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Inspection carried out on 20 August 2019

During a routine inspection

About the service

Ivy Dene is a residential care home providing personal care to 20 people. The service supports people with complex needs and/or people with a learning disability. At the time of our inspection 19 people were using the service. The accommodation is made up of three separate units. The largest unit accommodates 10 people, and this is larger than current best practice guidance.

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. This guidance helps 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 promoted independence and provided person-centred support within the constraints of an environment where a large number of people shared communal facilities. The provider had plans to improve the layout of the home and the environment which would help ensure the principles and values were consistently applied. People were encouraged to access the community and undertake person centred activities.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of the thematic review, we carried out a survey with the care and development director at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service rarely used restrictive intervention practices and then only as a last resort. When these practices were used it was in a person-centred way, in line with positive behaviour support principles.

People’s experience of using this service and what we found

The premises were clean and well maintained. We made a recommendation in relation to the risk assessment of radiator covers.

People told us the service was safe. There had been a lot of staff changes and this had been unsettling for people. However, safe staffing levels had been maintained and the provider was recruiting new staff.

People’s needs were assessed, and their care plans and risk assessments were detailed. This helped to make sure care was person-centred.

People’s communication needs were assessed and where needed appropriate support was provided.

People were supported by kind and caring staff, who promoted their independence.

People were supported to eat and drink a balanced diet which took account of their needs and preferences. People were supported to stay healthy and to access the full range of NHS services.

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 systems in the service supported this practice.

People were supported to maintain relationships with family and friends. People took part in a variety of social activities in the home and in the community. The service was planning how to give people more opportunities to get involved in the local community.

The provider had systems in place to check the quality and safety of the services provided. Any shortfalls we found during the inspection had already been identified and were being dealt with. There was a service improvement plan in place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The ra

Inspection carried out on 12 June 2018

During a routine inspection

The inspection took place on 12 and 14 June 2018 and was unannounced on both days. At the last inspection in February 2016 the service was rated overall as good. At this inspection we found two breaches of regulation in Safe care and treatment and good governance.

Ivy Dene provides accommodation for up to 20 people with learning disabilities. “The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.”

On the days of our inspection there were 20 people living in Ivy Dene. The home was split into three sections Ivy Dene, Ivy Rose and Ivy House. On the day of our inspection there were 10 people living in Ivy Dene, 5 people at Ivy house and 5 in Ivy Rose.

At the time of our inspection there was a registered manager in place, however they were absent from work due to maternity leave. An interim manager was in post and was supported by the deputy 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.

Most people told us they liked living at Ivy Dene. People said they felt safe. Individual risk assessments for people were in place.

Staff understood how to ensure people were safeguarded against possible abuse and they knew how to report any concerns.

People said they received their medicines on time, but we found some weaknesses in the management of medicines.

There were regular staff training, supervision and appraisal opportunities.

People enjoyed the meals and the food and drink provision was suitable for people's needs.

Staff interaction with people was mostly kind and caring and staff knew people well. People were encouraged to retain their independence with daily tasks.

Staff knew people's individual preferences and these were reflected in the activities provided. However, these had decreased over the past four weeks due to staffing. The management team were interviewing for staff on the first day of inspection.

People knew how to make a complaint and there was a system for recording complaints and compliments.

People, relatives and staff felt supported by the registered manager and they were confident their views were valued and acted upon. Systems were in place for monitoring the quality of the provision, although these were not always sufficiently robust. Accident and incidents were completed and analysis of any trends were identified and acted upon.

The interim manager was aware of the strengths of the service and the areas to improve.

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

Inspection carried out on 12 February 2016

During a routine inspection

The inspection took place on 12 and 18 February 2016 and was unannounced.

Ivy Dene provides accommodation for 14 people with learning disabilities. On the days of our inspection there were 12 people living in Ivy Dene.

At the time of our inspection there was a registered manager in place, however they were absent from work due to ill health. A deputy manager was in post and the operations manager was based in Ivy Dene. 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 home was split into two sections Ivy Dene and a flat attached named Ivy Rose. On the day of our inspection there were eight people living in Ivy Dene and 5 in Ivy Rose.

The atmosphere in the homes was welcoming from the people who used the service and the staff team. The service had safe recruitment process in place and appropriate checks were undertaken before staff began work. This showed staff had been properly checked to make sure they were suitable and safe to work with people.

We saw there was enough staff on duty to meet people’s needs. The deputy manager told us a dependency tool was used to calculate the number of staff required for each shift. This information demonstrated that the service considered the staffing numbers needed to ensure that people’s needs were met.

Appropriate arrangements were in place in relation to the recording handling storage and administration of medicines.

People were supported by, suitably qualified, skilled and experienced staff. Staff received regular management supervision to monitor their performance and development needs and ensure they had the skills and competencies to meet people's needs. Staff had received regular training which equipped them to meet the needs of the people who used the service.

People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005 (MCA).

Staff was trained to manage behaviour that challenges others, whilst ensuring people’s rights were protected

People’s food and drink met their religious or cultural needs. We saw each person was asked about any food preferences and this was documented in every ones care plan. People were supported to be able to eat and drink sufficient amounts to meet their needs.

We saw people were supported to express their views and were actively involved in making decisions about their care, treatment and support. People's privacy, dignity and independence were respected. People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care.

There was clear documentation in each person’s care plan about their likes and dislikes. Care plans were up to date and gave a detailed picture of how each service user liked to be supported. People were offered choices throughout the day including what activities they would like to do and when.

We saw the complaints procedure was followed and complaints were acted on in a timely manner.

The deputy manager was open to new ideas and keen to learn from others to ensure the best possible outcomes for people living within the home. The deputy manager regularly worked with staff ‘on the floor’ providing support to people who lived there, which meant they had an in-depth knowledge of the people living at Ivy Dene.

Robust auditing was in place. This meant the registered provider had a system in place to ensure that identified shortfalls were addressed in a timely manner.

Inspection carried out on 23 July 2013

During a routine inspection

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person said, �If I am not sure I am not afraid to ask and I only agree if I am happy. I know my rights.�

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There was an emphasis on promoting independence and encouraging people to do as much as they could so that people were able to achieve their maximum potential.

People were cared for in a way that protected them from unlawful discrimination. We observed staff interacting with people in a respectful and helpful manner. People looked relaxed and friendly with staff.

Two family members said that they had witnessed the staff at the home co-ordinating and co-operating with external agencies to make sure people received appropriate service without delay.

We noticed staff using personal protective equipment (PPE) such as gloves and apron appropriately. We observed staff washing their hands before and after attending to each person's personal needs.

People we spoke with said if they had a complaint they would talk to any member of staff or the manager. They said staff were approachable and always helpful. Two people said if they were not happy with the way their comments were handled by staff then they would make a formal complaint and they would use the forms provided by the manager to make the complaint.