Archived: Kirkdale

Updated 16 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 1 November 2017 and was unannounced which meant the provider did not know we would be visiting. The inspection team was made up of one adult social care inspector, an inspection manager, a specialist professional advisor and an expert by experience. A specialist professional advisor is someone who has a specialism linked to the service being inspected, in this case a nurse. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed the information we held about the service. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally required to let us know about.

We also contacted the local authority commissioners for the service, the clinical commissioning group (CCG) and the local Healthwatch to gain their views of the service provided. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

During the inspection we spent time with people living at the service. We spoke with eight people who used the service and nine relatives. We also spoke with the chief executive officer, acting manager, deputy manager, two nurses, six care assistants, the chef, three members of housekeeping staff and a person on work experience at the service.

We reviewed six people's care records and six staff files including recruitment, supervision and training information. We reviewed medicine administration records for people as well as records relating to the management of the service.

Due to the complex needs of some of the people living at Kirkdale we were not always able to gain their views about the service. We used the observations around the service to help us understand the experience of people who could not talk with us.

Updated 16 December 2017

We inspected Kirkdale on 1 November 2017. The inspection was unannounced. This meant that the staff and provider did not know we were coming.

Kirkdale is a single storey purpose built nursing home registered to provide care for a maximum of 38 people. At the time of our inspection there were 28 people using the service, all of whom were living with a dementia. The service was separated into two areas, Lavender accommodated those people who were more mobile and independent. People who required a higher level of support were accommodated on the Rosemary section. There was a spacious dining room for each area and a number of communal seating areas and lounges.

At the last inspection on 5 January 2016, the service was rated good. At this inspection we found some areas remained good however others required improvement.

The provider did not have a registered manager in place at the service. The position had been vacant since the previous registered manager’s contract ended on 18 August 2017. The provider had appointed an acting manager to oversee the day to day running of the service, however, at the time of our inspection no candidates had been interviewed for the permanent role.

Quality assurance checks and audits undertaken to monitor service delivery were not always effective and had not identified the issues we found during our inspection.

The service was in need of refurbishment and redecoration. The environment had some dementia friendly adaptation but this was in need of improvement to ensure all areas of the service reflected best practice. We have made a recommendation about this.

There were areas of malodour around the service, some areas were in need of deep cleaning and there were no hand washing facilities in dining areas. We have made a recommendation about this.

At mealtimes people were given sufficient to eat and drink but were not fully supported to make choices about their food. We have made a recommendation about this.

Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Appropriate recruitment procedures and pre-employment checks ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were in place and reviewed regularly.

People’s medicines were safely stored, correctly recorded and administered as prescribed by trained staff.

Staff received appropriate training and support. Training in equality and diversity was completed by all staff. Staff supported people in the least restrictive way possible in line with the principles of the Mental Capacity Act 2005 (MCA). Where people’s freedoms were restricted this was done following best interest assessments and the correct authorisation was obtained. People’s health and wellbeing was supported by appropriate access to healthcare professionals such as community matrons, the falls team and the dietician.

There was a calm atmosphere around the service. People were at ease with staff and relatives told us staff were caring. Staff treated people with kindness and compassion.

Staff demonstrated an understanding of people's needs and how they liked to be supported. People's religious and cultural needs were considered and access to religious support was available regardless of faith. Care plans were well organised, detailed and specific to people's individual needs.

We saw people enjoying a musical afternoon activity however the activity co-ordinator only worked at the service for two days and we did not see evidence of activities taking place on a regular daily basis. We have made a recommendation about the organisation of activities.

Complaints were investigated in line with the provider’s policy.

Relatives and staff felt the service was well managed. Staff described the acting manager as approachable and said there was an open culture. Records were well organised and easily accessible. Quality assurance checks and audits were undertaken to monitor service delivery.

One breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found during this inspection. You can see what action we told the provider to take at the end of this report.