Archived: Inver House

Inver House is a residential care home providing personal care to up to 50 people across three separate wings, each of which has separate adapted facilities. The service provides support to older people and in two of the adapted wings, supports those living with more significant dementia. At the time of our inspection there were 37 people using the service.

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

Risks to people were assessed and there was information within people's care plans so that staff could safely meet people's needs. Some improvements were needed to ensure information about risks and how these should be mitigated was clear and consistent.

There were enough staff to meet people’s needs safely. However, over the three units, staff were not always able to spend quality time engaging with people. We discussed this with the provider who were reviewing this and supporting staff development.

The provider used an external company to carry out recruitment checks on new staff. While this was safe, some improvements were needed to ensure the management team were aware of any actions they needed to follow up on. There was ongoing recruitment to continue to build the staff team.

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. Mental capacity assessments had been completed for people and were appropriate for the decisions being made. However, we identified some additional records were needed for some people. Staff understood how to support people to make choices about their life and people told us they were asked their views.

People told us they felt safe at Inver House. Information was shared with staff at handovers between shifts and other meetings, meaning staff understood how to keep people safe. The environment and equipment was clean, safe and well maintained and fire risks were managed well.

People were protected from abuse and staff understood their responsibilities to report any concerns. Staff respected people's human rights and diversity, and this helped prevent discrimination.

Medicines were administered by suitably trained staff who had been assessed as competent to do so safely. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

Accidents and incidents were monitored so that action could be taken to reduce the likelihood of a reoccurrence.

Activities were available and varied and staff supported people to maintain relationships with their relatives. There were positive links with the local community.

There was no one receiving end of life care at the tie of our inspection. However, people’s wishes at the end of their life had been captured in advanced care plans.

Staff felt they were supported in their role and told us they enjoyed working in the service.

The provider had systems and processes to effectively monitor the quality of the service provided within the home and there was a complaints process. The registered managers understood their regulatory responsibilities and shared information when required.

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 good (published 4 October 2018).

Why we inspected

We received concerns in relation to staffing, management oversight, safeguarding, risk management and medicines safety. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We found evidence during this inspection that some improvements were needed to risk management, recruitment, mental capacity assessments and staff engagement. Please see the safe, responsive and well led sections of this full report.

The overall rating for the service has remained good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Inver House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Inver House was clean, hygienic and well maintained. There was a robust cleaning schedule in place which included regular cleaning of frequently touched points, such as, door handles, tables, light switches and call bells. Windows were opened periodically to enable ventilation.

The service had a good supply of Personal Protective Equipment (PPE) available to meet current and future demand. Staff had received training in the correct use and disposal of PPE. We observed PPE being used appropriately.

People were fully supported to maintaining contact with families and loved ones and visits to the service were conducted in line with the latest government guidance.

Correct procedures were in place and followed for COVID-19 testing. When people needed to isolate the service was able to accommodate this and minimise the impact on people's well-being. Appropriate measures were in place to facilitate safe admissions to the home.

There was an up to date infection prevention and control (IPC) policy. Staff were regularly updated with any changes to government guidance and procedures to follow so they could keep themselves, people and visitors safe.

Inver House is a ‘care home’ owned by Somerset Care Limited. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided. The inspection team looked at both during this visit.

Inver House is registered to provide personal care and accommodation for up to 50 people. At the time of the inspection, there were 44 people living at the home. The provider divided the home into three units. One unit provided care and support to older people and the other two units provided care and support to people who were living with dementia. Two lifts are available to assist people to access the upper floors. The home has several dining areas and lounges, there was also a hair salon and communal IT facilities are available for people to use if they wished. The grounds were well-maintained and accessible to people living in the home.

At our last inspection, we rated the service as Good in all key question areas of Safe, Effective, Caring, Responsive and Well-led. At this inspection we found the information supported the rating of Good with the key question of Responsive which had improved to a rating of Outstanding.

At the time of this inspection, there was a manager in place who had taken over the overall running of the service in the absence of the registered manager. The manager had commenced the registration process with the Care Quality Commission (CQC). 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 in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People felt safe living at Inver House. People were protected from the risks of abuse and staff were trained in recognising and reporting safeguarding concerns. Safeguarding investigations were thorough and identified learning to help prevent a reoccurrence.

Individual and environmental risks to people were managed effectively. Risk assessments identified risks to people and provided clear guidance to staff on how risks should be managed and mitigated.

There were enough staff to meet people’s needs and staff were able to support people in a relaxed and unhurried way. Appropriate recruitment procedures were in place to help ensure only suitable staff were employed.

People received their medicines safely and as prescribed. Appropriate arrangements were in place for obtaining, recording, administering and disposing of prescribed medicines.

People were protected from the risk of infection. Staff had received infection control training. The home was visibly clean and well maintained and infection control audits were completed regularly.

People’s needs were met by staff who were competent, trained and supported appropriately in their role. Staff acted in the best interests of people and followed legislation designed to protect people’s rights and freedom.

People had access to health professionals and other specialists if they needed them. Staff worked in partnership with healthcare professionals to support people at the end of their lives to have a comfortable, dignified and pain-free death.

Procedures were in place to help ensure that people received consistent support when they moved between services.

People were provided with enough to eat and drink and mealtimes were a relaxed and sociable experience for people. Where people had specific dietary requirements, these were known by staff and catered for.

Staff treated people with kindness, respect, and compassion. People were actively involved in making decisions about their care. Staff respected people’s privacy and dignity and encouraged the independence of people living at the home.

People's cultural and diversity needs were explored to help ensure that people could be provided with effective, person centred care and support.

The management team and staff were proactive in using national guidance to better understand people’s individual needs to help ensure that effective person-centred care could be provided.

The management team and staff went the extra mile to help ensure that people were supported to maintain their interests.

The service had an innovative approach to using technology.

There were well established within the local community. The management team and staff were actively involved is alleviating loneliness for the people living at Inver House and the people within the wider community.

Care and support was planned proactively and in partnership with the people, their families and multidisciplinary teams where appropriate.

People knew how to raise concerns, which were listened and positively responded to and were used to make further improvements.

There were robust quality auditing processes in place. The quality of the service was monitored and appropriate actions were taken when required.

The provider used feedback to improve the quality of care. There was a clear vision to deliver person centred care, which achieved good outcomes for people.

Staff were respectful and patient with people. In the dementia unit, known as Petals, we used observation to help us understand people's experiences. We saw staff took time to help people understand their care, were unhurried and kind with people. We spoke with four care staff. They were fully aware of people's particular health and social care needs. We observed staff offering people choices and respecting people's wishes.

All areas of the home were clean and well maintained. We spoke with two domestic staff who were aware of infection control procedures.

We viewed two staff records. These contained all the relevant information and checks carried out before employment commenced. A range of quality assurance measures were in place. Feedback from these was acted on to improve the service for people.

We did not on this occasion speak to people. We spoke with the manager and staff and looked at how the service was managing people's medicines. We also looked at medication records. The home had taken immediate action to address the concerns we found in August 2012.