We undertook an unannounced inspection of this service on 17 and 19 October 2018.

Ivy Bank 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. There are 25 single rooms, with ensuite facilities and one double room. A lift is situated near the dining area for people to access both floors. There is a shared lounge and dining area, and an additional smaller lounge on the ground floor. The service provides residential and dementia care for up to 27 people. At the time of inspection, there were 22 people living at the service.

We last inspected Ivy Bank on 12 September 2017, and found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured that all risks had been mitigated in regard to supporting people with their behaviour, or the risk of developing pressure areas. Audits had not identified the shortfalls we found in these areas. We rated the service ‘Requires Improvement’ and the provider submitted an action plan to demonstrate how they would meet the breaches identified.

At this inspection, we found improvements in some areas but identified two continued breaches in of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the fourth consecutive time the service has been rated ‘Requires Improvement.’

Improvements had been in relation to supporting people with their behaviour, and there had been no pressure areas. However we identified issues, such as the implementation of care plans and risk assessments, and specific care plans to support people living with diabetes, catheters and epilepsy.

Audits had not been completed in a timely manner to resolve the concerns we identified during this inspection. Staff had not consistently received the training required to complete their roles effectively. However, staff told us they felt well supported by the management.

People’s needs were assessed prior to them receiving care, however care plans had not been implemented for one person. Care plans we reviewed were person centred, however in some cases they had not been updated in a timely manner to reflect people’s current needs. People were at risk of social isolation, as there was limited activity within the home to provide them with stimulation.

People told us and we observed the service to be tired in places and in need of decoration. Improvements could be made to ensure the premises is suitable for all those living there, including those with visual impairments.

There were sufficient staff to meet people’s healthcare needs. Safe recruitment processes had been followed to recruit new staff. Most staff had received training in safeguarding adults, and staff knew how to raise concerns about people. Most staff had received training in infection control, and the service was clean throughout.

People were supported to receive their medicines as prescribed, and by staff who were competent in medicines administration. People were supported to access healthcare professionals when their needs changed. People told us they enjoyed the food and received sufficient food and fluid to maintain a balanced diet.

People knew how to raise concerns. When accidents and incidents occurred, they were logged and used to improve the service.

People were supported to have a pain free, dignified end of life.

Staff treated people with kindness, respect and compassion. Staff knew people well, and were able to respond when people showed signs of distress. People told us staff treated them with dignity and encouraged them to be as independent as possible.

The service had a registered manager supported by a deputy Manager and a consultant who worked at the service previously and supported one day per week. A registered manager is a person who has registered with the

We undertook an unannounced inspection of this service on 12 September 2017.

Ivy Bank is providing residential and dementia care for up to 27 people. Residential accommodation is situated over two floors; there are 25 single rooms, with ensuite facilities, and one double room. A lift is situated near the dining area for people to access both floors. There is a shared lounge and dining area, and an additional smaller lounge on the ground floor. At the time of inspection there were 22 people living at the service.

This service had a registered manager in post. A registered manager is a person who is 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.

After the previous inspection in February 2017, four warning notices were served as there was a lack of effective governance in place. This included a lack of staff supervision and not gathering feedback from people to continually improve the service. Auditing systems were not effective or used to drive improvement in the quality and safety of the service. Risks had not been mitigated to ensure that people were protected from avoidable harm and medicines were not being managed safely. Care plans were not person centred to ensure that people received personalised care that was based on an assessment of their needs and preferences. The provider sent the Care Quality Commission an action plan to address the shortfalls, with a timescale to become compliant with the regulations. We found that the provider had taken action to comply with the warning notices. However, improvements were needed in the way risk was recorded and in the governance arrangements.

The provider and registered manager had made some improvements to ensure that people received safe care and treatment. However, there remained shortfalls in the records to guide staff when supporting people with certain types of behaviour, in recording required settings on equipment and when moving people. Staff knew people well and told us how they moved people safely and supported them with their behaviour but these details were not always recorded in their care plans. People’s medicines were managed safely by staff who were trained and assessed as competent. Protocols for people’s ‘as and when required’ (PRN) medicines had been completed. However they required more detailed guidance about when staff should offer the medicines.

The registered manager had completed audits to identify environmental risks. Action had been taken to address any issues identified. An external audit had been requested in relation to medicines and this had been followed by regular internal audits. A new computerised care planning system had been introduced to assist in improving monitoring. However, the audits failed to identify the shortfalls found at this inspection. Accidents and incidents had been summarised but further detail was required in some cases to add exactly what action had been taken to make sure people were safe.

At the last inspection two requirements notices were served as staff had a lack of understanding with regard to assessing people’s mental capacity and staff did not always uphold people’s privacy and dignity. At this inspection improvements had been made and the requirement notices had been complied with. 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’s mental capacity had been assessed and authorisations to deprive people of their liberty in line with the Mental Capacity Act had been applied for appropriately.

