Ivy Gate Lodge

Updated 17 October 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Ivy Gate Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Ivy Gate Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were two managers registered with the Care Quality Commission. One of the registered managers had recently left their post. The provider told us they would submit an application to deregister. The second registered manager was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. They were not based at the service.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 10 July 2023 and ended on 17 July 2023. We visited the service on 10 July 2023.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 2 people who lived at the home and 7 relatives to understand their experience of the care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with 12 members of staff including managers from the regional support team, deputy manager, nurses, healthcare assistants and the activities coordinator. We reviewed a range of records. This included 7 care plans and associated documentation. We looked at 2 staff files in relation to recruitment and multiple medication records. We reviewed multiple records relating to the management of the service, training data and a variety of policies and procedures.

Updated 17 October 2023

About the service

Ivy Gate Lodge is a care home providing nursing care to up to 72 people. The service is located in Southport and provides support to older people and people living with dementia. Accommodation is provided across three floors in one modern adapted building. At the time of our inspection, there were 23 people living at the home. Due to the number of people supported, only two floors were in use at the time of the inspection.

People’s experience of using this service and what we found

People were exposed to risk of harm as the provider had failed to ensure risks were managed appropriately. Staff did not always follow the control measures recorded in people’s care plans to keep people safe. There was a system in place to record and analyse accidents and incidents. However, appropriate follow up action was not always taken. Our observations showed there were enough staff to meet people’s needs, however they were not always deployed effectively.

There were systems in place to monitor the quality and safety of the service. Audits demonstrated concerns with areas of care provision were generally identified and addressed. However, concerns we found with risk management and staff deployment had not been identified.

There was a complaints management system in place. However, not all records were updated to show complaints had been handled in a timely manner.

Inconsistent management had negatively affected the culture of the staff team. Staff explained they often felt unsupported in their roles due to lack of effective leadership. Some staff commented support had improved since the provider had been more present in the home. People and their relatives shared concerns about the approachability and visibility of management.

Staff did not always see people's privacy and dignity as a priority and failed to take action to ensure people's private space and possessions were respected.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Medicines were safely managed. Systems were in place to ensure safeguarding referrals were made when required. Effective systems were in place to ensure infection prevention and control processes were safely operated.

Staff received an induction and completed mandatory training to enable them to carry out their job roles effectively. Detailed care plans were in place which guided staff on the level of support people needed with food and drink. People and relatives provided mixed feedback about the quality of the food. Some relatives told us the food was of a high standard, but others felt that the quality could be improved.

The home was appropriately designed to meet people’s needs and a high standard of interior design created a homely environment. People's individual rooms were personalised with items of their choice.

People's care plans contained contact details for the health professionals involved in people's care and support. Detailed communication care plans were in place to guide staff on how to effectively communicate with people according to their needs and preferences.

Staff treated people with kindness. We observed many caring interactions during the inspection. For example, a person was admitted to the home on the day of the inspection and staff went above and beyond to reassure the person and their relatives to ensure they settled in.

An activities programme was in place and there were dedicated staff to provide social activity for people. The provider had developed an action plan to improve the choice of activities.

Detailed care plans were in place to guide staff on how to support people with long term health conditions. Areas of clinical care such as wound care, catheter care and diabetes were well recorded and managed.

The provider was cooperative with external stakeholders. They embraced the inspection process as a learning opportunity and was open and honest when sharing information.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 1 March 2022 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about complaints management and quality monitoring systems and staff culture.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.