Archived: Ivy House

Updated 22 October 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team:

On the first day of the inspection the team consisted of one inspector and an expert-by experience. The expert-by-experience had personal experience of caring for someone living with dementia who uses this type of care service. The second day of the inspection was completed by the inspector.

Service and service type:

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

Ivy House accommodates 20 older people and those living with dementia. At the time of our visit there were 15 people using the service.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

What we did:

We reviewed information we had received about the service from the provider since the last inspection, such as serious injuries. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make.

We sought feedback from the local authority who work with the service. We also sought feedback from Healthwatch, which is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information helps support our inspections.

During inspection we spoke with seven people who used the service and a relative about their experience of the care provided. We spoke with a health care professional who regularly visit the service. We spoke with five members of staff. These included senior carers, one care staff with responsibility for activities, house-keeping staff and maintenance staff. We spoke with the nominated individual and company director who were present on the first day of our inspection visit. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included four people’s care records which included risk assessments, care plans and medicines records. We looked at five staff files in relation to recruitment, training and supervision. We looked at other records relating to the management. This included a range of policies and procedures, accident and incidents reports.

We asked the senior care worker, in the absence of the registered manager, the nominated individual and director to email further information to us, so that we could see how the provider monitored the service to drive improvements. We did not receive all the requested information relating to audits and survey results.

Updated 22 October 2019

About the service: Ivy House is a care home. It is registered to provider personal care for up to 20 older people including those with living with dementia aged 65 and over. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 15 people were in residence.

People’s experience of using this service:

At the last inspection on 6 and 7 November 2018 we asked the provider to take action to make improvements in a number of areas. These included; the premises and equipment, the recruitment, training and ongoing support of staff, people’s privacy and dignity and effective oversight and governance of the service. At this inspection we found the provider had not improved sufficiently and continued to be in breach of regulations. The provider had not sufficient improvements to meet the requirements of the warning notice.

The lack of oversight and governance systems remained fragmented and there were continued failings as a result. The audits in relation to people’s care, care plans and medicines did not always identify issues which impacted on the quality of people’s care. Where issues had been identified, the provider did not take action to improve care. Systems to identify any trends from incidents and accidents were not in place. Opportunities for people and staff to comment upon the quality of the service were limited.

The service had a registered manager but in their absence the leadership was ineffective. The registered manager did not fully understand the requirements of Duty of Candour in relation to information about the management of the service and complaints.

We found some improvements were made to the premises. However, further action was needed to ensure the repairs identified at the last inspection were addressed as well as the new issues found during this inspection. The premises were not always clean and hygienic. The home environment did not promote the lives and independence of people living with dementia. There signage and lighting was poor in parts of the home and a lack of furnishings and fixtures made the service less homely. The outdoor space was accessible to people but had nothing of interest to people.

Staff recruitment procedure was mostly followed to protect people from unsuitable staff. Further action was needed to ensure all staff had references and the appropriate level of police check. Staff completed on-line training, but their competencies were not always checked to ensure safe procedures were followed.

People did not always received individualised care and support. People’s communication needs had been identified but information was not available in formats that people could understand.

People were not always involved in the reviewing of their care to ensure they received person centred and responsive care as their needs changed.

People’s complaints were not recorded or responded to. The complaints procedure was not accessible to people who required easy read or large print.

People’s privacy and dignity was not always protected. There were limited opportunities for people to take part in meaningful activities of interest, especially for those living with dementia.

People told us they felt safe and protected from discrimination. Risks to people were assessed and managed in a safe way. There were enough staff to meet people’s needs. Staff knew what abuse looked like and the action they should take.

People had enough to eat and drink and cultural dietary requirements were met. People received their medicines in a safe way. People were supported to access health care services as required.

People’s rights to make their own decisions were respected. Mental capacity assessments were completed as required. Staff sought consent before care was provided.

People were supported by kind and caring staff.

People had the opportunity to express their wishes about their end of life care.

Rating at last inspection: Requires Improvement (report published 29 January 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service was rated as Requires Improvement because systems and processes to assess, monitor and improve the quality and safety of the service were not used effectively.

Following the last inspection on 6 and 7 November 2018, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection the provider continued to fail to meet Regulation 12: Safe care and treatment. The provider had not made sufficient improvements to meet the warning notice and is still in breach of Regulation 17: Good governance.

Enforcement:

We have identified a further breach of Regulation 15: Premises and equipment, and Regulation 16: Receiving and acting on complaint at this inspection. Please see the action we have told the provider to take at the end of this report.

Since the last inspection we recognised that the provider had failed to display the rating. This was an offence under Regulation 22 of the 2014 Regulations. Full information about CQC’s regulatory response to this is added to reports after any representations and appeals have been concluded.

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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.