At our last inspection in May 2016 the service was rated as Good in all five key questions. At this inspection we found that the key questions of Safe, Responsive and Well-Led were now rated Requires Improvement.

Kirk House 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. Kirk House is registered to provide care to 35 people and at the time of our inspection, there were 30 people using the service.

There was no registered manager in post. An acting manager had been in post since January 2018 but was not registered with the CQC. 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 acting manager was available on the day of our inspection.

Specific health care needs were not always assessed and planned for. Risks to people were managed but records did not always reflect this. There were activities in place for people but these were not always consistent or person-centred. People's end of life care needs were not planned for effectively.

The service did not have a registered manager in post. Governance process that were in place were not sufficient to promote good outcomes for people. Quality audits were completed.

People received their medications as prescribed. There were enough trained staff to meet people's needs and staff were recruited safely. Staff knew how to protect people from the risk of abuse and harm and from the risk of the spread of infection. Lessons had been learned when things went wrong.

Staff treated people with kindness and compassion. People told said that they had their dignity and privacy respected. People were given choice and people's independence was promoted.

People and their relatives were given opportunities to feed in to how the service was run. The service worked well with other agencies and professionals to improve the care and support people were receiving. People spoke highly of the acting manager.

We inspected this service on 17 May 2016. It was an unannounced inspection. At the last inspection, the service was rated overall ‘Good’, but ‘Requires improvement’ in Well Led. We asked the provider to make improvements to their quality monitoring systems to ensure they were effective in identifying shortfalls to enable the provider to continuously improve the service people received. At this inspection, we found the required improvements had been made.

Kirk House Care Home is registered to provide accommodation and nursing care for up to 35 people. At the time of our inspection 26 people were using the service, some of whom were living with dementia.

There was a registered manager at the service. 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 provider of the service is made up of a group of volunteer trustees.

People told us they felt safe living at the home. Staff understood their responsibilities and the actions they should take to keep people safe from abuse. Risks to people’s health and safety were identified and staff followed the management plans to minimise the risks. There were sufficient numbers of suitably recruited staff who were supported and trained to meet people’s individual needs.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Staff encouraged them to have choice over how they spent their day. Where people needed to be restricted of their liberty in their best interests, the registered manager had made the necessary applications for approval.

Staff were kind and patient with people and ensured they received the support they needed. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People were supported and encouraged to eat and drink enough to maintain a healthy diet and accessed the support of other health professionals to maintain their day to day health needs.

People received personalised care and were offered opportunities to join in social and leisure activities. People were supported to maintain important relationships with friends and family and staff kept them informed of any changes. People’s care was reviewed to ensure it remained relevant and relatives were invited to be involved.

There was an open and inclusive atmosphere at the home. People and their relatives were asked for their views on the service and this was acted on where possible. People knew how to raise complaints and were confident their concerns would be taken seriously. Staff felt supported and valued by the registered manager and were involved in the development of the service. The registered manager carried out checks and audits to continuously monitor and improve the service.

We inspected this service on 5 November 2015. It was an unannounced inspection. Kirk House Care Home provides accommodation and nursing care for up to 35 people. At the time of our inspection 25 people were using the service. Most of the people living at the home were living with dementia.

There was no registered manager at the service. 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 provider of the service is made up of a group of volunteer trustees. The trustees had employed a manager who was working at the service at the time of our inspection and had started the process of registering with us. We refer to them as the manager in the body of the report.

At our last unannounced inspection on 19 May 2015, multiple regulatory breaches were identified and the service was judged to be ‘Inadequate’ and placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment that was responsive to their changing needs, were protected from abuse and not unlawfully restricted. We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and to drive improvement.

At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the quality and safety of the service was effectively monitored.

The manager had introduced checks and audits to assess and monitor all aspects of the service. However, further improvements were needed to ensure the checks were effective in identifying and acting on shortfalls found, to drive continuous improvements in the service. The complaints process was visible and the provider had introduced systems to encourage people and their relatives to express their views about the service to enable improvements to be made.

We found the provider had taken action to ensure people’s health and nutritional needs were met. People were supported by sufficient numbers of suitably recruited staff who knew how to protect them against the risk of abuse. Staff followed plans to manage identified risks to people’s health and wellbeing. Improvements had been made to ensure people’s medicines were managed safely. People received personalised care and support that met their identified needs and preferences. People were supported to maintain good health and accessed the services of health professionals when needed.

Improvements had been made to ensure the manager and staff acted in accordance with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Capacity assessments had been completed to show how people who were unable to make important decisions had been supported to do so.

People told us they liked the staff and that they treated them with kindness.  Staff knew people’s needs well and encouraged them to maximise their independence.  Staff supported people to make choices about their daily routine and promoted their privacy and dignity. People were supported to maintain the relationships which were important to them.

