Ivonbrook Care Home

Ivonbrook Care Home is a residential care home providing personal care for up to 40 people. The service provides support to older people. At the time of our inspection there were 35 people using the service across three separate wings, each of which has separate adapted facilities.

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

People were safely cared for by trained staff.

There were enough staff working at the service to meet people’s needs.

Staff were employed using safe recruitment procedures.

Medicines were stored and administered safely.

The building was clean, tidy and well maintained. Staff understood and followed infection prevention control procedures.

Staff were well supported in their roles, by managers who had a positive vision for the service, and sought out opportunities for development.

People’s feedback was gathered and listened to, and changes made to suit people’s needs.

Audits and checks were in place to find any errors, and action was taken as required.

Staff felt communication was good, and received the information they required to do their jobs safely.

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.

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 last rating for this service was good (published 21 February 2019).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about staff recruitment. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ivonbrook Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We inspected Ivonbrook Care Home on 11 January 2019. The service is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ivonbrook Care Home provides personal care and accommodation for up to 40 people in one single building. The service provides a permanent residence for people and short-term care beds are available for people to access. On the day of our visit 14 people were using the service.

At our last inspection on the 10 and 11 October 2016 although the provider was not in breach of any regulations we rated the service as requires improvement. This was because people’s care records were not always updated to reflect their current needs and staff were not receiving regular supervisions. At this inspection we saw improvements had been made. People’s care plans were up to date and reviewed on a regular basis to ensure any changing needs were identified. Staff supervisions had commended and a schedule was in place to ensure this was provided on a regular basis.

The service did not have a registered manager in post. 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.

Plans were in place to gather the views of people and their representatives to ensure they were involved in the ongoing development of the service. Systems were in place and being further developed to monitor the quality of the service, to enable the provider to drive improvement.

People’s individual needs were met as sufficient numbers of trained staff were available to support them. People were supported by staff who understood their role in protecting them from the risk of harm and reporting any concerns. People were supported to keep safe, as individual and environmental risks were assessed and managed. People were supported in a safe way to take their prescribed medicine. The staff’s suitability to work with people was established before they commenced employment. Systems were in place to guide staff on the prevention and control of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People and their representatives were involved in their care to enable them to make decisions about how they wanted to receive support in their preferred way. People received a balanced diet that met their preferences and assessed needs. People were supported to access healthcare services and received coordinated support, to ensure their preferences and needs were met.

Staff knew people well and understood the support they needed and their preferences on how this support was delivered. People were treated with consideration and respect by the staff team and they were supported to maintain their dignity. People were supported to maintain relationships with those who were important to them; such as family and friends.

People had opportunities to take part in social activities to promote their well-being. The management and staff team included people and their representatives in the planning of their care. There were processes in place for people and their representatives to raise any concerns about the service provided.

Staff were clear on their roles and responsibilities and felt supported by the management team. The provider understood their legal responsibilities with us and the rating of the last inspection was on display in the home.

Ivonbrook Care Home provides accommodation with nursing and personal care for up to 40 people, some of whom were living with dementia. At the time of our inspection 8 people were using the service.

A registered manager was not in post, as the previous registered manager had left the service prior to our last inspection in June 2016. However, an acting manager was in post and was present throughout the first day of this 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.

At our last inspection in June 2016, we found the service to be rated as ‘Inadequate’ overall and the service was therefore placed in ‘Special measures’. In all, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. At the time of this inspection we found enough improvements had been made to take the provider out of special measures. However, there were still some improvements not yet completed.

Systems for identifying and reporting concerns had improved. The acting manager had informed the Care Quality Commission (CQC) of any changes and reportable incidents at the service.

At the previous inspection, we found people's care records were not effectively updated and evaluated. At this inspection we found improvements had been made, however we could not be assured information had always been shared and updated effectively.

We saw improvements had been made to medicines management; staff had received support and training to manage medicines safely. There were procedures in place to keep people safe in emergencies. We saw there was an extensive plan of refurbishment and redecoration taking place. The acting manager was in the process of recruiting new staff to the service, although none had yet commenced their employment.

People were supported to have access to health care professionals at the time they required. Staff received training and looking at ways to implement new skills and knowledge. There were sufficient numbers of staff available to meet people’s needs.

We saw drinks were readily available throughout the day. Where people required special diets or supplements, we saw the staff ensured they were provided. People told us they were involved in making decisions about the support they needed and felt able to ask staff should they need any help or something in particular. People’s dignity, privacy and independence were respected by the staff.

People were encouraged and supported to spend private and quality time with their family members. Staff were kind, caring and compassionate. People felt listened to and informed of developments at the service. People were supported to follow activities and interests of their choice.

A complaints procedure was in place and were monitored, investigated and acted upon. Improvements had been made in relation to sharing information with the local authority and the Care Quality Commission (CQC). People felt the acting manager and the staff were visible and approachable.

Other improvements were still in progress. For example, updating of people’s care plans and staff training.

There was no registered manager in place and day-to-day management of the service was provided by the acting manager who received support and guidance from care home consultants. Staff supervisions were not carried out on a regular basis.

At our last inspection in August 2015 we found the service to be rated as good in all key areas.

Ivonbrook Care Home provides accommodation with nursing and personal care for up to 40 people, some of whom were living with dementia. At the start of our inspection there were 31people living at the service.

There was no registered manager in place. 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.

People were not protected against the risks of receiving inappropriate or unsafe care; care was not planned or delivered to meet people’s individual needs. Medicines were not safely managed.

There were sufficient numbers of staff on duty but they did not all have the skills, knowledge, understanding and experience to support people’s needs well.

People were not protected from abuse because staff failed to recognise and report concerns appropriately. Risk assessments failed to provide information on how to reduce the risks and promote people’s independence.

People’s nutritional and hydration needs were not met. Sufficient quantities of fluid were not maintained for some people who required encouragement or assistance to drink.

The key requirements of the Mental Capacity Act (2005) were not fully understood and capacity assessments were incomplete. People’s individual needs were not always recognised and met. This was particularly the case for people who had complex needs or who were unable to communicate their wishes verbally.

Applications for Deprivation of Liberties Safeguards had been made because the local authority requested them.

Systems to assess, evaluate and monitor the quality of the service were not effective. There was a lack of effective leadership of the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

During this inspection we found the service to be in breach of several of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Whilst we noted that members of staff received safeguarding training every three years, and the majority of safeguarding issues were handled appropriately, we had concerns that not all safeguarding allegations were handled in a way which ensured the protection of people living at the home, their relatives and staff working in the service.

All the family members that we spoke to said there were enough qualified, skilled and experienced staff to meet their relative's needs.

Family members observed the atmosphere of the home to be "calm and relaxed because there were enough staff on duty", and a number of people commented on the positive attitude of staff "who showed a real interest in the person they were caring for".

All the evidence that we reviewed indicated that staff working in the home: were well supported; had received an induction, with appropriate mandatory training when they started in their role; and were encouraged to obtain further professional qualifications.

We found that the service provider had a number of different mechanisms for gathering, recording and evaluating accurate information about the quality and safety of the service provided, including a complaints system.

The person we spoke with told us that staff knew their needs and were able to fully meet them. They added, '[Staff] seemed to take to me straight away.'

We spoke with two members of care staff who both told us they had enough information about people's needs at the time of their admission. We read records that confirmed that sufficient information was recorded, at the time of people's admission, to enable staff to meet people's needs and provide safe care.

Although people felt their needs were met we found that their needs were not always assessed promptly at the time of their admission.

People told us they felt safe at Ivonbrook. Staff had received training that kept people safe and the people we spoke with felt that staff were well trained to meet their needs. Records we saw supported this.

People were asked for their views, and comments that they made were acted on. One person told us that, at residents meetings, 'You can say what you want.'