Ivy House

Updated 12 May 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was completed by two inspectors.

Service and service type

Ivy House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ivy House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

This service is required to have a registered manager. A registered manager is a person who has registered with the CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection, there was not a registered manager in post. A new manager had started at the service in February 2022. They were in the process of applying to become the registered manager.

Notice of inspection

This inspection was announced. We gave 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure staff and people would be in the service when we inspected.

What we did before the inspection

We reviewed information we received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with one person who used the service, the manager and the provider’s nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included four people’s care records and three people’s medicine records. We looked at two staff files in relation to recruitment and staff supervision. A variety of other records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We spoke with two members of staff, two professionals who worked with the service and three people’s relatives by telephone to gather their feedback. We continued to seek clarification from the provider to validate evidence found and seek assurances about risks.

Updated 12 May 2022

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 the Care Quality Commission (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.

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.