Ivydene Residential and Nursing Home is a care home for up to 57 older people. The home provides care and support to people with varying and at times complex care needs, including those who were no longer able to live safely at home, those with nursing needs and those who were living with dementia.

The home is purpose built to provide three care areas, one for nursing care, one for residential care and one for people living with dementia. Care is provided over two floors and a passenger lift provides access to the first floor. There is also a large enclosed garden. At the time of the inspection 53 people were living at the home: 27 people in the nursing unit, 12 people in the residential care unit and 14 people in the dementia care unit.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

The care and support provided at Ivydene Residential and Nursing Home continues to meet all relevant fundamental standards.

People received safe care and support. One person told us, “Heavens, yes. I never feel at risk, I feel quite secure.” The home employed sufficient numbers of safely recruited and well-trained staff to meet people’s needs and to spend time socialising with them. Risk assessments were carried out to enable people to retain their independence, which guided staff to support them in a way that minimised risks.

People's healthcare needs were monitored and people received their medicines safely. The home was involved in a new initiative with the local Clinical Commissioning Group. This involved increased monitoring of people’s health care needs in the care home by the GP and a pharmacist to try to avoid admissions to hospital. In addition, a consultant in the care of older people visited the service periodically to review those people with the most complex care needs. 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 home supported this practice.

People told us, and we observed, that staff were kind, caring and patient. One person said, “Believe me, they’re good; I cannot fault the place. I am lucky to be here. When I had to go to hospital I couldn’t wait to get home here.” Another said, “They pamper me, they look after me wonderfully. Nothing is too much trouble”.

Individualised care plans provided staff with clear guidance and information about people’s care needs and their preferences. People said they enjoyed the social activities provided by the home, particularly the visits from the children from the local nursery. People told us the management team were open and approachable. The registered manager encouraged feedback about the quality of care and support provided at the home. Complaints were fully investigated and responded to.

There were effective monitoring systems in place to ensure the home provided person centred care in a safe environment.

People were supported by sufficient numbers of well trained and safely recruited staff.

Further information is in the detailed findings below.

During our previous inspection in June 2013 we found staff at Ivydene Nursing Home were not receiving regular supervision and appraisal. We visited the service in September 2013 and found significant improvements had been made in this area.

We reviewed the training files and supervision notes of staff during our visit and we found staff had regular access to a wide variety of health related training courses including infection control, dementia and manual handling. We found the home had implemented regular supervision and appraisal of staff. This meant staff were well trained to meet the care and treatment needs of people living at Ivydene Nursing Home and supported in their roles.

There were 52 people living at the home on the day of our visit, nearly half of whom had nursing needs. We visited the three wings at the home and spoke with 17 people living at the home, five visiting relatives or friends, a visiting church minister, a visiting GP, and seven nursing or care staff.

We saw that the environment was clean, homely yet tidy, with no malodour.

People experienced care and support that met their needs and protected their rights. Their comments included "It's like home from home, except you don't have to clean!" and, "What I can't do for myself, they do for me." One person said "We go to the top [meaning the management] if there's anything wrong."

People were protected from the risks of unsafe or inappropriate care because accurate and appropriate records were kept. There were appropriate arrangements for managing their medicines safely.

The great majority of people we spoke with were very positive about the staff and the support they received. Their comments included “Staff are very good and work to a very high standard” and "You can always get them if you want...If you want help, you get it."

There were systems to monitor the service's quality, to bring about improvements. Results of a recent survey were due. One person who went to the residents' meetings told us the home was "very responsive to food requests". There were also systems to manage risks to the safety and welfare of people who lived in or went to the home.

We made an unannounced visit to Ivydene Nursing Home as part of the review. This was to check on the provider's compliance with a warning notice issued following our previous inspection in June 2012. The provider was required to become compliant by 28 July 2012.

The previous concerns were that the assessment of some people's needs, the planning of care and the delivery of planned care were not always such as to meet these people's individual needs. This meant that there was a risk to their welfare and safety.

During this visit, we spoke with five people who lived at the home, two visitors, five care and ancillary staff, the deputy manager and the regional manager for the service. We observed support that four people received and looked at their care records.

We found that improvements had been made. The provider had taken steps to ensure that people experienced care and support that met their needs appropriately.

