Archived: Kirklands

At that inspection we found the service was not meeting all the regulations that we assessed. The requirement notices were in relation to medicine management because people had not received their creams and ointments as their doctor had intended. Also because people's care records were not person centred and did not reflect up to date information about people's care and support needs. At the last inspection, the management of risk and the use of effective monitoring systems were found to be in need of improvement. We issued four requirement notices and asked the registered provider to tell us how they were going to make the improvements required. The registered provider gave us an action plan setting how what they were going to do to improve and the timescales to carry out the improvements. At this inspection 2 May 2017, we found that all the requirement notices had been met and the changes and improvements stated in the action plan had been completed.

Kirklands is owned by Anchor Trust which operates residential and other care services for older adults. Kirklands is registered to provide accommodation and personal care for up to 40 older people, some of whom may be living with dementia. Accommodation in the home is provided on two floors and all bedrooms are for single occupancy and have ensuite toilets. There is a lounge and dining room on each floor. The home is situated in a residential area of Cockermouth and was purpose built twenty years ago. It is within walking distance of all the local amenities. There is a garden for people living there to use and this is secure, private and has accessible outdoor seating. There is parking available at the front of the home for staff and visitors. There were 36 people living at the home at the time of our inspection.

The service had a registered manager in post at the time of this inspection. 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.

People living in the home told us that they felt safe living there and relatives we spoke with told us they were “very pleased” with the care being provided. We saw that the people who lived there were being well cared for and were relaxed and comfortable in the home and with the staff that were supporting them. People told us the staff were “kind” and “always did their best”. The atmosphere within the home was friendly and inclusive. Everyone we spoke with praised the staff that supported them. We saw examples during the inspection of staff giving people their attention, offering reassurance and displaying empathy

We found that all areas of the home used by the people living there were clean and tidy. People told us they had a choice of meals, snacks and drinks. The people who lived there told us that the food was “very good” and “always good” and that they enjoyed their meals.

People who lived at Kirklands told us that care staff were available to help them when they needed assistance and that staff respected their privacy. People were able to see their friends and families as they wanted. There were no restrictions on when friends and relatives could visit people the home. People were supported to follow their own interests, practice their religious beliefs and see their friends and families as they wanted.

Systems were in place for the recruitment of staff and for their induction and on going training and development. We have made a recommendation that the service consider routinely including checks on the previous employment of new staff.

Staff told us they had received training in safeguarding adults and the training records confirmed this. Staff we spoke with knew the appropriate action to take if they believed someone was at risk of abuse. The staff we spoke with were confident that the registered manager would follow up any concerns about people’s safety and take action promptly.

We looked at the risk assessments in place for people and these included risk assessments for skin and pressure area care, falls, moving and handling, mobility, nutrition and the safe use of bedrails. The district nurse had done assessments of peoples’ skin integrity and had advised and supported the care staff on this subject. We saw that where appropriate referrals had been made to other professionals such as physiotherapists and occupation therapists.

During this inspection we looked at the way medicines were managed and handled in the home. We found that medicines were being stored and administered safely and records were kept of the medicines kept in the home, their use and disposal.

The registered manager used a range of methods to get feedback from people living, working and visiting home and promoted open communication. People living at Kirklands were involved in deciding what went on in their home and in projects such as their new shop and garden renovations.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. We saw that the registered manager had applied to relevant supervisory authorities for deprivation of liberty authorisations for people. We saw that people who had capacity to make decisions about their care and treatment had been supported to do so. We have made a recommendation that the service improved checks on forms about resuscitation and evidence of who had a power of attorney.

Kirklands is owned by Anchor Trust which operates residential and other care services for older adults. The home is situated in a residential area of Cockermouth and was purpose built twenty years ago. It is within walking distance of all the local amenities.

Kirklands is registered to provide accommodation and personal care for up to 40 older people, some of whom may be living with dementia. Accommodation is provided on two floors and all bedrooms are single ensuite rooms. There is a lounge and dining room on each floor.

There is a registered manager in post at Kirklands. 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.

People who used this service told us that they were happy at the home. One person said; “All I can say about this place is that it is good. You get your meals brought to you, my room is kept clean and the girls (staff) are kind. I would tell anyone to come here.”

