This was a comprehensive inspection. It took place on 16th and 17th May and was unannounced. Ivy Cottage provides accommodation and personal care for five people with learning disabilities who may have complex needs.

At the time of the inspection four people were living at Ivy Cottage and there was one vacancy. The premises are purpose built on one level with good access for people with limited mobility or wheel chair users. It is set on Highlands Farm near the village of Woodchurch.

Each person had their own room with additional communal bathroom and separate wet room. There was also a lounge/diner and kitchen. There was a fenced rear garden with a paved seating area.

Ivy Cottage 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 Cottage accommodates people with a learning disability and some with complex needs.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Rating at last inspection

At our last inspection we rated the service as good. At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

However, since the last inspection the service had not remained well-led. The registered manager had been absent for several months and a deputy manager with limited management experience had taken their place.

The provider had continued to deliver good service for the people who live there but, there had been a deterioration in the day to day support for staff especially in relation to staff supervision and appraisal.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good

People were protected from abuse with sufficient numbers of trained staff to meet people’s needs. Individual risk assessments provided staff with the information they needed to reduce and manage risks whilst ensuring people’s individual freedom and independence was respected.

Staff rostering ensured sufficient numbers of trained staff supported people’s activities, appointments and needs.

People received their medicines safely from trained staff. The service had worked with local health and social care professionals and sought guidance from the GP about the storage and administration of homely remedies as part of its regular auditing processes.

People’s individual needs were met through the design of the building. The service was clean, with measures in place to protect people from cross contamination and infection. Incidents had been recorded appropriately with systems to record follow up actions.

People’s needs and choices were assessed and reviewed regularly to reflect their needs and wishes. Support plans provided staff with clear guidelines about the support people needed in line with national guidelines.

Staff recruitment continued to follow safe procedures, ensuring statutory checks, induction training and shadowing of experienced staff, were all completed before new staff started work.

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.

Their consent was sought and external advocacy used where there were limitations to verbal communication, to ensure that the provider worked in line with the principles of the Mental Capacity Act 2005 (MCA) and assoc

This was an unannounced inspection carried out on 5 April 2016. The previous inspection on 19 November 2014 found breaches in records and quality assurance systems and these had been addressed.

Ivy Cottage provides accommodation and personal care for up to five people with a learning disability who may have an autism spectrum disorder. The service accommodates older people with a learning disability who may have complex needs. At the time of the inspection there were four people living at Ivy Cottage and one vacancy. The service is a purpose built bungalow with accommodation provided on one level. It is set in a rural area on the outskirts of Woodchurch village on Highlands Farm, which is a tourist attraction and where the provider has other registered services located. Each person has a single room and there is a communal bathroom, separate wet room, kitchen and lounge/diner. There is a garden with a paved seating area at the back of the bungalow.

The service is run by 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.

People received their medicines safely and when they should. Risks were assessed and staff took steps to keep people safe whilst encouraging their independence.

People were involved in the planning of their care and support. Care plans contained information about people’s wishes and preferences. They detailed people’s skills in relation to tasks and what support they required from staff, in order that their independence was maintained. People had regular reviews of their care and support where they were able to discuss any concerns or aspirations.

People were supported to make their own decisions and choices and these were respected by staff. Staff had received training in the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. The registered manager understood this process.

People were protected by safe recruitment procedures. New staff underwent an induction programme, which included shadowing experienced staff, until staff were competent to work on their own. Staff received training relevant to their role. Staff had opportunities for one to one meetings and team meetings, to enable them to carry out their duties effectively. Five staff had gained qualifications in health and social care. People had their needs met by sufficient numbers of staff. Staff rotas were based on people’s needs, health appointments and activities.

People were relaxed in staff’s company and staff listened and acted on what they said. People were treated with dignity and respect and their privacy was respected. Staff were kind and patient in their approach, but often used good humour. Most staff were new, but because the team was small, had already built up relationships with people and were familiar with their life stories and preferences.

People had a varied diet and were involved in planning the menus, making their lunches and light snacks and helping with the evening meal. Staff encouraged people to eat a healthy diet. People had a varied programme of interactive and leisure activities that they had chosen and accessed the community as they wished.

People were supported to maintain good health and attend appointments and check-ups. Appropriate referrals were made to health professionals when required. People did not have any concerns, but felt comfortable in raising issues. Their feedback was gained both informally and formally. The reg

Ivy Cottage provides accommodation and personal care for up to five people with a learning disability. At the time of the inspection there were four people living at Ivy Cottage.

The service does not have a registered manager, although the manager had submitted an application to the Care Quality Commission to register. 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 manager was not available during the inspection and a covering manager had been brought in by the trust to cover their leave arrangements.

The trust had various systems in place to obtain people’s views including meetings and informal discussions. However the trust had not regularly sought the views of people, persons acting on their behalf and staff about their experience of the care and treatment provided.

Records were not easily accessible during the inspection or could not be found. A second visit had to made to view some records.

The service had undergone and was still undergoing a period of major change. A decision had been taken to develop Ivy Cottage into a service for older people who had a learning disability with more complex needs. Two people had moved out and a new person had moved in, which meant that people had very different skills and abilities and support needs. There had also been an almost complete change of the staff team and a change of manager. New staff felt supported, but a minority of staff felt they had not always been supported and had received “mixed messages” from management, who had given different advice and direction. Senior management had recognised that staff worked hard, but there was a lack of leadership to pull the staff together to work more effectively as a team and were working to address this.

