Ivy Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection in March 2023, not all risks to people’s safety and wellbeing were identified and recorded. This was a breach of Regulation 12 [Safe care and treatment] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. Enough improvement had been made at this assessment and the provider no longer remained in breach of Regulation 12. People told us they felt able and comfortable to raise concerns. Arrangements were in place to record, investigate and respond to any concerns and complaints raised with the service. Staff knew how to record accidents and incidents. People’s needs were assessed prior to their admission to the service and this information was used to inform their care plan and associated risk assessments. People were safeguarded from abuse. Not all risks to people were safely monitored and managed to support them to stay safe. We discussed the latter with the management team for corrective action. Care for people improved on the second day of assessment to mitigate and minimise any ongoing risk. Comments relating to staffing were variable with some people expressing concern about night and weekend staffing levels. At the time of our assessment there were enough staff deployed in line with staffing levels stated by the registered manager. Staff recruitment records demonstrated relevant checks were completed before a new member of staff started working at the service. Staff received an induction, mandatory training and regular supervision. However, improvements were required to ensure staff received specialist training in key subjects. Staff met good practice standards to ensure the proper and safe use of medicines. People were protected by the provider’s prevention and control of infection procedures.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The majority of people and relatives spoken with told us they felt able and comfortable to raise concerns. Comments included, “I have brought some things up and we [management team and relative] have talked about them and they have been resolved” and “We have no concerns, we have no complaints. I believe they [management team] listen; I have had no reason to complain. X has not told me anything is wrong, and they seem happy there [Ivy Court].” Another relative told us they had noticed their family member was not being regularly shaved. They spoke with staff and the issue was dealt with. However, a relative told us although the management team/staff listened to peoples’ complaints and concerns, they were not always addressed.

Staff knew how to record accidents and incidents. These were dealt with as an opportunity to put things right, learn and improve. A member of staff told us they would document information relating to the above and escalate this to senior staff and/or the management team to ensure any follow up action required was undertaken and lessons learned.

Suitable arrangements were in place to record, investigate and respond to any concerns and complaints raised with the service. There were procedures in place to record incidents and accidents. The management team reviewed the latter to identify where actions where needed, for example, medicine errors and to ensure improvements were made when things go wrong.

Most people and their relatives believed there was continuity of care when they or their family member moved between different services. This ensured people's care and support was planned and organised.

The registered manager and staff confirmed where possible care and support for people was planned and organised with them and those acting on their behalf to ensure they worked collaboratively across different services.

People’s needs were assessed prior to their admission to the service and this information was used to inform their care plan and associated risk assessments. The registered manager told us about the service’s assessment and admission process. They confirmed that people’s care and support was planned where possible with the person, those acting on their behalf and other key partners to ensure continuity of care.

People and their relatives considered themselves and their family member to be safe living at Ivy Court. A person using the service told us, “I feel safe.” Relative’s comments included, “Yes, I think X is safe because of the care that is shown to them. They [staff] show great concern for X so I have no reason to think they are not safe”, “No, I have no concerns about X safety” and “Yes, I do think X is safe, I would be on it if I thought family member was not. I have not noticed anything I am worried about.” Specifically, relatives told us they were assured about their family member’s safety as measures were in place to safeguard people from leaving Ivy Court without staffs’ knowledge and there was a key code entry system in place to keep their family member safe.

Staff had received training on how to recognise and report abuse. Staff were able to tell us about the different types of abuse and what to do to make sure people were protected from harm. They were confident any concerns raised would be taken seriously and acted on by the registered manager and management team.

Our observations demonstrated people's human rights were not breached and they were protected from discrimination. Observations during our assessment showed staff supported people to move safely using appropriate equipment when required.

The registered manager kept good oversight of all safeguarding referrals and were aware of their responsibility to notify us and the Local Authority of any allegations or incidents of abuse at the earliest opportunity.

People and their relatives told us how staff knew the people they supported well and were able to identify risks to them and or their loved ones and how staff supported them on a daily basis. A relative told us, "They [staff] are very good. If X is slipping down in their chair, they will come and sit them up again. They come straight away when I call or attract their attention, they are very kind."

Staff spoken with demonstrated an understanding of the risks posed to people being supported. Specifically, staff were able to tell us how they supported people who could become anxious and distressed, the preventative measures to be taken for people who were at risk of developing pressure ulcers, people who were at risk of falls or who experienced difficulty mobilising. While staff’s comments were positive, our assessment identified there were areas of improvement needed to ensure that people were not placed at potential risk of harm. The latter was highlighted and discussed with the management team for immediate corrective action.

Not all risks to people were safely monitored and managed to support them to stay safe. On the first day of our assessment staff failed to support a person to eat safely. Despite the person being identified at risk of choking, they were given food items which should be avoided as they were categorized as a high choking risk. Observations demonstrated there were potential risks associated with a person’s catheter care and this had not been picked up by staff. Care was not taken to ensure the catheter bag was placed on a stand to ease the flow of urine and to prevent the potential risk of infection from occurring. A catheter is a medical device used to empty the bladder and collect urine in a drainage bag. Additionally, we could not be assured that the catheter bag was regularly emptied as the records were not routinely being completed. The above was highlighted and discussed with the management team for corrective action. Staff were spoken with by the registered manager and we observed that care for both people improved on the second day of our assessment to mitigate and minimise any ongoing risks.