Another person told us; “I like it here better than I thought I would. I was able to bring some of my things from home with me to brighten my room. I get help when I need it and my visitors can come any time. I can have what I want to eat, the food is very good and I get well fed.”

A third person added; “It is generally exceptionally good here. The help I need is increasing rather than decreasing but the staff usually come to help quite quickly. The staff are respectful and nice but there are occasions when you feel like you could have been spoken to in a better manner.”

There were sufficient numbers of staff on duty during the daytime to meet the needs of the people who used this service. However, the night staff told us of the difficulties they experienced in trying to meet the needs of people who used this service during the night. One of the people we spoke to also told us that they did not always receive the support they needed during the night.

People who used this service were not properly protected from the risks of receiving unsafe or inappropriate care. This was because care plans and risk assessments had not been reviewed and updated as people’s needs changed.

With the exception of creams and ointments, medicines were managed appropriately and safely. Where people needed help and support with their skin care, risk assessments, care plans and medicine administration records had been poorly maintained.

On the day of our visit the home was generally clean, tidy and there were no unpleasant odours. Housekeeping staff told us that they were not familiar with the cleaning schedules in place at the home and highlighted some of the difficulties they experienced when cleaning some of the individual bedrooms.

Staff received training and supervision to help them carry out their role safely and appropriately. There were some gaps in their training particularly in relation to personal planning.

People who used the service told us that the food and drink provided was “very good” and that there were always plenty of choices available. We observed the service of the lunch time meal, which confirmed everything we were told by the people that lived at Kirklands.

The home had adaptations to help people move around the home safely, for example there were hand rails, a passenger lift and stair lift available. Communal areas and individual bedrooms were clearly signed to help people orientate themselves around the building.

We observed staff supporting people who used this service. Staff spoke kindly and were discreet when supporting people with their personal care needs. People were treated with respect and dignity and wherever possible encouraged to be as independent as possible.

We found that care planning and assessments of people’s needs was not always carried out in a person centred way.

The service had a process in place to help ensure people were able to effectively raise concerns or complaints or compliments with the provider. There were systems in place to enable people to comment on the standard and quality of the service they experienced.

People who used the service told us that they knew the manager of the service and that she was approachable. Staff also said they felt well supported in their work by the management team at the home.

We have made a recommendation about the control and prevention of infections, particularly in relation to maintaining a clean and appropriate environment.

We found breaches of the following Regulations:

Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people were placed at risk of receiving care and treatment that did not meet their individual needs and personal preferences.

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people did not receive their creams and ointments as their doctor intended.

Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people were not protected against the risks of receiving unsafe care, treatment and avoidable harm.

Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because effective monitoring systems were not in place to help ensure complete and accurate records in respect of each person using this service had been maintained. This placed the health, safety and welfare of people who used this service at risk.

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because the home was not appropriately staffed and people who used the service did not receive the care and support they needed, particularly during the night time.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We had evidence to show that the staff in this service were aware of the need to protect vulnerable older adults. They understood what constituted abuse and were aware of how to report any potential abuse. All staff had been trained in adult protection. Senior staff knew how to make a safeguarding referral. We had not received any recent safeguarding reports.

We also saw that the provider made sure that they monitored staff practice and that any poor practice was dealt with appropriately. We had evidence to show that recruitment was done correctly with appropriate checks and references being completed before any new staff members had contact with vulnerable people.

We judged that there were enough staff on duty to ensure that people were safe in their environment. Suitable external locks were in place. The staff were now much more aware of fire safety. Food safety measures were of a high standard.

Is the service effective?

We saw that care planning in the service was much more detailed and that this meant that people had more effective care delivered to them. We asked the provider to continue to work with the care planning systems so that they could continue to give more effective care to people with dementia. We noted that the people in the dementia care unit were more settled in their environment because staff were working more effectively with them.

People in the home told us that they had "plenty" of choice in activities, that they were happy in their environment and they felt that staff had their best interests at heart.

Is the service caring?

