kept informed of important events and they were invited to reviews of care. They were confident that their relative living at the home was safe from abuse.