Kilburn Care Centre 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.

Kilburn Care Centre is registered to accommodate 49 people. At the time of our inspection 45 people were using the service. The service accommodates people in one building over two floors. The home is divided in to two areas; the main nursing unit and a 10 bedded residential unit. Both had separate adapted facilities with lounge and dining areas on each unit. A garden and enclosed patio were also available that people could access.

The service had 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.

Our last comprehensive inspection was undertaken in November 2015 and the service was meeting the regulations that we checked and was rated as good.

The local authority advised us they were investigating concerns regarding the safety of two people using the service at the time of our inspection. We saw that the registered manager had worked with them and taken action to enhance the safety of these two people.

There was sufficient staff to support people and people told us they felt safe at the home. Staff had knowledge about people’s care and support needs to enable support to be provided in a safe way. Staff were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments that identified risks to people’s health and safety were in place and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies; to ensure people were supported in accordance with their needs. Staff had the equipment needed to assist people safely and understood about people’s individual risks. The provider checked that equipment was regularly serviced to ensure it was safe to use.

Staff gained people’s verbal consent before supporting them and helped people to make their own decisions. Where people were unable to do this; decisions were made in people’s best interests. People received food and drink that met their nutritional needs and preferences, and if required were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People liked the staff and their dignity and privacy was respected by the staff team. Visitors were made welcome and staff were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

We inspected Kilburn Care Centre on 17 November 2015. This was an unannounced inspection. The service was registered to provide accommodation and nursing care for up to 47 older people, with a range of medical and age related conditions, including arthritis, frailty, mobility issues, diabetes and dementia. The service is divided into two areas: the main 45 bedded nursing unit and a residential wing accommodating 10 people. On the day of our inspection there were 45 people living in the care home.

At our last inspection on 3 October 2013 the service was found to be compliant in all outcome areas and no concerns were identified.

A registered manager was in post and present on the day of the inspection. 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.

People were happy, comfortable and relaxed with staff and said they felt safe. One person told us, “The staff here are fabulous. I get everything I need and they are kindness itself.” A relative we spoke with was also very satisfied and told us, “I come here every day. This home has a lovely atmosphere. It's very homely.”

People received care and support from staff who were appropriately trained and confident to meet their individual needs and they were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to assist staff on how keep people safe and there were sufficient staff on duty to meet people’s needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

We found that the provider was delivering appropriate treatment to people who were bed bound 24 hours a day by appropriately managing their skin integrity and treating pressure sores.

We saw that staff were respectful when assisting people to eat and drink. We saw that care plans showed that people and their relatives were involved in decisions about their care.

People told us "They look after me well here" and "I can't grumble. I would if I had to though". The provider did not take proper steps to ensure that service users were protected against risks of inappropriate or unsafe care and treatment. Clear care plans for people using the service were not being followed by staff such as for people requiring to be repositioned in their bed or a person who required encouragement with eating.

People told us they felt safe living at the home. The provider had clear policies and procedures in place for safeguarding. We also saw that the provider was using Deprivation of Liberty Safeguarding for people when it was in their best interest.

On the day of our inspection, there were two nurses and eight care workers providing care, treatment and support for 41 people. There were enough staff to meet the needs of the people using the service.

The provider had a clear policy and procedure for complaints in place. We saw that the provider followed the procedure when dealing with any complaints and worked well with other organisations in resolving complaints.

People we spoke with told us their care and treatment is discussed and consented to on a regular basis. They said that there were regular reviews regarding their needs and if changes were needed, they were discussed and agreed to before they were changed.

People who used the service all provided positive comments about the home. One person told us that she “felt safe and had never been so well looked after”. Another person told us “I’ve lived here for 13 years and it has been the best 13 years in my life”.

Despite some minor errors, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. The provider also had appropriate arrangements in place regarding controlled drugs and this medication was being stored, recorded and administered correctly.

People we spoke with said that they felt there were sufficient staff on duty at all times to ensure that their needs were met. One person said “the staff are good. I don’t have to wait long for anything if I need it”.

The provider had clear systems in place to obtain feedback from all persons involved in the service as well as auditing their own service. This shows that the provider was reducing the risks identified in order to prevent the service becoming non-compliant with the regulations.