The inspection took place on 23 October 2018 and was unannounced.

We undertook this unannounced focused inspection because we had been made aware of concerns regarding the safety and leadership of the service. The team inspected the service against two of the five key questions we ask about services: is the service safe? and is the service well-led?

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring, or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

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

Ivy Court accommodates up to 71 people in one purpose built building. People who used the service, some of whom were living with dementia, received either residential or nursing care. Some areas of the service, such as the garden and cinema room, were shared spaces to which everyone had access. At the time of our inspection visit there were 61 people using the service, two of whom were in hospital.

The service had a 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.

At our last comprehensive inspection of the service, which was carried out on 8 and 9 January 2018, we rated the service as Good overall. However, we found that some improvement was required in the key question of Well-Led due to concerns about disorganised care plans and about staff culture and morale. At this inspection we found that these concerns had not been fully addressed and had significant concerns about the safety of the service. We identified poor management of some risks and of people’s medicines. We also found that there were not always enough staff as people told us they had to wait a long time to have their needs met. We have judged that there are three breaches of regulation, relating to safe care and treatment, staffing and the leadership of the service. You can see what action we told the provider to take at the back of the full version of this report.

Medicines were not always managed safely. Some people failed to receive their medicines because they were not made available to them. Stocktaking and storage procedures, and records relating to medicines given covertly, required improvement. We could not be sure people always received their medicines as prescribed.

There was a mixed picture with regard to the management of risk. Some environmental risks were well managed with regular servicing and monitoring checks of equipment and safety procedures. A variety of specific risks people might be subject to, were assessed and specific guidance was documented to help guide staff. It was not always clear what steps the service had taken to reduce future risk and respond to patterns and trends, where people were frequently falling out of bed for example. Some risks, such as those posed by hot radiators, had not been assessed. Risks and procedures relating to infection control required some attention to fully protect people, although cleaning in communal areas and kitchens was very good.

Risks were further heightened as, in recent months, people were regularly supported by agency staff who did not know them well. Although the service aimed to only use agency staff who were known to the service this was not always possible in practice. Using agency staff so regularly and having a high number of new staff, along

This inspection took place on 8 January 2018 and was unannounced. We returned on the 9 January 2018 to complete the inspection. The management team was given notice of the second date, as we needed to spend specific time with them to discuss aspects of the inspection and to gather further information.

At our last comprehensive inspection on 4 and 5 May 2017 the overall rating of the service was, ‘Requires Improvement’. This summary rating was the result of us rating the key questions ‘safe’, ‘effective’, ‘caring’ and ‘responsive’ as, ‘Requires Improvement’. At our last inspection for the key question, ‘is the service safe?’ we found three breaches of regulations. The provider had failed to ensure that care and treatment was provided in a safe way. They had not assessed all risks to people's safety or taken appropriate actions to mitigate these risks. People's medicines were not always managed safely. The management of the service had failed to have sufficient numbers of staff. The management of the service had failed to have effective systems in place to ensure suitable staff were employed.

At our last inspection for the key question, ‘is the service well led?’ we found one breach of regulation, and gave a rating of ‘inadequate’. The management of the service had failed to have effective systems and processes in place to monitor and improve the safety of the service provided. We found the manager had failed to maintain accurate and complete care records in respect of each person. We also found the culture of the home was not open. Care staff, relatives, and people who lived at the home were not being involved in the development of the service. We were told that the management team and provider were not making opportunities for staff to share their views about the home. Meetings were poorly attended and care and nursing staff had limited supervisions. Their competency to ensure their care practice was safe and effective had not been assessed for some staff and was periodic for others.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection we found significant improvements had been made and maintained, resulting in the overall rating of the service changed to, ‘Good’.

At this inspection for the key question ‘well led’ we have rated it as ‘Requires Improvement’. We found although there were significant improvements in the care planning time was still needed to ensure they were accurate and fully completed. The provider agreed with our findings and gave a target of April 2018 for completion. The home has been opened since July 2015 and since this time has had two registered managers and two appointed home managers at different times. Some staff and relatives expressed their concerns about this. We found that this had impacted the home and improvements were needed to how information was being communicated, particularly around staffing levels. This had impacted staff behaviour leading to serious conduct issues and how relatives felt their loved ones needs were being met.

Ivy Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Ivy Court accommodates 71 people in one adapted building. There were 58 people living in the service at the time of our inspection visit.

Although there was an appointed manager in post at the time of our visit, they had not registered with the Commission. 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 of the Health and Social Care Act 2008 and associated regulations. The appointed ma

The inspection took place on 4 and 5 May 2017 and was unannounced.

Ivy Court is registered to provide residential and nursing care for up to 71 people. At the time of the inspection 61 people were living at the home. The home supports older people, some of whom are living with different forms of dementia and some people who have nursing needs. The accommodation is purpose built and was completed in 2015. The building is over two floors, and is set in a large garden.

