Ivy House

About the service

Ivy House is a residential care home providing accommodation and personal care for up to five younger adults who may be living with a learning disability, autistic spectrum disorder, physical disability or sensory impairment. At the time of our inspection, the service was being used to provide respite care for people who needed support in an emergency or to give their regular carers a break from their caring role. One person was using the service on an ongoing basis and three other people regularly stayed at the service for periods of respite.

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

Based on our review of the key questions safe, effective and well-led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right culture

People were at increased risk of receiving ineffective or unsafe care. The provider had not effectively monitored the quality and safety of the support provided. The service had not embedded a culture of improvement and had not made timely improvements to minimise risks to people. Issues identified at our last inspection had not been adequately addressed.

The service had not fully engaged people and those important to them in planning and developing the service. Feedback had been received from relatives and professionals, which was positive. However, there was a lack of systems in place to support people to give feedback about the service.

Right Care

People's needs were not always thoroughly assessed before they moved into the service. Care and support plans did not always reflect the range of people’s needs and provide sufficient guidance for staff on how to promote their wellbeing. Risk assessments for health did not always provide clear guidance for staff. Whilst people gave positive feedback about the support staff provided, these issues meant we could not be assured people would receive consistently effective and person-centred care.

The failure to fully meet the underpinning principles of right support, right care, right culture, meant we could not be assured that people who used the service were able to live as full a life as possible and achieve the best possible outcomes.

Right Support

The service was small and well-integrated into a residential area, close to local amenities. People were supported in a clean and well-equipped environment, which had been designed to meet their needs and promote independence. However, some maintenance issues had not been identified and addressed, which put people at increased risk of harm.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People felt staff provided safe care, and systems were in place to report concerns. Staff had been safely recruited. Staff had training on how to recognise and report abuse and they knew how to apply it. Systems were in place to record and respond to any accidents or incidents that occurred. People received their medicines when they needed them. Staff enabled people to access specialist health or social care support when needed.

Staff followed government guidance in relation to COVID-19 to help keep people safe and manage infection prevention and control risks.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve. At this inspection, the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out a comprehensive inspection of this service on 22 June 2021. Breaches of legal requirements were found, and we issued a Warning Notice in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This focussed inspection was carried out to follow-up on action we told the provider to take and to check whether the provider had met the requirements of the Warning Notice and to assess whether the service is applying the principles of right support, right care, right culture.

We also 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. This included checking the provider was meeting COVID-19 vaccination requirements.

This report only covers our findings in relation to the Key Questions safe, effective and well-led, which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained the same. This is based on the findings at this inspection.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Ivy House is a residential care home that provides accommodation and personal care to young people who have a learning disability, autistic spectrum disorder, physical disability or sensory impairment. The service can support up to five people. At the time of our inspection visit there were two people receiving respite care.

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

The service was not always well-led. The provider had failed to retain a competent manager. Leadership was poor and ineffective; staff lacked direction and support. The provider's quality assurance systems were not effective in identifying and addressing issues.

Risks associated with people's care had not always been clearly recorded in their care plan or risk assessments with measures which were in place to reduce the risk of harm. Safety checks of the premises and equipment were not routinely carried out.

Infection control measures were not effectively implemented. Staff did not consistently follow guidance regarding COVID-19 testing and appropriate visiting procedures were not in place.

Medicine practices were not always in line with best practice guidelines.

The principles of the Mental Capacity Act 2005 were not always followed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff were not recruited safely. The provider had failed to gain references from previous employers and gaps in employment were not explored.

There were enough staff to meet people's care needs. Staff had received training for their roles.

Staff knew how to keep people safe from abuse and were confident to raise concerns with external agencies. When required, notifications had been completed to inform us of events and incidents.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The model of care and setting maximised people’s choice, control and independence. People’s dignity, privacy and human rights were promoted. The ethos, values, attitudes and behaviours of care staff ensured people using the service led confident and inclusive lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 19 September 2019 and this was their first inspection.

Why we inspected

This was a planned comprehensive inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service is requires improvement. This is based on the findings at 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, consent, environment safety, safe recruitment, infection prevention control, medicine management and good governance.

Please see the action we have told the provider to take at the end of this 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.

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 work alongside the provider and 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.