Care plans now gave more detail about people’s life history and preferences. Staff knew people well and treated peo

We undertook an unannounced inspection of this service on 7 March 2017.

Ivy Bank is providing residential and dementia care for up to 27 people. Residential accommodation is situated over two floors; there are 25 single rooms, with ensuite facilities, and one double room. A lift is situated near the dining area for people to access both floors. There is a shared lounge and dining area, and an additional smaller lounge on the ground floor. At the time of inspection there were 23 people living at the service.

This service had a registered manager in post. A registered manager is a person who is 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 provider and registered manager had failed to ensure that the service was compliant with the regulations. After the previous inspection in February 2016, the provider sent us an action plan to address four breaches in the regulations. They told us they would be compliant by April 2016. At the time of this inspection the requirement notices had not been met, therefore there were four continued breaches of the regulations.

The registered provider and registered manager had failed to ensure that the checks and audits carried out by staff were effective; these had not identified the shortfalls found at this inspection.

Potential risks to people were identified; however there was a lack of control measures detailed in the moving and handling, and behaviour risk assessments to guide staff on how to safely manage the associated risks.

Accidents and incidents were recorded, however we could not confirm that appropriate action had been taken to investigate and look for patterns or trends, to prevent further occurrences.

The provider had made some improvements to the premises, and a maintenance and redecoration plan was in place. A recommendation was made with regard to seeking advice and guidance of how to design areas to be more dementia friendly.

Checks had been carried out regularly on the environment and equipment, however when there was a fault with a dial on a pressure relieving mattress the fault had been recorded but there was no record of the action taken. The systems to reduce the risk of fire were checked and staff had a clear understanding of what action to take in the event of a fire.

Medicines were not stored in line with current legalisation and there were no protocols to ensure that people received their ‘as and when’ required medicines when they needed them.

People were supported to access health care appointments and relevant health professionals were requested as required.

There were no mental capacity assessments in place and there was a lack of professional meetings to ensure that decisions were made in people’s best interests.

Nutritional needs had been assessed but there was a lack of accurate monitoring of fluid charts to ensure people had enough to drink. The recommendations made by health care professionals with regard to the consistency of people’s meals was not being followed.

Staff did not always uphold people’s dignity, when supporting them to eat and drink. Staff treated people with kindness, encouraged their independence and gave them choices. Staff responded to people promptly when they needed help but there was a lack of interaction from staff during the morning. This improved in the afternoon when activities for some people were provided.

People’s needs were assessed before they came to live at the service, however one person had been living at the service for over two weeks and their care plan had not been completed. People’s care plans were not personalised to ensure they received care in line with their choices and preferences. Care plans were not always updated with current needs.

Alth

We undertook an unannounced inspection of this service on 29 February and 1 March 2016

Ivy Bank is providing residential and dementia care for up to 27 people. Residential accommodation is situated over two floors; there are 26 single rooms, with ensuite facilities, and one double room. A lift is situated near the dining area for people to access both floors. There is a shared lounge and dining area, and an additional smaller lounge on the ground floor. At the time of inspection there were 25 people living at the service.

This service had a registered manager in post. A registered manager is a person who is 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.

Staff had received training in how to keep people safe and safeguarding procedures were in place to keep people safe from harm. However, the safeguarding policy had not been updated in line with current legislation. Staff understood the whistle blowing policy and were confident that the registered manager would take appropriate action if required.

Potential risks to people were identified; however there was a lack of control measures detailed in the care plans and environmental risk assessments to guide staff on how to safely manage the associated risks.

Checks on the fire call points had not been carried out in line with good practice. Not all staff had been involved in the fire drills to ensure they had a clear understanding of what action to take in the event of a fire.

Accidents and incidents were recorded, and appropriate action had been taken to investigate and look for patterns or trends, to prevent further occurrences. Equipment to support people with their mobility had been serviced to ensure that it was safe to use, and plans were in place in the event of an emergency.

The registered manager worked closely with the staff on a daily basis but there was a lack of regular one to one meetings with staff and yearly appraisals. This did not give staff an opportunity to discuss their performance, training, and development needs.

Relatives and staff told us that there were sufficient staff on duty at all times to meet people’s needs. Staff made sure that they spent quality time with people, giving reassurance and support, to ensure they had everything they needed.

Staff were recruited safely and there was a training programme in place to ensure that staff had the skills and competencies to carry out their roles. New staff received an induction and shadowed experienced staff until they were confident to perform their role. Records of the induction training were not sufficient to confirm the full programme of induction had been completed.

Staff knew the importance of supporting people to make decisions and had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). However, they were not all able to demonstrate an understanding of DoLS and what this would mean to the individual.