We (the Care Quality Commission) conducted an unannounced visit to Ivydene Nursing Home on 27 July 2012 due to concerns identified by a recent safeguarding alert.

We met or observed the majority of people who were living on the ground floor and two relatives. We spoke to one health care professional, talked with the staff, and checked the provider’s records. The company’s regional manager and home manager also provided information.

The areas we visited were the residential wings, including the residential wing which accommodated people with a diagnosis of dementia. We visited to look at Outcome 5: Meeting Nutritional needs. People told us about the quality and choice of food and drink available. This was because this inspection was only looking to assess whether people living in the residential care parts of the Ivydene Nursing Home were treated with dignity and respect and whether their nutritional needs were met.

We looked at the care records of all the people who used services on the residential areas of the home. This involved looking at the Eating and Drinking sections of the care plans, with a follow up look at weight charts, food and fluid charts and monitoring of all these aspects for people’s wellbeing.

One person told us “food all OK”. We talked with most of the people who lived in the home but some people were not able to communicate verbally to us in a meaningful way.

We saw people’s privacy and dignity being respected and staff were being helpful. One person required assistance due to choking at lunch time. The staff were observed acting promptly, provided reassurance, and remained calm. Comments from people who lived in the care home included “there is a choice offered”.

One relative was staying for lunch and said the food was very good and they provided a special diet for their relative. This meal was made to look appetising and was well presented. This relative also commended the home for providing “bistro tables”, in a separate area, so they were able to enjoy their lunch just with their relative.

We saw and heard staff speak to people in a way that demonstrated a good understanding by staff of people’s choices and preferences. We spoke to staff about the meals provided, looked at records related to individuals eating and nutritional needs, and met with individuals and observed staff working with them, particularly at a main meal time.

We saw that the staff had a good understanding of people’s individual needs and that they were kind and respectful. They took time to work at people’s own pace when assisting people with their meals.

We observed people being supported to make decisions about the meals available so as to be as independent as possible. People were asked their choice as close to meal times as possible. This was due to people sometimes forgetting what they had ordered if asked too soon. Providing this service assisted people from becoming upset and confused. We saw that people’s care records described their likes and dislikes as well as how best to provide support at meal times.

During our visit to the home we saw sufficient staff to assist people with meal times and to offer one to one support where needed.

We (the Commission) carried out this inspection as part of our routine inspection schedule, intending to follow up on what progress had been made with those standards of care which were not compliant with the Health and Social Care Act 2008 at our inspection in October 2011. We made an unannounced visit to the home on 11 June 2012 as part of the inspection process.

We met with and spoke to or observed some of the support received by 12 of the 51 people who lived at the home, to get an understanding of their experience of the service. We spoke with a visitor, a visiting professional, six care and ancillary staff to get their views of the home, as well as being assisted by administrative staff, the deputy manager and a regional manager employed by the provider. The home's unregistered manager was not at the home on the day we visited and we spoke with her on a later date.

People were consulted and involved daily in decisions about their care, such as when to get up or go to bed, and having a choice of meals at mealtimes. One person we met in their bedroom told us they preferred to sit there rather than in the lounge with others, and that staff respected this. They added “No, I’m not stuck in here because they don’t care – I do as I want.” Another person also commented, “They put things [events] on and you go if you want, like for the Queen’s Jubilee. Sometimes they have a church service.”

People felt they received enough information about life at the home, and showed us the home's newsletter they had been given. Two people told us that staff took them out locally to a hairdresser and to a manicurist, which enabled people to be part of the local community. A residents’ committee group had been set up recently, which some people's relatives attended as well.

People's privacy and independence was promoted. Colours and pictures were used to identify bathrooms and toilets on the wing for people with needs due to dementia, helping them to use the environment more independently despite their memory problems. There were other adaptations to promote people's independence and privacy safely. We heard staff engaging with people in a friendly yet respectful manner, whilst providing support that would ensure their dignity was not compromised. We saw dining rooms had the same homely touches whether they were on the wing for those with dementia or on the nursing wing. Tables had cloths, cutlery laid out, drinks glasses and condiments, for example. This showed people were treated equally, despite their needs or disability.

