Kirkley Manor is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Kirkley Manor is registered to provide personal and nursing care to a maximum of 71 older people.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

The service continued to protect people from the risks of abuse or avoidable harm and risks to people were identified and planned for. Medicines were managed and administered safely and the premises remained clean and there were processes in place to reduce the risk of the spread of infection.

The service continued to ensure that there were enough staff to meet people’s needs in a timely way and that recruitment procedures were safe.

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 continued to support this practice.

The service provided people with a choice of adequate food and drink. Support people required to maintain good nutrition and hydration was reflected in care planning. People were supported to have contact with other health professionals where appropriate.

People received care from staff who had the training, skills and experience for the role. The service continued to promote and reward excellence in staff practice.

People told us staff were kind to them and the service continued to promote a culture of kindness, with the registered manager, staff and senior managers leading this practice.

The service continued to offer people personalised care based on their individual preferences and to involve people and their representatives in the planning of care.

People were provided with adequate sources of meaningful engagement and were supported to feedback their views and experiences through meetings and surveys. People were made aware of how they could complain and the service continued to respond to complaints appropriately.

The registered manager and other staff were undertaking training on the Gold Standards Framework for end of life care in order to make and maintain improvements to care planning.

The registered manager, senior managers and the provider continued to operate an effective system to monitor the quality of the service provided to people. Areas for improvement were identified and acted upon. The service continued to work towards an improvement plan which set out future changes and improvements to the service people were provided with.

Further information is in the detailed findings below.

We inspected this service on 4 February and 11 February 2015 and the inspection was unannounced. Kirkley Manor provides personal and nursing care for up to 71 older people, some living with dementia.

There was 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.

There were enough staff to support people safely and staff knew what to do if they suspected someone may be being abused or harmed. Recruitment practices were robust and contributed to protecting people from staff who were unsuitable to work in care. Medicines were managed and stored properly and safely so that people received them as the prescriber intended.

Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Staff were clear about their roles. Where people were not able to give informed consent staff and the manager ensured their rights were protected.

People have enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support. However, people’s mealtime experience could be improved, some people were expected to eat off small tables that could not be positioned properly so that they could eat comfortably.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled. Staff also made sure that people who were becoming unwell were referred promptly to healthcare professionals for advice about their health and welfare.

Staff showed commitment to understanding and responding to each person’s needs and preferences so that they could engage meaningfully with people. Outings and outside entertainment was offered to people and staff offered activities on a daily basis.

Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that any complaints they made would be addressed by the manager.

The service had consistent leadership. The staff told us that the manager was supportive and easy to talk to. The manager was responsible for monitoring the quality and safety of the service and asked people for their views so that improvements identified were made where possible. The organisation also carried out quality assurance visits, set action plans and checking the actions had been undertaken.

Some of the people who used this service were living with dementia and were not able to communicate easily with us. To enable us to assess people’s wellbeing we spent time sitting with them in the lounge and dining area observing the care they received and the level of staff interaction with people. This is called a Short Observational Framework for Inspection (SOFI). This is a specific way of observing care to help us understand the experience of people who could not talk with us because of their dementia.

We also spoke with five people, the deputy manager, the operations manager and four staff members. The manager of this home was not available on the day of our inspection. We looked at six people's care records and also looked at other records including quality audits and health and safety checks.

During our inspection and through analysis of our inspection findings we considered the questions we always ask, is the service safe, effective, caring, responsive and well led?

This is a summary of what we found

Is the service safe?

We found that the service was safe. When we arrived our identification was checked and we were asked to sign the visitor's book. This showed that the staff took the security of the building and the safety of the people who lived there seriously.

When we spoke with people they told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We examined medication records, how it was stored and observed the way medication was administered to people. We found that the medication was managed and administered in a way that ensured the welfare and safety of the people who used the service.

We saw that the staffing levels were based on the assessed needs of the people who used the service. There were enough qualified, skilled and experienced staff to meet people’s needs. We also found that staff received appropriate training, professional development and supervision.

We saw records which showed that health and safety checks were carried out in the service regularly and action was taken if equipment was found to be faulty or unsafe. This included regular visual checks and servicing of equipment such as hoists, the fire alarm panel and wheelchairs. Regular fire safety and legionella tests and checks were carried out, which showed that people were protected from unsafe or poorly maintained equipment.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Is the service effective?

