About the service: Kilkee Lodge is a residential care home that was providing care to 76 people aged 65 and over at the time of this inspection. Kilkee Lodge is a purpose -built building providing single ensuite rooms in a residential area in Braintree.

People’s experience of using this service:

The service met the characteristics of good in most areas. We did identify some shortfalls with staffing as people had to wait for support. During the course of the inspection the registered manager increased staffing levels.

We also identified shortfalls in documentation and the service was in the process of moving from a paper to an electronic system. We saw staff provided good care, but this was not always reflected in the written records. We have recommended that staff receive more training on using the new electronic recording system.

People told us they enjoyed the food and meals looked attractive.

There were clear systems in place for the ordering, administration and monitoring of people’s medicines.

Communication with health and social care professionals was effective in ensuring that people received joined up care. We have recommended that further work is undertaken to ascertain peoples wishes at the end of their life.

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

People had access to activities to enhance their wellbeing and told us that staff were kind and helpful.

Incidents and accidents were recorded and reviewed to prevent a reoccurrence.

The service was clean and there were systems in place to check on equipment to ensure that it was safe. We have recommended that the provider review exit doors, as they were not alarmed, in line with the needs of the people resident in the service.

The registered manager understood their responsibility under the duty of candour to be open and to take responsibility for things that go wrong. There were oversight systems in place to audit and check on the delivery of care. The service worked with ‘Prosper’ which is a local multiagency project which aims to improve safety in care homes and reduce falls and pressure ulcers.

People’s views on the service were sought in several ways and used to help make improvements at the service.

Rating at last inspection: At our last inspection, the service was rated ‘Requires Improvement'. Our last report was published on 27 April 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

The inspection took place on the 6 and 7 March 2018 and was unannounced.

Kilkee Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kilkee Lodge is registered to provide care and support for up to 80 older people. The service is located in Braintree and the care and support provided in a purpose built building over two floors. There were 70 people living in the service when we inspected.

The service had a registered manager who had been appointed and registered since the last 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.

At our last inspection of the service on 14 December 2016, we rated the service as "Requires Improvement" overall. This was because we found shortfalls in the way medicines, risks and nutrition were overseen and managed. We found that the provider was in breach of a number of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection the provider sent us an action plan setting out the actions they intended to take to ensure improvement. At this inspection we found that improvements had been made and the service was no longer in breach of the regulations we identified in the 2016 inspection. However we concluded that further work was still needed to ensure consistency of practice across the service. The service remains rated as “Requires improvement.”

Improvements had been made to medicine administration and there was a clear process in place for ordering, receiving and disposal of medicines.

There were systems in place to mitigate risks to people. Risk assessments were in place which set out how risks should be managed and the likelihood of harm reduced. People had access to a range of specialist equipment, such as pressure relieving mattresses to reduce the likelihood of them developing skin damage. Moving and handling risk assessments were in place but we have recommended that further advice is sought from occupational therapy about the use of specific slings. The environment was regularly monitored and checks were undertaken on equipment to reduce the likelihood of equipment failure.

People gave us mixed views on staffing levels and told us that there was not always enough staff available. Staffing rotas showed variable numbers of staff on duty on some days. There was a dependency tool in place to assess overall staffing levels and according to this tool there were sufficient staff employed. We have recommended that further analysis is undertaken to ensure that the staffing levels fully meet people’s needs.

Staff received training on how to recognise abuse. There were systems in place to review incidents and identify learning.

There were clear processes in place to check on staff suitability prior to them starting work at the service which included references and disclosure and barring checks. The new registered manager had reviewed the training which was previously undertaken and commissioned additional areas. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills. Staff received supervision to support them in their role and identify any learning needs and opportunities for professional development.

The service was clean and there were systems in place to control infection. However parts of the service were cluttered and some equipment in need of replacement which meant that they were difficult to keep clean.

People had good access to drinks and there were clear systems in p

The inspection took place on 14 December 2016 and was unannounced. The service provides accommodation and personal care for up to 80 people, some of whom are living with dementia. On the day of our inspection 76 people were using the service.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The previous registered manager left the service in September 2016 and another registered manager working for the provider has been managing the service. They returned to manage the service where they are registered in early December. Throughout this period an experienced deputy manager has been working at the service. A new manager has been appointed and will commence at the service in January 2017 and the provider informed us that they would be seeking registration with the (CQC).

Kilkee Lodge is a care service over two floors with dining and communal rooms for the use of the people that use the service. Work had recently taken place to develop and refurbish the upstairs dining room and experience for people using the service. The entrance way had some information available about the service for example, but we found this was limited. For example there was no complaints process displayed, but there was a suggestion box available, however we noted there were no forms to fill in. The corridor flooring on the ground floor was unclean in places, but the cleaning staff tried their best to keep this flooring clean as it was difficult to maintain. We found the people's rooms we saw, were clean and odour free, as were the communal rooms, bathrooms and lavatories.

People were not always safe because the service had made an error with the recording of medicines, but this has no impact upon the well-being of the person. When people fell this had not always analysed, or the care plan for reducing the falls had not followed. For example some people required supervision but were left alone. We saw one person lying in bed and their catheter was on the floor instead of being housed in a catheter stand. Although this was not necessarily a trip hazard, it was a concern with regard to effective infection control.

