About the service:

Ivybank Care Home provides nursing and personal care for up to 38 people. There were 34 people living at the home at the time of the inspection. People who used the service had a range of support needs related to old age and dementia.

People’s experience of using this service:

When we completed our previous inspection in September 2017 we identified there was a breach of Regulation 17 Good Governance of the Health and Social Care Act Regulations 2008 (Regulated Activities) 2014. We found on this inspection the provider was no longer in breach of this regulation.

People receive safe care and staff knew how to keep them safe from harm. People received their medicines as it was prescribed. Staff followed infection control guidance and had access to personal protective equipment. Accidents and incidents were noted and trends monitored to reduce the amount of accidents.

People received effective care. Staff were supported and had the skills and knowledge to meet people’s needs. The provider followed the principles of the Mental Capacity Act (2005). People’s nutritional needs were met and they accessed health care when needed. The environment was welcoming, warm, comfortable and clean.

Staff were caring. People we spoke with were complimentary about the service and said they would recommend the home. There was a culture within the service of treating people with dignity, respect and compassion.

People received responsive care. Their support needs were assessed and planned with their involvement to ensure they received the support they needed. Support was individualised and reviewed. People were supported to take part in activities of interest and their preferences, likes and dislikes were known to staff. The provider had a complaints process which people and their relatives were aware of to share any concerns.

The registered manager was known and made themselves available. Spot checks and audits were taking place to ensure the quality of the service was maintained but we identified some additional areas which needed to be included as part of these audits.

Rating at last inspection:

Inspection September 2017 Rated Requires Improvement (Report published January 2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This comprehensive inspection took place 27 and 28 September 2017. At the last inspection completed in April 2017 we identified improvements were required within the service. We gave a rating of ‘requires improvement.’ We carried out this inspection to see if the provider had made improvements and to respond to concerns about staff moving and handling practice, food hygiene standards and changes to the environment.

The home is registered to provide nursing care and accommodation for up to 38 older people, some of whom may be living with dementia or have complex healthcare needs. There were 36 people living at the home on the days of our inspection visit.

The registered manager had left their post in July 2017. 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. We were informed that the general manager who was also the current nominated individual would be applying to be the registered manager. A new clinical care manager had also been recruited who was responsible for the nursing care.

We found new audit and quality assurance systems had been introduced into the service. However, we found these systems were still not adequately identifying the areas of improvement required within the service. We found the provider was not meeting the regulations around the effective management of the service. Further improvements were needed and we are considering what further action to take.

We saw there were systems and processes in place to protect people from the risk of harm but the assessment of risk needed to be more robust. Risk assessments and care plans in place identified the assistance people needed with their mobility and in relation to the risk of falls. However we saw that these needed improvement to make sure staff had sufficient information on how to support people safely and in line with their risk assessments. The majority of people we spoke with told us they felt safe in the home and told us how the staff made sure they were kept safe. People were protected by a staff team who understood how to recognise and report any signs of potential abuse or mistreatment of people.

Effective recruitment and selection procedures were in place and checks had been undertaken before new staff began work. New staff received induction training but this was not always suitable to their role. Training was provided but additional training was needed to ensure staff had the knowledge and skills needed to support people. Where gaps in training had been identified we were informed plans were in place to schedule this.

We reviewed the systems for the management of medicines and found that people received their medicines safely but some improvements were needed.

Sufficient numbers staff were available to safely meet people’s needs. People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Staff demonstrated an understanding of people’s individual needs and preferences but did not always demonstrate an awareness of how to meet people’s dementia care needs. Practice from staff was not always consistent to ensure that all people were always treated with care and respect.

People were offered a range of food, drinks and snacks that met their cultural, dietary and health needs but the location had received a poor food hygiene rating following an Environmental Health Officer inspection. People had access to a range of healthcare when this was required.

The manager was taking action to improve systems to ensure deprivations to people's liberty were identified and that the appropriate applications made to the supervisory body.

The provider had an on-going programme of refurbishment of the environment. Recent chang

This comprehensive inspection took place on 5 and 6 April 2017. The first day was unannounced. We last inspected this service in May 2016 where we awarded an overall rating of requires improvement. The home is registered to provide nursing care and accommodation for up to 38 older people, some of whom may be living with dementia or have complex healthcare needs. There were 34 people living at the home on the days of our inspection visit.

