Archived: Kirkwood Care Home

Kirkwood Care Home is a residential care home providing accommodation and personal care to up to 20 people. The service supports older people and people living with dementia in one building. At the time of our inspection there were 17 people using the service.

People’s experience of using this service and what we found

The service had some areas of safe practice but in general people were not safe. People were at risk of harm because the provider did not always manage risks well. Medicines were not managed safely. There were enough staff to keep people safe. Robust recruitment checks were not completed before staff started working at the service. People were safeguarded from abuse; the management team had improved their safeguarding processes. Systems were in place to control infection.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff usually received the training and support they needed for their role. The service consulted other professionals when they wanted advice and guidance, and health professionals visited on a frequent basis. However, the monitoring of appointments such as podiatry was poor, which meant people’s health needs could be overlooked. People were provided with a nutritionally balanced diet but their dining experience and feedback about the quality of food was mixed. People lived in a suitable environment although the physical decoration throughout the service was not consistent.

There was a lack of consistency in people’s experience and how well the service was managed. Systems to assess and monitor the service did not drive the required improvements. Care records were inconsistent and not always accurate.

Feedback was consistently positive about the changes the registered manager, who had only been in post for 6 months, had made. Improvements included, communication, staffing and environmental. People were confident they would make further improvements. One relative said, “I have seen changes with the new manager, it’s more organised and I think she is a lot more approachable and listens and it seems a happier place in many ways.”

The service was developing systems which gave people more opportunities to share their views. Staff had daily handovers where they received key information. A visiting professional told us the service worked effectively with their team.

The provider was responsive to the inspection findings and sent information to show they were taking action to address shortfalls identified at the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

This focused inspection was planned to only cover our findings in relation to the Key Questions Safe and Well-led. However, we inspected and found there was a concern with ensuring consent to care and treatment was in line with law and guidance, so we widened the inspection to include the Key Question of Effective.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Kirkwood Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management, consent to care, recruitment of workers, medicines management and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kirkwood is a ‘care home.’ 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. The care home can accommodate up to 20 older people and older people living with dementia in one purpose-built building. At the time of Inspection there were 20 people living at the home.

At the last inspection March 2017, the home was rated requires improvement. There were breaches in Regulation 12 safe care and treatment and Regulation 17 good governance. At this inspection we found improvements and the service was no longer in breach of these regulations.

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 2008 and associated Regulations about how the service is run.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate identified risks. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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 supported this practice.

People’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was very good. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The home was clean and tidy, but in need of refurbishment in some areas. However, there was a plan in place to address this.

The home was using the garage as a storage area, this was a cause of concern and we referred this to the fire service.

The complaints procedure was displayed. The home had not received any complaints since the last inspection.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

Kirkwood Care Home provides personal care for up to 20 people. Care is primarily provided for older people, including people living with dementia. The home is situated in Ben Rhydding which is on the outskirts of Ilkley.

On the day of the inspection there were 18 people using the service.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where their could discuss their on-going development needs.

People who used the service told us they felt safe at Kirkwood Care Home and we found staff understood the safeguarding process.

People who used the service were receiving personalised care and were very happy at the home. They told us staff were kind, caring and compassionate. Activities were on offer to keep people occupied and staff provided people with companionship. People’s healthcare needs were being met and healthcare professions spoke highly about the care and support people received.

We found although peoples medicines were being managed safely, prescribed topical lotions and creams were not being stored safely and no records were being kept to show they were being administered as prescribed.

Meals at the service provided a wide range of choices and lots of home baking. Plenty of drinks were available, including alcoholic drinks if people wanted them.

We found action was not always being taken to mitigate risks within the service in relation to the premises and following accidents or incidents.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible..

Quality assurance systems were in place, however, they were not always effective in identifying areas which required improvement such as medicines management and safety within the service.

The views of people using the service were sought and acted upon to make sure people’s preferences were met.

We identified two breaches 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 the report.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe

People who used the service told us they felt safe at Kirkwood. The relatives and visitors we spoke with also said they felt people were safe at Kirkwood. They said they had never seen or heard anything while visiting the home which had caused them concern.

We spoke with two care staff and they confirmed they had received training on safeguarding vulnerable adults. They were aware of the different ways in which people could be subjected to abuse and were aware of how to report any concerns they might have. They said they felt confident the management team would take appropriate action if concerns were raised about people's safety and welfare.

The manager confirmed no one who used the service was deprived of their liberty at the time of the inspection. They understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

In the care records we looked at we saw people had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

There were procedures in place to guide staff on the actions to take in response to medical emergencies.

We found the home was clean, free of unpleasant odours and well maintained.

Effective -

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

The home had good working relationships with other healthcare professionals and worked closely with them to make sure people's needs were met. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care records.

Caring '

The people we spoke with were satisfied with the care and support provided. One person who used the service said 'It is very nice here'. Another person's relative said the 'Staff are caring' and a visitor said the 'Care is very good here'.

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them. We found people's privacy, dignity and independence were respected.

Responsive '

People's needs were assessed before they moved into the home. We saw people's care records had information about people's individual needs and preferences.

People had access to a range of activities and were consulted about the types of activities they wanted to take part in.

Two visitors told us the staff were always polite and welcoming and said they could visit at any time. They said they were able to visit their friend in private.

Well led '

A relative told us the manager listened to them and acted on what they said. They said they had seen improvements in the service since the new manager had been appointed.

The manager told us they operated an 'open door' policy and encouraged people who used the service and/or their representatives to take an active part in planning and reviewing people's care. During the visit we observed the manager talking with people who used the service and visitors. The care records showed people who used the service and/or their representatives were involved in planning and reviewing their care.

The staff we spoke with said they enjoyed working at the home. They said the worked well as a team and felt supported by the manager. They told us they had regular supervisions and appraisals and could talk to the manager at any time if they had any concerns. They said any issues they raised were dealt with promptly.

We found the provider had effective systems in place to assess and monitor the quality of the service. This included weekly visits by one of the senior management team and a planned programme of monthly audits which included areas such as care, catering, housekeeping and administration.

People told us the staff were kind and respectful. One relative described the staff as 'gentle' and said they had never heard them speak inappropriately to people who used the service. Another relative said they found it reassuring the home had a 'stable' staff team. Another person said the staff were 'always cheerful and always seem to have time for people'. We found the provider carried out checks to make sure staff were suitable to work with vulnerable people.

People told us the food was 'very good'. One person said it was like eating in a restaurant. One person who had a vegetarian diet said the chefs went out of their way to make sure they had a variety of good food. We found people were provided with a varied and nutritious diet.

People said it was a 'homely' place and told us they liked the fact the home had a dog and kept chickens in the garden.

People told us the home was clean and when we looked around we found it was clean.

During our observation we saw people were treated with consideration and respect. People and their relatives told us they were happy with the care which was provided. One person said, "I'm looking at other homes to be closer to my family, but I'll be sad to leave here. I'd like to pick it up and take it with me. The staff are lovely and the care is wonderful." Another person said, "We are well cared for. They do a good job here."

People we spoke with told us they were involved in making decisions about how their care was provided. One person said, "The staff are very courteous they ask me before they do anything."

We reviewed three care records and saw that people's preferences and care needs had been well documented. We spoke with three members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

There were enough qualified, skilled and experienced staff to meet people's needs. We saw there were systems in place to ensure medications were handled and administered safely. There was an effective complaints system available.