Archived: Ivy Close

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found-

Is the service safe?

We conducted a visit to the home and during this time we spoke with five staff and met the two people who lived at the home. They were not able to speak with us about the care they received and their experience of living in the home. This was because they had learning disabilities and communication needs.

Risks to people had been identified, assessed and kept under review. We found that the staff were able to tell us about the support they needed to give people to keep them safe and reduce risks to their wellbeing from hazards such as dehydration, falls and pressure sores. We observed that people had freedom to spend time as they chose in their home. Restrictions were used appropriately to help keep people safe. Staff understood that the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) needed to be considered in their work but most had not attended training on these. The registered manager reviewed any accidents and incidents. They had made appropriate safeguarding referrals to the local authority and had applied for authorisation under DoLS when a restriction was used to help keep a person safe. This meant that decisions were made by a multidisciplinary team which helped protect the vulnerable people using the service.

We found that staff had the skills and knowledge to know how to meet people's needs and keep them safe. Staff had undertaken training important to their role including manual handling. There were some gaps in refresher training and not all staff had taken part in a fire drill in the last year but these shortfalls were being addressed. Some actions identified in the fire risk assessment had not been followed up. Once alerted to this at the inspection the new registered manager had taken immediate action.

Is the service effective?

People's ongoing needs were regularly re assessed. Changes in how care was provided were discussed with people's relatives and professionals involved in their care. Monitoring records were kept up to date and accurate which gave staff and professionals reliable information to base care decisions on.

The systems in place to inform staff about changes in people's needs were effective. Staff meetings and supervision sessions were held regularly. Staff felt that their views were listened to and any concerns they had were taken seriously.

Is the service caring?

The staff team was stable and they knew people's needs and preferences very well. We observed a relaxed, yet respectful atmosphere in the service. We saw staff treated people in a kind and caring way. They encouraged people to make choices in areas such as food and activities. We saw staff praise people when they took part in a task or made a choice.

Staff discussed people's needs during their shift and at shift handovers to ensure that there was a continuity of the care provided. We saw in care records and staff meeting minutes that people's care was regularly reviewed. Decisions were made in people's best interest after consultation with their relatives and professionals. Feedback from two health professionals was very positive about the standard of care provided. They had found staff willing to pull together to provide complex care. This had meant that one person and their family had their wish which was for the person to remain at the home until the end of their life.

Is the service responsive?

The registered manager had made changes to the staffing arrangements in response to one person's increased needs. They had applied for additional funding to further improve arrangements. People's relatives had given positive feedback about the service offered. No complaints had been received since our last inspection. Staff were working hard to meet everyone's needs and were contacting health professionals for advice when they had any concerns about people's welfare. The providers had supplied a new accessible vehicle and other equipment to ensure people's needs were met. The views of people's representatives were sought through an annual survey.

People were being offered a fresh healthy diet. One person's needs had changed significantly and they had become at risk of dehydration and malnutrition. The service has responded by accessing advice from health professionals including a speech and language therapist. Their advice was being followed and staff were encouraging food and drinks around the clock. They were completing detailed records and monitoring closely to help ensure the risks were reduced as much as possible.

Is the service well led?

Since our last inspection a manager had been appointed and they were registered with us in March 2014. The areas of non-compliance reported on at the last inspection had been addressed. The few areas found at this inspection where improvement was needed were taken seriously by the manager and team leader and action was taken during the inspection or shortly afterwards.

Staff told us that team morale had greatly improved. They felt well supported informally and through the staff management systems such as meetings and supervisions which now took place regularly. General training was planned more effectively. Specific training to help staff support one person with complex needs had been provided and staff felt competent in performing new care duties and taking on added responsibilities. The standard of record keeping had improved and all confidential information was now stored securely.

The staff team knew people and their preferences well. They were able to tell us about the support people needed with high risk needs such as mobility and hydration. The staff took people's wellbeing and any concerns seriously.

Overall people's medicines were being safely managed. There was scope to improve some medicine records including audits.

We found that the management arrangements for the home had not been effective. People had not always been protected from the risk of injury because equipment assessed as needed had not been provided in a timely manner.

Records containing confidential and personal information were not always securely stored.