Ivy Lodge is registered to provide care and accommodation for up to 34 older people. The home provides accommodation on two floors. At the time of our inspection there were 33 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At our last inspection we found the service to be outstandingly caring. At this inspection, we found this continued to be the case. Staff were exceptionally compassionate and kind. We observed numerous caring interactions between staff and people who used the service. It was evident positive relationships had been formed and staff knew people extremely well. Staff used this knowledge to provide a personalised service and enhance people’s wellbeing. Throughout our inspection, we saw staff payed great attention to detail when supporting people, in order to ensure they felt valued and respected. We heard comments between staff and people which demonstrated the mutually high regard with which they held each other.

The service was safe and people were protected from harm. Care workers were knowledgeable about safeguarding adults from abuse and knew what to do if they had any concerns and how to report them. There were sufficient staff to meet the needs of the people who used the service and care workers demonstrated they had the relevant knowledge to support people with their care.

Recruitment practices were safe and records confirmed this.

Medicines were managed and administered safely.

Training was provided regularly and updated when required. Care workers demonstrated an understanding of the Mental Capacity Act (2005) and told us how they obtained consent before assisting with care. People were supported to maintain a balanced diet. People were offered choice of meals that were provided in line with their preferences.

Care plans were extremely person-centred and comprehensive. Since the last inspection the provider and registered manager had developed the social activities for people; this was evident in the records.

People were supported to access healthcare services and received ongoing support. Referrals to healthcare professionals were made appropriately.

People who used the service, staff and relatives all spoke very positively about the provider and the registered manager and all expressed the positive impact their involvement had.

Quality assurance audits were in place and actions taken promptly to address any issues identified.

Further information is in the detailed findings below.

The inspection took place on the 1 December 2015. The inspection was unannounced. At the last inspection of the service which took place on 28 May 2014 the provider was compliant with all of the regulations assessed.

Ivy Lodge is registered to provide care and accommodation for up to 34 older people. There were 31 people living at Ivy Lodge on the day of our inspection. The building is situated in a residential area of Haxby, approximately four miles from the centre of York. The home provides accommodation on two floors. There is a choice of communal space and a passenger lift to the first floor to make access easier. The home has a garden area, and parking places are available for visitors.

Ivy Lodge has 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 and their relatives spoke of the outstanding care they received. They described the care they received as ‘excellent’ and ‘fantastic’ and told us of the high regard they had for the registered provider, his wife, the registered manager and staff who they told us were consistently prepared to go the extra mile. They gave an example of the registered provider popping out to the shops to get something that they fancied to eat or drink or bringing in a jigsaw. People consistently felt that ‘nothing was too much trouble’ and they knew that they mattered.

People spoke of the outstanding leadership and management at the service stating that the registered provider and registered manager ‘led by example.’ The registered provider and his wife spent time at the home on a daily basis. It was evident that management were passionate and committed about valuing those they supported and their staff. Staff were proud to work at the home. There were clear values in place which the management and staff were committed to.

The registered provider and registered manager had systems which supported people in sharing their views and opinions and where suggestions for improvement were made these were always acted upon. Their approach to offering ‘compassionate and person centred care’ was evident and this view was echoed by visitors and the professional we spoke with.

People told us that they were treated with dignity and respect. We saw examples of this during our visit. A professional said “They really do know the people they support.” People viewed Ivy Lodge as ‘Their home’, and we were struck by the warm, friendly, caring ambience that was clearly in place.

There was an open and transparent culture and all of the people we spoke with told us that they were asked to feedback their views. There were good management systems in place which enabled the registered provider to review the quality of care being provided.

People spoke highly of the staff and told us that they responded quickly to their needs. Staff received a varied training programme so that their knowledge, skills and experience could be kept up to date. The registered provider and registered manager were enthusiastic about evaluating and improving practice at the home and they had recently won a national care home award.

They had an excellent working relationship with their GP who told us that the service was proactive in ensuring people received the right health support. There were good systems to monitor people’s health and wellbeing. People consistently told us that the standard of care and support was ‘excellent.’

Staff had a clear understanding of The Mental Capacity Act and the importance of consent. People told us that they could make decisions and choices regarding all aspects of their lives, which was a comment echoed by relatives. Staff provided clear explanations to people before carrying out any care.

People received a varied range of social opportunities which helped to prevent isolation and was designed to respond to a range of sensory elements. People spoke positively of the social opportunities provided. They made suggestions for places they wanted to visit or things they wanted to try.