Risks to people's health and wellbeing had been assessed and each person had personalised risk assessments, which identified the risks they could be exposed to, and the support needed by staff to minimise the risks. We saw that the risk assessments had been reviewed. However, fluid intake records viewed showed not all people's fluid targets were being met. No information was recorded to demonstrate how this was being monitored and addressed to mitigate their risk of dehydration. Where people exhibited behaviours that could be distressing to themselves and others, observation data failed to provide necessary information detailing staffs’ interventions and outcomes when a person became anxious and distressed, and improvements were required. This was highlighted and discussed with the management team for corrective action. Personal Emergency Evacuation Plans [PEEPs] documented the level of staff assistance necessary to evacuate people safely. No consideration had been made to identify people’s physical and neurological needs which could affect their ability to evacuate, their ability to communicate and understand instructions and where they could be anxious and distressed. This was a bespoke plan for people who may have difficulties evacuating to a place of safety without support or assistance from others.

No people using the service or those acting on their behalf raised concerns about the environment.

Staff confirmed they were aware of their responsibilities to make sure that the facilities and equipment at Ivy Court supported the delivery of safe care for people using the service.

Equipment utilised at the service for people’s use was clean and had been checked regularly to ensure it remained safe and in good working order. Our observations demonstrated people were supported by staff when feeling anxious or distressed.

There were systems and processes in place to ensure the environment was safe. Health and safety checks were in place and carried out regularly and where corrective actions were required, these were identified on the service’s action plan.

People’s and relatives’ comments relating to staffing were variable with some people expressing concern about night and weekend staffing levels. Concerns expressed related to people preferring to be cared for by staff that knew them well. A person using the service told us, “They [staff] say I’ll be back later on, then it’ll be an hour later.” Another person told us, “Staff do not always come promptly when I use my call alarm, I sometimes have to wait a long time, especially at night.” The person’s relative confirmed this as accurate as their family member often telephoned them when this happened. A relative told us, “I think staffing levels vary, at the weekends sometimes there doesn’t always seem to be enough.” Another relative told us their family member did not routinely sleep well at night and was often ready to get up in the morning at 9.00am, but frequently was not assisted by staff until late morning to get up. The relative told us, “I think X has got used to waiting, staff seem quite happy to leave X until last. X will get things but not timely, X would not be able to complain.” Where positive comments were cited by relatives, these included, “I guess there could be more staff but the staff do an amazing job, there is always someone about to give X support, I can’t knock them, they are never alone”, “I have never had any issues with staffing, at peak times they could be run off their feet and take a little time to get to you, but they do eventually get there. X gets what they need, whenever I have been there, X gets the support” and “When X has needed someone they [staff] have been there.”

Staff’s comments about staffing levels were variable. Whilst some members of staff felt there were sufficient numbers of staff on duty, others did not, for example on Beech Unit. This was because it was perceived that the care and support needs of people residing on Beech Unit which principally related to their mobility needs, were high and could result in people not receiving care and support in a timely manner.

During our assessment there were enough staff deployed in line with staffing levels stated by the registered manager. Observations throughout both days demonstrated call alarms to summon staff assistance were responded to in a timely manner. However, observations on the second day of our assessment showed a person using the service repeatedly asked staff to have their comfort needs met. Despite assurances from some staff that support would be provided, staff did not respond in a timely way. This resulted in the person becoming distressed until support was provided. This was an isolated incident and throughout the rest of the day, staff were visible and responded to people’s requests for support promptly.

Staff recruitment records demonstrated relevant checks were completed before a new member of staff started working at the service. This included an application form, written references, proof of identification and Disclosure and Barring Service [DBS] checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Newly employed staff received an induction and were given the opportunity to ‘shadow’ more experienced staff to ensure they understood the routines of the service and their roles and responsibilities. A member of staff told us it had taken them a while to adapt to the routines of Ivy Court and when they asked for their induction to be extended this had been agreed. Staff had received mandatory training appropriate and relevant to their role. However, we found not all care staff had received specialist training in key subjects, for example, catheter care, continence awareness, Diabetes, nutrition and hydration and pressure area care. Following a discussion with the registered manager and senior management team we were assured that steps would be taken to resolve this to enhance staffs learning. Staff had received regular formal supervision in line with the provider’s expectations, including the registered manager.

People and relatives told us they were happy with the cleanliness at the service. A person told us, “My room is kept clean and tidy.” A relative said, “The home is very clean, I have no issues.

Staff were clear about their roles and responsibilities to ensure people were protected by the prevention and control of infection arrangements at Ivy Court. Staff confirmed they had access to clear policies and procedures on infection control and had sufficient Personal Protective Equipment [PPE].

Staff were observed using Personal Protective Equipment [PPE] appropriately and when required. People were protected from the risk of infection because the premises and equipment were kept clean. The service was odour free, and equipment was found to be clean and in good working order.

There was an effective approach to assessing and managing the risk of infection at the service, which was in line with current relevant national guidance. Infection control audits were conducted at regular intervals, highlighting where the provider was compliant and areas for improvement.

People and relatives, we spoke with told us they had no concerns regarding the management of medicines at Ivy Court.

Staff were able to competently describe how they supported people with their medicines management. Staff confirmed they had received appropriate medicines training and had their competency assessed at regular intervals to ensure their practice remained safe when supporting people with their medicines.

During our assessment staff were observed to administer people’s medicines appropriately and in line with current guidance. The medication rounds were evenly spaced out throughout the day to ensure people did not receive their medicines too close together or too late. Observation of staff practice showed staff undertook this task with dignity and respect for the people being supported. Medicines were stored correctly. Medicine records were maintained to a good standard, and Medication Administration Records [MAR] demonstrated people received their medicines as they should and in line with the prescriber’s instructions. The service ensured people's behaviour when anxious and distressed was not controlled by excessive and inappropriate use of medicines. Where medicine errors were identified, reviews and investigations were conducted to ensure lessons were learned.