We inspected Ivonbrook Care Home on 11 January 2019. The service 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.

Ivonbrook Care Home provides personal care and accommodation for up to 40 people in one single building. The service provides a permanent residence for people and short-term care beds are available for people to access. On the day of our visit 14 people were using the service.

At our last inspection on the 10 and 11 October 2016 although the provider was not in breach of any regulations we rated the service as requires improvement. This was because people’s care records were not always updated to reflect their current needs and staff were not receiving regular supervisions. At this inspection we saw improvements had been made. People’s care plans were up to date and reviewed on a regular basis to ensure any changing needs were identified. Staff supervisions had commended and a schedule was in place to ensure this was provided on a regular basis.

The service did not have a registered manager in post. 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.

Plans were in place to gather the views of people and their representatives to ensure they were involved in the ongoing development of the service. Systems were in place and being further developed to monitor the quality of the service, to enable the provider to drive improvement.

People’s individual needs were met as sufficient numbers of trained staff were available to support them. People were supported by staff who understood their role in protecting them from the risk of harm and reporting any concerns. People were supported to keep safe, as individual and environmental risks were assessed and managed. People were supported in a safe way to take their prescribed medicine. The staff’s suitability to work with people was established before they commenced employment. Systems were in place to guide staff on the prevention and control of infection.

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 and their representatives were involved in their care to enable them to make decisions about how they wanted to receive support in their preferred way. People received a balanced diet that met their preferences and assessed needs. People were supported to access healthcare services and received coordinated support, to ensure their preferences and needs were met.

Staff knew people well and understood the support they needed and their preferences on how this support was delivered. People were treated with consideration and respect by the staff team and they were supported to maintain their dignity. People were supported to maintain relationships with those who were important to them; such as family and friends.

People had opportunities to take part in social activities to promote their well-being. The management and staff team included people and their representatives in the planning of their care. There were processes in place for people and their representatives to raise any concerns about the service provided.

Staff were clear on their roles and responsibilities and felt supported by the management team. The provider understood their legal responsibilities with us and the rating of the last inspection was on display in the home.

We carried out an unannounced inspection at Ivonbrook Care Home on 10 and 11 October 2016.

Ivonbrook Care Home provides accommodation with nursing and personal care for up to 40 people, some of whom were living with dementia. At the time of our inspection 8 people were using the service.

A registered manager was not in post, as the previous registered manager had left the service prior to our last inspection in June 2016. However, an acting manager was in post and was present throughout the first day of this inspection. 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.

At our last inspection in June 2016, we found the service to be rated as ‘Inadequate’ overall and the service was therefore placed in ‘Special measures’. In all, we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. At the time of this inspection we found enough improvements had been made to take the provider out of special measures. However, there were still some improvements not yet completed.

Systems for identifying and reporting concerns had improved. The acting manager had informed the Care Quality Commission (CQC) of any changes and reportable incidents at the service.

At the previous inspection, we found people's care records were not effectively updated and evaluated. At this inspection we found improvements had been made, however we could not be assured information had always been shared and updated effectively.

We saw improvements had been made to medicines management; staff had received support and training to manage medicines safely. There were procedures in place to keep people safe in emergencies. We saw there was an extensive plan of refurbishment and redecoration taking place. The acting manager was in the process of recruiting new staff to the service, although none had yet commenced their employment.

People were supported to have access to health care professionals at the time they required. Staff received training and looking at ways to implement new skills and knowledge. There were sufficient numbers of staff available to meet people’s needs.

We saw drinks were readily available throughout the day. Where people required special diets or supplements, we saw the staff ensured they were provided. People told us they were involved in making decisions about the support they needed and felt able to ask staff should they need any help or something in particular. People’s dignity, privacy and independence were respected by the staff.

People were encouraged and supported to spend private and quality time with their family members. Staff were kind, caring and compassionate. People felt listened to and informed of developments at the service. People were supported to follow activities and interests of their choice.

A complaints procedure was in place and were monitored, investigated and acted upon. Improvements had been made in relation to sharing information with the local authority and the Care Quality Commission (CQC). People felt the acting manager and the staff were visible and approachable.

Other improvements were still in progress. For example, updating of people’s care plans and staff training.

There was no registered manager in place and day-to-day management of the service was provided by the acting manager who received support and guidance from care home consultants. Staff supervisions were not carried out on a regular basis.

We carried out an unannounced inspection at Ivonbrook Care Home on 9, 10, 14 and 15 June 2016.

At our last inspection in August 2015 we found the service to be rated as good in all key areas.

Ivonbrook Care Home provides accommodation with nursing and personal care for up to 40 people, some of whom were living with dementia. At the start of our inspection there were 31people living at the service.

There was no registered manager in place. 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 were not protected against the risks of receiving inappropriate or unsafe care; care was not planned or delivered to meet people’s individual needs. Medicines were not safely managed.

There were sufficient numbers of staff on duty but they did not all have the skills, knowledge, understanding and experience to support people’s needs well.

People were not protected from abuse because staff failed to recognise and report concerns appropriately. Risk assessments failed to provide information on how to reduce the risks and promote people’s independence.

People’s nutritional and hydration needs were not met. Sufficient quantities of fluid were not maintained for some people who required encouragement or assistance to drink.

The key requirements of the Mental Capacity Act (2005) were not fully understood and capacity assessments were incomplete. People’s individual needs were not always recognised and met. This was particularly the case for people who had complex needs or who were unable to communicate their wishes verbally.

Applications for Deprivation of Liberties Safeguards had been made because the local authority requested them.

