Care service inspection report
Follow-up inspection
Ivybank House Nursing Home
Care Home Service
Ivybank House
Main Street
Polmont
Falkirk
Inspection report for Ivybank House Nursing Home
Inspection completed on 04 December 2015
Inspection report
Service provided by: Ganarn Limited
Service provider number: SP2003002297
Care service number: CS2003011596
Inspection Visit Type: Unannounced
Care services in Scotland cannot operate unless they are registered with the
Care Inspectorate. We inspect, award grades and set out improvements that
must be made. We also investigate complaints about care services and take
action when things aren't good enough.
Please get in touch with us if you would like more information or have any
concerns about a care service.
Contact Us
Care Inspectorate
Compass House
11 Riverside Drive
Dundee
DD1 4NY
[email protected]
0345 600 9527
www.careinspectorate.com
@careinspect
Inspection report for Ivybank House Nursing Home
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Inspection report
1 About the service we inspected
Ivybank is registered to provide care for up to 42 older people. The home is situated
close to local facilities in Polmont. It maintains close links with the local community
and local entertainers and church organisations are invited to the home on a regular
basis.
The service has a clear statement of aims and objectives. The philosophy of the
home is that "all residents living in the home will be cared for in a secure, warm,
welcoming and homely environment with individually planned care."
The accommodation is well furnished and offers single ensuite bedrooms. There are
various communal areas available to the service users over the two floors (accessible
by lift). All catering is done within the care home and there is also a personal laundry
service offered.
2 How we inspected this service
We wrote this report following an unannounced inspection carried out by one care
inspector and one inspection volunteer. The inspection took place on Friday 4
December 2015 from 9.00am - 1.15pm. The Care Inspectorate gave detailed feedback
to the manager and deputy manager from 12.15pm-1.00pm on Friday 4 December
2015.
As part of this inspection, we took account of the completed annual return and a self
assessment form that we asked the provider to complete and submit to us.
During this inspection process, we gathered evidence from various sources, including
the following:
-Direct observation of staff practice,
-A sample of four service user plans,
We also spent time looking at the equipment and the environment.
We spoke with:
-Seven service users,
-Five relatives,
-Manager,
-Depute manager.
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3 Taking the views of people using the service
into account
The inspection volunteer who has experience of using care services made the
following observations:
'All of the interactions I saw between staff and residents were warm and polite.
There was an occasional bit of humour and banter, which was perfectly appropriate
and enjoyed by the residents. Residents and families I spoke with were all happy with
the care provided at Ivybank. One or two residents had previously stayed at other
homes but said the care at Ivybank was superior to that which they had previously
experienced elsewhere. All of the residents I spoke with were complimentary about
the quality of the meals they received. Residents said they particularly enjoyed the
entertainment provided by people who visit. Some residents also attend local clubs in
churches etc.
A few residents felt that there was a shortage of staff. This seemed to be either at
bedtime or breakfast. One resident told me she occasionally has to read her
newspaper for half an hour while she awaits breakfast. None of those who felt there
was a delay in staff attention, felt that this was any lack of staff endeavour and
indeed spoke of perceived staff fatigue at the end of twelve hour shifts. One or two
residents told me they preferred to do as much as they could of their personal care
themselves. This seems to be sensibly supported by care staff. One resident I spoke
with really enjoys doing some small tasks to assist staff and other residents. He folds
napkins to assist laundry staff and has taken responsibility for watering the plants in
the greenhouse. This resident's self-esteem was improved by the feeling that he
contributed something'.
We spoke with residents and relatives about each of the four quality themes we look
at during our inspections, these were Quality of Care and Support, Quality of the
Environment, Quality of Staffing and Quality of Management and Leadership. We
have detailed people's comments under each of the four themes below:
Quality of Care and Support:
Residents told us:
"Care is the tops."
"I wouldn't like to be anywhere else."
"I'm lucky to be here."
"Meals are great and we have tea at any time."
"The food is good quality and there is choice."
Inspection report for Ivybank House Nursing Home
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"Meals are nice and you don't have to order the day before."
"Meals are very good - I have a good appetite."
"There's nothing I'd change - I'm happy."
"I've no fault to find in the care I get."
"They take me to the Wednesday club in the church."
"The singers are good."
"Better than where I stayed before."
"Last night it took a while to get somebody to help me to get to bed."
"They could do with more staff at night time."