We observed the medicines being administered, and found that when people refused their medicines, no record had been kept to explain what action had been taken. The storage of the medicines also needed to be improved.

Staff responded to people promptly when they needed their help. People were treated with dignity and respect. Staff treated people with kindness, encouraged their independence and gave them choices.

There had been no formal complaints during the last year. There was a system in place to process complaints, but the policy was out of date and not in line with current legislation.

There were no dedicated hours for an activity co-ordinator. There were people who visited the service to provide entertainment, such as music for health, and sport activities. Staff also pr

This inspection was carried out by one inspector, who visited unannounced on the 17 September 2014. During the visit we met and talked with people that used the service and their relatives/representatives. The manager and staff on duty assisted with the inspection process. They helped answer our five questions;

Is the service safe?

Is the service caring?

Is the service responsive? Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We found that action had been taken and improvements had been made by management and staff since our last inspection visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Care records were reviewed and regular auditing was undertaken to ensure that people were protected against the risks of inappropriate or unsafe care and treatment.

People received their medicines when they needed them and in a way that was safe.

There were sufficient numbers of staff on duty at all times to make sure people were safe and received the care and support that they needed.

Is the service effective?

The service was effective. People’s health and care needs were assessed with them and /or their representatives. Specialist dietary, mobility and equipment needs had been identified and the equipment was provided.

Care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or doctor. The staff acted promptly to make appointments for people. People were referred to health and social care professionals so they received the care and treatment they needed.

Is the service caring?

The service was caring. People were treated with respect and dignity by the staff. Staff interacted well with people and knew how to relate to them and how to communicate with them. People told us they were happy with the care they received and they got the help and support they needed.

Is the service responsive?

The service was responsive. Staff listened to people, and took action to deal with any concerns.

Is the service well-led?

The service was well-led. The registered manager had an open door policy and was available to speak with people using the service, their relatives or staff.

There were systems in place to provide on-going monitoring of the service. This included checks of the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual meetings with the registered manager or a senior member of staff, and staff meetings.

People who used the service had their comments and complaints listened to and acted on effectively. One person told us “I would speak to the staff or the manager if I had any concerns”.

There were 19 people using the service and we met, spent time with or spoke with most of them. Everyone we spoke with said that they were happy with the service.

One person said “The staff are nice here” and “We have very good parties.” Another person said “I am quite happy. The staff are very good, I have no complaints.”

A visitor told us “(Our relative) is happy here. We have no complaints. They always keep us informed and make us feel welcome when we visit” and “The staff are good here, they are ever so patient and kind, it is quite humbling to see really.”

People said or indicated that they were happy with their bedrooms and with the facilities. People told us that the food was very good and that they always had a choice of meals. Some people were enjoying a cooked breakfast when we arrived. People said that enjoyed the organised activities and events.

People’s health and personal care needs were supported and the service worked closely with health and social care professionals to maintain and improve people’s health and well-being. People were treated with dignity and respect and the service responded to people’s changing needs.

Checks were made on staff, as part of the recruitment process, to make sure that people were safe and supported by appropriate staff. The service was well managed and was safe and well maintained.

We spoke with five people and spent time in the main lounge with people living at Ivy Bank. Not everyone living in the home was able to talk about their lifestyle with us, so we observed the interactions between the people and staff. We saw people having conversations and engaging in meaningful activities with staff.

We saw that staff knew how to care for the people using the service and responded quickly when people needed support. Staff spent time with and empathised with people by responding to them respectfully and positively. Relatives told us that they were satisfied with the care their relative was receiving.

We observed people being given the choice of meals and staff explained the options clearly so that people had time to understand and make up their minds about what they would prefer.

We found records to show how people's health needs were supported and the service worked closely with health and social care professionals to maintain and improve people's health and well being.

The staff we spoke with had knowledge and understanding of people's needs and knew people's routines and how they liked to be supported.

In this report the name of one of the Registered Manager's Mr Manoj Daswani appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Concerns were raised to us anonymously about staff numbers, staff skills and that people’s needs may not be met. The timing of the concerns coincided with the dismissal of one staff member and the departure without notice of a second staff member.

We looked into the anonymous concerns and found them to be unsubstantiated. We found that Ivy Bank Residential Care Home was meeting the essential standards of quality and safety that we assessed.

People who use the service told us or expressed that they were happy at the home. People said that the staff were kind and that they felt that there were enough staff on duty.

Everyone we spoke to said that the food was good and that they felt safe. People said that the home was always clean.

Some visiting relatives told us that they were happy with the service and that they had been able to choose a bedroom for their relative. People told us that they trusted the staff and the manager and that they had no complaints. One relative said, ‘The staff are lovely’.