About the service:

Kiln Lodge is a residential care home that was providing personal care to 24 people aged 65 and over at the time of the inspection. Everyone living in the home was living with dementia.

People’s experience of using this service:

• There was a lack of governance oversight of the service, a lack of clear risk assessments and mitigation plans which although not impacting on people at the time of the inspection, did place them at risk.

• People were supported by plenty of staff who had been recruited safely, understood their roles and responsibilities and how to protect people.

• Staff had a good knowledge of people and understood what was important to them. Staff were skilled and received training to ensure they could meet people’s needs. Staff ensured people had support that met their needs and choices. People’s rights to make their own decisions was respected.

• People were supported by staff who understood their needs, wishes and preferences well. Staff were kind and compassionate respected people’s dignity and privacy; promoted their independence but at times were task orientated in their approaches.

• Everyone was happy living in the service, felt it was their home and that they received good care and support.

Rating at last inspection:

Requires Improvement (report published 8 November 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will ask the registered provider for a clear action plan to address the breaches of regulations and as this is the second time this service has been rated as requires improvement we will also request a plan from the registered person on how they intend to achieve good by our next inspection. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

We recently received a number of significant concerns telling us people were not cared for appropriately. We responded to these concerns by conducting an unannounced comprehensive inspection. On the first day of our inspection we visited Kiln Lodge at 0530. The inspection was carried out by three inspectors. We were unable to substantiate the concerns raised, however, we found several areas that required improvement

Staff did not always receive effective support, supervision and appraisal.

The provider did not have robust quality assurance systems in place to identify and implement actions needed for improvement.

The culture within the home was not always person centred, appeared to be task focused and at times was institutionalised.

The provider had robust systems in place to recognise report and investigate any possible allegations of abuse.

Staff had received appropriate moving and handling training to enable them to reposition people effectively. Healthcare professionals had no concerns about how people were repositioned.

The provider had appropriate arrangements in place to ensure people were not unlawfully deprived of their liberty.

People were able to get up and go to bed when they chose.

Staff were knowledgeable about people's care needs and delivered care with compassion.

People's privacy and dignity was respected.

People and relatives told us staff were caring.

People received care and support that had been appropriately assessed.

The provider had good arrangements in place to deal with any complaints.

Healthcare professionals, relatives and people told us they were happy with the care provided in the home.

Appropriate equipment and measures were in place for people who required assistance during the night and day.

People were satisfied with the quality of food they received and told us they had choice in what they had to eat.

We found three breaches of the Health and Social Care Act 2008.

Kiln Lodge is a care home for older people and offers care and support for people who have dementia. They are registered for 24 people. At the time of the inspection there were 24 people living at the service.

At our last inspection on 24 January 2014, the provider was meeting the regulations that were assessed.

When we visited there was a registered manager in post, this person was the also the registered provider. 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 service recruited staff in a safe way, making sure all necessary background checks had been carried out and that only suitable people were employed. Systems were in place to assess the staffing levels needed on each shift. This was based on people’s dependency levels at any one time and the lay out of the building. Relatives told us staff were always available, during the day and night when required. Our observations during the inspection showed there was appropriate deployment of staff, including staff providing care, catering and housekeeping tasks.

Records showed staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up to date and future training was planned.

Medicines management was organised well and administered in a safe way. This meant that people received their medicines in accordance with the prescriber’s instructions.

Staff told us the manager, and other senior staff employed by the service, were professional in their role, supportive and approachable. They also confirmed to us that the on call arrangements were well managed. Staff told us they could seek advice and help out of hours if necessary. This meant there was good oversight of the service, and staff were confident about the management structures.

Staff told us they felt supported by the management team and the organisation. Staff told us they had ample opportunities to reflect on the service they provided through supervision and regular contact with each other. People were cared for and supported by qualified and competent staff.

