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Ivy Court Requires improvement

Reports


Inspection carried out on 17 February 2020

During a routine inspection

About the service

Ivy Court is a residential care home providing personal and nursing care to 45 people at the time of the inspection (currently half receiving nursing). The service can provide both residential and nursing care, for up to 71 people, aged 65 and over, including support for people living with dementia. The home is a modern purpose-built building over two floors with communal areas, including lounges, dining areas, a cinema room and gardens.

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

People had experienced a high level of instability of management and staffing at the service which had been without a registered manager since May 2019. Whilst improvements had been experienced since the last inspection, there were still significant areas of concern regarding the oversight and management of the service. Some of the systems and processes in place to monitor the quality and safety of the service required further improvement and embedding to support identifying and driving improvements. Where issues had been identified action had not always been taken to ensure improvements were made in a timely manner.

People's care plans still did not always contain accurate, consistent and accessible information about their needs, risks or the care they required. Care was not always sufficiently personalised to reflect people’s preferences. The service supported social activities and made visitors welcome. People felt listened to and responses to complaints had improved. End of life care plans were in place and training was to take place to improve this aspect of care.

Risks were not always monitored and mitigated for effectively. Staff recruitment practice was appropriate to ensure staff were suitable to work in a care environment. We found there were sufficient staff, but they were not always managed appropriately to meet the needs of people in a timely way. We made a recommendation about the deployment of staff. Overall medicines were being managed safely and infection control measures were appropriate. Safeguarding procedures were being followed. Accidents and incidents had been analysed so that lessons could be learnt, and preventative action taken.

The environment was modern, pleasant and well maintained; and people were positive about recent improvements to meals and choice. Staff were generally well trained and capable. People’s health was well monitored, and they were supported to access health and social care services as required. 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 staff were kind, caring and considerate and respected their dignity. However, they felt staff were busy and did not always have time to chat. People were given opportunities to feedback regarding the quality of service and how the service was organised.

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 16 September 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection whilst we found improvements, not enough had been made and the provider was still in breach of regulations. The service is now rated Requires Improvement overall but remains with a rating of Inadequate for well-led. This service has now been rated Requires Improvement or Inadequate for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to not ensuring safe care, providing personalised care and not having an adequate management structure in place to ensure nec

Inspection carried out on 15 July 2019

During a routine inspection

About the service

Ivy Court is a residential care home providing personal and nursing care to 68 people aged 65 and over at the time of the inspection. The service can support up to 71 people. People who used the service, some of whom were living with dementia, received either residential or nursing care. Some areas of the service, such as the garden and cinema room, were shared spaces to which everyone had access.

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

People were placed at risk of harm because safeguarding procedures had not been followed. Risk assessments and care plans did not provide staff with all of the information they required to keep people safe. People had been restrained which was against the providers policies. Staff had not been trained in how to restrain people safely. Management of medicines continued to place people at risk of not receiving the right medicines at the right time. People did not always receive the support they required in a timely manner. Accidents and incidents had not been analysed so that lessons could be learnt and preventative action taken.

Some of the systems and processes in place to monitor the quality and safety of the service remained ineffective in identifying and driving up improvements. This meant that the service was not well led. Where issues had been identified action had not been taken to ensure improvements were made in a timely manner.

Best practice guidance was not followed to ensure people received effective care and support. Staff did not always receive the support and training they required to carry out their roles. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. Although people were asked their views on the service this was not always acted on.

People's care plan still did not always contain sufficient or accurate information about their needs and risks or the care in a way that reflected their preferences. Complaints had not been recorded, investigated or the appropriate action taken to prevent a reoccurrence. The experience people received of end of life care was variable. Written information about people’s preferences and wishes were minimal. Staff had not received training in end of life care.

Thorough recruitment procedures had been followed to ensure staff were suitable to work with vulnerable people. Staff mainly treated people with respect and kindness and upheld their dignity. People had sufficient food and drinks throughout the day. A variety of activities were offered for people to take part in. People were supported to access health professionals and appointments.

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 improvements overall with Safe being rated inadequate. (Report published January 2019.) There were three breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was in breach of seven regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to not providing personalised and safe care, not protecting people from risk of harm, unsafe management of medicines, unlawfully restraining people and not following the procedures to make decisions in people's best interests , not acting on complaints and not having a governance system in place which ensures necessary improvements are made in a timely manner at this inspection.

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

We will meet

Inspection carried out on 23 October 2018

During an inspection looking at part of the service

The inspection took place on 23 October 2018 and was unannounced.

We undertook this unannounced focused inspection because we had been made aware of concerns regarding the safety and leadership of the service. The team inspected the service against two of the five key questions we ask about services: is the service safe? and is the service well-led?

