At the last inspection in February 2015 the service was rated good. At this inspection we found the service remained good.

Kirksanton Care Centre has three distinct areas. The Croft is in the oldest part of the property and accommodates up to twelve people who may have had problems with alcohol abuse leading to memory loss and other associated conditions. The annexe to the Croft is for older adults, some of whom may be living with dementia. The Mews is currently unoccupied. Bedrooms are mainly single occupancy. Some rooms have ensuite facilities. There are suitable shared facilities. The home is owned by St. Phillips Care Ltd who own other homes in the UK.

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 home had a suitably qualified and experienced registered manager. She had created an open culture where both staff and people in the home felt supported and valued. Everyone we spoke with judged that the care of vulnerable people was the focus of the service.

Staff were trained to understand and report any potential or actual abuse. We had evidence to show that the manager understood how to make appropriate referrals, where necessary.

The service had suitable risk assessments in place and a plan for any foreseeable emergencies, which had been tested as this is a very isolated service. Accidents and incidents were monitored and dealt with appropriately.

Staff were suitably recruited, inducted and trained. Staff received supervision. Staffing levels were suitable but some vacancies were proving hard to fill due to the rural situation. Plans were in place to use creative ways of recruiting to the vacancies.

Medicines were appropriately managed. People had their medicines reviewed by GPs and consultants so that people had the right medicine for their health.

The house was warm, safe, suitably decorated and well furnished. Equipment was maintained and replaced as necessary. Some areas needed upgrading and the maintenance person was working on this. The provider had plans to upgrade the environment in all areas.

The home was clean and good infection control practice was in place.

The registered manager understood her responsibilities under the Mental Capacity Act 2005. 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. Restraint was not used and we had evidence people were asked for consent for all interventions.

People told us the food was of a very high standard and staff supported people who needed help taking good nourishment.

Health care professionals visited the home regularly. Staff supported and cared for people during times of ill health and at the end of life.

We observed caring and sensitive interactions between staff and people in the service. We learned that people were respected and treated with dignity and patience. Matters of equality and diversity were taken into account by the team.

Each person had a care plan and these gave suitable guidance for staff. People were well groomed and told us the care delivery was of a good standard.

Activities had lessen due to the activities organiser post being vacant but the staff team were trying their best to provide activities and entertainments. Recruitment was underway for the post.

The provider had a suitable quality monitoring system in place that was being used to identify how well the service was running. Changes and improvements were based on this auditing of quality. Good recording systems were in place.

This was an unannounced inspection held on 6th January 2015. The inspection was undertaken by the lead adult social care inspector and a specialist advisor.

Kirksanton Care Centre has three distinct areas providing accommodation for up to 45 people. The Croft is in the oldest part of the property and accommodates up to twelve people who may have had problems with alcohol abuse. The annexe to the Croft is for up to 23 older adults, some of whom may have dementia. The Mews, which can accommodate ten people, is currently unoccupied.

Bedrooms are mainly single occupancy. Some rooms have ensuite facilities. There are suitable shared facilities.

It is owned by St. Phillips Care Ltd who owns other homes in the UK. The home has a manager who is registered with the Care Quality Commission. 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.

We found the service to be safe because the registered manager and her team understood their responsibilities under the local safeguarding protocols. There had been no safeguarding alerts made for some time. Staff had received suitable training in protecting vulnerable adults.

Recruitment, disciplinary matters and staff development were all done appropriately. Accidents and incidents were monitored correctly and any changes to care or services made when incidents were recorded. There were enough staff on duty by day and night to deliver safe and caring services. Medicines were managed correctly.

We found the service to be effective because we saw that staffing levels were sufficient to allow for good care and service delivery. Staff were suitably inducted, trained and developed. Staff understood their responsibilities in relation to deprivation of liberty, human rights and any restrictions on people who lacked capacity to make their own decisions. Staff had received suitable training.

We learned that no one was subject to restraint in the service but we asked the manager to consider updating staff training on restraint so that any potential restraint would be managed appropriately. People in the home were happy with the food provided and we saw good nutritional planning in place. People who lived in Kirksanton had access to GPs, community nurses and health care specialists like dieticians and psychiatrists. The home’s environment was suitably adapted for people with mobility issues.

We judged that staff in the home had a caring approach to the people who lived in the home. We asked people in the home and they told us they felt they were treated as individuals and were given respect and their dignity was maintained. People were given privacy and information about people was kept confidential. Records were written in a positive way without subjective judgements. Where possible people were encouraged to be as independent as possible.

We had evidence to show that assessment, care planning and review were done in a responsive way. People had activities and entertainments that they were satisfied with. Some people wanted more and varied activities and we had evidence to show that the manager was developing new activities. Concerns and complaints were dealt with appropriately. People were supported if they had to receive care from other services.

We judged the service to be well led because people in the home and the staff had confidence in the registered manager. The registered manager was suitably trained and experienced. She was, in turn, managed by an operations manager who visited the home regularly and who monitored quality in the home. The company had a suitable quality monitoring system in place and we saw evidence that this was working efficiently. There were good audits in place of all of the systems in the home. The company’s visions and values were evident in the home and these met with current good practice and protected people’s human rights and personal dignity.

People in this service told us that they were asked for their consent about all aspects of their life.

We observed some good care delivery and people told us they were happy with the way staff supported their care and welfare. One person we spoke to told us:

"I have been happy here since day one. The staff are very good and I get all the care I want and need."

We looked at the arrangements for supporting people with their medication. The arrangements in place were suitable and people were satisfied with the way staff dealt with this. One person said:

"They don't run out of my pills and I get them when I need them. If I need a painkiller they can give me something."

We looked at the staffing levels in the home and we judged that there were enough care and support staff on duty at all times to meet the needs of people in the home.

During our visit we saw that there were suitable systems in place to make sure that people in the home had the quality of care and services they needed. We saw examples of quality checks and people told us they were consulted about what they wanted.

"My opinion is respected and I can tell them what I would like. I think they are good at checking quality."

We looked at the arrangements in place for managing complaints and these were in order. No one had any complaints on the day of our visit. One person said:

"I am quite content. I have nothing to complain about!"

People told us about the experience of living in the service in a generally positive way.

"I am fine here...no problems".

"I am settled...my room is nice and the staff are very good".

"We are well fed here...no complaints at all".

"I think things are getting better all the time".

"They get the doctor if I am not well...and my pills are given out to me".

"I get bored sometimes but we do go out and we can play pool and things".

We visited Kirsanton Care Centre on 31st August 2011. Overall the people living at Kirksanton Care Centre that we talked with were satisfied with the care and support they were receiving. They were taking part in activities and younger people living in the Mews were participating and attended a meeting with the activities organiser when we visited and they were keen to attend.

One person told us about a trip out to Blackpool they were making with the day centre they attended and that they were looking forward to. People living there told us that they went out with the home staff on days and trips out and and enjoyed these trips. While we were there one person was arranging with the activities organiser a date to go out with them to help them buy some items they wanted.

We asked some people about the ways they were helped with their mobility by staff using the moving and handling equiment and people told us that they were happy with the way staff were doing this.

People told us they were generally satisfied with the care and services provided. One or two people said they were bored and didn’t join in the activities.

A number of people commented on the flies that were in the home when we visited.

Some relatives told us they were not satisfied with the personal care given in the service.

Some people told us they sometimes had to wait for attention although staff ‘did their best’.