Kirk House

Updated 22 April 2020

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection was completed by one inspector.

Service and service type:

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.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection took place on 7 and 13 November 2019 and was announced. We gave the service 72 hours' notice of the inspection because some of the people using it could not consent to the home visit from an inspector, which meant that we had to arrange for a 'best interests' decision about this.

On 8 and 14 November 2019 we contacted relatives, health and social care professionals to gather their feedback about the service.

What we did:

We used information we held about the service which included notifications that they sent us to plan this inspection. We also used the completed Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. However, the provider had completed this over 12 months previously and we therefore gave opportunities for them to update us throughout the inspection.

We used a range of different methods to help us understand people's experiences. People were unable to talk with us so we observed interactions between people and staff. We contacted eight relatives to gain their feedback on the quality of care. We contacted Healthwatch which is independent consumer champion that gathers and represents the views of the public about health and social care services in England. Additionally, we spoke with health and social care professionals the service had worked with over the last year.

We spoke with four support workers, a positive behaviour support partner [support people to reduce periods of anxiety], the assistant manager, the registered manager, the health and wellbeing manager, the positive behaviour manager, two registered managers and three area managers. We reviewed care plans for five people to check they were accurate and up to date. We also looked at medicines administration records and reviewed systems the provider had in place to ensure the quality of the service was continuously monitored and reviewed to drive improvement. These included accidents and incidents analysis, complaints management, meetings minutes and quality audits.

We used the Short Observational Framework for Inspection (SOFI) when we visited people in their home. SOFI is a way of observing care to help us to understand the experience of people who could not talk with us.

Updated 22 April 2020

About the service:

Kirk House is a care home registered to provide personal care to young adults who live with a physical/sensory disability, learning disability and/or autism. Kirk House is a purpose built home over two floors which can accommodate eleven people. At the time of the inspection there were nine people living at the service. People had access to their own private rooms. The building was being upgraded to enable everyone to have access to a private lounge, bedroom and bathroom.

The service had been developed and designed before the principles and values that underpin Registering the Right Support had been published. This guidance aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. People using the service received planned and co-ordinated bespoke person-centred support that was appropriate and inclusive for them.

People's experience of using this service:

People received personalised care that was exceptionally responsive to their needs. Some people had never lived in a shared care setting and a relative told us, "This was an extraordinary achievement for [family member]." There was strong sense of leadership in the service that was open and inclusive. People raised funds for local charities that supported people living in isolation.

The registered persons had focused on achieving exceptional outcomes for people and their staff. Relatives, professionals and our observations confirmed staff provided exceptional care. A relative summed this up by saying, "We remain delighted at the level of care my [relative] receives at Kirk House."

We found robust systems, processes and practices were followed and sustained effectively to safeguard people from situations in which they may experience harm. Risks to people's safety had been thoroughly assessed, monitored and managed so they were supported to stay safe while their freedom was respected. People were supported creatively to live healthier lives by having on-going support to access suitable healthcare services.

Care staff understood the importance of promoting equality and diversity by supporting people to make choices about their lives. People who used the service were treated with compassion and kindness and their privacy and dignity respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and live data recording systems in the service supported this practice. People and their representatives had been involved in agreeing their care plans and participated in reviews of the care and support provided to them. One person and family members confirmed staff always asked for consent when carrying out care and support tasks. Confidential information was kept private.

Safe recruitment practices were followed. People were supported by a small team of staff that fully understood their needs. Medicine records reviewed confirmed people received these safely. People lived in an environment that was clean and free from the risk of the spread of infection.

Staff received a thorough induction process and had completed all the training required to support people safely. Staff received regular supervision and annual appraisals and were able to reflect on the care and support they delivered. Staff were able to access further training and development opportunities in addition to their mandatory training. Staff were given the support and opportunities to progress within the organisation. People and relatives benefited from a robust data management recording framework that helped care staff to understand their responsibilities so that risks and regulatory requirements were met.

The provider had flexible ways of encouraging regular feedback from people who used the service, relatives, care staff and professionals. Views were gathered through annual surveys, telephone conversations, regular face to face meetings, house (residents) meetings and at staff team meetings. One complaint had been received in the last 12 months and this was responded to appropriately. People were introduced to lay advocates if necessary.

Comprehensive quality checks were available in real time as the provider had a bespoke live data recording system which could review all records and incidents instantly. This made sure people benefited from the service being able to quickly put problems right and to innovate so that people could consistently receive safe care.

Excellent team work was promoted and care staff were supported to speak out if they had any concerns about people not being treated in the right way. Staff were clear about the vision and values of the service.

The registered persons worked in partnership with other agencies and stakeholders like Skills for Care to support the development of joined-up care. More information is available in the full report.

Rating at last inspection:

Good (report published 14 December 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection when we rated the service as good overall. At this inspection there had been further improvements which resulted in the service being rated outstanding overall.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.