This inspection took place on 6 and 7 November 2018 and was unannounced.

Ivy House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Ivy House accommodates 20 people in one adapted building. The service specialises in caring for older people including those with living with dementia. At the time of our inspection 17 people were in residence.

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.

This was the first inspection of the service since they were registered in December 2017. At this inspection we found evidence to support the rating of ‘requires improvement’.

The provider did not have systems and processes to assure themselves about the quality of service provided. There was a lack of oversight on the service and monitoring was ineffective.

People were not safe. Risks associated with the premises had not been effectively managed. People were not protected from the risk of burns or scalding from excessively hot surfaces. We found fixtures, fittings and furniture were damaged and not safe. Infection control procedures and practices were not always followed. Maintenance was not provided in a timely manner to ensure the premises were safe and fit for their intended purpose.

We found medicines were not stored safely. The registered manager removed and returned all the medicines that were no longer used to the pharmacy. Further action was needed to ensure medicines were stored securely in people’s rooms and people were supported with their medicines as prescribed.

Staff recruitment process was not followed to protect people from unsuitable staff.

There were enough staff to meet people’s needs. A system was in place to ensure staff were trained and supported in their role. Further action was needed to ensure staff training was kept up to date and staff practices were observed and monitored.

Risks associated with people’s needs had been assessed; safety measures were put in place and they were monitored and reviewed regularly.

People’s dietary needs were met. Drinks and snacks were available. People had access to health care services.

People were involved in decisions made about all aspects of their care. 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 were cared for by kind and caring staff. Staff knew people well; understood their wishes and daily needs. People had the opportunity make decisions about their end of life care.

People did not always receive care that was person centred and responsive. People’s dignity and privacy was not always respected. Care plans lacked information and clear guidance for staff to follow to provide person centred care such as guidance provided by health care professionals, food preferences and hobbies.

The provider employed an activity co-ordinator but people’s experiences about the activities, social stimulation and engagement varied. People were not always protected from the risk of loneliness.

Information was made available in accessible formats to help people understand the care and support agreed. The provider was developing picture menus to help people living with dementia choose what they want to eat.

People and their relative knew how to make a complaint and felt confident that action would be taken. However, there were limited opportunities for people to express their views about the service and influence how the service was run.

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