When we asked people if they felt safe with staff and if their property was looked after properly, they responded positively. One added, “They’re nice staff.” People told us they felt able to speak up if something was wrong or they had a complaint, and they felt the problem would be addressed.

Their consent was sought regarding care and support they received. Two people we spoke with told us staff managed their medication for them because they felt unable to do this themselves and we saw signed consent forms in people’s care records in relation to this. We found variable record-keeping in relation to people's mental ability to make decisions for themselves about their care and how this was assessed, however.

Action was taken by the service, in part through working with other professionals, to meet people's various health needs, such as through a regular chiropody service and involvement of specialists such as dieticians and Speech and Language Therapists. The service had also taken steps to meet people's recreational needs and preferences, with events planned three times each day, including week-ends. One person told us they liked animals, and we saw information about a Pat-a-pet scheme, which was going to bring animals into the home for people to enjoy.

Someone sitting in their bedroom told us that staff answered their call bell quickly enough, and that staff went into them at intervals to see they were ‘okay’. A community-based health professional told us that they could locate staff easily on their visits if they needed them. One person commented that staff were always happy to help, and we saw that staff did not rush people. Staff were very committed and caring, but people were not protected against the risk of inappropriate or unsafe care because planned care was not always provided. We had asked the home to take action to achieve compliance with the standard relating to people's care and welfare at our last two inspections.

One person told us they had completed surveys for the home about the service they received, though they were not told the outcome of these surveys. The unregistered manager told us that results were to be put in the newsletter in future. Someone commented that housekeeping staff didn’t always have time to move furniture in their room to clean it thoroughly. We saw records that were being introduced to monitor this, with a system for communicating any cleaning that hadn’t been undertaken as originally planned. Thus there was ongoing action by the service to improve its systems for assessing and monitoring the quality of the service.

We spoke to ten people during this visit and all told us they were happy with the care and treatment they received at Ivydene.

One person told us told us, “staff are so kind, even though they are always busy”. Another said, “I couldn’t be living at a better place” and “you won’t find anything wrong here”. Another person said that when they call for assistance staff sometimes take a long time in responding but they were ‘used to it’.

We asked people whether staff had discussed and asked them for their consent to the care that they were being given. None of them could confirm that they had been asked but all said that they were happy with how their needs are met. One person told us that they had not been ‘formally’ asked to agree or consent to care or treatment. They said ‘I would soon stop them if I didn’t consent, as long as I was able to and knew what they had in mind’.

A relative of a person living at Ivydene told us they had not been given any information about, and not been involved in, care planning for their relative. They said they had been given some information but it was ‘after it had all been arranged’.

People told us that they enjoyed the meals served at Ivydene and that meal times were pleasant.

All the people we spoke to during our visit told us they were well cared for by the staff and that they felt safe.

The people we spoke to at Ivydene were all happy with the care and treatment they received. They said they were happy with how they were looked after by the staff.

One person told us told us, “all the staff are so kind”. Another said, “couldn't wish for more” and “We all have great fun, we can't complain”. Another person said that when they call for assistance the staff come “as quickly as they can, there are others here for them to look after as well as me”

We had concerns that privacy, dignity, respect and consent were not always present in some of the practices that we saw.

Although people told us that they were happy with their care we saw that the management and recording of care was poor and disorganised. Assessments of individuals’ needs, their care planning, and their risk assessments did not consider all of their needs. They also often lacked basic information and were not always accurate.

All the food served to the people was prepared at Ivydene. People told us how much they enjoyed the food and we saw that there was plenty of choice at each meal time.

All the people we spoke to during our visit told us they were well cared for by the staff and that they felt safe. People told us that they knew how to complain if they were unhappy; we saw people raising issues verbally with staff.

This inspection took place on 27 and 29 July 2015, the first day of which was unannounced.

Ivydene Nursing Home is situated close to the town centre of Ivybridge. It is registered to provide nursing and/or personal care for up to 57 older people who may be living with physical or mental disabilities, including dementia. The home provided care and support to people with varying and at times complex care needs, including those who were no longer able to live safely at home, those with nursing needs and those who were living with dementia. The home is purpose built to provide three care areas, one for nursing care with 27 bedrooms, one for residential care with 13 bedrooms and one for people living with dementia with 15 bedrooms.

