Archived: Ivy House

Ivy House is registered to provide residential care for up to 22 older people. At the time of this inspection some people were living with dementia. The service was providing support for 17 people at the time of our inspection.

There was 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.

We found that the leadership and management of the service and its governance systems were not robust. Systems to monitor and review the quality of some areas of the service people received were not effective and therefore we found a number of areas that required improvement.

At this inspection we identified environmental risks for people who lived at Ivy House. These included an external door not being locked, which provided unauthorised access into the service. This also meant people who lacked road safety awareness due to their health condition, could leave the service without supervision. We saw that some furniture in the main dining lounge was damaged, which made it unsafe for people to use.

We identified shortfalls with the management of medicines. This included medicines not being stored securely. We saw the medicines fridge was not locked, as well as the cupboard where this was stored. This meant medicines could be accessed by unauthorised people who were not prescribed them.

Our observations showed that staff did not always respect people rights to make their own decisions when possible.

We observed a person carrying a walking frame whilst using the stairs. This showed that the level of risk had not been considered by the provider to avoid injury to the person and others including staff.

We saw staff were not suitably deployed. Our observations showed staff were not always present in communal areas which meant people did not always get the support they required. For example we saw one person pushing their zimmer frame into another person as they were frustrated with the other person’s behaviour.

Recruitment procedures were not thorough. Staff recruitment records showed that a full employment history was not always in place.

We saw insufficient evidence regarding the training that staff had undertaken. The provider did not have effective systems to monitor training staff had undertaken or waiting to be completed, to enable them to do their job effectively.

Staff gained people’s verbal consent before supporting them with any care tasks. However the provider did not have effective procedures for staff to follow in relation to the Mental Capacity Act (MCA) 2005. We saw that were people lacked capacity, mental capacity assessments had not been completed and staff had not undertaken training on the MCA

The needs of people living with dementia were not fully met because people’s social and therapeutic needs were not addressed. People and their relatives were not always involved in planning and agreeing on how they were supported. This did not ensure people received personalised care.

People who used the service told us they felt safe. Staff we spoke with understood their responsibility in protecting people from the risk of harm. People told us that staff treated them in a caring way and respected their privacy and supported them to maintain their dignity.

People enjoyed the food and drink they were served. People were supported at mealtimes if they required this. Arrangements were made for people to see the GP and other healthcare professionals as and when they needed to.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found people were supported in an unhurried way and helped to live as independently as possible. A person said, 'I like to read my books in large print, and they get these for me when I ask them.' Another person said, 'I often go to the local public house to play pool with a friend.'

We saw that the provider took adequate steps to protect the people they cared for and their staff from harm. The provider had adequate quality assurance systems to ensure the safety and comfort of the people who lived at the home.

Staff were supported and received on-going training and development.

The provider had a process by which they ensured the quality of service people received.

The provider introduced weekly medication audits following our visit, and also requested a pharmaceutical advice visit from their local pharmacy. These audits did not highlight any major issues around the administration of medication. In future monthly medication audits would be carried out.

All staff who administer medication had been observed and assessed as competent to do so. Staff would also be attending medication training provided by the local authority during January and February 2013.

Additional systems to minimise distractions whilst administering medication had been introduced. A lockable medication room from which staff can administer medication without being disturbed had been created, and 'Do not Disturb' tabards would be worn.

We saw people were treated with dignity and respect. Staff were polite and respectful when offering care and support. Staff greeted people by name as they approached, and knocked on doors before entering people's bedrooms.

Two people told us they felt safe and comfortable at Ivy House and staff were generally kind and gentle. No one spoken with raised any concerns about the care and support they received. One person told us 'It is not like being at home, but it is second best.'

We saw information about people had been recorded. People's care needs had been assessed, although care plans were not in place for everyone. Staff had a good understanding of people's needs, and explained the care and support they provided to individuals.

We asked people if they knew how to raise any concerns. They told us they felt able to discuss issues with any member of staff or the manager, and were confident the issues would be resolved.

Although medication systems were in place, the medication records did not accurately reflect the amount of medication that people had been given.

We saw appropriate checks were undertaken before staff started work, to ensure suitable staff were employed.