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring, or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

Ivy Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ivy Court accommodates up to 71 people in one purpose built building. People who used the service, some of whom were living with dementia, received either residential or nursing care. Some areas of the service, such as the garden and cinema room, were shared spaces to which everyone had access. At the time of our inspection visit there were 61 people using the service, two of whom were in hospital.

The service had a registered manager in place. 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.

At our last comprehensive inspection of the service, which was carried out on 8 and 9 January 2018, we rated the service as Good overall. However, we found that some improvement was required in the key question of Well-Led due to concerns about disorganised care plans and about staff culture and morale. At this inspection we found that these concerns had not been fully addressed and had significant concerns about the safety of the service. We identified poor management of some risks and of people’s medicines. We also found that there were not always enough staff as people told us they had to wait a long time to have their needs met. We have judged that there are three breaches of regulation, relating to safe care and treatment, staffing and the leadership of the service. You can see what action we told the provider to take at the back of the full version of this report.

Medicines were not always managed safely. Some people failed to receive their medicines because they were not made available to them. Stocktaking and storage procedures, and records relating to medicines given covertly, required improvement. We could not be sure people always received their medicines as prescribed.

There was a mixed picture with regard to the management of risk. Some environmental risks were well managed with regular servicing and monitoring checks of equipment and safety procedures. A variety of specific risks people might be subject to, were assessed and specific guidance was documented to help guide staff. It was not always clear what steps the service had taken to reduce future risk and respond to patterns and trends, where people were frequently falling out of bed for example. Some risks, such as those posed by hot radiators, had not been assessed. Risks and procedures relating to infection control required some attention to fully protect people, although cleaning in communal areas and kitchens was very good.

Risks were further heightened as, in recent months, people were regularly supported by agency staff who did not know them well. Although the service aimed to only use agency staff who were known to the service this was not always possible in practice. Using agency staff so regularly and having a high number of new staff, along

Inspection carried out on 8 January 2018

During a routine inspection

This inspection took place on 8 January 2018 and was unannounced. We returned on the 9 January 2018 to complete the inspection. The management team was given notice of the second date, as we needed to spend specific time with them to discuss aspects of the inspection and to gather further information.

At our last comprehensive inspection on 4 and 5 May 2017 the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating the key questions ‘safe’, ‘effective’, ‘caring’ and ‘responsive’ as, ‘Requires Improvement’. At our last inspection for the key question, ‘is the service safe?’ we found three breaches of regulations. The provider had failed to ensure that care and treatment was provided in a safe way. They had not assessed all risks to people's safety or taken appropriate actions to mitigate these risks. People's medicines were not always managed safely. The management of the service had failed to have sufficient numbers of staff. The management of the service had failed to have effective systems in place to ensure suitable staff were employed.

At our last inspection for the key question, ‘is the service well led?’ we found one breach of regulation, and gave a rating of ‘inadequate’. The management of the service had failed to have effective systems and processes in place to monitor and improve the safety of the service provided. We found the manager had failed to maintain accurate and complete care records in respect of each person. We also found the culture of the home was not open. Care staff, relatives, and people who lived at the home were not being involved in the development of the service. We were told that the management team and provider were not making opportunities for staff to share their views about the home. Meetings were poorly attended and care and nursing staff had limited supervisions. Their competency to ensure their care practice was safe and effective had not been assessed for some staff and was periodic for others.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection we found significant improvements had been made and maintained, resulting in the overall rating of the service changed to, ‘Good’.

At this inspection for the key question ‘well led’ we have rated it as ‘Requires Improvement’. We found although there were significant improvements in the care planning time was still needed to ensure they were accurate and fully completed. The provider agreed with our findings and gave a target of April 2018 for completion. The home has been opened since July 2015 and since this time has had two registered managers and two appointed home managers at different times. Some staff and relatives expressed their concerns about this. We found that this had impacted the home and improvements were needed to how information was being communicated, particularly around staffing levels. This had impacted staff behaviour leading to serious conduct issues and how relatives felt their loved ones needs were being met.

Ivy Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Ivy Court accommodates 71 people in one adapted building. There were 58 people living in the service at the time of our inspection visit.

Although there was an appointed manager in post at the time of our visit, they had not registered with the Commission. 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 of the Health and Social Care Act 2008 and associated regulations. The appointed ma

Inspection carried out on 4 May 2017

During a routine inspection

The inspection took place on 4 and 5 May 2017 and was unannounced.

Ivy Court is registered to provide residential and nursing care for up to 71 people. At the time of the inspection 61 people were living at the home. The home supports older people, some of whom are living with different forms of dementia and some people who have nursing needs. The accommodation is purpose built and was completed in 2015. The building is over two floors, and is set in a large garden.

