Ivers

Ivers is a residential care home providing accommodation and personal care to up to 25 people. The service provides support to younger adults who have learning disabilities and / or autism. At the time of our inspection there were 12 people using the service which increased to 13 on our last visit.

The provider was also registered to provide domiciliary care. When we inspected, 4 people living locally received support however no regulated activities were provided to them at this time.

The care home could accommodate 9 people in the main house including the self-contained flat. There were 4 additional bungalows on the same site, each able to accommodate 4 people. At the time of our inspection 1 of these properties was vacant. A person was using a bungalow as an emergency return placement and had their own package of care from a separate service provider.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Risks had been assessed; however, people were able to take positive risks and lead fulfilling lives. People were kept safe by staff who had been appropriately trained and who were familiar with people’s care plans. There were sufficient staff deployed to meet people’s needs and, while there had been significant reliance on agency staff, this was now decreasing as the provider had recruited new staff and would be fully staffed soon.

Right Care:

Care plans were person-centred, and staff told us they provided clear information about how to support people. Staff had completed training in a range of areas that were specific to the people they supported and responded to situations such as managing seizures or choking according to people’s care plans.

People and their key workers met monthly and completed a ‘wheel of engagement’ meeting. They spoke about progress made towards goals and about their aspirations in life. Positive achievements were also displayed on a blackboard in the main house.

Right Culture:

The registered manager led by example and worked alongside their teams in the care home and bungalows, covering shifts and spending time observing staff and people. There had been several changes to the management team however there was now a more stable team in place providing strong leadership.

We received positive feedback about the leadership of the service. The registered manager was aiming for the service to become more involved in the local community, and had arranged events to include relatives where possible.

For more details, please see the full report which is on the CQC website at

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 April 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve person-centred care and need for consent.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective, and well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ivers on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Ivers is a group of care homes on one site for up to 25 people who are autistic or have a learning disability and/or a physical disability. The service had previously been a college for people with a learning disability but no longer operated as such. It is a large service with five properties on one site. ‘The House’ can accommodate nine people; there were also four bungalows, Tyneham, Crantock, Kenley and Trafalgar, that could each accommodate four people. There were 15 people living at Ivers when we inspected.

People’s experience of using this service and what we found

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

Consent to care was generally sought in line with legislation, although the practice and record keeping regarding people’s legal rights to make decisions and/or impose restrictions upon people needed to be improved. This was being worked on. The environment continued to be improved to meet people's individual needs; people were being involved in this process.

People were receiving more personalised care than when we last inspected. Care and support was much more responsive to people’s current or changing needs. Improvements were being made with people taking part in more trips, activities, work placements and groups of their choosing. These could occasionally be affected by staffing issues and/or a lack of staff.

People’s communication needs were being better met by staff whose training and practice had improved. People had access to healthcare services and received appropriate healthcare support. There had been improvements in medicine administration since our previous inspection, and we found that people’s medicines were well managed. Further improvements in staff training were planned.

Ivers is located in a rural location away from local services found in an urban area. The provider had ensured people had support to access the local services they wanted or needed in order to comply with the principles of right support, right care, right culture.

Right Care

Risks to people were not always properly assessed or sometimes conflicted with other information in care plans. Risk assessments continued to be improved.

Systems, processes and practices generally safeguarded people from abuse and avoidable harm. People were now much safer and there was a focus on continuing to improve the safety culture. People were protected by the prevention and control of infection measures in place. Lessons were now learned and improvements made, when things go wrong.

Staff were recruited in a safe way. There were enough staff to support people, although there remained a reliance on agency staff.

People were treated with kindness, respect and compassion. People's privacy and dignity was respected. Staff were patient, dedicated and caring.

People were now supported to express their views and be actively involved in making decisions about their care and support. People were being supported to become more independent.

Right culture

The provider and current management team had worked very hard to develop a positive culture that was person-centred, open, inclusive and empowering. There was a clear improvement plan in place designed to enable the service to measure improvement and deliver good quality care and support. Staff support, team work and staff morale had all significantly improved.

