Archived: Iona

The service had a registered manager. 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.

The service was last inspected on 4 October 2016 when we found there were breaches of the regulations. We rated the provider as requires improvement in the areas of safe, effective and well led. At this inspection we found the provider had made some improvement’s however further improvements were needed.

We could not be assured people were safe as the provider did not provide us with documentation to show us checks had been carried out to determine staff suitability to work within the home.

Staff understood how to recognise and report potential abuse. They felt listened to and were assured action would be taken if concerns were raised. Individual risks had been identified for people and staff had the information needed to keep people safe. Medicines were administered, stored and recorded to ensure people were protected from the risks associated with them.

People were supported in a caring way and encouraged to remain independent. People’s privacy and dignity was maintained. When people needed support to access health professionals this was available for them. People were able to maintain relationships that were important to them.

When needed capacity assessments had been completed and decisions considered in people’s best interests. There were enough staff available to meet people’s needs and they had received relevant training and an induction which helped them to offer effective support to people. People were encouraged to make choices about how to spend their day and were involved with activities they enjoyed.

Quality monitoring was completed by the provider to drive improvements within the home. Staff and people felt the service was well managed and were given the opportunity to raise concerns. The provider had a complaints procedure in place so any concerns could be addressed accordingly. The previous rating was displayed in the home in line with the requirements of registration with us.

Iona was last inspected on 23 April 2015 and was found to require improvement in the areas of safe, effective, responsive and well led.

At the last inspection we saw that the provider had not always assessed people’s capacity to make decisions about their care and not ensured that restrictions were legally approved. At this inspection we found that some improvements had been made but that there were still some improvements required. This was because peoples’ capacity to consent to decisions was not always assessed nor completed in their best interest.

At the last inspection the provider did not always ensure there were enough staff to meet people’s needs, care was not always given in line with peoples’ preferences and they did not use feedback from people and their relatives to improve the service. At this inspection we saw that there were sufficient staff and that arrangements had been made to ensure that there was staff cover to provide extra support when required. People were supported to plan their week in advance to ensure that they could pursue their hobbies, daily living skills and leisure activities. We saw that the provider had sent surveys to families and spent time with people who used the service to plan its future development.

At this inspection we saw that risk was not always assessed and managed to ensure people were protected from harm. Some environmental risk assessments were not completed and other risk management systems were not regularly reviewed to monitor the wellbeing of people or to take account of their changing needs. The provider had not informed us of changes within the service which is required for their registration with us.

There were systems in place to manage medicines and they were securely stored. Staff received the training and support that they needed to do their job effectively. They understood their responsibilities to detect and report abuse.

People were supported to maintain good health and had regular access to healthcare professionals. They were supported to have enough to eat and drink and to maintain a healthy diet. People’s care plans were personalised and accessible to staff. The care plans were regularly reviewed to correspond with people’s changing support needs.

Staff developed caring relationships with the people they supported. They knew people well and provided care that met their preferences. People were encouraged to communicate their choices and staff understood when they used signs or gestures to do this. People’s privacy and dignity were considered. They were included in staff celebrations and their families were welcomed at any time.

There were systems in place to drive quality improvement which included regular audits and developing systems and procedures to meet action plans. People knew the manager and were comfortable raising concerns with them.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

At a previous inspection on 11 November 2013 we identified areas of non-compliance with regulations we inspect against. We asked the provider to tell us how they intended to make improvements. Improvements were required in relation to the security of the building, the maintenance of room temperatures and redecoration of the environment.

During this inspection, we checked if the provider had acted to improve the quality of the service. We found that improvements had been made in relation to the security of the building, the maintenance of room temperatures and redecoration of the environment.

Is the service Safe?

People told us they liked it at the home. One person who used the service told us, 'I like it here very much. I've been here fourteen years'. The provider ensured that people who were assessed as being at risk of falling were provided with downstairs bedrooms and facilities. Safeguarding procedures were in place and staff understood how to safeguard the people they supported.

We saw that the provider maintained appropriate standards of cleanliness and hygiene. We found that the provider did not have suitable arrangements in place to prevent the spread of health care associated infections. This meant that people who used the service were not always protected against the risks of acquiring health care associated infection.

Is the service Effective?

People's care records were personalised, and the provider ensured that people's dietary, mobility and equipment needs had been identified in care plans where necessary. People who used the service were encouraged to be independent and to make use of facilities in the community. We saw that the staff spent time with the people who used the service to support them in carrying out various tasks. People who used the service said that staff helped them to understand their individual needs.

Is the service Caring?

People at the home were treated with respect and their dignity was maintained at all times. We saw that people were supported by kind, attentive and friendly staff. We saw that staff were caring and gave encouragement when supporting people. One person told us, 'They look after me well'.

Information in care plans and around the home was available in formats to enable the people who used the service to understand information relating to them

Is the service Responsive?

We saw that people were involved in a range of activities in and outside the service. The provider involved other professionals in the care and treatment of the people who used the service. People told us that staff always responded to their needs in a timely manner. People knew how to raise complaints and we saw that complaints were dealt with appropriately.

Is the service Well Led?

The service worked well with other agencies and services to make sure care was joined up and effective. People we spoke with told us that the manager was always available to deal with any concerns. Staff told us they were clear about their roles and responsibilities. We noted that the provider needed to make improvements on how the home would be managed effectively in the case of her absence.

People who used the service told us that they liked living at the home. They said that they felt safe and that staff were kind, caring and supportive. One person said, "I love my home and all the staff are really nice." Another person said, "It's just one big family here."

People were supported to participate in activities of their choice in the local and wider community. This helped to promote people's independence and wellbeing.

People received care and support according to their personal needs and people's individual health care needs were monitored. Staff were responsive and enabled people to access health care professionals for treatment and advice.

Staff felt supported with their training needs but some staff refresher training was required. Staff supervision took place whilst the manager worked alongside staff. Staff sometimes worked alone which meant that, for some of the time some people were not always supervised.

Improvements were required in relation to the security of the building, the maintenance of room temperatures and redecoration of the environment. The provider also needed to take advice from the environmental health officer in respect of arrangements for the disposal of continence products and the washing of laundry including soiled laundry.

Everyone was eager to tell us how happy they were at the home. One person said "I love it hear this is my home". They told us how they felt involved in the running of the home. One person said, "I help out and do baking and cooking and go shopping" and another person said, "I tidy my room and sort my washing out".

People also said that they had enjoyed doing the things they liked to do. People felt able to express their views and that they were listened to and had a 'voice'. People's preferences and choices were taken into account in all aspects of their daily life in the home.

Staff we spoke with were happy to work at the home. A staff member said, "This is just one big family, its lovely". Staff had received training so that they could meet the needs of people but some of this training needed updating.

The management of the home was open and inclusive. A relative told us, "The manager is very good. She is approachable and will always listen to you". Another relative told us, "We could not ask for more. We are very pleased with the care X gets and we know that X is happy there".