Archived: Ivanhoe Residential

We found the following examples of good practice.

Visitors to the service were required to have a temperature check and complete a health declaration on arrival. Visitors were required to participate in the lateral flow coronavirus testing before visits could take place.

National guidance was followed on the use of personal protective equipment (PPE). The service had well maintained supplies of PPE with donning and doffing stations in place to ensure staff had access to PPE in a safe and accessible area. All staff had completed training on the donning and doffing (putting on and taking off) of PPE.

Staff monitored people for signs and symptoms of COVID-19. The provider knew what actions to take in the event anyone using the service or staff displayed symptoms of COVID-19 or received a positive test result. Staff and people who use the service were taking part in regular COVID-19 testing and the vaccination programme.

The provider has implemented additional risk assessments for people who use the service and staff who could be at increased risk of complications from contracting COVID-19.

Ivanhoe Residential provides residential care for up to 26 older people, some of whom may be living with dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. At the time of this inspection 20 people were living at the service.

The management of the home had changed since our last inspection. The new manager had registered with the CQC in June 2018. A registered manager is a person who has registered with the 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.

At our last inspection in February 2016, we rated the service as good overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People received their medicines safely and on time from staff who were trained to manage medicines safely. Risks associated with people's care and support were assessed, reviewed and managed well. People were protected from the risk of infection, and staff understood the importance of infection prevention and control.

People told us they felt safe. Support staff were able to confidently explain the process for reporting any suspected abuse. Staff and people told us they felt happy to raise any concerns they had.

There were enough suitably recruited and trained staff on duty to provide people with safe care and support when they needed it. Staff felt supported in their role and received regular supervisions.

We found 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's needs were assessed and staff and other healthcare professionals worked together to ensure good outcomes for people. People were supported to eat and drink sufficient amounts to maintain good health.

The culture of the service was person centred. People were supported by staff to express their views where they were able to, and have choice over their day to day care. People were seen to be treated with respect, kindness and compassion. People’s diversity and dignity was respected and promoted at the service.

We saw staff cared about the people they supported, were knowledgeable about people and had formed positive relationships with them. People's care plans were detailed and contained information individual to the person.

Confidential information was stored in line with the Data Protection Act, and information was provided to people in a format that met their needs.

Systems and processes were in place to support people should they need to raise a complaint. People living at the service felt confident the registered manager would address any concerns appropriately.

Staff spoke highly of the registered manager and the culture they promoted. Staff told us they felt happy speaking to the registered manager if they had any concerns and felt they would be listened to.

Quality assurance systems were in place to assess and monitor the quality of service people received and identified any areas that required improvement.

We undertook this unannounced inspection on the 18 and 19 February 2016. There were 25 people using the service at the time of the inspection. At the last inspection on 21 January 2014, the registered provider was compliant in the areas we assessed.

The service had 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.

We found there were times when there was insufficient staff on duty, mainly at tea-time at the weekend. The registered provider told us they were addressing this and plans were underway to rearrange the staffing structure at these times.

We found the service was generally clean and tidy in communal areas and bedrooms. However, there were some areas of the environment and practice that could be improved in regards to good infection prevention and control. These were mentioned to the registered manager during the inspection to address.

We found staff were recruited safely although some documentation could be improved regarding the decisions made. For example, when it was difficult obtaining a reference from previous employers or when there were minor issues on disclosure and barring service checks but employment was to go ahead.

We found people received their medicines as prescribed. Medicines were obtained, stored, administered and recorded appropriately.

We found people’s health care needs were met. They had access to a range of community health care professionals when required. When people required closer monitoring due to their nutritional intake or risk of developing sores, this was completed consistently.

We found the registered provider worked within the Mental Capacity Act 2005 [MCA] and Deprivation of Liberty Safeguards [DoLS] with regards to making applications to the local authority when people who lacked capacity were deprived of their liberty. Staff had a good understanding of the need to obtain consent from people prior to delivering care and support.

People liked the meals provided to them and there was sufficient quantity and choice available. Staff supported people to eat their meals in a sensitive way when required. We saw there was plenty of drinks and snacks available in between meals.

Staff had received training in how to safeguard people from the risk of harm and abuse. They knew who to raise concerns with.

We saw staff had developed good relationships with people who used the service and treated them with dignity and respect. We saw people had their needs assessed prior to admission. This was added to when people were admitted to the service and plans of care were produced so staff had guidance in how to deliver care that met their preferences and wishes.

We saw people participated in a range of meaningful activities to promote their interests and help prevent them from feeling isolated in the service. Staff also helped them access community facilities.

Staff had access to a range of training in order to meet people’s needs. They also received induction, supervision, support and appraisal in order for them to feel confident when supporting people. There was a system to identify when refresher training was required.

There was a quality monitoring system in place which included audits and questionnaires. This helped to identify shortfalls so action could be taken to address them. People told us they felt able to complain and staff had a policy and procedure to provide guidance when complaints or concerns were raised with them.

We looked at four care plans and found each contained a history of the person's life to date.

One person's relative told us, 'When XXX came to Ivanhoe they made us feel very welcome and treated us with great respect.'

People who lived in the home told us the food was good. Comments included, 'The food's really nice' and 'I like the food a lot.'

We confirmed people with dementia were provided with an adequate diet. The cook told us, 'The kitchen staff have a very good knowledge of each resident and the senior staff will always brief us each day about whether the residents are well or losing weight.'

We observed members of staff gave people with dementia choices about what they wanted to do, where they wanted to sit, and what they wanted to eat.

We saw members of staff explaining activities and tasks to people. One person's relative told us, 'The staff are very good at working out what XXX wants to do or whether he wants to be left alone. There seems to be a really good bond between the staff and XXX.'

We spoke with the activities coordinator who explained that activities were organised around the needs of the people. The provider may find it useful to note people told us no activities took place at the weekend; one person said, 'Nothing happens at the weekend which can make it really long.'

We saw the home had recently nominated a member of staff from each shift as a 'dementia champion'. The provider told us, 'This is to ensure they promote best practice amongst the staff.'

The care plans for people with dementia showed that a variety of health professionals were involved with their care. We spoke with one visiting district nurse who told us, 'We have no concerns at all about the care here. The residents seem well looked after and the staff are well trained and caring. We have no issues about tissue viability here.'

Records showed each person with dementia or their relative was asked to complete a 'residents' pre-meeting questionnaire' every month. Questions asked included: 'Are you happy living here?' and 'Do you feel your needs are met?'

We asked one person's relative if concerns they had had been listened to; they said, 'We've been very impressed by the care and kindness shown by the staff in sometimes very difficult situations. Our concerns were listened to acted on.'

People who used the service they told us the care and support offered to them was of a good standard. Comments included, "The staff are great, they help me when I need it", "No problems whatsoever" and "It's a real home from home." We also spoke to two relatives who were visiting their family members and they confirmed that they were involved in the planning of their relative's care. They also said that consultation took place with other professionals.

Several people who used the service and two relatives told us the menu was varied and plentiful.

During our visit we carried out a tour of the building and saw that the home was well maintained. However, the provider may find it useful to note that although there was a fire risk assessment and evacuation plan in place, there was no lifting equipment for those with poor mobility. We discussed this with the registered manager who confirmed that this would be followed up with the Fire Department immediately and feedback would be given to us.

We saw evidence that people's complaints were fully investigated and resolved, where possible, to their satisfaction.