The Care Quality Commission
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  • Care home

Archived: Ivybank Care Home

Overall: Requires improvement read more about inspection ratings

73-75 Middleton Hall Road, Kings Norton, Birmingham, West Midlands, B30 1AG (0121) 624 3006

Provided and run by:
Akari Care Limited

Important: The provider of this service changed. See old profile

All Inspections

29 and 30 January 2015

During a routine inspection

This inspection took place on 29 and 30 January 2015 and was unannounced. At the last inspection in July 2014 we found that the provider was meeting the requirements of the three regulations we looked at. An earlier inspection in the year before we had considered more of the regulations and at that time we found that the provider was not meeting five of the regulations. They supplied an action plan which indicated how they would address the issues raised.

The home is registered to provide care and accommodation for up to 58 older people, some of whom may be living with dementia or have complex healthcare needs. Nursing care is also provided. On the day of our inspection there were 29 people at the home.

A manager was registered with us. 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.

People we spoke with told us they felt safe in the home and the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm. People were supported by staff who had received training on how to protect people from abuse.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with people. Improvement was needed to the staffing arrangements to make sure there were enough staff to meet people’s needs.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The associated safeguards to the Act require providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. We looked at whether the service was applying the safeguards appropriately. The registered manager and staff we spoke with understood the principles of the MCA and associated safeguards. They understood the importance of making decisions for people using formal legal safeguards.

People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Staff demonstrated an understanding of people’s individual needs and preferences. They knew how people communicated their needs and if people needed support in certain areas of their life such as assistance with their personal care. We saw staff talking and listening to people in a caring and respectful manner.

We have made a recommendation that the provider seeks guidance about how to improve access around the home.

People told us they were supported to eat and drink sufficient amounts to maintain their health but we found systems to monitor that people were getting enough to eat and drink needed improvement. Risks to people’s nutrition were minimised because staff understood the importance of offering appetising meals that were suitable for people’s individual dietary needs. People had access to healthcare professionals when this was required.

People who lived at the home, their relatives and other health professionals were encouraged to share their opinions about the quality of the service. We saw that the provider had a system in place for dealing with people’s concerns and complaints.

We found that whilst there were systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the home was consistently well led. We found that some improvements were needed.

16 July 2014

During an inspection looking at part of the service

In April 2014 we inspected the home and at that time found that the home was noncompliant with some of the essential regulations. We issued a warning notice against one regulation and compliance actions against four regulations. We conducted this inspection to follow up on the issues of concern and see what progress had been made against three of these regulations. Progress with the remaining two regulations will be checked at our next inspection.

This inspection was undertaken by one inspector. On the day of our unannounced inspection of Ivybank, we found that 28 people were living at this care home. We spoke to seven people who lived there, the area manager and with the relatives of three people. Following our visit, we spoke with two care professionals who had made recent visits to the home.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There had been an increase in staffing levels since our last inspection. Previously the usual staffing levels for the morning had been five carers and one nurse. This had now been increased to six carers and one nurse. We observed that on the day of our visit that people did not have any long delays in receiving the support they needed from staff.

At our last inspection we found that although the provider had identified some areas of risk, appropriate action had not been taken to manage or reduce these risks. Several fire doors had been identified as needing attention and this work had not been undertaken or scheduled to take place. This work was completed and the West Midlands Fire Service confirmed that it was of a satisfactory standard.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no applications have been made under this legislation for any person living at Ivybank, we found that the area manager understood their responsibilities in relation to the law.

Is the service effective?

We found that records were kept of the food and fluids offered to people. Our last inspection found that some of the records had not been specific about how much food or fluid the person had taken. At this inspection we looked at the food and fluid records for four people. We found that the standard of recording food and fluid intake had improved. Advice had been sought from other health care professionals when required to respond to unplanned weight loss.

People were given a soft diet, when this was assessed as needed, and staff were aware of these diets. At our last inspection one person's soft meal was served in an unappetising manner. At this inspection food was adequately presented and we were informed that food moulds were being obtained to help improve the presentation of meals for people on soft or pureed diets.

During our visit we spoke with people about the meals and drinks provided at the home. People told us they were happy with the meals provided and that they were offered plenty of drinks. One person told us, 'I enjoy the food here.'

Is the service caring?

We spoke to people about the care staff who supported them. People told us that staff were caring and treated them well. Comments from people included, 'Staff are nice, they help me when I need it. I don't think I have to wait too long.'

We spoke with two health care professionals who were involved in supporting people at the home. Both professionals told us they found staff to be knowledgeable about people's health and care needs.

Is the service responsive?

We were shown a range of audits completed by the area manager and other staff at the home. We found that the robustness of these checks on the quality of the service had improved. We found that care plans had been checked and a number of areas for improvement had been identified. Action plans were in place with dates for completion. Records and discussion with staff showed that work was in progress to address the issues identified.

People told us they felt able to raise a concern or complaint. One person told us, 'I've no complaints but I would soon let staff know if I did.' A relative told us, 'I would not feel frightened to raise any concerns. They do try and respond to things raised.'

People told us that they were asked for their views on the service. Records showed that meetings were held with people and that relatives had the opportunity to complete a quality questionnaire about the home. This showed that people's relatives were generally satisfied with the care provided.

Is the service well-led?

Since our last inspection the registered manager had left the employment of the provider. The area manager was currently managing the home and we were shown evidence that recruitment of a new manager was underway. During our visit we did not received any concerns about the current management arrangements.

