Care Home: Kirkby House Residential Care Home

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What the care home does well The home provides a pleasant, homely and well-maintained environment which has been furnished and decorated to meet the specific needs and abilities of the service users. Service users are stimulated through a comprehensive activities programme and given every opportunity to continue with their lifestyle preferences. Detailed pre-admission assessments are undertaken to evaluate the needs of the service users and this information is used to prepare the initial plan of care. Care plans are informative and are reviewed and updated regularly to provide staff with full details of the care and support required. Risks are reduced through robust risk management strategies. Staff are well trained and are given opportunities to further develop their knowledge and skills. Management arrangements ensure that standards of care are maintained and that records are kept appropriately. What has improved since the last inspection? The programme of redecoration and refurbishment of the home has now provided a comfortable and pleasant place for service users. Orientation signs around the home have now provided pictorial identification for service users to enable them to find their way around the home. Records are now kept up to date and regular audits ensure that they are maintained to a high standard. Staff training opportunities have increased to ensure that staff have the knowledge and skills to meet the needs of the service users. Risk assessments have been prepared and risk management plans put in place to ensure that service users are protected. What the care home could do better: The programme of redecoration and improvements should now be focussed on the redecoration of bedrooms where paintwork has become damaged or worn. Key inspection report Care homes for older people Name: Address: Kirkby House Residential Care Home James Holt Avenue Kirkby Knowsley Merseyside L32 5TD     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jeanette Fielding     Date: 2 4 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Kirkby House Residential Care Home James Holt Avenue Kirkby Knowsley Merseyside L32 5TD 01512899202 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: kirkbyhouse@meridiancare.co.uk Meridian Healthcare Ltd care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following categories of service only: Care home only - Code PC to people of either gender whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Old age, not falling within any other category - Code OP (maximum number of places 12) The maximum number of people who can be accommodated is: 44 Date of last inspection Brief description of the care home Kirkby House is a care home for 44 older people. The acting manager of Kirkby House is Tracey Conlin and the home is owned by Meridian Healthcare Ltd. Kirkby House is a single storey building surrounded by well-maintained grassed areas and secluded gardens. The home is situated in a residential area of Kirkby, close to bus routes and a train station. Care and accommodation in Kirkby House is provided in three units. General administration, laundry and cooking are carried out centrally, and the manager has over all responsibility. Individual Units are otherwise self-contained, Care Homes for Older People Page 4 of 24 Over 65 0 12 44 0 2 8 1 1 2 0 0 8 Brief description of the care home having designated staff, toilet and bathing facilities and lounge/dining areas. The building is suitable for people who have a physical disability, providing level access, mobility aids. Further communal spaces are available to all residents for joint social gatherings. All Service Users are registered with local doctors when admitted to Kirkby House on a permanent basis. The fees for the home range between 435 and 451.50 pounds per week Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was undertaken in one day over a period of seven hours. As part of the inspection process, all areas of the home were viewed including many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. The care files of six service users were case tracked to evaluate their care. Discussion took place with the acting manager, deputy manager, nurses, care staff, service users and visitors to the home. The acting manager completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. Care Homes for Older People Page 6 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides detailed information regarding the services and facilities within the home to enable prospective service users to make an informed decision regarding their care provider. Evidence: The home is owned by Meridian Healthcare Limited who have produced an extremely detailed brochure and information books which give full details about Kirkby House and other services provided by the company. These are displayed in the foyer of the home, together with the service user guide and a copy of the last inspection report. The information about the home provides details which are specific to the needs of the service users who have dementia and include photographs of the home. Copies of these may be obtained from the home on request. All prospective service users are fully assessed prior to their admission to the home. An assessment is usually carried out by the social worker which is followed by a Care Homes for Older People Page 9 of 24 Evidence: further assessment by one of the senior staff from the home. The care file of a service user who had recently been admitted to the home was inspected. It was evident that all care needs had been identified by the person undertaking the assessment and included physical health needs, mental health needs and abilities and individual preferences. Information is gathered from the service user, their family and any healthcare professional involved in their care. The homes uses a dedicated assessment form which is well laid out and informative. Sufficient information is gathered at the time of the assessment to enable a plan of care to be prepared. The home provides short term and respite care and it was pleasing to note that the same level of assessments and care plans are prepared for all service users, regardless of the time that they are to be accommodated at the home for. The home does not provide intermediate care. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that service users receive is based on their individual needs and respects their privacy and dignity to promote a good quality of life. Evidence: Individual care plans are prepared for each service user. The initial plan is prepared using the information gathered at the pre-admission assessment and new service users are continually reviewed in the few weeks following their admission to the home. All service users have their care plans reviewed and updated on a monthly basis and whenever their needs change. The reviews are detailed and provide evidence that the service users are assessed as individuals with their needs and preferences clearly identified. The care plans are also reviewed following visits by healthcare professionals and any advice is incorporated into the information provided for staff. A sample of six care plans were inspected and all were extremely detailed to inform staff of the care and support that the service users require, together with details of how that care was to be given based on the service users preferences. Comprehensive risk assessments are undertaken on all aspects of daily living and risk management Care Homes for Older People Page 11 of 24 Evidence: plans are put in place to remove or reduce any potential risks to the service users. The risk assessments include the use of specific moving and handling equipment, bed rails, skin care, nutrition, continence, falls, the ability to use the nurse call and the individuals dependency level. Many of the service users are unable to express their needs and preferences and so family members and friends are consulted regarding their previous lifestyle and social preferences. The files provide evidence that the service users lifestyle and preferences are taken into consideration when preparing the care files. Daily reports are completed by the staff and provide clear evidence of the actual care given and show that service users health care needs are met at all times. Aids and adaptations are provided to assist service users and the home provides a range of moving and handling equipment. Pressure relieving mattresses and cushions are provided where the assessment shows that these are necessary. Individual choices and preferences are clearly identified in the care files and include information about the service users preferred time of going to bed and rising and of the gender of the staff who should provide personal care. All care files are audited on a regular basis by the acting manager. All laundry is attended to within the home and attention is given to the avoidance of cross infection. Personal items are carefully laundered and are returned to service users promptly. Medications were observed to be dealt with in accordance with safe practice and in line with the homes policy and procedure. All medication administration record sheets were signed appropriately and were up to date. Medications are securely held and all storage areas were clean and organised. The medications are audited on a regular basis and clear information was available regarding the medications that entered the home. Detailed records are held of medications that service users refuse or no longer require and appropriate disposal arrangements are in place for these. No excess or unwanted medications are held in the home. Observation at the time of the visit provided evidence that service users privacy and dignity were respected at all times by the staff team. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The programme of activities provides service users with a stimulating and entertaining lifestyle which promotes social interaction and the retention of skills and abilities. Evidence: The home does not currently employ an activities co-ordinator although the position is being advertised. All activities and social stimulation is provided by the care staff who are aware of each service users preferences and abilities. The home provides a range of activities including skittles, card games, dominoes, art, crafts and shopping trips. At the time of the inspection, service users were observed to enjoy singing, art and one to one sessions with the staff. Service users are making Christmas Cards and some of the Christmas decorations that service users had made were already in place. Ministers visit the home each week and provide services for those who wish to participate. One relative confirmed that her husband is taken to church by the staff on a regular basis. Recently, service users enjoyed petting and feeding small animals from a local farm and a visit from a Ranger who brought some reptiles in to show to the service users. One relative visits with a guitar to play for the service users. Staff were observed to spend time with service users on a one to one basis and in small groups to provide activities and stimulation. Staff are currently preparing My Life Care Homes for Older People Page 13 of 24 Evidence: Story books for service users to give details of their childhood and adult memories. Relatives are working with the staff to give information and to provide photographs. These books will also provide staff with greater insight into the lifestyles of the service users. The majority of service users take their meals in the dining room but can take them in their bedroom or in the lounge as they prefer. Dining tables were attractively laid and a range of condiments were provided. Menus are displayed and a choice of meal is offered. Special diets can be provided on the advice of the GP or dietitian or at the request of the service users. Staff were observed to assist service users with their meals in a dignified manner. The menus provide evidence that a varied and balanced diet is offered. Meals are prepared in the main kitchen and served from heated trolleys. Relatives spoken to said that they had observed the meals which looked and smelled delicious. Service users spoken to said that the meals were good and confirmed that the chef would provide a different meal if they did not want any of the meals on the menu. The kitchen was seen to be clean and organised and the chef confirmed that all equipment was in working order. Some new items had been ordered and the chef was awaiting delivery. A good stock of fresh fruit and vegetables were available and all foods were seen to be stored appropriately. Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All members of the staff team have been trained in the protection of vulnerable adults to protect service users from harm or abuse. Evidence: The home has a robust complaints procedure which is displayed in all bedrooms and the foyer of the home. Information on how to make a complaint is also detailed in the service user guide which is readily available from the home. Since the last inspection, three complaints have been made to the manager and the records held in the home show that these were dealt with in a timely and professional manner. Staff spoken to were aware of how complaints are to be dealt with and to whom all comments from service users and visitors are to be addressed. The company has a Safeguarding Adults Manager who can be contacted by service users and a free Safeguarding Adults telephone line. All staff have been given training on the protection of vulnerable adults and evidence of this training is held on the staffs files. Training has also been given on the Mental Capacity Act and Deprivation of Liberty Safeguarding to further protect service users. Staff spoken to were able to demonstrate that they were aware of the different types of abuse and of the action they would take in the event of it being suspected. All staff are fully vetted prior to commencing work at the home to ensure that the service users are protected. