Archived: Ivydene Care Home

Ivydene Care Home provides care and support for up to 23 older people. At the time of our inspection 18 people were using the service many of who were living with dementia. The accommodation was offered over two floors. There were two communal lounges and two dining areas.

At the time of our inspection there was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 had not always followed their policy and local safeguarding guidance when responding to suspected or actual abuse. This meant that the police and local safeguarding team were not able to investigate concerns at the time they occurred.

People were not always supported in line with the Mental Capacity Act 2005 (MCA). The provider had not assessed people’s mental capacity to make specific decisions where this was necessary. Decisions had not always been made in people’s best interests. This meant that people may have received care that was not in their best interests. The registered manager told us they would complete the assessments. We saw that some people had restrictions placed upon them as they were not able to go out independently and may not have had the capacity to make a decision about their safety. Applications to ensure these restrictions were lawful were made to the local authority. Staff understood their responsibilities under the MCA and sought the consent of people when delivering care.

The provider did not meet the requirements of their registration with CQC. The provider did not always submit statutory notifications to CQC following significant incidents at the home as required by law. We also found that the provider did not display their rating from the latest CQC report. This is a legal requirement to inform people about our judgement about the quality of the service provided. The provider told us they would make sure the rating was displayed within the home and on their website.

Staff members understood their responsibilities to protect people from harm and to remain safe. We saw that the provider had a system to manage accidents and incidents. However, the analysis and investigation of these by the registered manager was not always recorded. This meant that there was a risk that measures put into place to help people to remain safe were not always monitored to check their effectiveness when an incident occurred. The registered manager told us they would use their incident forms more thoroughly in the future to detail their investigations.

People told us they felt safe. However, we saw there were some risks to people’s health and well-being. This included equipment stored against a fire door. The provider told us they would remove the items. We saw that the provider had plans in place to keep people safe during emergencies such as a fire. The provider also regularly checked the safety of the environment and equipment to reduce risks to people’s safety.

People’s care records did not always detail their specific health care requirements to support them to maintain their health. For one person there was no guidance for staff about what constituted a suitable blood sugar level for them to determine if the advice of a health professional should be sought. The registered manager told us they would make improvements to people’s care records. People had access to regular health care professionals to maintain their health including their GP.

People did not always receive care when they required it. For example, some people spent periods of time without staff enquiring if they wanted to engage in an activity or if they required support. The provider had not adapted the environment to be responsive to people living with dementia such as having clear signs to help people know where they are.

People and their relatives were not satisfied with the amount of activities offered to them. On the day of our visit some activities were occurring including one-to-one activities with people. The provider had displayed a notice asking relatives for activity suggestions.

The provider’s quality checks were not always suitable to ensure people received good care. We found concerns during our visit that were not identified by the provider’s own audits. These included the provider not always notifying the correct authorities following significant incidents.

People were involved in decisions about their care wherever possible and information on advocacy services were made available to help them to speak up where this may have been required. People were supported to be as independent as they wanted to be in order to retain their skills and abilities. People or their representatives had opportunities to contribute to the planning of their care where they were able to. People’s care plans were regularly reviewed but did not always contain information specific to all areas of their care requirements.

The provider had a suitable recruitment process in place for prospective staff which included relevant checks. People, their relatives and staff felt there were enough staff to offer safe care. We found staffing numbers to be appropriate to meet people’s needs safely.

People received their prescribed medicines in a safe way at the time they required them. Staff recorded the administration of people’s medicines and handled them in line with national medicines guidance. We saw that staff were trained in the safe handling of medicines and their competency was due to be checked by the registered manager to make sure they continued to have the required skills and knowledge.

People received care from staff who received regular training and guidance on their work. Staff undertook training in topic areas such as assisting people to move and in fire safety. New staff received an induction when they started working for the provider so that they were aware of their responsibilities. Staff members also met regularly with a manager so that they could gain feedback on their work.

People were satisfied with the food and drink available to them and mealtimes were relaxed. Their likes and dislikes were known by staff. Where there were concerns about people’s eating and drinking, specialist advice had been sought and incorporated into the support that staff offered. This included modifying people’s diets where this was required to support people to maintain their health.

People received support from staff who were kind and compassionate. Staff protected their dignity and privacy by, for instance, closing dividing curtains within shared rooms when delivering care. Staff knew the people they supported including their preferences and life histories. People’s care records were stored safely in line with the provider’s policy to maintain their confidentiality. People and their relatives told us that visitors were made welcome and could visit without undue restriction.

People’s relatives knew how to make a complaint should they have needed to. The provider had a complaints policy in place which was displayed so that visitors knew the process. The provider had not received any complaints in the last 12 months.

People, their relatives and staff felt that the service was well-led and had opportunities to give feedback to the provider. Staff felt supported by the registered manager and they were aware of their responsibilities. They knew how to report the inappropriate or unsafe practice of their colleagues should they have needed to.

We found four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Relatives told us the home provided good, safe care. One relative said, 'Now that my (family member's) here I don't have to worry about them anymore. It's lovely to come and visit and then go away knowing they are safe and well-cared for.'