One member of staff told us, 'I feel the home is well run and they are trying to improve things. I can tell the area manager things as her door is always open to anyone.'

We found that the provider had taken account of our previous inspection findings and that the provider had taken actions to improve the service that people received.

4, 7 April 2014

During an inspection looking at part of the service

On the days of our unannounced inspection of Ivybank , we found that 28 people were living at this care home. We subsequently spoke to eleven people who lived there, and also spoke with the relatives of four people. We found that some people were not able to give us their views on the service because of their needs and health conditions. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People, staff and visitors were not protected at the home against the risks of unsafe or unsuitable premises. The provider conducted regular maintenance checks but had not always taken timely or satisfactory action as a result. Issues with fire doors had been outstanding for some time and no assurance through risk assessment was provided in respect of the risks arising from the fire doors. We met with the provider following our visit and were given assurance that work to repair the fire doors was now in progress.

Many of the people we spoke with raised concerns about how busy the staff on duty were. We observed that over the two days of our visit that generally people did not have any long delays in receiving the support they needed from staff. However we observed that people on the first floor of the home people had little interaction from staff except when they were assisted with personal care or with their meals. We have raised this issue with the provider and will consult on taking further action in respect of these concerns.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been made under this legislation for any person living at Ivybank , we found that the manager understood their responsibilities in relation to the law.

Is the service effective?

People were at risk of not having their needs met in relation to the wound management, nutrition and hydration needs. We checked people's care plans and found most of them to be detailed, relevant and up to date. However, some records which related to people's health were sometimes inconsistent and failed to demonstrate that timely action had been taken. This meant that some people were at risk of receiving inadequate or inappropriate care. We have asked the provider to tell us what they are going to do to address these shortfalls.

Is the service caring?

People were supported by kind and respectful staff. Care staff were very busy and their emphasis was often on ensuring tasks were completed. We spoke with eleven people at the home. People made positive comments about the staff who supported them. One person told us, 'It's really nice living in this home, very caring and I feel treated with respect and dignity; they treat me as a person which I feel is nice.'

Prior to our inspection, we spoke to a professional who regularly visited the care home. They expressed concerns about staffing levels in the home and the impact that this had on a person they supported to have their care needs met.

Is the service responsive?

People told us that they were asked for their views on the service. One person told us, 'At certain times we get together and talk about my care to make sure it's all that I want it to be.' People and relatives told us that concerns they had raised had been responded to. People using the service and their relatives completed an annual satisfaction survey. There were some shortfalls, and concerns had been raised by people. Unfortunately a report of the findings and any actions taken as a result had not been completed and made available to people.

We have raised this issue with the provider and will consult on taking further action in respect of these concerns.

Is the service well-led?

The service has a quality assurance system, but this had not always ensured that areas that needed improvement had been identified and appropriate action taken. Systems in place to make sure that manager and staff learn from events such as incidents and complaints were not always effective. This increases the risk of harm to people and fails to ensure that lessons are learned from mistakes.

Risk assessments undertaken in the home had failed to ensure that risks were appropriately responded to or managed. Steps to address the impact from some issues in the home had not been undertaken.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to these concerns.

3, 4 April 2013

During an inspection looking at part of the service

During our visit we spoke with six people who lived at the home and two care professionals. We spoke with ten members of staff, this included the manager, nurses, domestic, catering, maintenance and care staff. We also spoke with the relative of a person at the home during our visit and with five relatives on the telephone.

We observed that people were supported with kindness and respect. People told us they were satisfied with the care they received. One person told us, 'I love it here as they look after me.'

Records showed that although each person had an assessment of dependency for staffing support this information had not been used to help determine the staffing levels needed in the home. People were complimentary about staff. People had mixed views on the availability of staff but the majority did not have any concerns about staffing levels.

Staff told us that training arrangements had improved and that they had recently undertaken a variety of training. Not all staff had undertaken all of the required training but plans were being made for all staff to complete training.

The provider did not have an effective system to regularly assess and monitor the quality of service that people received. Where improvements had been identified as needed, these were not always made in a timely way.

2 July 2012

During a routine inspection

We visited Ivybank unannounced on 2 July 2012 and spoke to four people about the care and support they received. Some people who lived at the home were not able to tell us their views so we carried out a Short Observational Framework for Inspectors (SOFI) activity in one of the home's downstairs lounge / dining areas. SOFI involved sitting and observing the interactions between people using the service and the staff providing care. Following our visit to Ivybank we spoke with the relatives of five people who lived at the home via the telephone.

We spoke with four people who lived at the home. They told us they were satisfied with the care they received. One person told us: 'They get the doctor out if you are unwell. They look after you here.'

We spoke with the relatives of five people who lived at the home. They told us they were happy with the care provided and that people's privacy and dignity was respected.

People in the home generally appeared relaxed and comfortable with the staff who were supporting them. People did not raise concerns with us about their safety. Four people who lived at the home confirmed they felt safe. One person told us 'If I had a complaint I would feel confident in telling the manager, she is very fair.'

We spoke with four people who lived at the home. One person told us: 'Staff are brilliant.' Two people told us they did not think there were enough staff. One person told us: 'Sometimes you have to wait a long time but it's not their fault as they have other people to look after.'

Relatives of people at the home told us they felt confident about raising any concerns and said that the manager was very approachable. One relative told us: 'The manager is always walking around the home, checking that everything is okay.' One relative told us they had raised a concern and were told that action would be taken but that they received no further feedback about this.