Kirk House

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At this assessment we did not assess all quality statements within this key question. We found 1 breach in regulation which related to person-centred care. People’s needs and risks were not always assessed appropriately or reviewed regularly. People were not supported to have maximum choice and control of their lives. Regular assessments of people who had been using the service long term, had not been carried out to ensure the provider continued to work in line with the Mental Capacity Act (MCA). Some staff we spoke with understood the principles of the MCA.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

A relative had fed back to the provider through a survey that staff tried to give their family member a variety of experiences although stated staff feedback could be repetitive with few actual insights or comments as to what their family member had been up to. Some relatives we spoke with told us their family members were supported with health appointments and referrals when necessary. A relative told us they were always informed if their family member had to attend hospital.

The registered manager told us the monitoring of people’s health needs was managed by their electronic computer system. They told us they worked closely with the GP and psychiatrists to manage and review people’s health and medicines.

People’s sensory needs had not always been formally assessed and when asked, managers and staff did not know what people’s sensory needs were. Some information from an initial assessment around a person’s need for deep pressure to help them feel grounded had not been incorporated into the care plan to give staff information on how to meet that need. There was no evidence on how people were supported to explore what other opportunities might be available or of interest to them. It was not evident how people were involved in a meaningful way to make choices about what they did. Some people’s days were often spent in the house or a walk in the village. The environment did not always suit people’s needs or preferences. A person’s wet room had a collapssable travel bath that was approximately half the length of a standard permanent bath. Although this was meant to be a temporary measure this had not been updated or replaced for over a year. Care plans were detailed and contained information about people’s health and care needs, however not all information was accessible or easy to find. For example, in a person’s care plan there was information related to them eating inedible objects. This information had been included in various parts of the care plan which meant you had to read all the sections to get a full picture of the risks. Following our assessment the provider implemented a profile sheet which gave a summary of the person’s needs. Lessons learnt were focused on staff need and not on what the person might have been trying to express. This meant staff were not supported following incidents to understand why something happened and how they could reduce the risk of reoccurrence to achieve more positive outcomes. We expect providers to try and understand people so they can provide effective person-centred care with a view to not require the use of restrictive practices.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We saw in a family survey sent by the provider that a relative had raised concerns about their family member losing weight. They stated that although they had raised concerns with the provider, no actions were taken until they had requested a best interest meeting with the local authority. This person had no free access to drinks or snacks so had to solely rely on staff to make these available to them. The relative told us their family member was now being supported to integrate with others and not eat in their bedroom which they said was working. However, records showed it took 11 months and a loss of 11kg before the persons weight began to stabilise. This mean their BMI reduced to concerning levels. A relative told us their family member had been supported to eat fruit and vegetables which had been difficult to do in the past. Another relative said their family member had been introduced to a variety of foods and they could see they were enjoying their food.

The registered manager told us a link nurse at the GP surgery visited the home regularly. They explained this was beneficial as the nurse had got to know people and were familiar with them. The registered manager told us they had been supporting a person with their anxieties around mealtimes by introducing menus and supporting them to choose meals by showing them pictures on the computer.

Systems were in place to monitor and follow up referrals of people’s needs and changing care requirements. People’s health diagnoses and support needs were not always easily located in their care plans to ensure staff had good guidance. Since the assessment, the provider acknowledged our concerns and reviewed how care plans are written to make this information clearer.

Some relatives told us they were involved in reviews for their family member’s care and support plans. One relative had stated in a provider questionnaire their family member had not had a review for a long time.

The registered manager told us they completed care plan reviews as and when people’s needs changed. Additionally, reviews were carried out every 6 months or annually which were completed by the management team.

The provider carried out annual review reports which were created using the same format for each person. The report stated the reviews gave people a 'data voice'. However, the person’s 'human' voice and that of their relatives or any other person involved in their care other than feedback from staff, was missing. There was no evidence of people’s involvement or that of their families in either the preparation of the report or an actual review meeting. There was no evidence of how they agreed what was working well and what could be improved. The review report did not evidence a meaningful review of people’s lives. People had a goal that staff were supporting them to achieve. However, there was no evidence how people were supported to choose their goal and no evidence in daily diaries of when this has been attempted or what the outcomes were.

Relatives provided mixed feedback on whether their views were sought when their family member was deemed to lack capacity to make a specific decision. A relative had fed back to the provider that they had not been involved in a high-level decision involving their family member even though there had been an opportunity to discuss it to ensure it was in their best interests.

Some staff we spoke with understood the principles of the Mental Capacity Act. A staff member told us they would always encourage but never push someone to do something as ultimately, it’s the person’s choice. However, we reviewed daily notes and staff did not document how they supported people to make decisions or alternative choices. The registered manager told us they ensured people were given opportunities to consent to their care and treatment by using different resources to support their understanding on decision to be made.

Assessments of people’s mental capacity and best interest meetings had taken place however there was no evidence these were regularly reviewed to ensure decisions remained relevant and proportionate. There was evidence that relatives and other professionals were not always involved in best interest meetings. We have reported on this more in Safe.