Kirklees

Kirklees is a residential care home providing accommodation and personal care for up to 21 younger adults, older adults who may be living with a learning disability, autistic spectrum disorder, and dementia. At the time of our inspection there were 16 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Medicine practices were not always in line with best practice guidelines.

People were not supported to have maximum choice and control of their lives, staff did not support them in the least restrictive way possible and in their best interests; policies and systems in the service did not support this practice. Staff did not always follow the Mental Capacity Act key principles when making best interest decisions. We have made a recommendation about this.

People felt staff provided safe care, and systems were in place to report concerns. Staff had been safely recruited and had received training on how to recognise and report abuse and staff knew how to apply it.

Right Care:

The provider had systems in place to report and respond to accidents and incidents. However, not all accidents, incidents or safeguarding concerns had been explored to identify any potential themes, trends or lessons learnt.

People were regularly asked their views on the service provided and action had been taken when suggestions were made.

People were supported to have access to healthcare services to monitor and maintain their health and well-being. We observed kind and caring interactions between people and staff during the inspection.

Right Culture:

There was a lack of effective monitoring in place, and this had resulted in poor outcomes for people using the service. Quality monitoring systems had failed to pick up and address the issues we identified during our inspection.

There was a positive culture within the service. Staff interactions with people were kind and compassionate. Staff knew people well and were responsive to their needs. People and their relatives were involved in their care.

Following our visit to the service, we asked the provider to send us an improvement plan which detailed the actions they had taken/were going to take in relation to the issues identified during our inspection.

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

Rating at last inspection and update

The last rating for this service was good (published 2 August 2017).

Why we inspected

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

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to medicine management and good governance at this inspection. We have also made a recommendation in relation to consent and person-centred support.

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.

At the last inspection in March 2015 the service was rated Good. At this inspection we found the service remained Good.

This inspection visit took place on 28 and 29 June 2017 and was unannounced.

We spoke with people who lived at the home. They told us they felt safe with the staff that supported them and enjoyed the independence staff encouraged them to be. Over the two days we observed staff providing good support for people in various ways such as preparing to go out on activities and joining in with activities. In addition we observed staff being kind and patient in various ways.

We found recruitment checks were carried out to ensure suitable people were employed to work at Kirklees. There were sufficient staff to meet people’s needs on duty at the time of the inspection visit. This was confirmed by talking with staff members, looking at staff rotas and looking at records of staff recruitment. Staff had been appropriately trained and supported. This was confirmed by talking with staff and training records we looked at.

Risk assessments had been developed to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported and how their independence would be encouraged. People who received support or where appropriate their relatives/advocates were involved in decisions and consented to their care.

Medication procedures observed were safe and people received their medicines as prescribed. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us they were happy with the variety and choice of meals. They also told us if they did not like what was on the menu then they could choose something else. Comments included from people who lived at the home, “I like the food and if I don’t then there is always something else. “ Also, “The cook is very good, lovely meals.” We saw regular snacks and drinks were provided between meals during the day to ensure people received adequate nutrition and hydration.

People had access to healthcare professionals and their healthcare needs were met.

People who lived at the home told us staff and the registered manager had a caring and supportive manner. Comments from people who lived at Kirklees included, “Lovely, caring and nice people, all of them.”

The registered manager had a complaints procedure which was made available to people on their admission to the home and their relatives. No complaints had been received. People who lived at the home told us they were aware of who to talk with if they had any concerns.

Activities were organised throughout the home and out in the local community. People were encouraged to be as independent as possible and were supported to follow their chosen hobbies and interests. A display board using pictures provided people with information of what activities were arranged daily. One person who lived at the home said, “[Entertainer] is great always look forward to her coming.”

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff and ‘resident’ meetings to seek their views about the service provided and their opinions to improve the home.

We found the home to be clean and tidy throughout and systems to manage clean laundry had improved.

We found sytems to improve staff practice and ensure accuracy of medicines records had been implemented. Whilst there had been some errors, such as missed signatures on records, these had been well managed and action had been taken to minimise the risk of errors.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We observed staff discuss people's care needs with them and explain the assistance to be provided. However written consent to their care plan was not routinely obtained.

People we spoke with were pleased with the meals provided, comments included, "I liked my dinner, I had pie." However some people did not always receive the monitoring and support they required to ensure they ate their meals.

We found systems in place to reduce the risk and spread of infection, however, we found that these were not consistently or effectively implemented.

People were not protected against the risks associated with medicines because records were not accurately maintained and controlled drugs had not been safely managed.

There were enough qualified, skilled and experienced staff to meet people's needs and appropriate checks were undertaken before staff began work.

People's complaints were fully investigated and resolved, where possible, to their satisfaction.

We found that there had been improvements to care planning and risk assessment processes and that equipment to meet people's needs had been provided. One person who used the service told us staff encouraged them to remain as independently mobile as their health allowed but also told us that a hoist had been provided to assist them to transfer. They said "Staff know how to use the hoist if I need it and I always have two people to help me." They also told us that they had a new bed and with bed rails provided because they felt safer with these in place.

We found that staff understood their responsibilities to ensure that peoples needs were met safely and to report poor practice.