"I think they are short staffed at breakfast, I read my newspaper when
I'm waiting."
"I have a lot of sympathy for the staff, they are drained at the end of a shift."
"I get myself up in the morning because I want to. I'll tell them when
I can't do it anymore myself."
Relatives/carers we spoke with told us:
"Care is excellent."
"I think the activities are really good."
Quality of the Environment:
The Inspection Volunteer who has experience of using care services made the
following observations:
'The rooms I saw were mostly not large, although one or two were bigger and had
two windows. Rooms have ensuite toilets. Residents I spoke with had no complaints
about room size or housekeeping. All of the communal areas I saw were well looked
after and tidy. There were no bad odours anywhere I visited. Corridors were narrow
and seemed to have a lot of noise from room alarms being sounded. New signage is
awaited. The grounds are not large but are secure. A few residents told me they
enjoy sitting out in summer'.
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Residents told us:
"I'm happy with my room."
"My room is comfortable and clean."
"Room is quite adequate."
"I've no problem with the housekeeping."
"My room is kept in good nick, it's hoovered and dusted."
"My bed is changed regularly."
"Housekeeping is up to scratch."
"I got a choice of colours when they decorated."
"It's lovely to sit outside in the summer."
Relatives told us:
"*****'s room is kept very tidy."
"We are encouraged to personalise the room."
"The rest of the place is kept nice and clean."
"They could do with some wind breaks outside."
Quality of Staffing:
The Inspection Volunteer who has experience of using care services made the
following observations:
'In the time I observed, staff were attentive and respectful, which is what residents
told me is normal. Residents and family used many complimentary adjectives to
describe the staff. It was obvious that the staff largely have respect from residents.
Residents obviously regard the housekeeping staff as part of the 'care' system at
Ivybank. When I asked about how secure and safe residents felt when being assisted
to rise and mobilise, their reactions were very positive. One or two residents
expressed some concern about staff fatigue, saying staff were 'drained' at the end of
12 hour shifts'.
Residents told us:
"I've got no problem with the staff."
"They are very patient."
"They do a job I couldn't."
"Couldn't get better staff."
"I'm treated with respect."
"They are courteous."
"I get my medication on time."
"Yes, I'm treated with respect."
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"They are very, very good."
"When they get young staff in, they soon get them into shape."
"I feel safe with them."
"They include you in any conversation."
"They make lots of time for you."
Relatives told us:
"They are excellent folk."
"They are good natured - They have to be."
"****** is treated respectfully."
"We are treated well when we visit - Always tea on the go."
Quality of Management:
The Inspection Volunteer who has experience of using care services made the
following observations:
'Some residents I spoke to were somewhat vague if I asked them if they knew the
manager. Some knew her as 'Boss Lady' and one resident called her the 'Gaffer'.
Others simply knew her by her first name. Some residents told me they had regular,
informal, conversations with her. While I was speaking with a resident who was
telling me she did not know the manager, the manager passed by, and was greeted
with "hello *****." The manager appeared to be visible while we were at Ivybank.
Whether the residents knew the manager personally or not, they largely told me that
the "place is well run"- Residents were satisfied with the regime at Ivybank.
Residents told us:
"****** makes her rounds of the place."
"I'd see her if I'd any complaints, but I don't."
"I see *****, the 'gaffer' regularly about the place."
"I get on all right with her."
"Can't say I know the manager."
"I know ***** - She's very pleasant."
"I don't know the manager -- Immediately followed by "Hello *****."
"There's nothing I'd change."
"The admin lady is also very helpful."
Relatives told us:
"I'm happy with the way the place is managed."
"We're well happy."
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4 Taking carers' views into account
We have reflected the views of relatives/carers under each of the quality themes
detailed above.
5 What the service has done to meet any
requirements we made at our last inspection
Previous requirements
There are no outstanding requirements.
6 What the service has done to meet any
recommendations we made at our last
inspection
Previous recommendations
1. Recommendation with reference to Theme 1, Statement 1:
The management team should use good practice guidance, for example,
'Beyond Life Histories' (www.helensandersonassociates.co.uk/media/86863/
beyondlifehistories.pdf) to inform practice around promoting the involvement
of residents who have dementia in assessing and improving all aspects of the
home.'