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is extremely well maintained and efforts have been made to ensure that service users are orientated and safe at all times. Evidence: Kirkby House is a single storey purpose built care home. The home provides accommodation in single bedrooms, many having en-suite facilities. Sufficient toilets and bathrooms are located around the home and the manager has provided pictorial identification on the doors to enable service users to orientate themselves around the home. Aids and adaptations are provided to assist service users such as hoists, slide sheets, assisted baths and handrails. At the entrance to the home is a seating area with settees which can be used by visitors and service users. This area is bright and pleasant. A good selection of information leaflets are provided in this area to give details of benefits and services provided by other agencies. The home provides three lounges and dining areas which are all decorated and furnished to a high standard. Relatives spoken to said that the standards within the home were poor until a few months ago but the redecoration and refurbishment that had taken place had dramatically improved the home, resulting in it now being bright and pleasant with no unpleasant odours. Care Homes for Older People Page 16 of 24 Evidence: Bedrooms are bright and comfortable and service users and their relatives are encouraged to provide pictures, photographs and items of memorabilia to promote a more homely environment. Service users can have their own telephone installed in their bedroom if they wish. The programme of improvements within the home is now well underway with new carpets and flooring being fitted in many bedrooms. Some bedrooms now require to be redecorated as damage has occurred to walls, doors and skirting boards by wheelchairs. Since the last inspection, two new kitchenettes have been provided. These are accessible to staff and visitors to the home and remain locked to unaccompanied service users to prevent the risk of accidents. New furniture has been provided in the dining room. All corridor carpets have been replaced and also in the smoking lounge. New equipment has been provided in the laundry. The home is maintained to a good standard and all repairs are addressed as soon as they are identified. The home was found to be clean throughout and there were no unpleasant odours. The home provides a secure garden with raised flower beds and seating. Service users are free to use the garden at any time. The grounds around the home are well maintained. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by a well trained, effective staff team who have gone through a thorough recruitment process , so their needs are met and they are safe from possible harm or poor practice. Evidence: The home has a structured staff team and employs a manager, deputy manager, senior care assistants and care assistants to provide care for the service users. Additional staff are employed to attend to housekeeping, laundry and catering. The home has a robust recruitment policy and inspection of a selection of staff files showed that this had been followed. The procedure requires that all prospective staff complete an application form prior to being called for interview. Two references are taken and checks are made through the Criminal Records and Protection of Vulnerable Adults bureaux to ensure that service users are protected. Qualifications are verified and certificates are required to be provided. Records are held of interviews and gaps in employment are explored. All applications are audited by the Company Human Resources department. All new staff are required to undertake a five day induction training which includes all mandatory training courses. Training continues to be given to all staff and recent training provided includes updates on moving and handling, infection control, the Mental Capacity Act and Care Homes for Older People Page 18 of 24 Evidence: Deprivation of Liberty Safeguarding. At present, 80 of the care staff hold NVQ qualifications with senor staff having achieved NVQ at level 4. Acting senior staff are currently working towards NVQ level 3. Certificates are held on the staff files and the manager maintains a matrix which gives details of training undertaken by all staff. Training courses are planned in advance and the next training course is to be an update on the safe administration of medications. Supervision is given to staff every two months and annual appraisals are now planned. Staff who responded to the survey forms sent by CQC were positive about the home. They confirmed that the recruitment procedure had been followed and that training is provided on a regular basis. Two staff said that the home provided a high level of care for the service users. Staff spoken to on the day of the inspection said that they enjoyed working at the home. Care Homes for Older People Page 19 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed to ensure that the care and safety of service users are protected. Evidence: The manager of the home is currently applying to register with CQC. She is qualified and experienced in managing care services to older people and people with dementia. She has a sound knowledge of strategic and financial planning and works with the company to improve the home. She is supported by senior management within Meridian Healthcare Ltd. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of best practice operational systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. Equality and diversity, human rights and person centred thinking are given priority by the manager who is able to demonstrate a high level of understanding and demonstrate best practice in these areas. The manager is well supported by a well Care Homes for Older People Page 20 of 24 Evidence: trained staff team. Staff spoken to during the inspection said that the manager was knowledgeable and supportive and was always available if they needed her. The home holds the Investors In People quality assurance award and regular audits of service provision are undertaken internally. Record keeping is of a high standard and regular audits of all aspects of the home ensure that standards remain high. Safety checks are made on the premises and all equipment and certificates of these are held. Care Homes for Older People Page 21 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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