Some people had chosen to move to other homes which could better meet their needs; they had been well supported to choose and move to their new homes. Care and support were continuing to improve and develop for people who currently lived at Ivers.

The provider’s improved governance framework now ensured that responsibilities were clear, and that quality performance, risks and regulatory requirements were understood. There was honesty and openness when things went wrong. Concerns and complaints were now being listened and responded to and used to improve the quality of care.

People, their relatives and staff were now much more engaged and involved in the service; all felt the service had improved and hoped it would continue to do so. Relatives still felt both communication with, and their trust in, the service could be improved upon further over time.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update.

The last rating for this service was inadequate (published 21 September 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found many improvements had been made, however the provider remained in breach of regulations.

This service has been in Special Measures since 21 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service and what we found

People had been hurt by a person living at the home; staff had not been able to take action to prevent it. Staff said they lacked training and said they and other people who lived in the home were not always safe.

There was no effective oversight or management of incidents which had occurred. As a result, staff were placing themselves and others at risk. Incidents recurred and people were harmed.

People’s care needs, risks and behaviours were not always properly assessed or planned for. Care plans and risk assessments were not being followed consistently. There were generally enough staff to support people, but staff had not always been trained to ensure people’s safety or meet their needs.

People were not consistently supported to express their views and be actively involved in making decisions about their care and support. People's privacy, dignity and independence was not consistently respected and promoted.

People’s concerns and complaints were not always listened to, responded to or used to improve the quality of care.

The provider and the management team had failed to ensure a positive culture that was person-centred, open, inclusive and empowering. The service did not consistently achieve good outcomes for people.

There was poor oversight and governance of the service. The provider failed to complete effective audits of the service; they had not identified all of the significant concerns we found during our inspection.

The registered manager and provider failed to meet their regulatory requirement to notify us of safeguarding incidents and in being honest and open when things went wrong.

Following the inspection we met with the local authority safeguarding team to discuss our concerns. They took immediate action to ensure people and staff were safe. We also wrote to the provider’s ‘nominated individual’ (the person responsible for supervising the management of the service) to make them aware of our concerns and to ensure they would take immediate action to improve the service. An experienced interim manager began working at the home on 16 July 2021.

People were treated with kindness and compassion. Staff were dedicated and caring. People told us they liked the staff and they were kind to them.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not able to demonstrate how they were meeting some of the underpinning principles of Right Support, Right Care, Right Culture.

Right support:

• The model of care used at Ivers did not fully maximise choice, control and independence for autistic people or those with with a learning disability. The National Institute for Health and Care Excellence (NICE) recommends residential care ‘should usually be provided in small, local community-based units (of no more than six people)’. The environment, with 21 people with different needs and abilities living on one large site, was not ideally suited to the needs of people with learning disabilities or autism. We had registered this service under the new provider's registration despite it not being in accordance with the NICE guidance. People were not able to have maximum choice or control over their lives.

Right care:

The care and support provided did not always meet the needs of people with learning disabilities. Staff did not receive the training needed on how to meet the needs of people with learning disabilities and autism, so they did not have the skills they needed to provide appropriate support. This was made worse because of heavy reliance on agency staff which meant people did not always receive care from staff they knew and trusted. Where staff were inexperienced or unfamiliar with people’s needs, this had a negative impact on the quality of care.

People’s care wasn’t person centred, or planned with people having choice and control over how their health and care needs were met. Care plans were not consistently followed. People were not always cared for in a safe and consistent way.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people with learning disabilities led confident, inclusive and empowered lives. This was because there was a lack of leadership and oversight. The service was not person centred, open and inclusive nor did it always achieve good outcomes for people. People’s human rights were not always respected; people had been harmed and others put at risk.

Rating at last inspection

The last rating for the service under the previous provider was Requires Improvement, published on 7 September 2020.

Why we inspected

This service was registered with us by this provider on 25 September 2020 and this is the first inspection.

We looked at infection prevention and control measures under the ‘Safe’ key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, good governance, staffing, duty of candour and notification of other events at this inspection.

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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.