There was not a 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had recently left. The home was being managed by a regional manager who represented the provider and the deputy manager. The provider confirmed to us that a new manager will be starting at the end of the summer. For the purposes of this report we will refer to the acting manager and deputy manager as the management team. There were also clinical leads who led the nursing and care staff on shift.

At this inspection we found four breaches of the Health and Social Care Act 2008. You can see what action we asked the provider to take at the end of this report.

Risks to people’s safety had not always been managed well. Cleaning products, thickening agents used to thicken people’s drinks and people’s medicines were not always secure. The provider had not assessed whether it was safe for these to be left out. The home supported some people who were living with dementia. Therefore, these people could have been at risk of accidently ingesting these products.

Safe recruitment checks for new staff were not always completed as is required to ensure they were safe to work within a care environment. A recent safeguarding concern had not been managed in a robust way, in order to protect the people who were living at the home.

The administration of people’s medicines had been audited and checked. The deputy manager and clinical leads were proactive in responding to a change in people’s health needs. The deputy manager and clinical leads had completed risk assessments for people living at the home. Certain risks which people faced were being managed well for example pressure care and when people were at risk of being an unhealthy weight. The management team and provider also ensured that the equipment used was safe.

Care staff and nursing staff received training in a number of different topics relevant to their work. However they lacked supervision and their competency to perform their role safely and effectively had not been regularly assessed. This led to some care staff providing people with poor quality care.

There was not enough care staff working in the home to meet people’s needs or provide them with adequate stimulation to enhance their wellbeing. People, their relatives, and staff all raised concerns about the staffing levels of the home. The management team and provider had not responded to these concerns. They had not investigated and taken action.

The management team and the provider did not always have robust quality monitoring systems in place. They had not actively involved people, their relatives, and staff in the development of the home. The management team and provider had also not created an open and listening culture at the home.

People spoke positively about the food and drinks they had. The chef had a good knowledge of people’s likes and dislikes and people’s specialist dietary needs. People also had good access to drinks.

There were planned activities and outings. However, people did not feel there was enough daily social activities taking place. The management team and provider had not considered ways to encourage social stimulation wi

The inspection took place on 2 March 2016 and was unannounced.

Ivy Court was opened in July 2015 and provides residential and nursing care for up to 71 people, some of whom may be living with dementia. Accommodation is over two floors and all rooms have en-suite facilities that include a wet room. The home has one room that caters for people with bariatric needs and a small number of interconnecting rooms for family members. There are a number of communal areas including lounges with interconnecting dining rooms, kitchenettes, a café area, cinema room, two hairdressing salons, an activities room and library. At the time of our inspection, 24 people were living at Ivy Court, 22 of them on a permanent basis.

There was a manager in place who had been appointed in November 2015. At the time of the inspection, the manager had submitted an application to the Care Quality Commission (CQC) to become a registered manager; their application was being processed. 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.

The people who used the service at Ivy Court were supported by staff that had been well trained and fully inducted. They had been employed following appropriate recruitment checks that ensured they were safe to work in health and social care. Staff demonstrated the appropriate skills and knowledge associated with the training they had received.

Staff felt supported and happy in their work. They worked well as a team and morale was good. Staff communicated with others in a respectful and professional manner. There were enough staff to meet people’s individual needs. People had confidence in the staff that supported them.

People told us that they were supported by staff that were kind, caring and positive. Staff had time for people and treated them with respect. People received care in a dignified manner that protected their privacy. Staff encouraged people to be as independent as possible and offered choice in their day to day living. People told us that staff knew them and their needs well and responded to their wishes promptly. The relatives of the people who used the service felt welcomed and supported as family members.

People were protected from the risk of abuse as staff could demonstrate they understood what constituted potential abuse. Staff knew how to report any concerns they may have and they felt confident the service would address these appropriately. They knew how to report concerns outside of the service. Past concerns had been reported as required.

The risks to people who used the service, staff and visitors had been identified. These had been assessed, managed and reviewed on a regular basis to ensure people were protected from the risk of harm. People received their medicines on time and in the manner the prescriber intended. The service managed medicines safely and could account for medicines at any one time as clear and accurate records were kept.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Although the service had not recorded the capacity assessments they had made on the people they supported, the principles of the MCA had been adhered to. Applications had been made to the supervisory body for consideration and the service had involved appropriate people in best interests decisions. These had been recorded.

People had been involved in planning the care and support they received from the service. Their needs had been identified, assessed and reviewed on a regular basis. People’s care plans were accurate, appropriate and gave staff information to assist people in a person-centred way. Care plans were individual to each person and addressed their specific needs. People’s life histories and biographies were in place to help staff build