We inspected Kirk House Care Home on 19 and 21 May 2015. The inspection was unannounced and in response to concerns raised by other health and social care professionals and relatives of people who used the service. We also checked if the provider had made improvements following our inspection on 24 November 2014.

The provider is registered to provide accommodation, personal and nursing care for up to 35 older people who have physical health needs or are living with dementia. The provider had two intermediate care beds for people who required short-term support before returning home when they left hospital. At the time of our inspection, 29 people used the service. Fifteen of these people needed nursing care or palliative care.

There was no registered manager in post at the time of the 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 and associated Regulations about how the service is run. There was a manager in post who had not yet applied for registration. We refer to them as ‘the manager’ in this report.

At the last inspection in November 2014, we asked the provider to take action to make improvements in the following areas: How the quality of the service provided was monitored and assessed; how people were protected from the risk of abuse; how people were protected against the risks associated with unsafe use and management of medicines. Ensure that people had adequate food and drink; arrangements for obtaining and acting in accordance with the consent of people who used the service, and ensuring that people’s care records were accurate.

The provider sent us an action plan of how they intended to make the improvements. All but two actions were to be completed by 22 May 2015; the others were to be completed on 5 June 2015. We saw that improvements had not been made and the provider continued to be in breach of regulations we inspected against.

Staff did not always take appropriate action when abuse was suspected. This meant that people were not always protected against abuse. We made safeguarding referrals to the local authority about the concerns we identified.

People did not have risk assessments or management plans in place to ensure that they received safe care. Where plans were in place, staff did not always provide care as directed. People’s risks were not reviewed as their needs changed.

People were at risk of poor health because they did not always receive their medicine as planned, and staff did not take action when people missed their prescribed medicines. The provider did not have effective systems in place for storing and managing medicines.

Legal requirements of the Mental Capacity Act (MCA) 2005 were not always followed when people were unable to make certain decisions about their care. This meant that people’s liberties were at risk of being restricted unlawfully. The MCA and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interest.

People were at risk of malnutrition because their food and drink intake was not monitored effectively and staff did not did not take action when people were losing weight.

Recommendations made by health and social care professionals were not always followed. This put people at risk of poor care.

People’s dignity was not always maintained and their choices were not always respected.

People were at risk of isolation. The provider did not always ensure that people who were cared for in their bedrooms received adequate social stimulation.

People were at risk of harm due to widespread shortfalls in the way the service was managed. The provider did not have effective systems in place to regularly monitor the quality of the service provided. The provider did not maintain action plans for how concerns will be dealt with or improvements monitored. The manager had delegated some responsibilities to staff but did not always ensure that these responsibilities were carried out. We saw that very little progress had been made against the action plan and the provider did not have a system in place of how progress against the actions will be monitored. The provider did not always submit required notifications to us as required.

The provider had introduced meetings to obtain the views of people who used the service and their relatives and had started making some improvements in how services were provided based on feedback received.

People who used the service and relatives told us that staff were caring and they liked living in the home. We saw that staff spoke with people respectfully.

Some people told us and that they had a choice of food and drinks and were given adequate amounts. We observed that the atmosphere in the dining area was pleasurable.

We identified that the provider was not meeting some of the Health and Social Care Act 2008 Regulated Activities Regulations 2014 that we inspect against and improvements were required. You can see what action we have told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, we will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe."

We inspected Kirk House Care Home on 25 November 2014. The provider is registered to provide accommodation, personal and nursing care for up to 33 older people who have physical health needs and memory problems. The provider had two intermediate care beds for people who required short-term support before returning home when they left hospital. At the time of our inspection, 33 people used the service.

There was no registered manager in post at the time of the 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 and associated Regulations about how the service is run.

The provider was compliant at our last inspection of the service in September 2013.

Staff did not always recognise and take appropriate action when abuse was suspected. This meant that people were not always protected against potential abuse.

People did not always have risk assessments in place to ensure that they received care that was safe. People’s risks were not reviewed regularly to ensure that the care provided was still appropriate for them.

People’s care records did not always reflect they care they received. Information about people’s care needs were not always available. Care records were not kept securely.

There were not always appropriate numbers of staff to meet people’s needs. This meant that people did not always the assistance they required when they needed it.

People did not always receive their prescribed medicines as planned. People on as ‘required medications’ (PRN) for pain relief did not have care plans in place to guide staff on when these medicines should be administered. Systems for ordering medicines were not effective.

People’s liberties were at risk of being restricted inappropriately. The legal requirements of the Mental Capacity Act (MCA) 2005 were not always followed when people were deemed to lack the capacity to make certain decisions relating to their care and treatment. The MCA and Deprivation of Liberties Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interest.

People on special dietary requirements did not always have appropriate food to ensure that they remained healthy. People’s food and drink intake were not always monitored as recommended by other professionals.

