Ingleby Care Home

We found the following examples of good practice.

• Systems were in place to prevent people, staff and visitors from catching and spreading infections. There had been no known cases of Covid-19 at the service.

• The home had been adapted to support social distancing. Meal-times had been staggered to reduce the number of people in the dining room. Additional cleaning was being carried out.

• Staff had undertaken training in putting on and taking off PPE, hand hygiene and other Covid-19 related training. A dedicated infection control lead was in place. Staff practices were monitored to ensure the correct procedures were followed. The provider continuously shared important information about Covid-19 to staff.

• Staff supported people’s emotional and social wellbeing. People were supported to keep in contact with friends and relatives through telephone calls, social media and outdoor visits via an appointment system. National guidance were being followed to ensure visits took place at a safe social distance.

• The home was following national guidance for anyone moving into the home. Staff worked with people and their relatives to ensure they were aware of isolation procedures should they be needed. People were supported by a dedicated staff team who ensured any feelings of isolation and loneliness were reduced. This included a range of individual social activities and contact with friends and family.

• Infection control audits and checks were carried out. The registered manager spoke positively about the hard work and dedication which staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing.

Further information is in the detailed findings below.

The service was last inspected in May 2017 and was rated requires improvement. At that inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. We found records had not always been fully completed and contained gaps. We took action by requiring the provider to send us an action plan setting out how they would improve the service. When we returned for this inspection we found that records had improved and the provider was no longer in breach of regulation.

Ingleby Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Ingleby Care Home accommodates up to 56 people across two separate units, each of which have separate adapted facilities. One of the units specialised in providing care to people living with a dementia. At the time of our inspection 47 people were using the service.

There was a registered manager in place. 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.

People said they felt safe living at the service. Risks to people were assessed and plans put in place to reduce the chances of them occurring. Plans were in place to support people in emergency situations. The premises and equipment were clean and tidy and effective infection control processes were in place. Medicines were managed safely. People were safeguarded from abuse. The provider and registered manager monitored staffing levels to ensure enough staff were deployed to keep people safe. People told us there were enough staff at the service to keep them safe. The provider’s recruitment processes reduced the risk of unsuitable staff being employed.

A detailed assessment of people’s support needs was carried out before they started using the service to ensure the correct support was available. Staff received training to ensure they could provide the support people needed. Staff were supported with regular supervisions and an annual appraisal. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. People were supported to maintain a healthy diet. People were supported to access external professionals to monitor and promote their health. The premises had been adapted to ensure the comfort, health and wellbeing of the people living there.

Every person we spoke with was very positive about staff at the service and said they received kind and caring support. Relatives also praised the quality of the care people received. Staff were particularly sensitive to times when people needed caring and compassionate support. Staff were patient, caring and kind when supporting people living with a dementia. We saw numerous examples of kind and caring support being delivered throughout the inspection. Staff protected and promoted people’s dignity and sense of self-respect. People were supported to maintain their rights as active citizens and people and their relatives told us staff made them feel like welcome and valued. Staff we spoke with demonstrated a real empathy for and commitment to the people they supported. Policies and procedures were in place to arrange advocacy support where this was needed.

Care records contained evidence of personalised care planning and delivery and were regularly reviewed to ensure they reflected people’s current support needs and preferences. People were supported to access activities they enjoyed. Policies and procedures were in place to respond to complaints. At the time of our inspection nobody at the service was receiving end of life care. Policies and procedures were in place end of life care should this be needed.

Staff spoke positively about the culture and values of the service and provider. Staff, people and relatives said the service was well-led and spoke positively about the leadership provided by the registered manager. The registered manager and staff worked to create and sustain a number of community links for the benefit of people living at the service. Feedback was sought from people, relatives, staff and external professionals. The registered manager and provider carried out a number of quality assurance audits to monitor and improve standards at the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

We previously inspected the service on 18 and 22 December 2014 and found that the service was not meeting all of the regulations which we inspected. We found the service was not meeting the regulations for consent to care and treatment and good governance. This was because the service did not have suitable arrangements in place for obtaining consent. The service had not been following the principals of the Mental Capacity Act 2005 and this had not been picked up by the quality assurance measures in place at the time. There were also gaps in the quality assurance systems in place at the service. We noted that audits had regularly highlighted the same areas for improvement and actions plans had not been put in place following these audits. The registered manager was not given feedback following these audits which meant they had been unable to make the changes needed.

After inspection, the registered provider supplied an action plan to show us the action they had planned to take to improve the quality of the service.

Ingleby care home is registered to provide accommodation for people who require personal care, treatment of disease, disorder and injury and diagnostics and screening for up to 56 older people including people living with a Dementia. The service is located in a residential area within its own grounds and has on-site parking. The service is located close to local amenities. At the time of inspection there were 44 people using the service

The registered manager had been registered with the Commission since 21 January 2011. 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 this inspection, we could see the registered provider had made some improvements to their quality assurance processes. Appropriate procedures were in place to obtain consent. This meant they were following the principals of the Mental Capacity Act 2005.

At this inspection, we found improvements were needed to the quality and accuracy of record keeping at the service.

Some risk assessments reviewed were inaccurate because scores had not been calculated correctly. We could see that there had been no negative impact on people because of these inaccuracies in the records. There were also gaps in the information contained in care plans.

Topical cream records had not always been completed. This meant it was not clear if people were receiving their topical creams as prescribed. We also noted gaps in nutrition and hydration monitoring records. The registered manager told us that although there were gaps in these records, they were satisfied that people were receiving an adequate nutrition and hydration intake.

