This inspection took place on 19 September 2018 and was unannounced.

Kirkwood 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. The care home can accommodate up to 20 older people and older people living with dementia in one purpose-built building. At the time of Inspection there were 20 people living at the home.

At the last inspection March 2017, the home was rated requires improvement. There were breaches in Regulation 12 safe care and treatment and Regulation 17 good governance. At this inspection we found improvements and the service was no longer in breach of these regulations.

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.

Staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff were supported by the registered manager and were receiving formal supervision where they could discuss their ongoing development needs.

People who used the service and their relatives told us staff were helpful, attentive and caring. We saw people were treated with respect and compassion.

Care plans were up to date and detailed what care and support people wanted and needed. Risk assessments were in place and showed what action had been taken to mitigate identified risks. People felt safe at the home and appropriate referrals were being made to the safeguarding team when this had been necessary.

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’s healthcare needs were being met and medicines were being stored and managed safely.

Staff knew about people’s dietary needs and preferences. People told us there was a good choice of meals and said the food was very good. There were plenty of drinks and snacks available for people in between meals.

Activities were on offer to keep people occupied both on a group and individual basis. Visitors were made to feel welcome and could have a meal at the home if they wished.

The home was clean and tidy, but in need of refurbishment in some areas. However, there was a plan in place to address this.

The home was using the garage as a storage area, this was a cause of concern and we referred this to the fire service.

The complaints procedure was displayed. The home had not received any complaints since the last inspection.

Everyone spoke highly of the manager who said they were approachable and supportive. The provider had effective systems in place to monitor the quality of care provided and where issues were identified they acted to make improvements.

We found all the fundamental standards were being met. Further information is in the detailed findings below.

We inspected Kirkwood Care Home on 8 March 2017 and the visit was unannounced. Our last inspection took place on 9 and 23 March 2015. At that time, we found the provider was not meeting the regulation in relation to safe care and treatment (management of medicines). We told the provider they needed to make improvements.

Kirkwood Care Home provides personal care for up to 20 people. Care is primarily provided for older people, including people living with dementia. The home is situated in Ben Rhydding which is on the outskirts of Ilkley.

On the day of the inspection there were 18 people using the service.

There was a registered manager in post. 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.

We found staff were being recruited safely and there were enough staff to take care of people and to keep the home clean. Staff were receiving appropriate training and they told us the training was good and relevant to their role. Staff told us they felt supported by the registered manager and were receiving formal supervision where their could discuss their on-going development needs.

People who used the service told us they felt safe at Kirkwood Care Home and we found staff understood the safeguarding process.

People who used the service were receiving personalised care and were very happy at the home. They told us staff were kind, caring and compassionate. Activities were on offer to keep people occupied and staff provided people with companionship. People’s healthcare needs were being met and healthcare professions spoke highly about the care and support people received.

We found although peoples medicines were being managed safely, prescribed topical lotions and creams were not being stored safely and no records were being kept to show they were being administered as prescribed.

Meals at the service provided a wide range of choices and lots of home baking. Plenty of drinks were available, including alcoholic drinks if people wanted them.

We found action was not always being taken to mitigate risks within the service in relation to the premises and following accidents or incidents.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible..

Quality assurance systems were in place, however, they were not always effective in identifying areas which required improvement such as medicines management and safety within the service.

The views of people using the service were sought and acted upon to make sure people’s preferences were met.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The inspection visit was carried out by one inspector. During the inspection, we spoke with the home manager, care staff, people who used the service and relatives of people who used the service. We looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key 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. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

Is the service safe

People who used the service told us they felt safe at Kirkwood. The relatives and visitors we spoke with also said they felt people were safe at Kirkwood. They said they had never seen or heard anything while visiting the home which had caused them concern.

We spoke with two care staff and they confirmed they had received training on safeguarding vulnerable adults. They were aware of the different ways in which people could be subjected to abuse and were aware of how to report any concerns they might have. They said they felt confident the management team would take appropriate action if concerns were raised about people’s safety and welfare.

The manager confirmed no one who used the service was deprived of their liberty at the time of the inspection. They understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

In the care records we looked at we saw people had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks.

There were procedures in place to guide staff on the actions to take in response to medical emergencies.

We found the home was clean, free of unpleasant odours and well maintained.

Effective -

People had an individual care plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

The home had good working relationships with other healthcare professionals and worked closely with them to make sure people’s needs were met. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care records.

Caring –

The people we spoke with were satisfied with the care and support provided. One person who used the service said “It is very nice here”. Another person’s relative said the “Staff are caring” and a visitor said the “Care is very good here”.

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered.

We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them. We found people’s privacy, dignity and independence were respected.

Responsive –

People’s needs were assessed before they moved into the home. We saw people’s care records had information about people’s individual needs and preferences.