Since we last inspected the home's cleaning schedule had been improved and staff had had further training in infection control. As a result people were being cared for in a clean environment which reduced the risk of them acquiring infections.

However the home's latest maintenance audit was not fit for purpose. Although it showed some work had been carried out, for example the refurbishment of one of the bathrooms and an upstairs toilet, other work remained outstanding and it was unclear from the audit when this would be commenced or completed. We have asked the provider to take action to address this.

Is the service effective?

On the day we inspected the home was busy due to an emergency admission and a number of visitors and health care professionals coming to the home. Staff coped well with this and provided care in a calm and unhurried way.

We saw that staff took the time to talk with the people who used the service and engage them in activities. For example, one care worker helped a person to watch sport on the home's computer, and another care worker sat with a person in the reception area and chatted to them about their previous occupation.

Relative told us the people who used the service were well-cared for. One relative said, 'The care is excellent ' I can't fault it. If my (family member) needs to see the doctor they get one out straight away.' Another relative commented, 'It must be good here because my (family member) doesn't complain and they usually complain about everything.'

Care plans were well organised and person-centred as they focussed on people receiving individualised care that promoted independence and choice. They included information about people's lives, families, hobbies and interests. For example, one stated, 'I love to talk about working in the mills and really appreciate it when staff take the time to show me pictures of my home town on the computer.'

Is the service caring?

We saw staff providing care in a kind and friendly manner. The got on well with the people who used the service and their relatives. The home had a happy, busy atmosphere with relatives coming and going and staff attending to people's needs promptly.

Records showed that some of the people who used the service liked music and staff had acted on this. One person who was on bed rest was listening to their favourite radio station in their room. Another person was listening to a CD of a singer they liked in one of the lounges. A relative told us, 'We like Ivydene because the staff are really thoughtful and do everything they can to make my (family member's) stay here happy.'

Is the service responsive?

In response to people's need for stimulation a lively programme of activities had been provided at Ivydene. This included gardening, 'theme days', and other games and activities suitable for people living with dementia. One relative told us, 'My (relative) did very little when they were at home but they've come out of their shell since they've been here and have been doing more and making friends.'

Photos in the home showed people taking part in the 'theme days' when they celebrated life events, for example, childhood, summer holidays, and royal occasions. These gave people the opportunity to reminisce and enjoy the themed activities, for example an ice cream van coming to the home.

Is the service well-led?

Records showed that a survey of people's views had been carried out in April 2014 and the findings collated and displayed in the home's reception area. These showed a high level of satisfaction with the home and many positive comments had been made about all aspects of the service provided. In particular, respondents commented on the high quality of the care and how friendly and caring the staff were.

The manager said this survey would be repeated annually to help ensure the views of the people who used the service and their relatives would remain central to the home's programme of quality assurance.

People told us the manager was friendly and approachable. One relative said, 'The manager is excellent. She keeps us up to date about our (family member) and makes sure they have everything they need. She knows all the residents and relatives and if anything needs doing she makes sure it's done.'

Staff we spoke with were all happy working at the home and told us that they felt people were well cared for and that their needs were met. One staff member said: 'It's brilliant. I can't think of anything bad. People are well looked after.' Two of the staff we spoke with told us that the building needed some work doing on it. One staff member expressed concern about the cleanliness of the home.

We found major concerns with levels of cleanliness at the home. There were not effective processes in place to ensure that people were protected from the risk of infection.

We found improvements in relation to consent to care and treatment and in relation to the planning and delivery of care at the home. However, we found insufficient improvements in relation to quality assurance and obtaining the views and opinions of people using the service.

We found that staff were recruited with the appropriate checks.

We saw no evidence that any best interest meetings had been held for any of the people using the service who had been deemed to lack capacity. There was no explanation in the care plans we looked at as to who was representing people and how this had been agreed.

Care plans and daily records did not always take account of identified risks. However we saw and heard sufficient evidence to demonstrate that day to day care was delivered in a way that was intended to ensure people's safety and welfare.

The main areas and bedrooms appeared clean but high level dusting had not been undertaken for some time. We noted that the chandeliers, lampshades and curtain rails were very dusty throughout the home.

All people we spoke with stated that they felt the home was 'tired.' We understood that this meant they felt the home would benefit from some redecoration. We asked the provider about the redecoration plans for the home and were told that redecoration occurred on an ad hoc basis.

Staff felt that management were approachable and that they could report issues relating to the quality of the service. We asked all the relatives we spoke with if they felt confident to raise concerns. Their responses indicated they knew have to raise a concern and they felt the provider was open and approachable.

We spoke with five people who used the service and they told us they were happy with the care they received. One person told us:' The staff talk and listen to me'.

All the people we spoke with told us they felt safe. All the staff we spoke with had a good understanding of the different types of abuse and were able to explain what they would do if they suspected someone was being abused and who they would report to, both within the service and external agencies.

We spoke to three members of staff who confirmed they had received supervision in the last six months and had either received an appraisal or it was booked for January 2013.

One member of staff told us:' The manager and staff are very helpful and supportive' and another member of staff told us:' The manager monitors what we do and tells us if they see something right or wrong'.