This recommendation was made on 14 January 2015
We found that activities staff had been working with residents and their relatives to
develop resident profiles which contained detailed information about people's
hobbies, likes and dislikes and life histories. The service was working to complete
staff profiles which contained similar information and would support the matching of
residents and staff members with similar interests to each other.
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The activities co-ordinator had also supported residents to write a wish list which
was on display at the entrance to the building and also on display in the upstairs
lounge of the service.
We found that some of the wishes made by residents had been met by the activities
staff while others were being worked on. We saw evidence of a good level of activity
being made available for residents based on the information gathered about their
interests, likes and dislikes.
This work needed further development to demonstrate how this had supported
people to be involved in assessing and improving the quality of the service overall.
Therefore the recommendation had not been fully met but we were able to see that
good progress had been made towards meeting this recommendation.
2. Recommendation with reference to Theme 1, Statement 3:
The management team should ensure that risk assessments are completed
and updated immediately where new information, for example, a service user
is weighed should inform any assessment.
This is to meet National Care Standard 6 Care Homes for Older People Supporting Arrangements.
This recommendation was made on 08 July 2015
Care plans we looked at during this follow up inspection were more detailed and
provided a more accurate reflection of the current needs of residents than had
previously been the case. Care plan audits, which identified where improvements
should be made had supported staff to understand the changes required and the
importance of these. We were able to see how this had led to improvements in risk
assessments, care plans and record keeping.
We saw that dependency assessments were being completed accurately based on
up-to-date risk assessments. We focussed on residents with a particularly high level
of need and found that risk assessments were up to date and accurately reflected
the risks affecting residents. We then looked at corresponding care plans and saw
that these had been updated to reflect the changes in risks and levels of need
experienced by residents. We also found that appropriate equipment had been
sourced and put into place for residents. For example, residents who had been
assessed to be at high risk of a breakdown in their skin integrity had a specialist
mattress designed to reduce the pressure on their skin in place.
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This meant that the outcomes for residents in terms of the management of skin
integrity and risk of malnutrition were being more effectively managed than we
previously found. Therefore this recommendation had been met.
3. Recommendation with reference to Theme 2, Statement 2:
The provider and management team should ensure that equipment to meet
the assessed needs of residents is available to them for use at all times. Staff
should ensure that the equipment is provided to residents to promote safety
and address identified risks.
This is to meet National Care Standard 6 Care Homes for Older People Supporting Arrangements.
This recommendation was made on 08 July 2015
We found that there was adequate equipment at the service to allow staff to meet
the needs of residents who need equipment to mobilise or transfer. At the last
inspection there had been some delays for some residents who required the use of
equipment in the downstairs part of the home due to there only being one hoist
available in this area. At this inspection we found that there were two hoists
downstairs and one hoist upstairs. This meant that we did not observe any delays for
residents who required the use of equipment to move between areas of the home.
We looked at equipment in use in residents' bedrooms, for example pressure
relieving mattresses and cushions. Records we looked at and observations we made
showed that pressure relieving equipment was in place appropriately to protect
residents' skin integrity.
Therefore, this recommendation has been met.
We checked records of equipment in use and required by residents. We found that
this should be updated and maintained by the service. We advised the management
team that the service should maintain and update a record of equipment in place to
allow forecasting of equipment requirements and how these may change as the
needs of residents change.
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4. Recommendation with reference to Theme 2, Statement 3:
The provider should assess the quality of the environment using current
guidance with regards to promoting the quality of life for people with
dementia. Particular attention to wayfinding and visual barriers should be
included in this assessment.
This is to meet National Care Standard 4 Care Homes for Older People - Your
Environment.
This recommendation was made on 23 October 2014
The management team advised us that an environmental audit had been completed
and appropriate signage had been ordered for the home based on the preferences of
residents. However, this was not in place during this inspection, therefore this
recommendation has not been met and we will follow up on this at the next
inspection.
5. Recommendation with reference to Theme 3, Statement 3:
The action taken in response to the involvement of residents and their
relatives in assessing and improving the quality of staffing in the service
should be evidenced clearly.
This is to meet National Care Standard 5 Care Homes for Older People Management and Staffing Arrangements.
This recommendation was made on 23 October 2014
We were able to see evidence of the planned involvement of residents in recruitment
processes at the service however, there had been no involvement since the last
inspection. Therefore this recommendation has not been met and we will follow up
on this during the next inspection.