People had access to a range of activities and were consulted about the types of activities they wanted to take part in.

Two visitors told us the staff were always polite and welcoming and said they could visit at any time. They said they were able to visit their friend in private.

Well led –

A relative told us the manager listened to them and acted on what they said. They said they had seen improvements in the service since the new manager had been appointed.

The manager told us they operated an “open door” policy and encouraged people who used the service and/or their representatives to take an active part in planning and reviewing people’s care. During the visit we observed the manager talking with people who used the service and visitors. The care records showed people who used the service and/or their representatives were involved in planning and reviewing their care.

The staff we spoke with said they enjoyed working at the home. They said the worked well as a team and felt supported by the manager. They told us they had regular supervisions and appraisals and could talk to the manager at any time if they had any concerns. They said any issues they raised were dealt with promptly.

We found the provider had effective systems in place to assess and monitor the quality of the service. This included weekly visits by one of the senior management team and a planned programme of monthly audits which included areas such as care, catering, housekeeping and administration.

We spoke with two people who used the service and three people's relatives. Everyone we spoke with told us they were happy with the care and support provided at the home. One relative said they were “very happy” with the care and another said “I cannot fault the care”. Relatives told us they were kept informed and said staff did not hesitate to contact the doctor or the district nurses if they had any concerns about people’s health. The care records showed peoples individual needs were identified and planned for.

People told us the staff were kind and respectful. One relative described the staff as “gentle” and said they had never heard them speak inappropriately to people who used the service. Another relative said they found it reassuring the home had a “stable” staff team. Another person said the staff were “always cheerful and always seem to have time for people”. We found the provider carried out checks to make sure staff were suitable to work with vulnerable people.

People told us the food was “very good”. One person said it was like eating in a restaurant. One person who had a vegetarian diet said the chefs went out of their way to make sure they had a variety of good food. We found people were provided with a varied and nutritious diet.

People said it was a “homely” place and told us they liked the fact the home had a dog and kept chickens in the garden.

People told us the home was clean and when we looked around we found it was clean.

During this inspection we used a number of methods to help us understand the experiences of people who used the service. This included speaking with people, visiting relatives and carrying out an observation.

During our observation we saw people were treated with consideration and respect. People and their relatives told us they were happy with the care which was provided. One person said, "I'm looking at other homes to be closer to my family, but I'll be sad to leave here. I'd like to pick it up and take it with me. The staff are lovely and the care is wonderful." Another person said, "We are well cared for. They do a good job here."

People we spoke with told us they were involved in making decisions about how their care was provided. One person said, "The staff are very courteous they ask me before they do anything."

We reviewed three care records and saw that people's preferences and care needs had been well documented. We spoke with three members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

There were enough qualified, skilled and experienced staff to meet people’s needs. We saw there were systems in place to ensure medications were handled and administered safely. There was an effective complaints system available.

People commented that they were happy at the home and staff were friendly and approachable.

The inspection took place over two days, the 09 and 23 March 2015, the first day of the inspection was unannounced. There were 15 people using the service at the time of the inspection.

The last inspection was in May 2014 and at that time the provider was meeting all the requirements we looked at.

Kirkwood Care Home provides personal care for up to 20 people. Care is primarily provided for older people and people living with dementia. The home is situated in Ben Rhydding which is on the outskirts of Ilkley. 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.

People who lived at the home told us they felt safe and people’s relatives told us they had no concerns about people’s safety. The staff understood the different ways in which people could be subjected to abuse and were aware of how to report any concerns about any person’s safety and wellbeing. There were enough staff to meet people’s needs and the required checks were completed before new staff started work. This helped to protect people from the risk of being looked after by people who were not suitable to work in a care setting. The staff were trained and supported to help them understand and meet the needs of people living at the home.

In the majority of cases people received their medicines as prescribed. We found medicines were not always stored correctly and the provider did not have a system for checking the safe and proper management of medicines.

The home was clean and free of unpleasant odours and people had personal belongings in their rooms. We saw there were plans in place to make some improvements to the environment but the work had not started at the time of the inspection.

People were supported to have a varied and nutritious diet and they told us they enjoyed their food.

The staff were kind and caring. People were asked for consent before care was delivered and people were supported people to make decisions and maintain their independence. People living at the home and/or their relatives were involved in discussions about how their care needs would be met. People had access to the full range of NHS services and were supported to meet their healthcare needs. The home worked with other health care professionals to make sure people received end of life care which was safe and appropriate and took account of their wishes.

There was a varied programme of activities.

There was a complaints procedure in place. People told us they knew what to do if they had any concerns or complaints and were confident their concerns would be addressed. People had confidence in the registered manager.

There were meetings for people who used the service and their relatives to give them the opportunity to share their views and have a say in how the home was run.  

We found one breach of regulation in relation to the safe management of medicines. You can see what action we told the provider to take at the back of the full version of the report.