Staff had been recruited safely and had received training in a number of core subjects. Recruitment was on-going to fill staff vacancies which were covered by agency staff. Having to induct new agency staff into the way the service worked was demanding for all of the regular staff and they looked forward to a time when the service was fully recruited.

The deputy manager carried out dependency level assessments from the information provided by the staff team to calculate the number of staff required to provide care and support to people using the service. Although the staffing compliment on the rota was in agreement with the number of staff required, regular staff considered they were pushed to provide the care required when working with agency staff unfamiliar with the service. The deputy manager tried to use known agency staff to cover staff vacancies and this was usually successful.

Some people considered that there should be more staff on duty and in particular would have liked more activities. Other people spoke very highly of the staff and the service. We did hear call bells being used on many occasions during our inspection which were answered usually within a short period of time. However we did observe people being left in communal lounges for periods of time with no staff present.

The service had increased the number of staff employed at senior care levels since our last inspection. The deputy manager told us the staff team was stable with many staff having over ten years dedicated exper

This was an unannounced inspection which took place on the 13 October 2015. Kilkee Lodge Residential Home provides accommodation for up to 80 people who require nursing or personal care. At the time of the inspection there were 70 people living at the service.

Kilkee Lodge Residential Home had an experienced registered manager in place. 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.

There were sufficient staff working at the service throughout the 24 hour period to meet people’s needs.

People told us they felt safe living at the service. Systems were in place to ensure people’s care was delivered in a safe way, for example all staff had been training in how to safeguard people from abuse.

Care plans and risk assessments had been written to minimise the risk to people when care was being delivered.

Equipment in the service had regular service checks and audits had been completed to ensure the environment and the care provided were safe.

Safe recruitment methods and checks were carried out to minimise the risk of employing staff that were not suitable to work within the service. There were sufficient numbers of staff to meet the individual needs of people. Staff had received training and knew about the Mental Capacity Act 2005 and Deprivation of Liberty Safeguard (DoLS). Staff received on-going training, supervision and an appraisal.

People’s nutrition needs were assessed which were reflected in their care plans and how to support people to have enough to eat and drink while taking into account their preferences.

People’s chosen lifestyle and interests were maintained and supported by staff that cared for and about them. Staff were kind and gentle and encouraging when speaking to people. People were encouraged to make decisions and choices about how they spent their time. Care plans were being reviewed to ensure they reflected people’s choices.

Relatives meetings were held and questionnaires were sent to people and their relatives to gain feedback on how the service was run. Responses were positive. Staff spoke positively about working at the service and the management were supportive

An assessment of the persons needs was carried out prior to them coming to the service to ensure the service could provide a service to them. Complaints were dealt with effectively and staff knew how to deal with complaints.

Quality audits were carried out and information acted upon to promote an open and honest culture in the service.

During our inspection on 12 December 2013 we saw that staff were knowledgeable about people who lived at Kilkee Lodge Residential Home and promoted people’s independence and choices.

Where some people had complex needs and were unable to tell us about their experiences, we used observation and noted individual's responses to staff. We noted that people appeared calm and relaxed. We saw that staff supported people in a patient and sensitive manner.

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service.

There were systems in place to ensure people were qualified to provide care and support for people.

We found that the provider had systems in place to monitor and respond to any concerns or complaints received by the home.

We inspected the service on the 5 February 2013 to follow up concerns identified at the last inspection on the 17 September 2012. Following the first inspection we made some compliance actions and the provider sent us an action plan and supplementary evidence demonstrating how they were complying with regulations.

During this inspection we spoke with ten staff, including the manager. We observed care being provided, spoke with one relative and spoke with eight people using the service. We looked at one care plan, and other records which showed us how care was being provided.

We found the service had complied with all but one of the regulations inspected. People were asked for their views about their care. Records clearly described people's care needs and how they should be met by staff. People told us they were satisfied with how the service was delivered. One person said, "I am happy here, my needs are understood and met. I wish I had come in earlier." Another person told us, "Staff always ask me if I want to join in with the activities provided and will assist me if I need help, but I like my independence."

We saw improvements had been made in the way staff were supported through induction, supervision and training to ensure they were competent to meet people's needs. We still had concerns about the management of the service and have made a further compliance action but assessed the risk has been reduced to a minor concern.

We spoke with eleven people using the service and observed the care given throughout the day. One person told us ‘the place is “lovely” and “the staff are lovely, they are great.” They said when they arrived at the home they were not introduced to other residents. They told us “In the morning sometimes I have to get myself up as they are busy but its one of those things” Other people told us, “The food is not always nice, but today it is pretty good” “There are not enough staff around, they do not get to spend any time with us as they are so busy” “The activities are not very good” “we are expected to watch a lot of television” “musical bingo is fun” “at the weekend there is nothing for us to do, all we do is watch TV” “I would like more exercise activities more movement activities.” Several people told us they would like to get out, one person said;” I want to go to the seaside.”