People were not always involved in planning their care. People’s personal interests and preferences of activities were not always taken into consideration when activities were planned.

The provider did not have effective systems in place to deal with complaints. Records of complaints were not maintained, therefore, the provider could not monitor if they had been acted on effectively.

The provider did not regularly monitor the quality of the service provided. We saw that there were no action plans for recommendations made following recent Inspections of the service.

People who used the service told us that staff understood their care needs and provided care to meet these needs. We saw that staff communicated well with people.

People told us and that they always had a variety of food offered them during meals and enjoyed the food provided. We observed that the atmosphere in the dining area was pleasurable.

People told us that staff were caring. Staff obtained people’s views about various aspects of their care before care was provided. We saw that people were happy and were treated with dignity and respect.

The service manager had been in post for just under three months. The provider had employed them to manage the service in the absence of a registered manager. People told us that the manager was approachable and was always available. Staff told us that they felt supported by the manager. The manager told the service faced a number challenges which they were confident will be resolved in due course. The manager told us that they planned to apply to be the registered manager at the end of their probationary period.

We identified that the provider was not meeting some of the Health and Social Care Act 2008 Regulations we inspected against and improvements were required. You can see what action we have told the provider to take at the back of the full version of the report.

This inspection was unannounced which meant the provider and the staff did not know we were coming. At our last inspection on 21 June 2013 we made one compliance action regarding capacity and consent. This meant the provider had to make improvements to demonstrate they were fully protecting people using their service in this area.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate how arrangements to seek people’s consent to care, support or treatment had been agreed in the person’s best interests.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming. There were 32 people residing in the home. We spoke with nine people using the service, four staff, four visitors and the registered manager.

The staff provided sensitive support and people using the service were treated with respect. People told us they were very happy with the support provided. One person told us , “It’s not as lonely as being at home.” People using the service told us they felt it the home was well led managed well and informed us that they could speak with the registered manager should they have any concerns. This meant people felt safe and comfortable living at the home.

We saw information about how people made decisions was not in place. This meant the home could not always demonstrate how arrangements to seek people’s consent to care or treatment had been agreed in the person’s best interests.

We found people using the service received appropriate nutrition. People told us they enjoyed the meals provided. One person said, “It is very good here, it is the food that is so nice.”

We saw that suitable medication systems were in place. This meant people received their medication as prescribed.

We checked records were stored correctly and found systems were as required. This ensured people’s confidential information was stored appropriately.

We carried out our annual unannounced scheduled inspection on 8 November 2012. During the inspection we made one compliance action about the management of medication. This meant the provider had to make improvements and demonstrate they were fully protecting people who used their service in this area.

This inspection was to look at the evidence available, following the action plan we received from the provider and to see if improvements had been made in relation to medication management.

We found that suitable and sufficient improvements had been made in the area where we had identified concern. We saw the provider had put right what was required. This meant they ensured people using the service received medication that was managed in a suitable and safe way.

We carried out this inspection to check on the care and welfare of people using this service. The inspection was unannounced which meant the provider and the staff did not know we were coming. During our inspection we spoke with twelve people using the service, two staff on duty, the registered manager and two visitors. People told us they were satisfied with the care and support they received and were happy with the staff team that supported them.

People using the service told us that they felt safe. We observed the way staff interacted with people and saw positive relationships.

People told us that their privacy and dignity were respected, comments included, “They always knock and ask me how I would like to be supported.”

We looked at the way medication was managed and saw that improvement to how the provider audited medication and recorded ‘when required’ medication were needed.

We looked at the recruitment procedures for staff and found that suitable systems were in place to protect people.

The provider had systems in place to check on the quality of the care people received. We saw complaints were acted upon to improve outcomes for the people using the service.

We carried out this review, as our records showed that there had been no recent inspection of this service. Therefore, we visited Kirk House in order to up date the information we held and to establish that people's needs were being safely met.

There where 31 people living at Kirk House when we visited on 21 December 2011. The visit was unannounced which means the provider and the staff did not know we were coming.

The home was decorated for Christmas and there was a festive ambiance. We spoke with people living at the home, visiting family and friends and staff members. People living at the home told us “The staff are friendly and approachable, they give me time to do things without feeling rushed.” One relative told us “The care is very good, I think it’s a very homely place. My relative has improved greatly since being here, and is a picture of health. We are welcomed by the staff and they inform us of any changes.”

One relative told us “The care is very good, the meals look lovely and the staff are very kind. We have been visiting for quite some time and not had any issues or concerns.”

We saw people seated in three homely lounges, people told us they chose where they preferred to sit. We saw that two dining rooms were available at meal times and people that needed more assistance were supported by a member of staff. We also saw people receiving nursing care in their bedrooms.

We observed staff attending to people’s needs in a friendly manner and we heard staff offering choices at mealtime.