Kirkby House Residential Care Home provides accommodation and personal care for up to 44 older people and people living with dementia. The home is located in a residential area close to Kirkby town centre, Knowsley. Accommodation is in single rooms with the majority having en-suite facilities.

At our last inspection we rated the service good. On this inspection, we found the service had remained good. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At the time of the inspection 38 people lived at the home.

The inspection visit took place on 06 December 2018 and was unannounced.

There was a 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.

People told us they felt safe and looked after by staff. We observed interactions between staff and people who lived at the home. These were positive, friendly and supportive. Written comments to the home included, ‘I can see why this home is so highly recommended the atmosphere and staff are so wonderful, really friendly I wouldn’t want my [family member] to be cared for by anyone else. And ‘The staff are marvellous, I couldn’t ask for better.’ And, ‘If I won the lottery I would not move my family member from Kirkby House.’

There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments had been developed to minimise the potential risk of harm to people. These had been kept under review and were personalised to meet people’s needs.

People were extremely positive about the care they received and the quality of staff. Throughout the inspection we saw staff were available to assist people in communal areas and patient and kind to people they supported. Staff assisted people promptly when people needed their help and were friendly talking and laughing with people. We saw and people told us staff provided care in a way that respected peoples’ dignity, privacy and independence. These included, ‘If you paid thousands you could not get better care than here.’ And ‘The staff are fabulous, they bend over backwards, nothing is too much trouble.’ A relative said, “The staff are attentive to resident’s needs, very kind, caring and professional.”

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

There were sufficient staffing levels in place to support people safely. Staff had been recruited safely, appropriately trained and supported. They had skills, knowledge and experience required to support people with their care and social needs.

Medicines were managed safely. People received their medicines when needed and appropriate records had been completed. We saw people had access to healthcare professionals. People told us staff cared for them in the way they wanted and met their care needs promptly. They referred them to healthcare professionals in a timely way.

People had been 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. Care plans were in place detailing how people wished to be supported. These were informative and personalised and regularly reviewed.

There were safe infection control procedures and practices and staff had received i

This inspection was carried out over two days on 12 & 16 May 2016. The first day of the inspection was unannounced.

Kirkby House Care Centre is registered to provide accommodation and personal care for up to 44 people. The service is located in the Kirkby area of Liverpool, close to local shops and road links.

The service has a registered manager who was registered with the Care Quality Commission in October 2010. 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.

The last inspection of the service was carried out in September 2014 and we found that the service was meeting all the regulations that were assessed.

We have made a recommendation about monitoring records. Charts for one person had not been completed as required despite daily records showing that the person had experienced certain behaviours which required monitoring. Records for monitoring people’s weight and food and fluid intake were completed as required and used to anticipate any changes in people’s needs.

People told us they felt safe and they were protected from abuse and the risk of abuse. Staff had access to training and information about recognising the potential signs of abuse and how to respond to such incidents. Staff were knowledgeable about the different types and indicators of abuse and were confident about reporting any concerns they had.

Environmental risks and those associated with people’s individual care and support were assessed and identified. Appropriate risk management plans which were in place instructed staff on the actions they were required to take to keep people safe. Staff had completed training in topics of health and safety and they had access to appropriate emergency equipment such as first aid and firefighting equipment.

Staff responsible for the management of medication had received appropriate training and they had access to up to date guidance and information about to managing people’s medication. Medication was checked on receipt and it was safely stored and administered. Medication administration records (MARs) were completed correctly using the correct codes to show when a person had taken or refused their medication. People told us they received their medication at the right times.

People received care and support from the right amount of staff that were suitably skilled and qualified for their job. The process for recruiting staff was safe and thorough. A range of checks to assess the suitability of applicants were carried out prior to an offer of employment, including a check with the Disclosure and baring Service (DBS).

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood what their responsibilities were for ensuring decisions were made in people’s best interests. Staff were aware of the need to obtain people’s consent prior to them providing any care and support.