There was not a registered manager in place. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had recently left. The home was being managed by a regional manager who represented the provider and the deputy manager. The provider confirmed to us that a new manager will be starting at the end of the summer. For the purposes of this report we will refer to the acting manager and deputy manager as the management team. There were also clinical leads who led the nursing and care staff on shift.

At this inspection we found four breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

Risks to people’s safety had not always been managed well. Cleaning products, thickening agents used to thicken people’s drinks and people’s medicines were not always secure. The provider had not assessed whether it was safe for these to be left out. The home supported some people who were living with dementia. Therefore, these people could have been at risk of accidently ingesting these products.

Safe recruitment checks for new staff were not always completed as is required to ensure they were safe to work within a care environment. A recent safeguarding concern had not been managed in a robust way, in order to protect the people who were living at the home.

The administration of people’s medicines had been audited and checked. The deputy manager and clinical leads were proactive in responding to a change in people’s health needs. The deputy manager and clinical leads had completed risk assessments for people living at the home. Certain risks which people faced were being managed well for example pressure care and when people were at risk of being an unhealthy weight. The management team and provider also ensured that the equipment used was safe.

Care staff and nursing staff received training in a number of different topics relevant to their work. However they lacked supervision and their competency to perform their role safely and effectively had not been regularly assessed. This led to some care staff providing people with poor quality care.

There was not enough care staff working in the home to meet people’s needs or provide them with adequate stimulation to enhance their wellbeing. People, their relatives, and staff all raised concerns about the staffing levels of the home. The management team and provider had not responded to these concerns. They had not investigated and taken action.

The management team and the provider did not always have robust quality monitoring systems in place. They had not actively involved people, their relatives, and staff in the development of the home. The management team and provider had also not created an open and listening culture at the home.

People spoke positively about the food and drinks they had. The chef had a good knowledge of people’s likes and dislikes and people’s specialist dietary needs. People also had good access to drinks.

There were planned activities and outings. However, people did not feel there was enough daily social activities taking place. The management team and provider had not considered ways to encourage social stimulation wi

Inspection carried out on 2 March 2016

During a routine inspection

The inspection took place on 2 March 2016 and was unannounced.

Ivy Court was opened in July 2015 and provides residential and nursing care for up to 71 people, some of whom may be living with dementia. Accommodation is over two floors and all rooms have en-suite facilities that include a wet room. The home has one room that caters for people with bariatric needs and a small number of interconnecting rooms for family members. There are a number of communal areas including lounges with interconnecting dining rooms, kitchenettes, a café area, cinema room, two hairdressing salons, an activities room and library. At the time of our inspection, 24 people were living at Ivy Court, 22 of them on a permanent basis.

There was a manager in place who had been appointed in November 2015. At the time of the inspection, the manager had submitted an application to the Care Quality Commission (CQC) to become a registered manager; their application was being processed. 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.

The people who used the service at Ivy Court were supported by staff that had been well trained and fully inducted. They had been employed following appropriate recruitment checks that ensured they were safe to work in health and social care. Staff demonstrated the appropriate skills and knowledge associated with the training they had received.

Staff felt supported and happy in their work. They worked well as a team and morale was good. Staff communicated with others in a respectful and professional manner. There were enough staff to meet people’s individual needs. People had confidence in the staff that supported them.

People told us that they were supported by staff that were kind, caring and positive. Staff had time for people and treated them with respect. People received care in a dignified manner that protected their privacy. Staff encouraged people to be as independent as possible and offered choice in their day to day living. People told us that staff knew them and their needs well and responded to their wishes promptly. The relatives of the people who used the service felt welcomed and supported as family members.

People were protected from the risk of abuse as staff could demonstrate they understood what constituted potential abuse. Staff knew how to report any concerns they may have and they felt confident the service would address these appropriately. They knew how to report concerns outside of the service. Past concerns had been reported as required.

The risks to people who used the service, staff and visitors had been identified. These had been assessed, managed and reviewed on a regular basis to ensure people were protected from the risk of harm. People received their medicines on time and in the manner the prescriber intended. The service managed medicines safely and could account for medicines at any one time as clear and accurate records were kept.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Although the service had not recorded the capacity assessments they had made on the people they supported, the principles of the MCA had been adhered to. Applications had been made to the supervisory body for consideration and the service had involved appropriate people in best interests decisions. These had been recorded.

People had been involved in planning the care and support they received from the service. Their needs had been identified, assessed and reviewed on a regular basis. People’s care plans were accurate, appropriate and gave staff information to assist people in a person-centred way. Care plans were individual to each person and addressed their specific needs. People’s life histories and biographies were in place to help staff build