Ideal Home

Ideal Home is a residential care home providing personal care to 30 people at the time of the inspection. The service is registered to support up to 50 people. There are two sides to the home, one side supports older people living with dementia and the other side supports people with enduring mental health problems.

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

This was a targeted inspection that considered specific parts of the safe and well-led key questions only.

People were not always safe as the physical environment was not safely maintained. The provider failed to identify risks or put effective measures in place to mitigate potential harm.

The provider’s quality checks were ineffective in identifying or driving good care.

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 12 November 2022). At that inspection there were breaches of regulation regarding safety, consent, safeguarding, complaints, notifying of specific incidents and overall governance processes.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. However, at this inspection the provider remained in breach of regulations and the service remains inadequate. This is the third consecutive inspection where breaches of regulation have been identified.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We have found continued evidence the provider needs to make improvements. Please see the safe and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this report.

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

Enforcement

We have identified breaches in relation to keeping people safe and overall governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore remains 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.

Ideal Home is a residential care home providing personal care to 28 people at the time of the inspection. The service is registered to support up to 50 people. There are two sides to the home, one side supports older people living with dementia and the other side supports people with enduring mental health problems.

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

Some improvements had been made to the physical environment since our last inspection. However, further improvements were required to keep people safe from harm. Improvements were still needed to the provider’s infection prevention and control practices. Although some improvements had been made to the provider’s quality assurance and monitoring systems further improvements were still needed to identify and drive good care. Although people were informed about what was happening in their home they were not engaged in decisions and felt their opinions were not encouraged.

People received safe support with their medicines by staff members who had been trained and assessed as competent. People were protected from the risks of ill-treatment and abuse as staff had been trained to recognise potential signs of abuse and understood what to do if they suspected wrongdoing. People were supported by a trained and supportive staff team. The provider followed safe recruitment practices when employing new staff.

The provider had assessed the risks associated with people’s care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests and the application of the policies and systems supported good practice. The provider supported staff in providing effective care for people through person-centred care planning, training and one-to-one supervision.

The provider had systems in place to encourage and respond to any compliments or complaints from people or those close to them. The management team had good links with the local community within which people lived. The last rated inspection rating was on display at the location and on the providers website.

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 12 November 2022). At that inspection there were breaches of regulation regarding protecting people from abuse, keeping people safe, consent, complaints and governance processes.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found improvements had been made although some were still required. The service is now rated requires improvement. However, the provider remained in breach of regulations regarding keeping people safe and the overall governance.

This service had been in Special Measures since 12 November 2022. During this inspection the provider demonstrated that some improvements had 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 actions we told the provider to take at the last rated inspection.

We looked at infection prevention and control measures (IPC) 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 the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection. We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this report.

Enforcement and Recommendations

We have identified continued breaches in relation to keeping people safe and how the service was managed.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ideal Home is a residential care home providing personal care to 36 people at the time of the inspection. The service is registered to support up to 50 people. There are two sides to the home, one side supports older people living with dementia and the other side supports people with enduring mental health problems.

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

People were not always safe as the physical environment was not safely maintained. The provider failed to identify risks or put effective measures in place to mitigate potential harm. People were not protected from the risks of abuse or neglect as the provider failed to consistently follow reporting procedures when concerns were raised with them. The provider was not promoting effective infection prevention and control practices throughout the building. The provider did not consistently learn from incidents, accidents, or near misses as their processes were inconsistent and did not robustly identify and promote good practice.

People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible or in their best interests; the application of policies and systems in the service did not always support best practice. People did not have concerns or complaints effectively managed.

The provider did not always promote people’s dignity or respect. People’s protected characteristics were not known by the management team or promoted.

The provider’s quality checks were ineffective in identifying or driving good care. The provider had not always told the care quality commission about significant events.

People received their medicines safely and as prescribed. When required the provider referred people for additional support with their diet and hydration.

People were supported by a trained and supported staff team. The provider followed safe recruitment practices when employing new staff.

The last rated inspection rating was on display at the location and on the providers website.

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 requires improvement (published 28 August 2019). At that inspection there were breaches of regulation regarding recruitment, governance processes, hydration and nutrition.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. We found improvements had been made in some areas. However, we also identified additional concerns at this inspection and the provider remained in breach of regulations. The service remains rated requires improvement. This is the second consecutive inspection where this service has been rated requires improvement with breaches.

Why we inspected

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

We looked at infection prevention and control measures (IPC) 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 the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence the provider needs to make improvements. Please see the safe, effective caring, responsive and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

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 keeping people safe, safeguarding from abuse, consent, complaints and overall governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

Ideal Home is a residential care home providing personal care to 42 people at the time of the inspection. The service is registered to support up to 50 people in one adapted building. There are two sides to the home, one side supports older people living with dementia and the other side supports people with enduring mental health problems.

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

People told us they felt safe living at the service, however, potential risks to people's health and welfare had not been consistently assessed. Staff did not always have guidance to mitigate risk and keep people safe with consistent care.

Peoples food and fluid intake had not been appropriately monitored when people were at risk of weight loss or malnutrition. The provider had recently changed the way food and fluid was monitored, and only people at high risk were to be placed on a food monitoring chart. We found there was a lack of guidance for staff on this new process and there seemed to be confusion as to when a food chart should be implemented. As a result, people who required a food monitoring chart did not have one in place.

People were not always referred for dietary advice when needed. We found people assessed as high nutritional risk were to be referred for dietary advice, according to the risk tool used. This has not happened, and there was not always a record of the person’s risk in their plan of care. When people had lost weight, we found action had not always been taken.