Staff showed they understood the procedures which they needed to follow if they suspected someone was at risk of abuse. Staff were able to discuss the types of abuse which people could be at risk from and how they could help to minimise these risks. All staff spoken with told us they would not hesitate to whistle blow (tell someone) if they needed to.

Risk assessments were in place for people's specific needs and for the day to day running of the service. Some risk assessments for people contained detailed information and had been regularly reviewed.

Health and safety certificates for the premises were up to date and showed that the service was safe for people and staff. Fire safety system checks had also been completed and staff had participated in regular fire drills.

All staff had a Disclosure and Barring Services check in place. DBS checks help employers make safer decisions and prevent unsuitable people from working with vulnerable client groups.

People, their relatives and staff told us there were enough staff on duty throughout the day and night to care for them safely. We could see staffing levels were regularly monitored.

People received their prescribed medicines when they needed them. From our observations, we could see that people were supported to take medicines and people were given the time they needed to do so.

Staff told us they were supported during their induction period and records confirmed this. We saw staff shadowed more experienced staff whilst they became familiar with people using the service and the requirements of their role.

All staff were supported to carry out their roles effectively. Staff received regular supervision, appraisal and training. These also included observations of practice. When we reviewed supervision records, we noted gaps in the recording of information contained within them.

People told us staff sought their consent before any care and support was given.

Staff had increased their knowledge and understanding of the Mental Capacity Act (MCA) 2005 and deprivation of liberty safeguards (DoLS). Staff were confident in these areas when we spoke with them and felt able to seek further support from the registered manager if they needed to. We noted that not all MCA assessments and best interests’ decisions were decision specific. The operations manager told us they were already aware of this and support was in place to address this.

Staff understood the action they needed to follow to ensure people received adequate nutrition and hydration. We could see that staff completed risk assessments and updated care plans when people became at risk of malnutrition or dehydration and worked alongside health professionals.

We were concerned that there was only one readily available choice at mealtimes. If people wanted something else to eat, they needed to wait for the meal to be prepared. However people spoke positively about the food provided to them.

People told us they had access to health professionals when they needed them. We saw evidence of this during inspection from our discussions with people and staff, from our observation of visiting professionals and from the care records we looked at.

People and their relatives spoke positively about the care and support they received from staff. People told us they enjoyed living at the service and felt well cared for.

Not everyone we spoke with was sure if they had been involved in developing and reviewing their care plans. Records did not always show if this had been the case, however people told us staff always asked their permission before care and support was carried out.

People told us they privacy and dignity was maintained at all times. During inspection we observed good practices from staff.

Care plans were in place for people and had been reviewed. We noted that some care plans contained detailed person-centred information.

People told us they enjoyed the variety of activities provided at the service. From speaking with people we could see they also went out into the community to local shops and participated in community events. We could see that activities at the service had a positive impact upon people's lives.

People and their relatives told us they knew how to make a complaint and felt confident that action would be taken. We could see a small number of complaints had been made and records detailed the action taken to resolve the complaint and included the outcome of the complaint.

Staff told us they were happy working at the service; they were positive about one another and communicated well. All staff told us they were supported by the registered manager. All staff told us they could approach them if they needed to.

The registered manager had good links with the local community and people attended events within the community. The local community were also invited into the service for events. During inspection, the service was visited by local school who participated in a Halloween party.

The registered manager had made some improvements to the procedures in place for monitoring the quality of the service. Action plans were in place when audits had been carried out. These were actioned and checked by the regional manager during their monitoring visit. The regional manager also carried out their own audit of the service.

The registered manager regularly reviewed all safeguarding alerts and accidents and incidents. This meant patterns and trends could be identified and action taken to minimise the risk of reoccurrence and harm to people.

Surveys had been carried out and had been aimed at people and their relatives, staff and health professionals. Positive themes had been identified and action plans created when improvements were required.

Staff and people told us they were kept up to date with any changes or events occurring at the service and minutes were available if they had not been able to attend any meetings. We could also see that people had access to regular newsletters and had been invited to participate in the latest survey.

The registered manager had good links with the local community. People actively attended community events.

We could see that staff understood the requirements of their role and worked under the guidance of the registered manager to ensure people received safe care and support. We could see the staff team worked well together and communicated well.

Notifications, which are legally required and contain information about incidents in the service, had been submitted to the Commission when required to do so.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People were supported to eat and drink sufficient amounts to meet their needs.

People's health, safety and welfare were protected when more than one provider was involved in their care and treatment, or when they moved between different services.

We saw that the service had appropriate equipment. We saw that regular checks and servicing of equipment was undertaken to ensure that it was safe.

We saw that there was sufficient staff with the right knowledge and experience to support people.

We spoke with four people who used the service and the relatives of four people. We also spoke with the manager and three staff. People who used the service expressed satisfaction with the care and service that they received. One person told us; 'It's lovely, the girls are very friendly.' Another person told us; 'They are very good to me, I don't want for anything.' One of the relatives we spoke with told us; 'The carers are very good and always helpful.'

Where able, people could make their own day to day decisions and lifestyle choices. They could choose to participate in activities or spend time in their rooms. We saw people could maintain contact with their friends and family.

People's views were taken into account in the assessment and care planning process.

Staff had received training in safeguarding of vulnerable adults.

The environment was clean and well decorated and systems were in place to ensure maintenance was carried out when required.

We found there were appropriate arrangements in place for the recruitment of staff.

We saw the home had a complaints procedure in place and this was accessible to people and their relatives.