Ivy Homecare Limited improved from Inadequate to Good across all five key questions following a focused follow-up inspection on 29 June 2023, demonstrating sustained remediation of six prior regulatory breaches. Minor gaps remained in risk assessment action guidance, PRN medicines documentation and end-of-life care plan detail, all of which the provider addressed immediately during the inspection.
Concerns (3)
minor
Care planning
: “for some risk assessments it was not always clear what action staff should take if concerns were noted. This was discussed with the provider who took immediate action to address this.”
minorMedication management: “we identified guidance for staff was not always detailed about how to support people with this medication when needed. This was discussed with the provider who confirmed this would be immediately addressed.”
minorEnd-of-life care: “we identified more information was required to help ensure people's wishes and preferences were understood by staff and adhered to. This was discussed with the provider who agreed to review these care plans.”
Strengths
· Significant improvement from previous Inadequate rating across all five key questions, resulting in removal from Special Measures.
· Effective safeguarding systems introduced with clear reporting processes to CQC and local authority.
· Safe recruitment practices implemented including DBS checks, references and employment gap checks.
· People and relatives consistently reported feeling safe and expressed high satisfaction with care quality.
· Strong person-centred culture with individualised care plans reflecting people's preferences, likes and dislikes.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: StaffingGood
safe: RecruitmentGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Staff support: induction, training, skills and experienceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Continuous learning and improving careGood
Ivy Homecare Limited was rated Inadequate overall at its first inspection in August 2022, with breaches across eight regulations including safeguarding, medicines management, staffing, recruitment, person-centred care, complaints, governance and CQC notifications. The service was placed in special measures with conditions imposed on registration, due to widespread and systemic failures in leadership, oversight and safe care delivery affecting all 20 people receiving personal care.
Concerns (15)
criticalSafeguarding: “The Local Authority had identified at least nine safeguarding incidents this year that related to missed and late care calls and failing to seek medical support in a timely way.”
criticalMedication management: “One person had a medicine prescribed four times a day, but there were no times documented on the MAR...putting the person at risk of being administered medicine too soon which could have resulted in an overdose.”
criticalCare planning: “The provider told us, 'I know this information but it's in my head, not on paper.' Care records were not person centred and did not reflect people's assessed needs and choices.”
criticalStaffing levels: “They have so many customers so they can't keep on time, once they never turned up, but they apologised...They don't always stay for the full time.”
criticalGovernance: “The provider failed to follow their own governance policy to ensure they had sufficient oversight of quality and safety within the service.”
criticalMissed or late visits: “Feedback from people and their relatives had been received by the provider which raised a number of concerns/complaints with a similar theme of late/missed care calls. There was no evidence action had been taken.”
criticalPerson-centred care: “Where end of life care was being provided, care plans were not person centred or reflective of the current level of support required.”
criticalIncident learning: “Provider's investigations did not always contain sufficient detail as to what action would be taken to prevent reoccurrence. This placed people at continued risk of harm.”
criticalLeadership: “The provider did not have a good understanding of their regulatory requirements and neglected their management duties...led to poor governance systems, lack of meaningful quality assurance processes.”
criticalEnd-of-life care: “One person was receiving end of life care. This person's care plan was not fully completed and did not demonstrate this person's end of life wishes had been adequately explored.”
moderateComplaints handling: “There was no system in place to investigate and respond to complaints...one relative told us of a complaint they had made to the provider in February 2022, but they had not received a response.”
moderateRecord keeping: “The provider failed to ensure records were accurate, contemporaneous and up to date...care planning documentation contained out of date, conflicting or inaccurate information.”
moderateStaff competency: “Staff were not able to clearly describe the basic principles of the MCA. One staff member believed it related to being taken care of by someone else and said, 'Where someone can be taken of, I'm not sure.'”
moderateConsent / capacity: “One person's care plan had a contradictory assessment of their capacity and the consent form had been signed by a relative on their behalf.”
moderateCommunication with families: “People's communication needs had not always been adequately assessed or recorded...one person's care plan stated they were registered blind and hard of hearing but had no guidance on how staff should support them.”
Strengths
· Staff were described by relatives as kind and caring: 'They are kind and caring, we both get on with them very well.'
· Staff completed mandatory training including specific courses for diabetes, epilepsy and oral care, and received induction including shadow shifts prior to working alone.
· Suitable infection prevention and control policies were in place; staff completed COVID testing twice weekly and could describe correct PPE use.
· Competency assessments and spot checks were carried out by the provider for infection control and medication administration.
· Body maps were in place in people's homes to guide staff on applying creams correctly.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Using medicines safelyInadequate
safe: StaffingInadequate
safe: RecruitmentInadequate
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supportedRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Improving care quality in response to complaints or concernsInadequate
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: End of life care and supportInadequate
responsive: Meeting people's communication needsRequires improvement
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving careInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Working in partnership with othersRequires improvement