The home had 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.

Those people who were able to share their experiences with us told us they felt safe living at the home. One person told us “yes, I feel very safe and well cared for.” For people who were not able to tell us, we observed how staff interacted with them. We saw people smiling and talking freely to staff, people were happy to have staff sit next to them and to hold their hand, indicating they felt safe in the staff’s company.

People and relatives told us they felt the staff to be very kind and caring. They had confidence in the staff and spoke positively about the care they received. One person said “I have been here a long time and they look after me very well.” Another person said “the girls look after us really well.” A relative told us “we’re very happy with the way the staff care for (their relative’s name)” and another said “(staff name) has shown my mother great kindness.

Staff told us they supported people to remain as independent as possible and involved people in decisions about their care. Throughout our inspection, we saw staff were kind, caring and attentive to people and their relatives. During our observations in the dementia care unit we saw staff comforting people who had become anxious due to their memory loss and who were unsure of where they were or what was expected of them. Staff were patient, held people’s hands and repeated as often as was necessary the information people required to ease their anxieties. People were encouraged to take interest in the events around them and staff engaged them in conversations which people were easily able to participate in.

People told us there were sufficient staff on duty to meet their needs, telling us their call bells were answered within a “couple of minutes.” One person said “it was unusual to have to wait for attention.” One member of staff told us “I feel like there is enough staff, and you can sit and chat.” We saw staff in conversation with people and people being assisted unhurriedly which indicated there were enough staff on duty to meet people’s needs. Staff had been recruited safely. They were provided with the training necessary to understand and meet people’s care needs and any associated risks to their health and safety. They demonstrated a good understanding of how to keep people safe and how they would report their concerns should they have any. One member of staff told us “the home puts a lot of time into training” and another said they were encouraged to undertake “lots of training” including qualifications in health and social care. Staff told us they enjoyed working at the home, comments included “I’ve always enjoyed it” and “I love working here.” They told us their caring role was about “making sure this feels like home for them” and “treating the residents as if they were my own family.”

Risks to people’s safety and well-being had been assessed prior to their admission to the home and regularly reviewed. Care plans provided staff with clear guidance about how to meet people’s needs in the manner they preferred. People had prompt access to health care professionals such as GPs and occupational and physio-therapists as needed. People’s medication was managed safely and they received their medicines as prescribed.

We asked people their views of the meals provided at the home and we received a varied response. Some people told us, “yes the food is good” and “the food is fine with plenty of variety. I tell the chef what I would like and I have it”, while others said “the food is alright” and “the food is not to my liking, although it is edible the portions are too large.” We shared these views with the registered manager who confirmed they audit people’s views of the meals regularly and would look again at this issue. We observed people having their lunchtime meal. Staff explained to people the food that was available, showed them the plated meals to aid their choice and encouraged them to try the dishes. Staff checked with people the food was to their liking and we saw people were offered alternatives if they wished. Those people who required support to eat were assisted appropriately by staff.

People were supported to take part in a variety of leisure and social activities. The home employed an activity leader who was responsible for discussing people’s hobbies and interests with them and planning activities around these. Relatives told us they were able to visit the home at any time and were always made welcome: they confirmed they were also invited to participate in the planned activities. Throughout the inspection we saw staff engaged in a variety of activities with people: playing board games; painting people’s nails; quizzes; assisting people with daily tasks such as setting the table, as well as involving people, some with very limited upper body movement, in an adapted game of indoor skittles. The home had a greenhouse where people were encouraged to grow vegetables as well as raised beds for growing flowers. People told us they had picked some of the vegetables to have with their lunch.

People and their relatives told us the home was well managed. They knew who the registered manager was, with one person saying they were “a very familiar figure as she was always out and about in the home. She is very accessible and approachable.” People said they had no concerns over the care and support provided at the home. They said they had confidence in the registered manager or any of the staff to deal with issues promptly and effectively should they arise. Staff understood their roles and said the communication between themselves, the nurses and the registered manager was good.

The registered manager used a number of methods to gain people’s views of the care and support provided at the home, and to ensure people’s needs were met safely, including meeting with , surveys, comment cards and daily and monthly audits.