No-one who we spoke with could think of any improvements to make at Ivy Lodge. They told us that the registered manager and staff were constantly making improvements as they wanted to provide the best care to people. People told us they could raise complaints but also told us that they did not have any as minor niggles were dealt with immediately.

People consistently told us how approachable, warm and friendly the registered provider and staff were. The service was focused on those who lived there and extended to their families and friends.

We carried out this inspection to answer our five questions; 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 who used the service, speaking with visitors, speaking with the owner and manager and from looking at records.

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

Is the service safe?

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no recent applications had needed to be submitted. All staff were due to receive training in this area and the manager confirmed that they understood when an application should be made, and how to submit one. This meant that people were safeguarded as required.

People received an assessment which helped to ensure that the home was able to meet their needs. We saw care plans and risk assessments were in place to help ensure people's safety and welfare. Information was reviewed regularly to ensure that it was up to date and reflected any changes.

The home had systems in place to make sure that managers and staff learnt from events such as accidents, incidents, complaints, concerns and whistleblowing. This helped to reduce the risks to people and helped the service to continually improve.

Is the service effective?

Individual choices and decisions were documented in the care plans we looked at and staff reviewed these decisions on a regular basis. However, people did not always sign their agreement to their records. This meant that it may be difficult for the provider to evidence who had input to people’s care file development and that the decisions made about care were agreed by the person who used the service or their representative.

All of the people we spoke with said that they liked living at the home, said they felt listened to and would recommend the home to others.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. One relative told us that they visited the service regularly and were delighted with their parent’s care.

Feedback from people who used the service, relatives and staff was obtained through the use of satisfaction questionnaires, meetings and one to one sessions. This information was usually analysed by the provider and where necessary action was taken to make changes or improvements to the service

Is the service responsive?

Since our last visit the service had reviewed their care records to ensure the care being delivered was appropriate for those who lived there. They had implemented a professional visitor sheet and updated the care plans.

We saw that the home had responded to suggestions made within questionnaires or within meetings and people were confident that the home would respond to any concerns if they were unhappy. They had improved the range of social activities available and carried out a programme of refurbishment and redecoration. Comments included "We have new furniture, including tables and chairs. There are a lot more activities taking place."

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. Meetings were held so that people could air their views. The relatives and those living at the home who we spoke with all confirmed that they felt able to air their views with the provider and manager and that these were responded to. One person told us "The service is under new management. It has improved. We can talk to the new owners and there is lots more going on."

Everyone told us they were satisfied with the care they or their relative received. People told us that they were treated with respect and were able to make choices and decisions about their care. Comments included "We are very lucky to live here, I am glad to call this my home." People also told us that they had ample opportunity to attend a range of social and leisure opportunities. They told us that the food was 'delicious' and that they were well cared for.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place which helped to ensure that medicines were well managed. People were supported to manage their own medicines where this was appropriate.

Records we looked at confirmed that staff received training in areas such as first aid, infection control and safeguarding. Staff we spoke with told us that they received ‘good support from the manager’ and that they received useful/appropriate training.

There were a range of effective quality management systems in place to assess and monitor the quality of service that people received. People's views and opinions were sought and their comments were acted upon.

We talked with ten people who live at the home. All told us staff were "very nice" and "very caring". One person mentioned staff "as being like a family". They all told us told us they were able to make choices about when they retired or arose from bed; they describe how their routine was "flexible".

People we spoke with told us that the food at the home was "Excellent" and "Very good" and that they always had choices. They also told us that there were activities daily. One person said "There is always something to do".

We spoke with four relatives who were visiting. They told us they were very pleased with the home. One said "The home is brilliant in everyway. The care is superb and the staff are always cheerful." Another relative said "It is lovely here - we find the home very accommodating. Any concerns are addressed. The manager is very good and the staff are really good. Mum is very happy here."

We spoke with two visiting health professionals who also spoke highly of this service. They made comments such as "Ivy Lodge is a brilliant home I like the little finishing touches, they do that little bit extra. The manager knows exactly what is going on in the home. We have a good relationship with the home, they are always willing to try and always refer people to us quickly to ensure people are getting the best care that they need." Another health professional told us "Super home in everyway. The manager is perceptive in following up concerns. They work well with us and communication is spot on."

We spoke with the Local Authority Contracts Officer who informed us that they did not have any concerns about this service.