People told us they received their medicines when they should. Medicines were managed and administered safely. Two people administered their own medicines. Some changes to medicine records were not signed, dated or witnessed as is good practice.

The service was well maintained. There were systems and checks in place to help ensure that the equipment and premises remained in good condition and working order.

People felt safe living at Ivy Cottage. The service had safeguarding procedures in place, which staff had received training in. Staff demonstrated a good understanding of what constituted abuse and how to report any concerns.

People were protected by robust recruitment procedures. Staff files contained the required information. New staff underwent a thorough induction programme, which including relevant training courses and shadowing experienced staff, until they were competent to work on their own.

People were supported by sufficient numbers of staff, in order to meet their needs and facilitate their chosen activities. Staff vacancies were filled by a bank of staff employed by the trust, so that there was always sufficient. The covering manager had identified that improved planning of staff’s time during their shift was required and would benefit people. Staff received supervision and training, but there had been a delay in some refresher training and supervision was not in line with timescales within the provider’s supervision policy.

Risks associated with people’s health and welfare had been assessed and guidance was in place about how these risks could be minimised. Risk assessments did not restrict people, but were used to promote their independence. There were systems in place to review any accidents and incidents and make relevant improvements, to reduce the risk of further occurrence.

People had opportunities for a range of work and leisure activities that they had chosen. Staff were familiar with people’s likes and dislikes and supported people to make their own choices. Staff supported people to be as independent as possible, demonstrated respect and upheld people’s dignity.

People said they “liked” the food. They had a variety of meals and adequate food and drink. People were involved in the planning, preparation and cooking of meals.

People were supported to make their own decisions and choices. The manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). They were aware of the process, where people lacked the capacity to make their own decisions, to ensure these decisions would be taken in their best interests, decisions such as medical treatment had involved best interest meetings.

People were involved in planning their care and support. Care plans included people’s wishes and preferences and skills and abilities. However one person’s care plan had not been recently reviewed. They had regular review meetings to discuss their support and aspirations. People’s health care needs were monitored; they had access to a variety of healthcare professionals and were support to attend healthcare appointments to maintain good health. Some advice and guidance from a healthcare professional had been slow to be implemented, but this was being addressed.

People were relaxed in staff’s company and staff listened and acted on what they said. People’s privacy was respected. People told us they “like” the staff. Staff were kind and caring in their approach and knew people and their support needs.

Staff were able to talk about the provider’s vision, mission and values of the trust. There were systems in place to monitor and audit the quality of service provided. Trustees and senior managers carried out visits to the service and staff undertook a variety of regular checks.

People felt comfortable in complaining, but did not have any concerns. Complaints procedures were displayed, but required reviewing and important information adding, to ensure that people were fully aware of how their complaint would be managed.

You can see what action we told the provider to take at the back of the full version of the report.

On 5 August 2013 we inspected Ivy Cottage and found non-compliance in the areas relating to management of medicines and staffing. This was a follow up inspection to check compliance against those areas.

During this inspection we spoke with two people who used the service, the registered manager and one member of staff. We later spoke to two staff by telephone and a social worker.

People spoken with told us they continued to be satisfied with the service received. People said they got their medication when they should and they felt there sufficient staff on duty to meet their needs.

We spoke with all five people who were using the service, the manager and three staff.

People told us they were encouraged to do things for themselves and make their own decisions. People said they knew about their care plans and had been involved in putting these together. People told us they were happy living at Ivy Cottage and satisfied with the care and support they received. One person said, “I like living here” and “everything is good”. Another person said, “We all get on here”. People told us they got their medicines when they should. One person talked about how some of their medicines were stored in their room, so they could manage these themselves. However we found some shortfalls in the way medicines were managed. People thought there were enough staff on duty to meet their needs. However staff spoken with felt there was not sufficient staff on duty to meet everyone’s needs. People confirmed that the staff helped them when they needed it and were always kind. People told us about regular residents’ meetings and other opportunities where they could talk about any concerns and feedback about the service provided.

We spoke with three people who used the service, the manager and two staff.

People talked about their interests, the places they had visited and those they planned to visit. People said they chose their meals and helped with the chores around the house. One person said, “I like ironing”. People told us they knew about their care plans and had signed them. People said they were happy living at Ivy Cottage and satisfied with the care and support they received. People told us they like their rooms, the home was well maintained and always clean and tidy. People told us they liked the staff team and thought they supported them very well. People knew who to speak with if they had any concerns, which they didn’t. One said, “If we have any concerns we can talk about them in our resident meetings or our talk time”. Talk time was a period of one to one time with staff to discuss any issues or aspirations.

People told us they had discussed their care and support with staff. They knew about their care plan and were involved in reviewing their care needs. Everyone was satisfied with the care and support received. People were able to make decisions and had control over their day to day lives. People confirmed they felt safe living at Ivy Cottage. People told us the home was always clean and tidy. The service did checks to ensure things ran smoothly and people were satisfied with their care and support. People said they felt confident to raise concerns.