We saw a lot of caring and responsive exchanges between people in the home and the staff who cared for them. Staff treated people respectfully and gave them the dignity, respect and choice they wanted. We spoke to staff who displayed empathy and understanding of people's needs. Daily notes were written in a professional and respectful manner. People told us :

"The staff team are really wonderful...very nice, polite girls and nothing is too much trouble for them."

Is the service responsive?

We spoke to the local health and social care professionals and they told us that the staff team were now much more efficient in the way they responded to people's needs. We saw in care planning that any issues were dealt with appropriately. A relative told us:

"The staff are much better at dealing with any issues. Any symptoms and they get the doctor. Any small complaints are dealt with straight away".

Is the service well-led

The service had a new general manager who was in the process of becoming the registered manager. This person had the right kind of training, qualifications and experience to manage the service. The company had ensured that an experienced manager had been in place until they recruited this new manager. We had evidence to show that both these managers had put into place effective systems to ensure the home was well led.

We were made aware that when there were problems in the service the company had made sure that there was a temporary manager, that staff from their quality monitoring department came to the home and that the operations manager visited frequently. Together these senior staff ensured that training and support was given to staff and that extra resources were in place to deal with issues in the environment. We saw that Anchor had ensured that difficulties in the service were dealt with as quickly as possible.

We spoke to people about their experiences of living in the home. We also spoke to some visiting relatives. Here are some of the things people said:

"The staff team have really helped my relative to get over a really traumatic time. They are trying to improve things."

"I feel better in myself and things have moved on."

"I am quite happy. I like all the staff. There have been lots of people around recently trying to change things."

We judged that the delivery of care had improved and that people were now receiving more acceptable levels of personal and health care.

We looked at the catering arrangements and found these to be good. We saw that staff were trying to support people at risk of malnutrition in a more planned and proactive way.

We looked at the medication held on behalf of people who lived in the home and found that the management systems had improved. We learned that the acting manager was working closely with the local GP's to make sure that people were receiving suitable levels of medication.

We walked around the home and saw that the staff team had tried to improve the problems we found at our last inspection. The kitchenette areas were cleaner and some attempt had been made to improve signs to help people find their way around the home. However we found a new concern about fire safety. We had also asked that the company look at the arrangements in place for door locks. We saw that these improvements had not progressed as well as we had hoped. A further compliance action was made about the environment.

"'They don't treat you like an invalid here. I've settled in very well.'

' I used to be a cook and I did some baking the other day. I really enjoyed that'.

Other people were not happy with the delivery of care. We were told that the GP was not always called soon enough and that sometimes staff were not responsive to people's needs. The care plans were not robust enough to provide guidance or give individual care delivery.

People told us the food was "excellent" but some people had lost weight and were not getting the right levels of nutrition because nutritional planning was poor.

Recent safeguarding issues had been reported and managed appropriately.

There were problems with the administration and recording of medication and some directions were not included in care plans.

The home was well decorated and most of the furniture and fittings were of a good standard. Bedroom door locks needed upgrading and some carpets and furniture needed cleaning or replacing. The environment needed to become more 'dementia friendly'.

Recent use of agency staff had provided enough staff by day to give good staff/service user ratios but this needed to be kept under review in line with dependency levels.

Staff supervision, development and training needed to be reviewed and improved.

"I am asked my opinion and staff are clear when they want me to do something. I have signed all sorts of things to show I consent to being here and to getting support."

We saw plenty of evidence to show that people were being given the right levels of personal and health care support. We met people who were satisfied with the way their care and welfare was being managed:

"I am given all the care I need... I like to join in with the activities and I especially enjoy the church services. Staff are very kind. I have been helped to eat a little better as staff worried about my weight. I feel a lot better as I have a lot of care and attention".

People in this service were protected from harm and abuse because there were suitable policies and procedures in place. Staff had been trained in how to recognise and deal with abuse or concerns. People living in the home said they had no concerns:

"I have never heard anything like that here. If I did I would tell the manager or write to Anchor".

We checked on the staff rosters and we could see that there were enough staff on each shift. Most of the staff have worked in the home for a number of years and have had plenty of experience and training.

We had evidence to show that complaints were managed appropriately. No one we spoke with had any complaints but were confident that the manager would deal with issues appropriately.