The people we spoke with told us that they were happy living in the service, one person told us, “I have nothing to complain about.” Not all of the people were able to communicate with us easily, but during our observations of the care and support staff gave to people we saw that the service was effective in meeting people’s needs.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

We saw that the service was effective in assessing people’s nutritional needs and offered a good and varied menu, while ensuring that health needs and preferences were met.

Is the service caring?

We saw that the staff interacted with people who lived in the home in a caring, respectful and professional manner. Not all of the people were able to talk with us, but during the time we spent at the service we saw that people were comfortable, looked smart and that staff were committed to caring for the people they supported.

The people we did speak with told us that they found the staff friendly and caring. One person told us, “They (the staff) are like family.” Another person said, “I get on with people here.”

Is the service responsive?

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including the doctor, the speech and language team and the dietician.

The people who used the service and their relatives were given the opportunity to complete annual satisfaction questionnaires. The operations manager said that the service responded to concerns raised with it through the survey. People and their families were also provided with the opportunity to participate in the running of the service by attending house meetings.

We saw that people's choices were taken into account and listened to in all aspects of the way the service was run. We saw that during dinner people were offered a variety of choices for their main meal and pudding. People were offered plenty to eat and given second helpings if they wanted more.

Is the service well led?

The service had an effective quality assurance system in place and the records we examined showed that identified shortfalls were addressed promptly. This ensured that the quality of the service was maintained.

The staff we spoke with told us that the manager was supportive, easy to approach and listened to what they had to say. The deputy manager, who was managing the service in the absence of the manager, told us that they felt supported by the providers. When the operations manager was told that we were carrying out an inspection at the service, they arrived at the home to support the deputy manager.

We carried out this inspection to check that the provider had made the changes they told us they would make to tackle the issues found on our 7 October 2013 inspection. Additionally,in response to concerns that had been brought to our attention since our last inspection, we looked at the care and welfare of people who used the service.

We found that some progress had been made. The service was notifying us, as required by law, of any incidents that could affect people’s health and welfare. We also saw that the provider had made adjustments to shift patterns to provide better evening cover.

However, we found that the service was still not complying with legal requirements regarding the management of medicines. Our sample audit of medicines revealed numerical discrepancies and there was still insufficient written guidance for staff to assist them in administering some medicines.

We also found shortcomings with regard to the care and welfare of people who used the service. We spoke with nine people who used the service and with a visiting family member. Their views varied from, “It’s great”, to concerns that, “There are not enough carers”. We found that care was not always delivered as planned and that there was very limited social interaction for some people. We have asked the provider to take action to tackle these issues.

This inspection was carried out in response to concerns that we had received regarding the administration of medication and the availability of staff to assist people in the evenings.

We arrived just after 8.00 p.m. We noted three people needing assistance, but could not find any care staff to help them. The only member on the ground floor was the nurse who was carrying out the evening medications round. She had to interrupt this work to assist one of the people. By about 8.30 p.m. care staff were attending to the people we had seen needing assistance. We spoke to four people using the service. Two of them told us that staff were often slow to respond in the evenings to bells that had been rung to summon assistance.

We assessed whether people’s medicines were being managed safely and checked the arrangements in place to protect people against the risks associated with the unsafe use and management of medication. Our sample audit of medicines identified gaps in the records and numerical discrepancies so we could not be assured that people were being given their medicines as intended by prescribers. We noted a lack of written information to assist staff in safely administering some medicines and we identified shortcomings regarding the storage of some medicines and time taken to complete the medicine rounds.

People also mentioned some resident-on-resident assaults. Services are required by law to notify us of such assaults, but this had not been done.

We carried out this inspection to see whether changes the provider told us they would make to address concerns found at our inspection of 30 April 2013 had been made.

We found that the improvements that they told us about had been introduced.

We spoke with six people who used the service about their care and treatment and with two family members visiting at that time. We also spoke with five staff who were working at the time of our inspection.

