We inspected Kirk House Care Home on 19 and 21 May 2015. The inspection was unannounced and in response to concerns raised by other health and social care professionals and relatives of people who used the service. We also checked if the provider had made improvements following our inspection on 24 November 2014.
The provider is registered to provide accommodation, personal and nursing care for up to 35 older people who have physical health needs or are living with dementia. The provider had two intermediate care beds for people who required short-term support before returning home when they left hospital. At the time of our inspection, 29 people used the service. Fifteen of these people needed nursing care or palliative care.
There was no registered manager in post at the time of the 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 and associated Regulations about how the service is run. There was a manager in post who had not yet applied for registration. We refer to them as ‘the manager’ in this report.
At the last inspection in November 2014, we asked the provider to take action to make improvements in the following areas: How the quality of the service provided was monitored and assessed; how people were protected from the risk of abuse; how people were protected against the risks associated with unsafe use and management of medicines. Ensure that people had adequate food and drink; arrangements for obtaining and acting in accordance with the consent of people who used the service, and ensuring that people’s care records were accurate.
The provider sent us an action plan of how they intended to make the improvements. All but two actions were to be completed by 22 May 2015; the others were to be completed on 5 June 2015. We saw that improvements had not been made and the provider continued to be in breach of regulations we inspected against.
Staff did not always take appropriate action when abuse was suspected. This meant that people were not always protected against abuse. We made safeguarding referrals to the local authority about the concerns we identified.
People did not have risk assessments or management plans in place to ensure that they received safe care. Where plans were in place, staff did not always provide care as directed. People’s risks were not reviewed as their needs changed.
People were at risk of poor health because they did not always receive their medicine as planned, and staff did not take action when people missed their prescribed medicines. The provider did not have effective systems in place for storing and managing medicines.
Legal requirements of the Mental Capacity Act (MCA) 2005 were not always followed when people were unable to make certain decisions about their care. This meant that people’s liberties were at risk of being restricted unlawfully. The MCA and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interest.
People were at risk of malnutrition because their food and drink intake was not monitored effectively and staff did not did not take action when people were losing weight.
Recommendations made by health and social care professionals were not always followed. This put people at risk of poor care.
People’s dignity was not always maintained and their choices were not always respected.
People were at risk of isolation. The provider did not always ensure that people who were cared for in their bedrooms received adequate social stimulation.
People were at risk of harm due to widespread shortfalls in the way the service was managed. The provider did not have effective systems in place to regularly monitor the quality of the service provided. The provider did not maintain action plans for how concerns will be dealt with or improvements monitored. The manager had delegated some responsibilities to staff but did not always ensure that these responsibilities were carried out. We saw that very little progress had been made against the action plan and the provider did not have a system in place of how progress against the actions will be monitored. The provider did not always submit required notifications to us as required.
The provider had introduced meetings to obtain the views of people who used the service and their relatives and had started making some improvements in how services were provided based on feedback received.
People who used the service and relatives told us that staff were caring and they liked living in the home. We saw that staff spoke with people respectfully.
Some people told us and that they had a choice of food and drinks and were given adequate amounts. We observed that the atmosphere in the dining area was pleasurable.
We identified that the provider was not meeting some of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 that we inspect against and improvements were required. You can see what action we have told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, we will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe."