Ivy Homecare Limited

Ivy Homecare Limited provides personal care to people in their own homes. At the time of inspection 10 adults were older adults were receiving a regulated activity.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Since the last inspection there had been a number of improvements made to the service. These improvements had resulted in safer, effective and person-centred care being provided to people being supported by Ivy Homecare Limited.

People and relatives told us they felt safe and were happy with the care. Effective systems and processes to safeguard people from the risk of abuse had been introduced and were followed.

Care plans and risk assessments were in place which provided information to staff on how to safely provide care and support to people. However, we identified with some risk assessments, it was not always clear what action staff should take if concerns were noted. The provider took immediate action to address this. Where people required support with medicines this was done safely.

Recruitment practices were effective, and people and relatives told us there were enough staff to meet the needs of the people using the service.

People's needs were assessed prior to care being commenced to help ensure they could be provided with the care they required.

People were supported to access appropriate healthcare services when required. Staff had received appropriate training and support to enable them to carry out their role safely. Staff felt well supported by the provider.

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 told us they were treated well by staff, who were kind and caring and treated them with dignity and respect. People and where appropriate those who were important to them were involved in decisions about their care. There was a person-centred culture within the service.

Since the last inspection, systems and processes had been introduced and were followed to help ensure any complaints received were investigated, acted on and responded to in a timely way. Full consideration had been given to people’s communication needs.

People and their relatives told us the service was well-led and said they would recommend this service to others.

Effective quality assurance systems had been developed and implemented to continually assess, monitor and improve the quality of care people received.

The provider was open and transparent and demonstrated they understood their regulatory responsibilities. The provider kept in regular contact with people, checking if they were happy with the service they received and if any changes were needed. The service worked well with other partners, organisations and commissioners.

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 inadequate (published 4 October 2022) and there were multiple breaches of regulations identified. The service was placed in special measures and conditions were imposed on the providers registration.

During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

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

Ivy Homecare Limited provides personal care to people in their own homes. At the time of inspection 20 people who were older adults were receiving a regulated activity.

Not everyone who used the service received personal care. The Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

People’s relatives told us they felt their relative was safe. However, we found significant concerns about safety and the management of the service which demonstrated people were not receiving safe care. People were not protected from abuse. The provider had failed to recognise and report safeguarding concerns where required. Action had not been taken to prevent risks from reoccurring. People were at risk of harm due to poor medicines management. Guidance was not always in place on prescribed medicines for staff to follow. Safe recruitment checks had not always been undertaken and there were not enough staff deployed to meet people's needs safely and effectively.

There was a lack of oversight and robust quality assurance measures in place to ensure adequate oversight. This meant patterns and trends which could have been identified if policies had been followed, had been missed and appropriate action had not been taken to learn and keep people safe.

The provider did not have a good understanding of their regulatory requirements and neglected their management duties. This had a negative impact on the management and oversight of the service and led to poor governance systems, lack of meaningful quality assurance processes and audits not being carried out. They failed to keep up to date with current best practice, legislation and regulatory requirements. This put people at risk of being negatively impacted by insufficient safe, good quality and personalised care practices.

The provider had failed to sufficiently assess people’s individual needs. Care records had not been maintained and were inaccurate or incomplete. Care records did not contain sufficient person-centred detail. This meant there was a risk of staff not providing person-centred care.

When complaints or concerns had been raised by people or external professionals, the provider had not followed their own policy and fully investigated these complaints. This meant that appropriate actions had not been taken or lessons learnt which would allow for improvements to be made.

The provider had failed to consistently act in an open and transparent way. The provider had a duty of candour policy that required the provider to act in an open and transparent way when accidents and incidents occur. However, we were not always assured this had been consistently followed. We have made a recommendation about this.

Records lacked some essential information around people’s nutrition and hydration preferences and the level of support they required from staff. We have made a recommendation about this.

We could not be assured that people were always supported to have maximum choice and control of their lives. Although staff did support people in the least restrictive way possible, records did not reflect how decisions were being made in people’s best interests; the policies and systems in the service were not followed to support this practice. We have made a recommendation about this.

People’s relatives told us that staff were kind and caring. Systems were in place to help ensure staff had received adequate training in a timely way to equip them to do their roles, safely and effectively. Suitable policies were in place for infection prevention and control. Competency assessments and spot checks were carried out by the provider for infection control and medication.

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

Why we inspected

This service was registered with us on 16 November 2021 and this is the first inspection.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding, risk management, medicines, staffing, recruitment, person centred care, complaints, governance and notifications. We have made recommendations in relation to nutrition and hydration, mental capacity and consent and duty of candour.

We have imposed conditions to the provider's registration.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.