Ivy Cottage

Ivy Cottage is residential care home providing accommodation for persons who require nursing or personal care up to a maximum of 14 people. The service is a care home without nursing. The service provides support to people living with learning disabilities or autistic spectrum disorder, in 2 adjacent buildings; Ivy Cottage and Ivy Croft. At the time of the inspection 14 people were using the service; 10 people lived in Ivy Cottage and 4 people lived in Ivy Croft.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The model of care and setting maximised people's choice, control and independence. Risks to people were assessed, monitored and managed safely. Systems in place protected people. The provider had acted to manage infection risks. There were enough staff to safely meet people's needs. Staff had the necessary skills, knowledge and experience to know how to meet people's needs, and people were actively involved in recruiting staff.

People's medicine support was managed safely, and staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. People were supported by staff to pursue their interests and to achieve their aspirations and goals. People had a choice about their living environment and were able to personalise their rooms. Staff supported people to make decisions following best practice in decision-making and communicated with people in ways that met their needs.

Right Care:

Care was person-centred and delivered in a way which promoted people's dignity, privacy and human rights. Staff offered people choices and involved people when supporting them with activities and meals. The provider worked alongside partnership agencies to ensure people's support needs were identified; this ensured people achieved good outcomes. People’s equality characteristics were explored and celebrated. Safety and support plans identified people’s circles of support.

Staff understood how to protect people from poor care and abuse and worked well with other agencies to do so. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

Right Culture:

The provider’s quality assurance systems, processes of audit and service review ensured the safety and quality of care. The ethos, values, attitudes and behaviours of leaders and care staff ensured all people using the service lead confident, inclusive and empowered lives. People were supported to regularly identify, or review, on-going individual aspirations and life goals.

Staff valued and acted upon people’s views. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 29 April October 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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 changed from requires improvement to good. 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 Cottage on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

• During our inspection, we found Ivy Cottage to be visibly clean. The environment was tidy and odour free.

• During our inspection, we found that staff were wearing the correct Personal Protective Equipment (PPE). Staff had a good understanding of the correct PPE they needed to wear.

• Throughout the pandemic, staff recognised that there was a need for more activities. There are now more more activities and events taking place regularly in the home.

• Throughout the pandemic, staff at the home supported people to keep in contact with their relatives and friends. This was achieved through telephone calls and writing letters.

• The home were in receipt of support from a Covid Lead from Ivy Care. This supported the manager and staff in managing Covid and working towards best practice.

Further information is in the detailed findings below.

People’s experience of using this service:

People were happy living at Ivy Cottage. They were comfortable in the company of staff and others they lived with. People were supported to maintain relationships with family and friends.

The service did not always consistently apply the principles and values of Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service promoted independence for those who expressed a wish to move on, and encouraged people to access the community and carry out person centred activities. The provider was improving the environment and creating more opportunities for people to gain new skills. This would help ensure the principles and values were applied consistently.

People talked to staff about how to stay safe. There were enough staff to meet people’s needs and the same workers provided support so people received consistent care. However, the recruitment process was not always robust. Medicines were managed safely although the auditing system did not pick up when the incorrect number of tablets were carried forward to the next medicine cycle.

Staff received support through regular training, supervision and appraisal. We have made a recommendation about meeting people’s health care needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the policies and systems in the service did not always support this practice.

People felt well cared for. The service was making improvements to the support planning process to make sure people's needs were fully reflected. They had introduced individual weekly activity planning meetings.

The manager had not been in post very long and had spent time getting to know people who used the service and staff. They were enthusiastic and had a clear vision about service improvement. Quality management systems were in place but these were not always effective because they did not identify some of the issues picked up during the inspection.

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

Rating at last inspection: Good

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to review intelligence about the service and visit again within our recommended return inspection timescales. If any concerning information is received we may inspect sooner.

Ivy Cottage provides accommodation and personal care and support for up to 14 people who have a learning disability. People using the service have complex needs and are supported and encouraged to use ordinary community based health and leisure services. People are also supported to do as much for themselves as possible in the pursuit of living an independent ordinary lifestyle.

The service had a registered manager. 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.

The service was split into two sections a large house where 10 people lived and a smaller unit where four people lived. The smaller unit provided a forensic mental health service. Forensic services are specialist services for people who have a mental health problem but have also been arrested or convicted of a crime.

Staff we spoke with knew how to administer medicines safely and records showed that medicines were being administered and checked regularly.

Accidents and incidents were monitored and analysed each quarter to see if any trends were identified.

We saw safety checks and certificates that were all in date. We saw fire drill were taking place but the information provided did not evidence that all members of staff had received at least one fire drill in the last year or if a fire drill had taken place for night staff. The operations manager said they would make sure this happened and update the staff list which still had names of people who were no longer working at the service. Water temperatures were not recorded routinely and fire alarm testing had not taken place since 23 May 2016.

Policies were in place to ensure people’s rights under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were protected. Where appropriate, the service worked collaboratively with other professionals to act in the best interests of people who could not make decisions for themselves. At the time of inspection three people were subject to a DoLS authorisation. Staff demonstrated a clear understanding of DoLS.

People were supported to maintain their health through access to food and drinks. Each person had their likes and dislikes documented and the majority of people shopped for their own food.

People who used the service chose what activities they wanted to do. In house activities also took place.

Staff we spoke with understood the principles and processes of safeguarding. Staff knew how to identify abuse and report it to the appropriate authority. Staff said they would be confident to whistle blow [raise concerns about the service, staff practices or provider] if the need ever arose.

The registered provider followed safe processes to help ensure staff were suitable to work with people living in the service. There were sufficient staff to provide the support needed and staff knew people’s needs well.

Staff had regular supervisions and appraisals to monitor their performance. Staff received regular training in the areas needed to support people effectively and were suitably trained to manage behaviours that challenge whilst ensuring people’s rights were protected.

People and a relative we spoke with spoke positively about the support they received. Throughout the inspection we saw people being treated with dignity and respect. People were actively involved in decisions about their care and support needs.

Three people using the service were using an advocate at the time of the inspection. Information on advocacy was available. Care plans for people who were older documented their end of life care wishes and preferences.

We found care plans to be person centred. Person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person.

The service worked with various healthcare and social care agencies and sought professional advice, to ensure that the individual needs of the people were being met.

The service had an up to date complaints policy. Complaints were properly recorded and fully investigated.

The registered provider carried out regular checks to monitor and improve the quality of the service.

Staff felt supported by the registered manager. The organisations values were evident in the way staff provided support.

Feedback was sought from people and their relatives on the quality of the service on a regular basis.

Staff and people who used the service had regular meetings.

The registered manager understood their roles and responsibilities, and felt supported by the registered provider.

Another person told us they were looking forward to their birthday and going out to celebrate with their relatives. People who used the service told us they felt safe. People also told us that they had a say in what they do and what happens to them. . One person said that 'People living in the home have meetings to discuss what meals everyone likes and what to put on the menu'. Another person said they had meetings to discuss what they are going to do and where they are going to go.

People told us they liked the people caring for and supporting them. One person told us that they helped with interviewing new staff and asking them questions. People told us that it was always clean and tidy and everyone helped to do the cleaning.

They told us they liked washing up and helping with the cooking. They went on to say that they liked sitting with the staff and chatting with them over a cup of coffee in the in the lounge'.

The provider had a system for checking the quality and safety of the service and records were maintained and held securely.