Archived: Ivy House

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.

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

The leadership and the management of the service was ineffective. The service had a registered manager, but they were no longer employed and were in the process of cancelling their registration.

The provider did not fully understand the requirements of Duty of Candour in relation to information about people, staff, complaints, and to comply with the legal requirements.

The was a continued lack of oversight and governance systems to monitor the service. There were no audits, record of visual checks and monitoring records to ensure people were safe and protected from avoidable harm or injury. People’s care was not planned, monitored or reviewed. Staff relied on their knowledge about people’s needs and information shared at the handover meetings. Records relating to people, staff and the management of the service were not kept up to date or securely. There was no formal opportunity for people and staff to express their views about the service.

The provider had appointed a new manager, not yet registered with the Care Quality Commission and a deputy manager. People told us staff supported them and they knew who the manager was.

Rating at last inspection and update

The last rating for this service was requires improvement (1 May 2019) and there were multiple breaches of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the day to day management of the service. As a result, we undertook a focused inspection to review the Key Questions of Well Led only.

We reviewed the information we held about the service. No new areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

At the previous inspection we found breaches of regulations. At this inspection we found the provider still needed to make improvements to meet the regulations therefore we are taking further action. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ivy House on our website at www.cqc.org.uk.

Enforcement:

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Ivy House is a ‘care home’. 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, and both were looked at during this inspection.

Ivy House accommodates 20 people in one adapted building. The service specialises in caring for older people including those with living with dementia. At the time of our inspection 17 people were in residence.

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.

This was the first inspection of the service since they were registered in December 2017. At this inspection we found evidence to support the rating of ‘requires improvement’.

The provider did not have systems and processes to assure themselves about the quality of service provided. There was a lack of oversight on the service and monitoring was ineffective.

People were not safe. Risks associated with the premises had not been effectively managed. People were not protected from the risk of burns or scalding from excessively hot surfaces. We found fixtures, fittings and furniture were damaged and not safe. Infection control procedures and practices were not always followed. Maintenance was not provided in a timely manner to ensure the premises were safe and fit for their intended purpose.

We found medicines were not stored safely. The registered manager removed and returned all the medicines that were no longer used to the pharmacy. Further action was needed to ensure medicines were stored securely in people’s rooms and people were supported with their medicines as prescribed.

Staff recruitment process was not followed to protect people from unsuitable staff.

There were enough staff to meet people’s needs. A system was in place to ensure staff were trained and supported in their role. Further action was needed to ensure staff training was kept up to date and staff practices were observed and monitored.

Risks associated with people’s needs had been assessed; safety measures were put in place and they were monitored and reviewed regularly.

People’s dietary needs were met. Drinks and snacks were available. People had access to health care services.

People were involved in decisions made about all aspects of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were cared for by kind and caring staff. Staff knew people well; understood their wishes and daily needs. People had the opportunity make decisions about their end of life care.

People did not always receive care that was person centred and responsive. People’s dignity and privacy was not always respected. Care plans lacked information and clear guidance for staff to follow to provide person centred care such as guidance provided by health care professionals, food preferences and hobbies.

The provider employed an activity co-ordinator but people’s experiences about the activities, social stimulation and engagement varied. People were not always protected from the risk of loneliness.

Information was made available in accessible formats to help people understand the care and support agreed. The provider was developing picture menus to help people living with dementia choose what they want to eat.

People and their relative knew how to make a complaint and felt confident that action would be taken. However, there were limited opportunities for people to express their views about the service and influence how the service was run.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

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.