Staff were not always recruited safely. Checks on staff character had not been completed consistently and risk assessments were not completed when needed.

Some accidents and incidents had not been recorded. Although most accidents had been analysed, some opportunities to learn lessons had been missed.

Care plans were not always completed to reflect the care being given to people. However, staff knew people well and people told us staff supported them in the way they preferred. Some audits had been completed but they did not cover all aspects of the service. The audits completed had not identified the shortfalls found

at this inspection.

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.

There were enough staff to meet people's needs. We saw people had good relationships with the staff that supported them. People were treated with dignity and respect. Staff supported people to be as independent as possible and express their views about the service and their care.

Staff understood their role and had confidence in the registered manager. Staff told us they worked well together as a team, and there was good morale amongst them.

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 12 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staff recruitment, nutritional monitoring and management, and the general management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was an unannounced inspection that took place on 6 December 2016. The home has a registered manager who was present during the 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 and associated Regulations about how the service is run.

People were supported by staff who understood how to recognise and report abuse. The risks connected with people's care and support needs had been individually assessed and plans introduced to manage these. People were involved in decisions about the risks affecting them.

The provider assessed and organised their staffing requirements based upon people's care needs. They followed safe recruitment practices that ensured that those staff who were providing care were suitable to be working at the home.

Systems and procedures were in place designed to ensure people received their medicines safely. Staff followed the provider’s procedures in administering medicines and medicines were stored safely.

Staff had the necessary skills and knowledge to meet people's needs. They received effective induction, training and support from the provider. People's rights under the Mental Capacity Act 2005 (MCA) were protected by the provider. The staff were aware of when people may be restricted and the need to submit applications to the supervisory body in relation to this.

People were provided with a choice of meals each day and those who had dietary requirements received appropriate foods. Staff followed the guidance of healthcare professionals where appropriate. People received the level of support they needed with eating and drinking. Staff helped people to access healthcare services.

There was a caring and calm atmosphere in the home where people and staff interacted together well. People and relatives were very happy with the care provided. Staff adopted a caring approach towards their work and took the time to get to know people as individuals. The provider encouraged people's involvement in care planning and decision-making. Staff protected people's dignity and privacy.

Staff supported people to take part in various activities. Staff were attentive to people and knew them well.

People received care and support that was tailored to their needs and preferences. Staff had the time to read and followed people's care plans. People and their relatives knew how to complain about the service and felt comfortable about doing so.

Care plans contained information to guide staff on how someone wished to be cared for. Staff had a good understanding of people's needs and backgrounds as detailed in their care plans.

The registered manager encouraged an open, on-going dialogue with people, their relatives and the staff team. Quality assurance checks were carried out to help ensure the environment was a safe place for people to live and they received a good quality of care. People and relatives were given the opportunity to provide feedback on the care they received.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

Risks to people had been identified, assessed and kept under review. Staff had undertaken training pertinent to their role including manual handling and infection control in order to care for people safely.

Appropriate arrangements were in place to manage medicines. This meant that people were protected against the risks associated with medication.

People's personal records were kept securely. Staff demonstrated an understanding of the need to maintain people's confidentiality.

Is the service caring?

People spoken with were positive about the care and treatment they received. One person told us, 'Staff treat me with respect, I have nothing to worry about here.' Staff told us, 'Residents always come first' and felt they delivered a 'Wonderful service'.

Staff interactions with people who used the service were both supportive and respectful. Staff demonstrated a good understanding of people's needs and preferences.

Is the service responsive?

People's views about care and treatment were acted upon. People using the service contributed to decisions relating to food and activities. People told us that they felt confident that any concerns raised would be acted upon.

The service responded to people's changing needs. People had access to support and advice from the multidisciplinary team.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the service met their needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Is the service well led?

The provider had an effective system to regularly assess and monitor the quality of service that people received. Satisfaction surveys had been sent out to people who used the service and relatives. The feedback gained from the surveys was positive. This meant that people's views about the service they received were represented.

A senior manager visited the home every two weeks to support the home and performed a number of checks on the quality of the service. This ensured that people using the service received a good quality service.

Suitable arrangements were in place to make sure that staff received appropriate training and professional development. Staff had received induction training to enable them to understand the requirements of the job. Staff felt well supported to do their work and people received care from a team of staff who were well trained and well supported.

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. Care plans were detailed and covered the psycho-social, religious as well as physical aspects of care and treatment. This helped ensure that all the needs of people were met.

There were arrangements in place for the safe storage and administration of medication. The recording of medication could however be improved.

People using the service commented positively about the support they received from the staff. We observed a calm and relaxed atmosphere in the home. People were supported in a relaxed and unhurried way.

People using the service and their relatives were asked for their views about care and treatment and they were acted upon where necessary. Systems in place for auditing the record keeping in the home was not robust enough to ensure standards were maintained. We noted a number of records that were either out of date or required reviewing.

Everyone spoken with was satisfied with the way they were cared for at the home. One person told us that, "Staff are very kind and look after me". People were supported to be involved in decision making.

We saw that people were offered choices about how their care was delivered and how they spent their time. People told us that they liked the activities provided. We observed staff being kind and courteous towards people.

Care records were kept securely and were well organised. Staff knew how to find information about each person's care needs in the care plans.

Measures were in place to keep the home clean, tidy and to reduce the risk of healthcare associated infections.

The service provided an adequate environment for people to live in. People's bedrooms reflected their taste and preferences.

The service had recruitment processes to make sure they employed the right people. People told us that they liked the staff and they felt well looked after. Staff told us they enjoyed their work and said they were well supported.

Measures were in place to monitor the quality of the service provided.