Staff did not always treat people with respect and systems in place to monitor and improve the quality of the service provided were not effective. This inspection found that improvements in these areas had taken place but that the systems in place for audits and checks had not always been effective at identifying areas that needed attention. Further improvement was needed to make sure the systems were consistently effective.

Ivybank had 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.

We saw there were systems and processes in place to protect people from the risk of harm but the assessment of risk needed to be more robust. Risk assessments and care plans were in place in regards to the assistance that people needed with their mobility and in relation to the risk of falls. We saw that these needed improvement to make sure staff had sufficient information on how to support people safely. The majority of people we spoke with told us they felt safe in the home and told us how the staff made sure they were kept safe. People were supported by staff who had received training on how to protect people from abuse.

Effective recruitment and selection procedures were in place and appropriate checks had been undertaken before new staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with people.

There was not always an adequate deployment of staff to meet people’s needs promptly. Recruitment was in progress to increase staff numbers and ensure there would be sufficient numbers of staff available to meet people’s individual needs. We reviewed the systems for the management of medicines and found that people usually received their medicines safely but some improvements were needed.

People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Staff demonstrated an understanding of people’s individual needs and preferences. Staff were kind and caring, and respected people’s privacy.

The registered manager had approached the appropriate authority when it was felt there was a risk people were being supported in a way which could restrict their freedom.

People were offered a range of food, drinks and snacks that met their cultural, dietary and health needs. People had access to a range of healthcare when this was required.

There was a programme of activities available within the home which involved various group activities and less frequently, activities on an individual basis. At the time of our inspection the planned activity schedule was not being followed as the activity co-ordinator had left the home four weeks before our inspection. The provider had taken prompt action so that a new activity co-ordinator was due to commence working at the service in the next few days.

People who lived at the home and their relatives were encouraged to share their opinions about the quality of the service. We saw that the provider had a system in place for dealing with people’s concerns and complaints. People and their relatives said they knew how to raise any concerns and most were confident that these would be taken seriously and looked into.

This inspection took place on 9, 10 and 16 May 2016. The first day was unannounced.

The home is registered to provide nursing care and accommodation for up to 38 older people, some of whom may be living with dementia or have complex healthcare needs. During our inspection there were 35 people living at the home. This was the first inspection of Ivybank Care Home since a new provider took over from a previous provider in November 2015.

Ivybank had 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.

People we spoke with told us they felt safe in the home and told us how the staff made sure they were kept safe. We saw there were systems and processes in place to protect people from the risk of harm. People were supported by staff who had received training on how to protect people from abuse. Despite this we saw some isolated incidents of poor staff practice that did not promote people’s safety. This included a member of staff letting in a visitor to the home without checking their identity.

Effective recruitment and selection procedures were in place and appropriate checks had been undertaken before new staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with people.

There were not always enough staff on duty to ensure people’s needs were met. Recruitment was in progress to ensure there would be sufficient numbers of staff available to meet people’s individual needs. We reviewed the systems for the management of medicines and found that people received their medicines safely.

People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Staff demonstrated an understanding of people’s individual needs and preferences. People told us they were involved in the planning of their care and were asked how they wanted to be supported. Staff were kind and caring, and respected people’s privacy however we observed domestic staff not seeking permission to enter people’s bedrooms.

The registered manager had approached the appropriate authority when it was felt there was a risk people were being supported in a way which could restrict their freedom. Staff had been provided with training about the Mental Capacity Act 2005 (MCA) but not all staff were aware that Deprivation of Liberty applications had been submitted for some people.

People were offered a range of food, drinks and snacks that met their cultural, dietary and health needs. Some people expressed their views about the lack of variety of the meals but the provider was already in the process of consulting with people and updating the menus.

People had access to a range of healthcare when this was required.

There was a programme of activities available within the home which involved various group activities and less frequently, activities on an individual basis. The frequency of activities was reduced when the activity worker had to cover for other staff absences. The provider had plans to improve the range and frequency of activities on offer to people to provide stimulation, and to reduce the chance of people being socially isolated.

People who lived at the home and their relatives were encouraged to share their opinions about the quality of the service. We saw that the provider had a system in place for dealing with people’s concerns and complaints. People and their relatives said they knew how to raise any concerns

and most were confident that these would be taken seriously and looked into.

We found that whilst there were systems in place to monitor and improve the quality of the service provided, these were not always effective