Systems to assess, evaluate and monitor the quality of the service were not effective. There was a lack of effective leadership of the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

During this inspection we found the service to be in breach of several of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports

Ivonbrook Care Home is registered to provide nursing and personal care for up to 40 people. On the day of our inspection 39 people were receiving care.

At our last inspection on 13 October 2013 we found the provider had not made suitable arrangements to ensure that people were safeguarded against the risk of abuse. The provider did not take reasonable steps to identify the possibility of abuse and prevent it before it occurred. The provider need to respond appropriately to any allegation of abuse. This was a breach of Regulation 11 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found improvement had been made.

Ivonbrook Care Home is required to have a registered manager. The previous registered manager still worked at the service as clinical lead. A new manager had been appointed and intended to register with the Care Quality Commission. 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.

Present throughout the inspection was the provider and a nurse, who was the previous registered manager and had extensive experience of the service. They were due to take up the role of clinical nurse. The provider confirmed a new manager had been appointed and they were in the process of applying to become the registered manager.

People and relatives were happy with the support and care being provided. Everyone felt the needs of people were being met. People told us they were treated with compassion and respect. People told us they felt safe and relatives confirmed this.

Staff were knowledgeable about the needs of people. We saw people being assisted and cared for by staff who were kind and friendly. Staff respected people’s individuality, their needs, choices and preferences.

People were cared for by staff who had received training for their job roles. Staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff told us they received supervision, support and appraisal to be able to carry out their jobs. People were supported and encouraged where possible to make their own choices and decisions. Where people were unable to do so, staff recorded how decisions were made in people’s best interests. Records showed that staff had assessed people’s capacity to make specific decisions.

There were  enough staff to respond to people’s needs in a timely manner. Staff were recruited in line with the provider’s policy and procedures. We saw pre-employment checks were completed for all staff, these included Disclosure and Barring Service (DBS) checks, proof of identity and written references. Nurses’ professional registration status was checked annually.

People received care and support from staff who had received training for their job roles. Staff received support, supervision and appraisal to carry out their jobs.

Medicines were safely managed in line with current guidance and legislation. Nurses administered medicines and received training to ensure their practice was safe. Systems were in place to ensure medicines were safely stored, administered and disposed of.

There were new systems in place to enable the manager to audit, monitor and assess the quality of the service. Any concerns or complaints people had were responded to by staff.

People were supported to maintain relationships with friends and families.

There was a timetable of activities available for people.

All the people that we spoke to were positive about the level of care provided at Ivonbrook Care Home, and our review of care planning documentation indicated that the care provided was carefully planned and individualised for each person using the service.

Whilst we noted that members of staff received safeguarding training every three years, and the majority of safeguarding issues were handled appropriately, we had concerns that not all safeguarding allegations were handled in a way which ensured the protection of people living at the home, their relatives and staff working in the service.

All the family members that we spoke to said there were enough qualified, skilled and experienced staff to meet their relative's needs.

Family members observed the atmosphere of the home to be "calm and relaxed because there were enough staff on duty", and a number of people commented on the positive attitude of staff "who showed a real interest in the person they were caring for".

All the evidence that we reviewed indicated that staff working in the home: were well supported; had received an induction, with appropriate mandatory training when they started in their role; and were encouraged to obtain further professional qualifications.

We found that the service provider had a number of different mechanisms for gathering, recording and evaluating accurate information about the quality and safety of the service provided, including a complaints system.

The purpose of this visit was to check if the provider had taken actions to address the findings of our visit on 10 October 2012. The provider had sent us an action plan showing that they had addressed our findings in October. We referred to this action plan, and the report from our previous visit, at this visit. We spoke with one person using the service and with two staff. We looked at the personal records of two people.

The person we spoke with told us that staff knew their needs and were able to fully meet them. They added, “[Staff] seemed to take to me straight away.”

We spoke with two members of care staff who both told us they had enough information about people’s needs at the time of their admission. We read records that confirmed that sufficient information was recorded, at the time of people’s admission, to enable staff to meet people’s needs and provide safe care.

The people we spoke with said that their privacy and dignity was respected at Ivonbrook and they were involved in planning their care. Staff respected their personal preferences and people thought that their needs were met. They felt that a range of suitable activities were offered, with one person telling us, “We’ve been on trips out. The sensory garden is good.”

Although people felt their needs were met we found that their needs were not always assessed promptly at the time of their admission.

People told us they felt safe at Ivonbrook. Staff had received training that kept people safe and the people we spoke with felt that staff were well trained to meet their needs. Records we saw supported this.

People were asked for their views, and comments that they made were acted on. One person told us that, at residents meetings, “You can say what you want.”

At our visit we spoke with five service users and two relatives visiting people at the home.

They told us about some of the ways they were informed and involved in the home. Examples they gave included the provision of key service information folders in people’s own room and meetings held regularly with them. All said they were supported to engage in the activities and interests they enjoyed and to access their family and friends and the local community, including for spiritual worship.

One person told us ‘I am a keen gardener and am pleased that I can continue with this here,’ ‘I even have my own shed.’

All of the people we spoke with expressed overall satisfaction with the care and services they received and for their ongoing care and support. One person said, ‘I am happy here,’ ‘Staff, help me in the way I need.’

Information people gave us told us there were suitable arrangements for their health care needs, including for the purposes of routine health screening, for their medicines, nutrition and to provide them with the equipment they needed. Such as to assist them in their mobility.

One person’s relative said they were always kept up to date with any changes to their father’s health and general condition. Another told us they were impressed by staff approaches with their father, who suffered from dementia.

Three people asked, said they were confident in raising any concerns or complaints they may have with staff in the home and felt these would be properly dealt with.

All confirmed that staff, were usually available when they needed them and usually listened and acted on what they said.