Kirkwood Court 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. Kirkwood Court accommodates up to 72 older people, in one purpose built building. Care is provided over three floors, including one floor, known as the Grace unit, for people living with dementia- related conditions. Nursing care is not provided at the home. At the time of our inspection there were 68 people living at the home.

This unannounced comprehensive inspection took place on 28 and 29 March 2018 and 4 April 2018. This meant that neither the provider nor the staff knew we would be visiting the home on the first day of our visit. Following these visits we requested further information from the provider and contacted relatives and staff by telephone. We concluded these inspection activities on 13 April 2018.

We last inspected this service in October 2015. At that time we found the service was meeting all legal requirements and rated the service as 'Good'. However, during this inspection we found some shortfalls in the delivery of care, and therefore rated the service as 'Requires Improvement'.

A registered manager was not in place at the time of the inspection. The previous registered manager had de-registered shortly before our inspection. The provider had employed a new manager who was in the process of applying to CQC to become registered manager. 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.

Whilst processes and procedures were in place for the safe management of medicines, these were not always being followed.

Staffing levels were not consistent. On the days we visited we saw people’s needs were well met, however staff, people and relatives we told us there were not always enough staff on duty. Rotas showed staffing levels were regularly below the number we observed during the inspection. The regional manager told us any staff shortage was dealt with by the manager or domestic staff providing care. However feedback from people, relatives and staff was that there were not always enough staff available.

Robust recruitment procedures were in place, and the provider had recently strengthened their agency staff protocol after an incident where someone had mistakenly been assigned to work in the home.

The home continued to monitor accidents and incidents, manage risks and follow infection control processes.

People's needs had been assessed. However, as care plans varied in quality and detail, in some instances information about how to meet identified needs was missing.

Staff were up to date with training the provider considered mandatory for their roles. They received regular opportunities to discuss their roles and care they provided.

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 told us they enjoyed the food at the home and that it was plentiful. Mealtimes were well organised and an enjoyable experience. Where needed, prompt referrals were made to health and social care professionals, such as speech and language teams, dietitians, specialist nurses and GPs.

People and relatives told us staff were caring. They gave us examples of when they had been touched by the way staff had gone out of their way for people. We saw that staff knew people well and had good relationships.

People were encouraged to be independent, and their right to privacy was respected. Staff supported people to maintain links with peop

We used a number of different methods to help us understand the experiences of people who used the service, as some people had complex needs which meant they were not all able to tell us their experiences.

We spoke to the staff at the home and during our visit we were assisted by the regional manager.

We found there were enough staff on duty to meet people's needs.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

People were given all the information they needed to make an informed decision about their care and were asked to provide their consent to such care.

We saw people were cared for effectively and care was planned for the individual.

We saw people were safe and protected from abuse.

We saw there was sufficient staff to provide care and support.

The provider had an effective system in place to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

The representatives or advocates of people who used the service were positive about the care and support provided. Comments included “I am very happy here, the care is very good” and “You get everything you need. They (the staff) treat me very well”.

We spoke with five people living at Kirkwood Court. They told us they were asked for their consent before agreeing to their care. One person said, “They confirm with me first.” Another person commented, “They tell me these are my tablets and you can always check.”

People told us they were happy with the care and support they received. For example, one person remarked; “It’s very pleasant; we’re very lucky to be here.” Another person said; “There’s a pull cord here and in my bathroom … they’re very patient.”

People also made positive comments about the staff, and the comments we heard included: “The staff are very good.” Another person told us; “The foods good, the staff are good.”

People told us that they were happy with the care and attention they received at Kirkwood Court. They confirmed that they were given choices in life and that staff supported them to take some risks and be independent. People we spoke with said ‘I feel safe here and have gained back my confidence’ and ‘I have made new friends and enjoy my life here’.

People said they received enough to eat and drink and relatives said they were happy that people who needed assistance to eat received it. They said ‘the food is really nice’ 'I have put on weight' ‘I really enjoy the food, breakfast is my favourite’ ‘you have lots of choice’.

People confirmed that they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said ‘there is lots to do’ 'the cinema is a bit small' ‘I can join in or relax in my room’ ‘we are always thinking and planning outings and we are involved in where we go’.

People told us that their home was clean, comfortable and warm and commented ‘come and look at my beautiful room’ ‘look at my views of the garden’ 'the place is spotless I feel proud when my family and friends visit'.

They said staff were kind and caring and seemed to be well trained. People confirmed that they were given the opportunity to comment on the service, change routine or raise complaints. They said that their visitors were made to feel welcome and information exchange was good.

The inspection took place on 21 and 22 October 2015 and was unannounced. This means the provider did not know we were coming. We last inspected Kirkwood Court in October 2013. At that inspection we found the service was meeting the legal requirements in force at the time.

Kirkwood Court provides personal care for up to 72 older people, including people with dementia- related conditions. Nursing care is not provided at the home. At the time of our inspection there were 63 people living at the home.

The service had a registered manager. 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 informed us that the registered manager was leaving and a new manager had been appointed who would be applying for registration.

People told us they felt safe at the home and with the staff who supported them. Care was provided in a clean, safe and comfortable environment. Staff were trained in safeguarding and understood how to protect people from abuse.

New staff were thoroughly vetted to make sure they were suitable to be employed. Staffing levels were determined according to the numbers and dependency of people living at the home. 

People were given support to maintain their health and well-being, access health care professionals, and to take their prescribed medicines safely. A varied and balanced diet was provided to ensure people had good nutrition. Where necessary, dietetic advice was obtained and staff supported people with their eating and drinking needs.

Staff were provided with training that enabled them to care for people effectively. All staff received regular supervision to support their personal development and an annual appraisal of their work performance.

People directed the ways they wished to be supported and gave consent to their care and treatment. Formal processes were followed to uphold people’s rights under mental capacity law when they were unable to make important care decisions.

Staff were caring and respectful in their approach and promoted people’s privacy and dignity. They had a good understanding of people’s preferences and encouraged them to make choices about their care.

People’s needs and any risks were assessed and documented in individual care plans. Care was routinely reviewed and adapted when people’s needs changed. A range of activities and events were provided to help people meet their social needs.

There was an open culture and people and their families were consulted about the running of the home. A complaints procedure was in place and any concerns were promptly responded to and investigated.

Appropriate management arrangements had been made to support the service and provide leadership until the new manager took up post. Standards at the home were subject to continuous monitoring to assure the quality of the service and the care that people received.