Archived: Ivers

Ivers is a care home for up to 25 people who have a learning disability or autism. The service had previously been a learning disability college but no longer operated as such. It would be unlikely that we would register this model of service now when considering applications for services for people with a learning disability and/or autism.

This is because there were several properties on one site. ‘The House’ could accommodate nine people; there were also four bungalows, Tyneham, Crantock, Kenley and Trafalgar, that could each accommodate four people. There were 19 people living at the home when we visited; four more people were staying with their families on the day of our inspection.

The provider had changed the way the service operated so that the main house and the four bungalows were each managed by a deputy manager and had separate staff teams. This was with the aim to personalise the services and to better reflect the Registering the Right Support Guidance.

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

The service was going through a period of significant change and restructuring, in an effort to create five very distinct ‘homes’ at Ivers. Each would cater for a small group of people with similar needs. This had been delayed due to the significant impact of COVID 19 both within the service itself and in the wider health and social care sector. We acknowledged the real pressures this had placed upon the service, upon people and the staff team.

Medicines were not always managed in a safe and consistent way. Infection control practice was not always in line with current guidance or best practice. Both of these issues were addressed immediately by the registered manager.

The provider and manager's oversight and monitoring of the service had improved. There was an action plan in place to address a number of improvements identified by the provider's monitoring in July 2020. This meant the service was not always providing consistent, high quality care to people.

Staff were very kind and caring and respected people's individuality and diverse needs. However, improvements were needed to ensure people living together were compatible, to make sure the service suited all people living there and to ensure staff teams had the right training and skills to provide specialist areas of support.

There were enough staff on duty to care for people, although some people’s staffing levels were being reviewed as their needs had changed. The provider had been very successful in recruiting new staff and reduce the use of agency staff. This means people were provided with more consistent staff support.

Relatives had mixed views about the quality of care, communication and their involvement in the service.

People who lived at the home told us they were happy at Ivers, well cared for and liked the staff who supported them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement. Our report was published in June 2019.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns we had about medicine administration, infection control, staffing levels, people’s compatibility, communication with families and quality assurance processes. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific 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.

The service had not originally been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This guidance was implemented in 2017 after the service had registered with us. This was because there was The House that accommodated nine people, including one flat and an annexe, and there were also four bungalows, Tyneham, Crantock, Kenley and Trafalgar, that could each accommodate four people.

The service is registered for 25 people and there were 23 people living at Ivers during the inspection. The service had previously been a college but no longer operated as such. It would be unlikely that we would register this model of services now when considering applications for services for people with a learning disability and/or autism.

The provider and manager had recently changed the way the service operated so that The House and two of the bungalows in a group were managed by separate deputy managers and staff teams. This was with the aim to personalise the services and to better reflect the Registering the Right Support Guidance.

People’s experience of using this service:

The manager and staff did not always have a good understanding of the Mental Capacity Act

(2005) (MCA) or Deprivation of Liberty Safeguards (DoLS). This was because the conditions on people's DoLS were not known or understood by the managers or staff. People’s representative and or professionals had not always been consulted or involved in making best interests decisions.

The provider and manager’s oversight and monitoring of the service had not effectively identified all the shortfalls for people. There was an action plan in place to address the shortfalls identified by the provider’s monitoring but not the areas identified during the inspection.

People were safe from the risk of abuse. Risks were assessed but the risk management plans needed to be reviewed alongside people’s assessments and care and support plans. These reviews were in progress. However, people’s monitoring records were not accurately or fully completed.

There were enough staff on duty, but this included a high number of agency staff. Recruitment and retention remained difficult.

Staff felt well supported but had not received supervision and development sessions. Not all staff had completed the provider’s training and induction programme and staff had not been trained in people’s communication methods. There was a plan in place to address this.

Overall, staff were kind and caring and respected people’s individuality and diverse needs. However, improvements were needed in relation to people’s dignity and privacy and staff respecting people’s identity.

Care and support was personalised to meet people's care, social and wellbeing needs. People had access to a range of activities that met their interests.

People and staff spoke highly of the manager and said they were listened to.

Rating at last inspection: Good (report published 25 May 2017).

Why we inspected: The inspection brought forward due to information of concern.

For action we have told the provider to take please refer to the end of full report.

Follow up: We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Requires Improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our last inspection in July 2015 the service was rated Good at this service we found the service remained Good.

A new provider had taken over the responsibility of the service in October 2016. There was a new manager in post who was applying to the Care Quality Commission to become the registered manager.

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.

The service cared for people with a variety of needs and abilities. Some of the people were able to carry out their own personal care and support with prompting from staff. Some people could go out into the community independently, others needed support from staff. People demonstrated they were happy in their home; they were relaxed and engaged with staff. One person told us, “It is really good living here”.

Staff were visible and attentive towards people they were supporting, noticing when those who could not verbally ask for assistance required help. They responded kindly and compassionately to people, they used objects of reference or signs to ensure they knew what was being requested.

Recruitment checks were robust and there were sufficient numbers of staff deployed to meet people's needs. Records confirmed that training was appropriate to people's roles and staff were suitably skilled. Staff were supported though supervision and appraisals. The manager told us specific training needs were currently being identified, for new and existing staff.

Staff had been trained how to recognise and report abuse. Staff spoken with had a clear understanding of what may constitute abuse and how to report it. All were confident that any concerns reported would be fully investigated and action would be taken to make sure people were safe.

Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely. Health professionals were routinely involved in supporting people with their health and wellbeing.

People were involved in planning activities, which was coordinated by learning support staff. Activities included animal care, gardening and IT skills. One person told us, “I like to look after the animals and give them their dinner”. The service had their own vehicles which could be used to access activities, appointments and other events.

There was a complaints procedure in place. Complaints had been dealt with in line with the service policy. Audits were carried out to monitor all aspects of the service and action plans developed which highlighted areas for improvement.