Staff had a good understanding of the Mental Capacity Act (MCA) and we observed consent being sought routinely before any support or care was given. People had been supported to make their own decisions wherever possible, and staff had taken steps to support people to do this. Where people were unable to make a decision there was a best interest decision recorded within their care plan and we saw the person and relevant people had been involved in making this. This meant people were given the opportunity to be involved in decision making and decisions were made in the person’s best interests. The service had effectively implemented the Deprivation of Liberty Safeguards (DoLS) as required.

Relatives spoke positively about individual staff and told us that staff treated people with the respect and kindness. Throughout our visit we saw good practice. This included the encouragement of people to eat and drink, move around the home and take part in activities. Staff approaches were friendly, discreet and appropriate.

The premises were well maintained, clean, fresh smelling and comfortable. The adaptations and equipment provided meant that people could maintain their independence.

People were provided with a varied menu at each meal time. People also had access to drinks and snacks in between meal times. If people were at risk of losing weight or choking, we saw plans in place to manage this. People had good access to health care services and regular input from their doctors and district nurses when required.

People had their care needs assessed and planned, and regular reviews took place to make sure peopl

People using the service had communication difficulties due to cognitive impairments which meant they were not able to tell us their experiences. Therefore, in addition to speaking with three individuals, we gathered evidence by observing care; reviewing records and speaking to one relative, the manager, two visiting professionals and five staff members.

Throughout our visit we observed staff interacting politely and respectfully with the people they were supporting.

Care and treatment was planned and delivered in a way that ensured people's welfare. We saw care plans were based on assessments that had been carried out to identify what help people needed and any potential risks to their welfare.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. We saw policies on ‘no secrets’ and safeguarding.

Effective recruitment and selection processes were in place which ensured people were cared for by suitably qualified, skilled and experienced staff.

We found the provider had effective systems of monitoring and auditing the quality of service provided.

The relative we spoke with told us "the attitude of staff has been first class, they are all so professional and caring. My wife and I have benefitted tremendously from her having respite stay at Kiln Lodge, we will certainly be back for more visits in the future".

We carried out an inspection in December 2012 when we identified concerns with medicine records and administration. We made a compliance action asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take.

We carried out an inspection on 29 January 2013 to review the progress the provider had made in taking action to be compliant in the area where we had previously assessed them as non compliant. We looked at the medicine records and spoke with staff about the changes that had been put in place following our last visit.

Kiln Lodge is a home for older people and they are registered for up to 24 people. On this occasion we did not speak with people using the service as we visited to look at progress regarding compliance with medicine administration and records. During our inspection we spoke with two staff and the manager.

Kiln Lodge is a home for older people and they are registered for up to 24 people. On the day we inspected there were 20 people living at the home, the majority of whom had memory impairment and or a mental health problem. During our inspection we spoke with three staff, the manager and three people who use the service.

As not everyone who lived at Kiln Lodge was able to tell us what they thought about the care and support provided, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spent time in their company in the lounge and dining area observing the support people received before and during their meal and support and activities in the lounge after lunch. We saw that the staff were friendly and the majority were respectful and that they were quick to respond if anyone appeared unhappy or distressed. People told us that “Staff are nice to know and hardworking”. “We are well looked after, I have no complaints”. One person said that “There is no choice about the meals but staff know what I like”. “Meals are mostly alright it does depend on who is cooking”.

Staff we met on the day told us about the training they had attended recently and that they were able to speak openly with the manager and provider about any concerns.

People told us that the home was well maintained. We spoke to relatives of some of the people who live at the home and they told us that they and their relatives in the home were consulted on how the home was run.

People in the home said that they felt “genuinely cared for” and involved. They were encouraged to make choices including what to eat and what activities they would like to participate in. We spoke to three people and they told us that they had plenty to eat and drink.

People told us that the home was kept clean and they were happy with the arrangements for cleaning the home.

People we spoke to told us they felt comfortable talking to staff about any improvements needed. They told us the staff were polite, friendly and helpful.