Kirklands

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safe care and treatment. The service did not always ensure safeguarding procedures in place were effective. The service did not always ensure people’s risks were recorded and some people’s risk assessments contained inconsistent information.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service identified and investigated concerns about safety and took action to keep people safe where required. However, lessons learned from safety incidents were not always shared and discussed with the staff team to continually embed good practice.

The service identified themes and trends from falls incidents to enable them to make changes to people’s care or deploy staff more effectively.

The service worked with people and healthcare partners to establish and maintain safe systems of care. However, a lack of information or inconsistent information in people’s care plans and risk assessments meant there was a risk people would not experience a smooth transition between different services.

The service was improving how it identified people’s changing needs and was working with commissioners to ensure people were in the right placement.

The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service did not always share concerns quickly and appropriately.

The service had safeguarding procedures in place, and concerns were investigated and acted on. However, some staff told us they did not feel confident to raise concerns orwhistle blow. This meant there was a risk not all safeguarding incidents would be reported or investigated in a timely way.

During our inspection we were told about a safeguarding concern which had allegedly occurred a considerable amount of time beforehand and had not yet been reported. Following feedback from the inspection team, the service ensured the safeguarding allegation was reported to the relevant authority and an investigation was started straight away.

Where people needed to be deprived of their liberty to keep them safe, the service ensured a deprivation of liberty safeguard (DoLS) was applied for through the relevant local authority.

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, care plans did not always include information about people’s risks.

For example, where people had a diabetes diagnosis, care plans did not always include information about how they were supported to manage this. There was a lack of guidance for staff about how to identify concerns and when to refer to health partners. Following feedback from the inspection team, the service sent us 1 updated care plan which now included a diabetes care plan and risk assessment.

1 person had risks around their skin due to a health condition. However, there was no information about how they were supported to manage this or guidance for staff about how to identify concerns and when to refer to health partners. Their skin issues were not being recorded to ensure ongoing monitoring.

Where a person was at high risk of falls and required support with moving and handling, their care plan included inconsistent information about this. This meant the person was at risk of receiving inconsistent care.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. There were effective systems in place to ensure the environment was kept safe.

Staff had received fire safety training and routine testing took place for fire alarms and evacuation procedures. One staff member told us, “I have had fire safety training and know evacuation procedures.”

Environmental risk assessments were in place such as fire safety, gas safety and water safety. These were up-to-date and where issues were identified, these had been addressed or there was a plan in place to address them.

Environmental audits took place to monitor the safety of the premises and equipment.

People were able to move safely around the environment. There were grab rails and specialist equipment available to support people who needed these. People were provided with specialist beds, hoists, and other equipment.

Following feedback from the inspection team about 2 sluice rooms and a laundry cupboard being left unlocked, and mobility equipment being stored in 1 person’s bathroom, these issues were addressed straight away by the management team. The service put a plan in place to ensure issues with 1 person’s room lock and an office fire door were actioned. The service had already begun replacing people’s room locks to ensure they could be locked and unlocked safely.

The service made sure there were enough qualified, skilled and experienced staff who worked together well to provide care that met people’s individual needs.

The service used a dependency tool to calculate the numbers of staff they needed. There appeared to be enough staff on duty to meet people's needs, and the service had recently put in place measures to free up care staff during busy spells.

There were robust and safe recruitment procedures in place to ensure all staff, including agency staff, were competent and able to carry out their roles.

Staff had completed the required training, and the service had requested additional training such as with managing people’s behaviours. One professional visiting the service told us, “The [service] has approached us to request bespoke training for their staff to improve support around people’s behaviours.”

Staff felt they delivered safe care, having received a robust induction and ongoing support. One staff member told us, “When I started, I had a DBS, all checks were completed, and I had an induction which included shadowing. I have been completing training. Everybody has made me feel so welcome and looked after.” However, improvements were required to ensure all staff received regular supervision in line with the service’s supervision policy.

The service did not always assess or manage the risk of infection.

Cleaning schedules were followed effectively, and appropriate infection prevention and control risk assessments were in place and reviewed. However, during our inspection, kitchen staff were observed to not be wearing any personal protective equipment (PPE) while preparing food. There were no hair nets available. Following feedback from the inspection team, PPE stock was purchased by the management team and delivered quickly for kitchen staff to use.

Care staff and domestic staff had the appropriate PPE available to them and were wearing it when required.

There were some gaps in the in the laundry cleaning records and an up-to-date COSHH policy and risk assessment was not available during our onsite inspection.

We observed the environment to be clean and tidy and domestic staff were routinely cleaning throughout our inspection and attending to any spillages quickly.

Where required, the service shared concerns about infection prevention and control with the relevant agencies promptly.

The service made sure that medicines were safe and met people’s needs, capacities and preferences. However, topical preparations were not well managed, and we found occasional shortfalls in medicines record keeping.

Care home staff worked with other professionals to review people’s medicines needs. Records we checked showed people were having their regular medicines administered safely. Where new medicines were prescribed, we saw that these were started promptly. Arrangements were in place should the covert (hidden) administration of medicines be needed. People were supported to take their medicines when away from the home. Homely remedies were available for the prompt treatment of minor ailments.

Records for the administration of medicines were generally clearly made. However, we did find some areas for improvement. For example, there were occasional gaps in recording the use of prescribed ‘thickeners’. A complete list of peoples’ medicines was not readily available, as medicines administered by district nurses were not included on people’s electronic records.

Creams were also less well managed; we found some unlabelled creams in people’s rooms and one example where the emollient applied was not the one recorded as used.

The administration of ‘when required’ medicines prescribed for when people were distressed or agitated was kept under review. However, on some occasions only limited information was recorded about why the medicine was needed. Similarly, although people who wished to could self-administer medicines, there was no written risk assessment or care plan to support this for 1 person. We raised this with the manager in order that this could be promptly addressed.

Staff members had received training in the safe administration of medicines and were assessed as competent before supporting people. Regular medicines audits were carried out so that should any shortfalls be identified, they could be promptly addressed. Medicines including controlled drugs were safely stored.