Ivybank House Care Home

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• 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

We reviewed 3 quality statements relating to safeguarding, safe and effective staffing and involving people to manage risks. Staff were able to tell us how to keep people safe from harm and abuse. Staff were assured leaders followed up on safeguarding concerns. Staff had received training relevant to the roles, although staff told us they needed more training in dealing with people with more complex needs. There were positive comments about staff, although people and relatives told us staff were busy. However, we found care plans and risk assessments did not always contain information to keep people safe. The provider already had an action plan in place and had brought in extra resources to support the service in this area.

This service scored 22 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe and knew who to contact if they had any concerns. Relatives told us they felt people were safe. One person told us “There are lots of measures in place for example key codes on doors and staff are visible.”

Staff understood their responsibilities to keep people safe from harm and abuse. They knew how to report any concerns and the processes to follow. Staff told us they had completed safeguarding training and were assured leaders followed up on safeguarding concerns.

People appeared comfortable and relaxed around staff and we observed people were supported safely during our on-site visit.

Staff had received training in safeguarding, Mental Capacity Act (MCA) and Deprivation of Liberties Safeguards (DoLS). A DoLS application had been applied for appropriately. There was a safeguarding policy in place and a safeguarding log which identified all safeguarding cases with actions and outcomes.

We received mixed feedback from people and relatives about care planning and risk assessing within the service. Additionally, we received mixed feedback from people and relatives about risk management within the service. One relative told us “[Person] is at high risk of infection. So, [person] is watched carefully and at the first sign of infection is on antibiotics.” However, another relative told us “I’ve been concerned about the length of time between incontinence aid changes and the risk of skin damage and soreness. I asked (manager) if that could be done 3 hourly. [Person] doesn’t have any bed sores. I feel I’ve had to agitate and campaign for [person] throughout.”

Staff showed a good awareness of managing risks. They told us if anything changed for a person, they would let the senior or managers know so care plans and risk assessments could be updated. People’s risks were discussed during daily meetings. However, 1 staff member told us a person’s needs had changed and they were told this verbally, but the care plan had not been updated to reflect the current needs. Leaders told us the new electronic care plan and risk assessment system had been implemented 8 weeks prior to the assessment. They were aware more work was needed in this area and already had an action plan in place to support this. They had also brought in extra resources to work directly on care plans and risk assessments.

We observed the medicines trolley was secured to the wall and locked. However, we found the sluice room unlocked and spoke to the provider who immediately rectified this. We saw a staff member supported a person at lunchtime with a textured modified diet in line with their care plan. Another person was provided with a drink in a lidded beaker with 2 handles. However, this person had not been assessed as requiring this at the time of the site visit. We were not assured the staff member knew the person’s needs and raised this with leaders who updated the person’s care plan to reflect this need.

Some care plans and risk assessments contained conflicting information. For example, 1 person’s care plan stated they needed 2 staff members to transfer. However, the Personal Emergency Evacuation Plans (PEEPS) risk assessment stated only 1 staff member was needed. We found another person used topical ointment for their skin, however this was not written on the PEEPS risk assessment. This conflicting information could place people at risk. The provider told us they had recently moved from paper-based care plans to an electronic system and work was ongoing to ensure care plans and risk assessment were up to date and accurate. We also found 2 people were not being monitored in line with their care plans. For example, both people needed hourly checks day and night. However, according to the daily notes people had not been checked within the hourly time frames. 1 of these people had been assessed as being at high risk of falls and unable to use their call bell. Due to another restriction in place, to protect other people, this person was unable to move freely around the building without support from staff. Without the regular monitoring taking place, this placed the person at risk of not having their needs met or gaining assistance when needed. Leaders told us they had identified this concern the day before we attended for the on-site visit. Leaders also told us they were in the process of introducing a checklist for staff to follow so regular monitoring and repositioning checks could be completed and recorded. They provided us with evidence of a ‘Must do’ checklist template for staff to follow. This checklist outlined the times of when a person needed repositioning.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People provided positive comments about staff, however frequently referred to staff being “stretched” and “very busy.” Some people and relatives told us staff did not always come quickly when they activated the call bell. For example, 1 person told us “Some staff promise to come back in a minute, but don’t return for a long time.” Some people expressed concern about the staff turnover and told us “Staff were always changing, which meant they didn’t always know about individual care needs.” One relative told us “Staffing levels impacted continuity of care and hampered staff following through on specific care needs, such as helping to improve mobility.”

Staff told us they were busy and did not always have enough time to provide timely care and support to people. They told us this impacted on people being supported with personal care needs. One staff member told us they did not have time to take regular breaks as it would impact on people’s needs being met. Leaders told us resident numbers had increased from 23 to 27 since they took over the service and they had changed their staffing levels to support this. They also told us their priority was looking at how staff were deployed within the home to meet resident’s needs and were currently working with staff to identify the areas they needed to focus on. Staff also told us there had been an increase in people with complex needs being admitted to the home. They told us they needed more training in supporting people with dementia and de-escalation techniques to be more confident in their practices. Leaders told us staff had received e- learning and face-to-face training in dementia and de-escalation techniques and there was evidence to support this. Training in these areas had taken place in March and July 2024. We received mixed feedback about access to supervisions and team meetings. Some staff told us they had regular supervisions and team meetings; however, others told us these had not been regular since the new provider took over the service.

We completed a Short Observational Framework for Inspections (SOFI) in the lounge area. We observed staff to be busy and task-focused, however, when staff interacted with people, it was positive. We observed the Registered Manager and Customer Relations Manager supporting residents with their needs. This was discussed with leaders who told us there had been a staff absence on the day of the assessment.

There was evidence of team meetings and supervisions for staff. There was daily ‘flash meetings’ to discuss residents and any changes to their needs. Although there was a process in place to assess safe staffing levels, we found this was not effective as timings were not always reflective of people’s needs captured in the daily notes. This was fed back to the provider and they told us the care planning system calculated the dependencies based on what was put into the system from care plans. They told us staff did not always change the times on the electronic daily notes when support was being provided. This meant there was a discrepancy in the timings in the daily notes. The provider had an action plan in place to review care plans and daily dependencies. They were also looking at providing training for staff around changing the times in the daily notes to reflect actual time spent with people. We asked the provider for a copy of an application form for a new recruit; however, they told us they accepted CV’s (Curriculum Vitae) as per their policy. We fed back to the provider that accepting CV’s and not application forms was contradictory to their policy which stated “Candidates need to complete an Application Form. CV’s will not be accepted.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.