6. Recommendation with reference to Theme 4, Statement 4:
Processes to evaluate the effectiveness of staffing levels at the home should
be developed to accurately evaluate the number of staff required to work in
the home. This should include the views of people who use the service, staff
and relatives.
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This is to meet National Care Standard 5 Care Homes for Older People - Management
and Staffing Arrangements.
This recommendation was made on 08 July 2015
Dependency assessments were being completed more accurately than had previously
been the case although the tool remains limited in terms of accurately assessing
more complex needs, particularly for people with a cognitive impairment or
dementia.
The deputy manager was now completing dependency assessments for all residents
and risk assessing skin integrity. We saw that this had led to more accurate
assessments and actions being taken as a result of increased risk.
The service had increased staffing levels following the last inspection but had found
this increase difficult to maintain due to staff recruitment and retention difficulties.
The manager told us that new staff were being recruited and that this should allow
the service to deploy additional staff. They also told us that a new shift was being
considered to support residents more effectively at peak times, this was being
discussed with staff imminently. The times of peak demand which residents
highlighted to us during this inspection included the periods of time which would be
covered by this new shift. However, the service did not have evidence of asking
residents or relatives for their views about staffing levels at the home.
Therefore although the service was making good progress towards meeting this
recommendation further work was needed to meet the recommendation fully. We
will follow up on this during the next inspection.
7 Complaints
No complaints have been upheld, or partially upheld, since the last inspection.
8 Enforcements
We have taken no enforcement action against this care service since the last
inspection.
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9 Additional Information
There is no additional information.
10 Inspection and grading history
Date
Type
Gradings
8 Jul 2015
Unannounced
Care and support
Environment
Staffing
Management and Leadership
4 - Good
4 - Good
4 - Good
4 - Good
15 Dec 2014
Unannounced
Care and support
Environment
Staffing
Management and Leadership
3 - Adequate
Not Assessed
Not Assessed
2 - Weak
1 Oct 2014
Unannounced
Care and support
Environment
Staffing
Management and Leadership
3 - Adequate
3 - Adequate
4 - Good
3 - Adequate
7 Mar 2014
Unannounced
Care and support
Environment
Staffing
Management and Leadership
4 - Good
4 - Good
Not Assessed
Not Assessed
9 Oct 2013
Unannounced
Care and support
Environment
Staffing
Management and Leadership
4 - Good
4 - Good
5 - Very Good
4 - Good
14 Mar 2013
Unannounced
Care and support
Environment
Staffing
Management and Leadership
Not Assessed
5 - Very Good
5 - Very Good
Not Assessed
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26 Oct 2012
Unannounced
Care and support
Environment
Staffing
Management and Leadership
4 - Good
Not Assessed
Not Assessed
4 - Good
12 Mar 2012
Unannounced
Care and support
Environment
Staffing
Management and Leadership
3 - Adequate
Not Assessed
Not Assessed
4 - Good
20 Dec 2010
Unannounced
Care and support
Environment
Staffing
Management and Leadership
5 - Very Good
Not Assessed
Not Assessed
Not Assessed
20 Oct 2010
Announced
Care and support
Environment
Staffing
Management and Leadership
5 - Very Good
Not Assessed
Not Assessed
Not Assessed
24 Mar 2010
Unannounced
Care and support
Environment
Staffing
Management and Leadership
5 - Very Good
Not Assessed
5 - Very Good
Not Assessed
13 Jan 2010
Announced
Care and support
Environment
Staffing
Management and Leadership
5 - Very Good
5 - Very Good
5 - Very Good
Not Assessed
31 Mar 2009
Unannounced
Care and support
Environment
Staffing
Management and Leadership
5 - Very Good
Not Assessed
5 - Very Good
Not Assessed
22 Oct 2008
Announced
Care and support
Environment
Staffing
Management and Leadership
5 - Very Good
5 - Very Good
5 - Very Good
5 - Very Good
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To find out more
This inspection report is published by the Care Inspectorate. You can download this
report and others from our website.
You can also read more about our work online.
Contact Us
Care Inspectorate
Compass House
11 Riverside Drive
Dundee
DD1 4NY
[email protected]
0345 600 9527
www.careinspectorate.com
@careinspect
Other languages and formats
This report is available in other languages and formats on request.
Tha am foillseachadh seo ri fhaighinn ann an cruthannan is c?nain eile ma
nithear iarrtas.
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