Ivybank House Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.This is the first assessment for this service. This key question has been rated good.This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The provider had implemented clear policies, protocols and comprehensive training for staff. Regular meetings and supervisions were held routinely to share information and gather feedback from staff. One leader highlighted significant efforts made to ensure staff were well-informed and supported during the transition when the provider first took over the service. There was a strong emphasis on teamwork, with leaders reinforcing that everyone was accountable for people’s wellbeing and united in working towards shared goals to achieve the best outcomes for people.

The provider had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

The registered manager showed a strong commitment to their role and to delivering person centred care. They demonstrated a clear understanding of people’s needs. People, their relatives and staff spoke positively about the registered manager, and we heard the registered manager was present in the service, including providing hands-on care if needed. Leaders supported the registered manager through their induction and continued to provide guidance with support of the quality team. The registered manager confirmed they felt well supported in their role.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard. A whistleblowing policy was in place, along with a confidential system to support staff in raising concerns safely.The provider actively sought feedback through various channels, including staff surveys. The registered manager operated an open-door policy, and staff told us they felt encouraged to share their views, which were listened to and acted upon. The provider’s records showed people and relatives had been informed of notifiable safety incidents as required under the Duty of Candour. The Duty of Candour is a legal requirement for all health and social care providers in England to be open, honest, and transparent with people receiving care, especially when things go wrong.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Staff told us they were treated fairly. One staff member said, “Team members are treated equally and supported to deliver the best care possible in a positive working environment.” Leaders told us how reasonable adjustments were made to support staff. The registered manager said they had accommodated shifts for a member of staff who was fasting as part of their religion.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The providers quality assurance systems gave management and provider oversight of the quality of care and people’s experience through its internal audits and surveys. A wide range of audits took place, and the provider had clear records which identified how the service could be improved and what actions were to be taken. These included audits of incidents, medicine administration and equipment. We found timed environmental checks were completed and roles and responsibilities were clear. Governance meetings were held weekly to share and act on specific audit findings. We found the registered manager and leaders to be open and transparent throughout the assessment.

The provider understood their duty to collaborate and work in partnership, so services worked seamlessly for people. They shared information and learning with partners and collaborated for improvement. The provider had strengthened their partnership with health professionals and improved how they communicate with each other. The manager said people go to church every fortnight if they wished, and members of the church were invited to coffee mornings in the service. The manager described other initiatives which took place to enhance people’s experience. For example, organising fun days and opening up the home to family, friends and the community.

The provider focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Leaders identified learning needs across the organisation and responded by providing relevant training. For example, managers received training and workshops on the newly introduced electronic medicine system.

Leaders said they had introduced a new method to collect visitor feedback and promptly alert management to any concerns raised. Leaders said they were also partnering with a person-centred software provider to trial the use of artificial intelligence (AI), and they had contributed towards improvements in the software system. Leaders said how they had improved their meal provision through introducing a specialist meal provider and how this had demonstrated positive health outcomes for some people.