Archived: Ivy House Nursing Home

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective? Is the service well led?

Before this visit we had received information about people's care and support needs not being met, safeguarding procedures not being followed, not enough staff and staff not being properly trained. We looked at these issues during our visit and found evidence to support this information.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit we saw there were times when no staff were present to supervise people in the communal areas. This meant staff were not responding to people's direct care needs or potentially unsafe situations.

We found there had been an unwitnessed incident between two people living at the home that had resulted in one of them being punched in the nose. No plan had been put in place to reduce the risk of this happening again. This incident should have been reported to the safeguarding team so that someone external to the service could have considered if action needed to be taken to maintain the person's safety.

We found some staff had not received specific training in relation to certain medical conditions. This put people at risk of being supported by staff without the appropriate skills.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping people safe from abuse.

Is the service effective?

We saw one person who had no laces in their shoes. They also had a visual impairment and had a bruise on their head. The bruise was caused by them walking into the door frame. We asked the manager why they had no laces in their shoes and they told us the person had taken them out. We asked if they thought this might be increasing their risk of falling. They told us perhaps they should ask the family to get some slip on shoes.

In another person's bedroom we saw they had a specialist mattress in place. This was to reduce the risk of them developing pressure sores. However, the mattress was not on the right 'setting' so therefore would not have been effective.

We spoke with a visitor who told us their relative liked to look smart, but had visited on a number of occasions and found them wearing someone else's clothing. The relative told us they had named all the clothing so it could easily be identified but continued to find clothing belonging to other people in the wardrobe.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and planning their care.

Is the service caring?

There was very little information for staff about people's life histories or personal preferences. This meant detailed information about how people would like their care and support delivered was not available.

We saw people didn't look well cared for. We saw people wearing stained and torn clothing and wearing dirty slippers. Many of the men hadn't been shaved and we saw a number of people with long dirty fingernails. A lot of people didn't look as if they had received any assistance to brush or comb their hair.

When we looked at people's care plans we saw staff should have been supporting people to meet their personal hygiene needs. However, we saw this support was not always being given.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's care and support needs.

Is the service responsive?

We observed staff were respectful of people when they were talking with them. However, we observed practices that showed a lack of regard for people.

We saw people wearing dirty and torn clothing. We also saw people wearing ill-fitting trousers that were falling down as they walked around.

We saw people were given cups to drink out of but no saucers. People were offered tabards to wear to protect their clothing. Many of these were discoloured and full of holes.

We saw staff were not always available to meet people's needs. For example we saw people indicating they needed the toilet, but no staff were available to assist.

We have asked the provider to tell us what improvements that will make in relation to maintaining people's privacy and dignity.

Is the service well-led?

We looked at the statement of purpose. This document should give detailed information about the service. It should set out the aims and objectives together with details of the range of people's needs the service intends to meet. We found this document lacked a lot of the information that is required. It did not give people information about what they could expect in relation to their individual needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the statement of purpose

We found that the necessary improvements had been made to the internal environment of the home and the overall environment was presentable and provided a comfortable environment for people who lived at the home. We found that significant improvements had been made to bedrooms and living areas.

We also found improvements had been made to the way medicines were managed within the home. The service had made substantial improvements which look to be sustainable.

We saw staff interact positively with people,, treating them with dignity and respect.

We spoke with one relative of a person who wished to move into the service who told us 'This looks like just the place for my relative'.

We found people experienced care, treatment and support that met their needs and protected their rights. Appropriate risk assessments and care plans were in place and there was evidence they were updated to reflect people's changing needs.

We found the provider had safeguarding procedures in place but they did not ensure all incidents were fully investigated and reported to the appropriate body. Staff were trained in safeguarding and were aware of the correct procedure to follow.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People were not being cared for in a clean and hygienic environment.

People who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises.

The interactions we saw between carers and people who used the service were respectful. We saw some people engaged in activities with members of staff such as watching a movie.

We found people had care plans and risk assessments in place. The care plans and risk assessments were accessible to staff and/or the people who used the service by way of computers which were located in the office.

Two relatives we spoke with said 'My relative is much better than before coming here'. They said their relative had "Settled into this environment very well' and said Ivy House was "Like a palace" compared to their previous accommodation.

All the interactions we saw between carers and people who used the service were respectful. We saw some people engaged in activities with members of staff such as playing 'catch' with a soft ball; two people playing dominoes and some watching TV. However we did not see evidence of activities which engaged the majority of people who used the service. The Registered Manager told us that this was due to the fact that the Care Quality Commission was inspecting on that day and the staff and people that used the service felt more comfortable taking part in group activities once we left.

We found people had care plans and risk assessments in place. However, one persons care plan did not provide clear instructions on how to manage certain aspects of their care, such as a seizure. The care plans and risk assessments were accessible to staff and/or the people who used the service by way of a computer which could only be accessed on two computers which were located in the office.

One relative we spoke with about their care said 'they are doing good work here'.

All the interactions between carers and people who used the service we saw were respectful. We saw some people engaged in activities with members of staff; however we did not see evidence of activities which engaged the majority of people who used the service.

We found people had care plans and risk assessments in place. However, some people's care plans did not provide clear instructions on how to manage certain aspects of their care. The care plans and risk assessments were not easily accessible to staff and/or the people who used the service because they were computerised and could only be accessed on two computers which were located in the office.

We saw one person had lots of personal belongings in their bedroom. However, in the other rooms we looked at we saw very little evidence of personalisation. We found some parts of the home were not clean and improvements were needed.

One person we spoke with about their medicines said 'I leave medicines to staff, I trust them, they know what they are doing'. However, when we looked at the way medicines were managed in the home we found improvements were needed.

We also found improvements were needed to the way staff were recruited and selected.