This comprehensive inspection took place on the 25 June 2018 and was unannounced.We carried out an unannounced comprehensive inspection of this service on 1 March 2017. The service was rated 'Requires Improvement'. Four breaches of legal requirements were found. One breach related to safe care and treatment. After the comprehensive inspection, we used our enforcement powers and served a Warning Notice on the provider for this breach on 7 April 2017. This was a formal notice which required the provider to meet the legal requirements by 5 May 2017. Following the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection in July 2017 to follow up the breach detailed in the Warning Notice and to confirm that they met legal requirements . At the focused inspection we found that the provider was still not meeting the legal requirements . We asked the provider what action they took already following the feedback they were given after the inspection and asked how they plan to meet legal requirements.
The breaches previously identified in the last comprehensive inspection in March 2017 were followed up as part of this inspection. You can read the report from our last inspections, by selecting the 'All reports' link for Ivybank House Care Home, on our website at www.cqc.org.uk. The service remains rated as requires improvement.
Ivybank House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ivybank House is registered to provide accommodation for up to 43 older people who require nursing and/or personal care.
Accommodation is provided on the first and second floors, accessed by a lift. Communal areas such as dining rooms and lounges are situated on both floors of the service. At the time of the inspection, 28 people were living at the service.
At the time of this inspection, the service was being managed by a newly appointed manager supported by the deputy manager, regional support manager and regional manager . The previous registered manager had left the service at the end of May 2018 and prior to the new permanent manager being appointed, two different registered managers from the providers other services had supported the deputy manager and the staff team.
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.'
At our last inspection, we found that staff were not supported to undertake training to enable them to fulfil the requirements of their role. We found that whilst staff told us there had been an improvement in training provision, some staff had not had training other than provider’s statutory updates for some months .
At our previous inspections, in January 2016, March 2017 and July 2017, we found that medicines were not always managed safely We found the management of medicines required further improvement to ensure medicines were handled and received safely.
At our last inspection in July 2017 lack of monitoring meant there was a risk that people might not have enough to eat or drink. At this inspection, we found that this had improved and people that were at risk from malnutrition and dehydration were now being monitored effectively.
At our last inspection in March 2017, we found the quality and content of care plans was variable. Although some were well written, with clear guidance for staff to follow, this was not consistent. We saw that some people's care plans had been rewritten and/or updated since our last inspection. We saw these care plans were more centred on the person and were being regularly reviewed.
People we spoke with told us they felt 'safe'. Relatives we spoke with did not express any concerns about their family members' safety. However, we received concerns from relatives and staff about the staffing levels at the service.
At our last inspection, we found the registered providers systems to assess, monitor and improve the quality and safety of the service required improvement. At this inspection we found whilst there were improvements, they did not highlight the issues relating to the management of medicines that we identified in this inspection showing they were still not effective.
People we spoke with were satisfied with the quality of care they had received. We saw practices at the service that promoted dignity and respect. We also saw staff offering choice and/or obtaining consent.
People and relatives, we spoke with told us the level of activities and quality and suitability of activities were excellent. Comments included, "The activities always suit people, there loads to do" and "My [family member] cannot take part in anything, and they always get a one to one visit."
The provider had a complaint's process in place and this was displayed in the reception area. People we spoke with told us that concerns and complaints were listened to by staff.
We found the registered provider ensured that people and their representatives views were actively sought for continually evaluating and improving the service. The deputy manager told us they had held meetings for people, relatives and staff.
We found two continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.