CQC report explained · a nursing home
What the CQC found at Ivybank Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People were protected from abuse and avoidable harm. Inspectors found safe medicines practice, enough staff, suitable recruitment checks and effective infection control.
- Effective?
- Good
- Staff were trained and supported, and people's nutrition, healthcare and consent needs were addressed. The home followed the principles of the Mental Capacity Act.
- Caring?
- Good
- People described staff as kind and friendly. Inspectors saw people treated with dignity and respect and supported to make choices and remain as independent as possible.
- Responsive?
- Good
- Care plans recorded people's preferences, communication needs and interests. Activities, complaints arrangements and end of life support were in place, although a minority of care plan reviews were a few days overdue.
- Well-led?
- Requires improvement
- Quality assurance had improved and the previous governance breach had been resolved. However, audits did not cover some short-term care plans, unexpected weight gain or a completed action plan following a survey.
What inspectors found, March 2019
Ivybank Care Home is rated Good overall; inspectors found safe, kind and responsive care, but management systems still needed improvement.
Inspectors visited unannounced on 19 and 20 February 2019. They spoke with people living in the home, relatives, staff and a healthcare professional. They observed daily care and checked medicines, care records and management records.
The home was rated Good for Safe, Effective, Caring and Responsive. Inspectors found enough staff, safe medicines practice, suitable training, clean surroundings and care that respected people's dignity, choices and individual needs.
Well-led was rated Requires Improvement. Quality checks had improved and the previous breach of good governance had been resolved, but some checks did not cover all the areas they needed to. No enforcement action was required.
Safe care and medicines
Inspectors found that people were protected from abuse and avoidable harm. Medicines were ordered, stored and given safely, and people received them as prescribed.
“People were safe and protected from avoidable harm.” from the report
Kind and respectful staff
People spoke positively about staff. Inspectors saw staff responding to people's emotions, respecting privacy and dignity, and encouraging independence.
“People were supported and treated with dignity and respect; and involved as partners in their care.” from the report
Individual care and activities
Care plans recorded people's likes, dislikes, communication needs and interests. Staff knew this information and supported people with activities and social contact.
“Staff understood and knew people's interests and preferences to support them to take part in activities that were important to them.” from the report
Improvement since the previous inspection
The previous governance breach had been resolved. Nursing staffing had increased, and food hygiene standards had improved.
“People's nutritional needs were met and they accessed health care when needed.” from the report
Quality checks missed some issues
needs fixingSome problems were not identified through the existing audits. The checks needed to cover whether short-term care plans were in place and whether unexpected weight gain was being reviewed.
“We identified a small number of issues which had not been picked up through the existing quality audits.” from the report
Some care plan reviews were late
needs fixingA minority of care plans were a couple of days overdue for review. Managers said they would complete them.
“We brought to the registered manager's attention that a minority of plans were a couple of days overdue for review.” from the report
- 01How do you now check that all short-term care plans are in place and reviewed on time?
- 02How do you monitor unexpected weight gain, as well as weight loss?
- 03What actions were agreed from the latest survey feedback, and how will families be told whether they have been completed?
- 04What improvements have been made to management and quality audits since this inspection?
- 05How has the increase in nursing staff affected staffing levels and the use of agency staff?
This was an unannounced planned inspection covering all five key questions, including the premises and care provided; the previous overall rating was Requires Improvement in September 2017. This explanation was written from the published report of 20 March 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, January 2018
Ivybank Care Home was rated Requires Improvement; inspectors found kind care and good responses to people, but important safety, training and management systems were not reliable.
This was a comprehensive inspection on 27 and 28 September 2017. The first day was unannounced. Inspectors spoke with people living there, relatives and staff, observed care, and checked care, medicine, staffing and quality records.
The overall rating was Requires Improvement. Safe, effective, caring and well-led were all rated Requires Improvement. Responsive was rated Good. Inspectors found enough staff and safe recruitment, but risk records, training, medicines records and quality checks needed improvement.
People generally said they felt safe and staff knew them well. However, care was not always respectful or suitable for people living with dementia. Environmental changes had reduced communal space, and the provider had breached Regulation 17 on good governance.
Enough staff
Inspectors found improvements in staff deployment. Staff were available to respond to immediate requests for help.
“This inspection found that staff were available to respond to immediate requests for assistance.” from the report
Safe recruitment
The home completed identity, reference and criminal record checks before new staff started.
“A range of pre-employment checks were being completed prior to new staff members starting work.” from the report
People were known well
Care plans included personal history, preferences and interests. Staff generally understood what mattered to people.
“Care plans included information for staff so they could provide support which reflected people's personal history, individual preferences and interests.” from the report
Access to healthcare
People could receive support from health professionals, including dentists, opticians, dieticians and tissue viability nurses when needed.
“People could be confident they would be supported to maintain and achieve good health.” from the report
Complaints process
People and relatives knew how to raise concerns. Inspectors found that the provider investigated complaints and gave detailed feedback.
“People could be confident their concerns would be taken seriously, investigated and detailed feedback provided.” from the report
Training gaps
needs fixingSome inductions were not suitable for the staff member's role, and not all staff had training for the needs of the people they supported.
“This meant there was a risk they would not be fully aware of their roles and responsibilities.” from the report
Dignity during meals
needs fixingSome people waited a long time for food, and limited space meant staff sometimes had to kneel while helping people eat. One person did not have suitable adapted equipment.
“One person was not provided with an adapted plate and had to use their fingers to load food onto their spoon.” from the report
Inconsistent dementia support
needs fixingStaff did not always adapt communication or the environment for people living with dementia. Some areas were noisy and signage was incomplete.
“We found that staff did not always demonstrate effective approaches in maintaining an appropriate environment for people living with dementia.” from the report
Weak quality checks
seriousAudits did not reliably find problems with falls, fluid records, DoLS applications or safety checks. The provider had not always acted promptly on known shortfalls.
“The provider had not ensured effective systems were in place to monitor the quality and safety of the service being provided to people.” from the report
- 01What has been done to make falls and moving and handling risk assessments complete and consistent?
- 02How do you check that every staff member has role-appropriate induction and training for dementia and other complex needs?
- 03How are medicines given through skin patches recorded, including both application and removal?
- 04What changes have been made to dining space, adapted equipment and waiting times since the inspection?
- 05What is the current position on the CQC condition about quality and safety monitoring, and how are overdue audits now checked?
This was a comprehensive inspection covering all five key questions; the report compares the findings with the previous inspection in April 2017. This explanation was written from the published report of 27 January 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Ivybank Care Home
4 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- March 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- January 2018Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- June 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- November 2015
Registered with the Care Quality Commission on 2 November 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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