People were offered a choice of food and drink which they enjoyed. Drinks and snacks were regularly offered in between main meals. A care plan was in place for people who were at risk of poor nourishment and when required, appropriate referrals were made to other professionals including dieticians.

Staff treated people with kindness and were caring in their approach. They knew people well and understood people’s preferences, personal routines, likes and dislikes. Family members were complimentary about the way staff cared for their relative and they said they were always

We considered our inspection finding to answer questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found –

Is the service safe?

Staff had the information they needed to ensure people received safe and effective care and support.

Systems were in place to regularly assess and monitor the service provision which people received.

Staff were knowledgeable about safeguarding procedures and would not hesitate to report any concerns they had about a person’s health, safety and wellbeing.

People who used the service told us they felt safe living at the home and their relatives were confident that people were safe. Comments included; “I would most definitely tell someone if I was mistreated.”

The required employment checks had been carried out on applicants prior to them starting work at the home, to ensure they were suitable for the job.

Is the service effective?

Relatives of people who used the service told us staff communicated well with them regarding their relatives care and support. Comments relatives made included, “They are very good at keeping me up to date.” And “They call me if there is a problem or if something changes.”

Staff told us that the procedure for reporting concerns had been effective and that they would not hesitate to use it again.

Is the service caring?

When staff spoke to people they made good eye contact and used touch to provide reassurance where appropriate and people who used the service responded positively to this.

People who used the service told us that staff were caring and respectful towards them.

Staff interacted positively with people and their visitors and we saw friendly banter between them.

People told us staff provided them with good care and support and we saw that staff took time to listen to people.

Is the service responsive?

A system of review was in place to enable care plans to be updated on a regular basis.

Staff responded promptly to any concerns they noted about people’s health and wellbeing.

We saw that systems were in place to monitor the service delivered and identify any areas of improvement required.

Is the service well-led?

There was a clear management structure in operation at the home and staff were aware of their roles, responsibilities and lines of accountability.

Policies and procedures which were in place and easily accessible, ensured staff had all the information they needed to provide people with the right care and support.

We spoke with people who used the service, their relatives, and staff that work at the home. We also consulted with the service commissioners and the local authority safeguarding team. We used a number of different methods to help us understand the experiences of people who lived at Kirkby House Residential Home. This was because the majority of the people who used the service had complex needs which meant they were not able to tell us directly their experiences.

We observed during our inspection that the people who used the service appeared happy and content living there. We found people were treated respectfully and given support to have their say, when possible, in how they wanted to be helped and we found people were supported to do the things they wanted to do.

People were treated with care and consideration. We observed that staff were focussed on completing tasks for people, but always acknowledged and engaged them.

The people who lived at Kirkby House were cared for by staff who were appropriately recruited, well trained and experienced at supporting them. We found that staff were happy working at the home and that they had received relevant training for their role.

We saw that there were appropriate systems in place to monitor the quality of care that people received at the home and we were told that the manager was approachable and responded to comments and suggestions made by people, their relatives and members of staff.

At our previous visit in July 2012 we found that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them. We carried out this visit to make sure that improvements had been made.

Most people living in the home were unable to discuss their medicines with us in a meaningful way; however no-one expressed any direct concerns about how they were given their medicines.

On this visit there were appropriate arrangements were in place in relation to the storage, recording and destruction of medicine. Medicines were safely administered as intended and were reviewed regularly as people’s needs changed.

We used a number of different methods to help us understand the experiences of people using the service, because people using the service had complex needs which meant they were not able to tell us their experiences.

However two people did comment that they liked the staff and they were kind.

We spoke to the relatives of four people, who told us staff were polite and respectful.

Relative’s comments included:

“The staff are all lovely and respectful”.

“They have contacted me straight away with important information about my wife”.

We spoke with trained care workers who demonstrated a good understanding of the policies and procedures for handling and recording medicines within the home.

We saw part of the medicines round over the lunchtime period and saw that people were given their medicines at appropriate times. We spoke with two relatives of people living in the home, who both told us that the care workers supported their relatives to take their medicines, and were always kind and patient.