Archived: Bury Council - Killelea Residential Care Home

Killelea Residential Care Home is a large detached building situated approximately one mile from the centre of Bury. It is on a main bus route and not too far from the motorway network. There is ample car parking to the front of the home with well laid out with clear signage and clearly defined parking areas for disabled visitors. Bedroom accommodation is provided on the ground and first floors and access to the first floor is via stairs or a passenger lift. Communal areas of lounges and dining rooms are situated on both floors. There is a small ‘therapy’ kitchen on the first floor for use by staff and people who use the service. The home provides intermediate care and rehabilitation for up to 36 elderly people. The aim of the service is to promote recovery and independence following an illness or accident. There were 18 people using the service at the time of the inspection.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day 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 2008 and associated Regulations about how the service is run.'

We found two breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. We found the premises were not as safe as they should have been because substances hazardous to health were not kept secure. We found medicines that people were self- administering were not stored securely. These breaches placed the health and safety of people who used the service at risk of harm.

You can see what action we have told the provider to take at the back of the full version of the report.

We found people were cared for by sufficient numbers of safely recruited, suitably skilled and experienced staff. In addition to the care staff people had their care and support needs met by a team of health and social care professionals who were based at the home; known as the Intermediate Care Team. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely.

The staff we spoke with had a good understanding of the care and support that people required. We saw people looked well cared for and there was enough equipment available to promote people's safety, comfort and independence. Interactions between staff and the people who used the service were warm, friendly and relaxed.

People's care records contained enough information to guide staff on the care and support required. The care records showed that risks to people's health and well-being had been identified, such as the risk of falls, pressure sores and poor nutrition. We saw that plans were in place to help reduce or eliminate the identified risks.

Food stocks were good, people were offered a choice of meal and the meals provided were varied and nutritionally balanced. People told us they enjoyed the meals.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. Staff were able to demonstrate their understanding of the whistle-blowing procedures (the reporting of unsafe and/or poor practice).

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was aware of their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); to ensure that people's rights were considered and protected.

All areas of the home were clean and we saw that procedures were in place to prevent and control the spread of infection. Risk assessments were in place for the safety of the premises and systems were in place to deal with any emergency that could affect the provision of care.

We saw that the equipment and services within the home were serviced and maintained in accordance with the manufacturers' instructions. This helps to ensure the safety and wellbeing of everybody living, working and visiting the home.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided and there were systems in place for receiving, handling and responding appropriately to complaints.

Our inspection of the home on 10 July 2014 identified that not enough staff were always provided at night to safely and effectively meet the needs of the people who used the service. Following the inspection we made a compliance action. This required the provider to tell us what they were going to do to meet the requirements of the law in relation to ensuring there were sufficient staff on duty at all times to meet people's needs.

Following the inspection the provider sent us an action plan telling us what steps they were going to take to make the necessary improvements.

They informed us they were going to undertake a detailed monitoring exercise with the night staff. This was to determine if the staffing requirements were sufficient for people's needs. We were also informed that there would be a review, between September 2014 and November 2014, of the eligibility criteria and pre admissions assessment process. We were told that the purpose of this work was to improve the screening of referrals and decrease the number of inappropriate admissions to the home.

We were also told that the management team have agreed that if dependency levels rise so there are more than 5 people requiring the support of two staff when the unit is more than 80% occupied, then an additional support worker will be secured to cover the shift.

During this inspection we found that sufficient staff were provided to meet people's needs.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive to people's needs?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, speaking with the staff supporting them, and from looking at records.

Is the service safe?

People who used the service had their care and support needs met by a team of health and social care professionals who worked within the home.

The staff we spoke with showed they had a very good understanding of the needs of the people they were looking after.

The management and administration of people's medication was safe. Medicines were stored securely and people received their medicines when they needed them.

Not enough staff were provided at night to safely and effectively meet the needs of the people who used the service. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring there are sufficient staff on duty at all times to meet people's needs.

Is the service effective?

People's health and care needs were assessed before they were admitted to ensure the service provided would be beneficial to them and, where relevant, help assist in their rehabilitation.

The provider had a clear procedure in place with regards to responding to any complaints and concerns made.

Is the service caring?

The people we spoke with were complimentary about the care provided. Comments made to us included; 'I feel very lucky to be here, everything is fine' and 'The care I am receiving is the best'. 'It is really very good, the girls are smashing' and 'They get the thumbs up from me, the staff are 'fab' and two staff in particular are fantastic'.

Is the service responsive to people's needs?

Information in the care records showed the staff at the home involved other health and social care professionals in the care and support of the people who used the service.

Suitable arrangements were in place to ensure that information was passed on when a person was transferred to another service, such as a hospital.

People who used the service were offered opportunities to comment on the care and support they received.

Is the service well-led?

The home had a manager who was registered with the Care Quality Commission and had the necessary skills and experience to undertake the role.

There were a number of quality assurance systems in place to ensure people were cared for safely.

Meetings were held regularly for staff to give them the opportunity to be kept informed of any developments within the service and also to express their views about the service and facilities provided.

Systems were in place to help ensure the manager and staff learnt from events such as accidents and complaints.

The provider had a satisfactory system in place for checking the quality of care the service provided.

People were protected against the risk of unsafe or inappropriate care and treatment because records required to protect their safety and wellbeing were accurate and up to date.

People using the service told us they were well looked after. Comments made were, 'Very good indeed, I am well looked after' and 'Some staff are extremely good and very caring'. The care plans that we looked at however did not contain enough information to show how people were to be looked after. They were not always accurate or up to date, putting people at risk of receiving unsafe care and treatment.

Systems were in place to help protect people by ensuring that staff were suitably trained in safeguarding vulnerable people. One of the people we spoke with told us, "The staff are kind and yes, I feel safe'.

At our previous visit in February 2013 we found that people were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage medicines within the home. During this visit we found that the handling of medicines remained unsafe. This could place people's safety, health and well being at risk.

Systems were in place for gathering and acting upon information about the quality and safety of the service provided, however the quality of the checks on medicines and care plans was not effective.

The planning and delivery of care ensured the individual needs of the people using the service were met. The care plans contained sufficient information to show how people were to be looked after and also showed that people gave consent to the care and treatment provided. Some of the care and treatment records however were not always accurate or up to date, putting people at risk of receiving unsafe care and treatment.

The handling of medicines was not as safe as it should have been. This could place people's safety, health and well being at risk.

Adequate equipment and adaptations were available to promote people's independence, rehabilitation and comfort and to assist in their safe moving and handling.

People needs were met by a sufficient number of suitably trained and qualified staff.

The complaints procedure in place ensured people were given clear guidance on how to make a complaint.