People who used the service told us that they were happy with their care and treatment and that there were sufficient staff available to meet their everyday needs. However, we found that some of the people we spoke with felt that they were not as many activities arranged as they would like.

We looked at the provider's complaints procedures which we found to be detailed and managed well.

We looked at the care records of people who used the service. We found that a recent computer problem had led to some records not being updated as planned but this had now been rectified.

At the time of our inspection, there were 59 residents living at Kirkley Manor. The service was divided into three units. These were the residential unit, nursing unit and continuing care unit. We were told by the deputy manager that 44 people living at the service were unable to tell us about their care.

We spoke with four people and four relatives who were able to give us their feedback. They told us, “They (the staff) are kind.” Another person said, “I have no complaints.” A relative said, “The staff are good, I am happy with the care.”

We saw that staff interacted with people in a kind and caring manner. People had access to other healthcare professionals such as doctors, dieticians and district nurses when needed. This showed that the service responded to changes in people’s health needs.

However, people living at the service, their relatives and the staff we spoke with told us that there was not always enough staff to meet people’s needs. We observed that there was limited time for staff to interact with people in a meaningful way to aide their wellbeing.

We checked three people’s care plan records and found that some areas of them were inaccurate. Some records were not being stored securely.

People told us what it was like to live at Kirkley Manor and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of an inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a professional advisor who has had experience of working in adult social care and who can provide that perspective.

People told us that they were happy with the service they received and that the staff were polite and treated them well. Some of the people we met living in the home were not always able to verbally communicate. Therefore to help us understand people's experiences we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We spoke with 13 people. They told us they were happy with the service they received. One person told us they had lived at the service for about six months, during which time they had found the staff to be, “Very nice”, they also said “I can’t grumble about the food, it is good”. They also told us that the location of the service suited them as they had friends that lived nearby and that they visited regularly.

People told us that the food was good. Comments included, “The food is wonderful here" and “The food is lovely, you get what you like". One person commented, “I am very happy with the food, I eat all that is provided”.

We spoke with a relative who told us that they visited the service regularly. They described the staff as very friendly and stated “I can’t find fault with them, they do the very best for my relative in an extremely difficult job”. They told us that they always received a pleasant welcome and that they were “Quite happy with the service, staff do the very best they can, my relative would not get better care elsewhere”.

We found that there was a good atmosphere in Kirkley Manor and that there was a good relationship between people using the service and the staff. People were being treated with dignity and respect and their nutritional needs were being met. It was clear from our discussions with people using the service and our observations that staff knew the needs of the people in their care well and showed genuine care and affection towards them. We saw numerous examples of staff engaging positively with people using the service.

People we spoke with said that the staff looked after them well. They said that they did not have to wait too long when they rang their call bell for a care worker to attend to them.

Many of the people living in the home were unable to communicate verbally but we were able to speak with some of the people. We also observed the care that people were receiving. People told us that they were content living in the home. Two of them said the food was sometimes cold by the time it got to the green dining room. However that was not the case during our visit. Two relatives told us that their family members were well cared for but the home needed more staff. Another visitor told us they were pleased with the care given to their relative but the staff were rushed and often very busy. They said that there had been occasions when people could not have showers because of this. We noted that people in the Kingswood unit appeared generally to be quiet and relaxed, and were able to catch the attention of a care worker if necessary.

We carried out this inspection to check that the provider had made the improvements required in relation to the non-compliance with the regulations found on our 4 December 2013 inspection. We found progress had been made.

We spoke with 11 people who used the service and with five visiting family members. Most of them indicated that they were happy with the service. One person told us, "It’s nice in here".

We found that people received good support, for example with eating and drinking.

The provider had implemented a new quality assurance process for supporting people who remained in their rooms and suffered with pressure areas. We inspected the electronic records and care documentation that was kept in people’s rooms, and found that overall the new process was proving effective.

We looked at medication records and found improvements. However, there remained lack of clarity where medicines were prescribed for administration to people when required at the discretion of staff on an occasional basis. Written guidance was still being developed.

The service promptly rectified some remaining shortcomings that we identified in care planning and in the guidance for, and recording of, the application of external medications. However, it was too early for us to make a judgement on the consistency with which the new records for the administration of external medicines were being completed.