Iceni House

Iceni House is a residential care home providing personal care and support to 57 people aged 65 and over at the time of the inspection. The service can support up to 75 people. The care home consisted of two units, one on the ground floor and one on the first floor of the building. Each floor providing single accommodation for people requiring residential or more specialist dementia care.

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

Audits that had been implemented were not effective in all areas and did not ensure care records were accurate and detailed. Not all environmental risks had been thoroughly assessed to ensure people were safe from potential harm.

People did not all consume their breakfast at a suitable temperature impacting on this experience.

The management team had made improvements to the support being offered at this service since our last inspection. Although some areas required further strengthening the management team had a development plan in place to further improve the compliance of this service.

People’s medicines were stored and administered safely. People received their medicines on time and as prescribed by healthcare professionals.

People and their relatives felt the care provided had improved since our last inspection and that staff were approachable.

People and their relative's feedback was regularly sought, and they were involved in shaping the support offered at the service.

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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 1 February 2022) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made however the provider remained in breach of regulation.

Exiting special measures

This service has been in Special Measures since 01 February 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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.

We carried out an unannounced focused inspection of this service on 13 December 2021. Breaches of legal requirements were found in relation to safe care and treatment, staffing and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Iceni House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to good governance and oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider and request an action plan following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Iceni House is a residential care home providing personal care and support to 60 people aged 65 and over at the time of the inspection. The service can support up to 75 people. The care home consisted of two units, one on the ground floor and one on the first floor of the building. Each floor providing single accommodation for people requiring residential or more specialist dementia care.

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

People were not supported to maintain their safety, and to prevent risk of harm. There were not sufficient numbers of suitably trained and skilled staff on each shift to respond to people’s assessed needs and risks, including where people’s call bells and sensor mats had signalled the need for assistance.

People were not being protected from the risk of the spread of infection, with concerns identified regarding infection prevention control and COVID-19 standards by the staff team.

People were not protected from access to risk items, including teeth cleaning tablets, razors and drinks thickener. Staff were not ensuring rooms and people’s individual storage units were being kept secure.

People did not all have access to a call bell to enable them to source support from staff where this need had been identified in their care plans. People were not being supported to eat in a safe posture when in bed. People’s breakfast was not being stored hygienically or at suitable temperatures to maintain food hygiene standards.

The provider was not maintaining consistent standards of oversight of the care provided to ensure people led safe and meaningful lives. The provider was not taking timely action to reduce the risk of incidents and accidents such as falls from reoccurring to keep people safe.

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

Rating at last inspection (and update) The last rating for this service was Requires Improvement, (published 15 October 2020).

Why we inspected

The inspection was prompted in part due to concerns received about the security and safety of the care environment, and the management of people at risk of experiencing falls. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Iceni House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing and the governance and oversight of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Iceni House is a residential care home providing personal and nursing care to 50 people aged 65 and over at the time of the inspection. The service can support up to 75 people. The care home is purpose-built with both ground and first floor accommodation and each floor provides single accommodation for people requiring residential or more specialist dementia care.

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

Since the last inspection a new registered manager had been appointed. They were supported by a representative for the provider known as the nominated individual. They had worked jointly with health and social care agencies, staff, relatives and people using the service to improve the quality of care.

Staffing levels have increased in line with people’s needs and staffing was flexible. There was a cohesive staff team who worked well together and communicated effectively.

The culture within the service had improved and staff were open and transparent. Staff understood their responsibilities and were held accountable as necessary. Staff were appropriately trained to recognise abuse and challenge poor practice. Families commented on the openness and approachability of staff and said poor performing staff had left or been dismissed.

Medicines were well managed, and support was given to senior staff to ensure they were sufficiently competent and confident to administer medicines safely and only after being fully trained.

Infection control audits helped to identify if cleaning practices were effective. The service was cleaned to very high standards and staff were adhering to infection control procedures. Staff understood how to protect people from cross infection.

The service was managed effectively in line with people’s needs. There was a person-centred culture and the service worked holistically with people, their families and other professionals.

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.

People were consulted about their care. The service was proactive in acting on people’s feedback and consulting family members.

The service ensured people’s health care needs were met. Staff had undertaken dementia training and they understood potential triggers for people’s behaviour and how to respond to people when they might be in distress.

The registered manager had high standards and observed, trained and coached staff. Team leaders had been appointed and supported by unit leads. Staff were encouraged to take a lead role and some staff had key areas of practice they oversaw. Job descriptions had been updated and staff were clear about their roles and responsibilities.

The environment had improved and there were robust audits which demonstrated that equipment was safe to use and there was a routine programme of maintenance.

Feedback was sought and people and their families were involved in their care and the service acted on and sought advice from other professionals.

The registered manager was experienced and knowledgeable of the relevant legislation and best practice and had moved the service forward in a clear and professional way.

Rating at last inspection

The last rating for this service was inadequate (published 14 February 2020.) There were multiple breaches of regulation and we served requirement notices and requested an action plan to be sent to us. The provider completed an action plan after the last inspection to show what they would do and by when to improve. They have continued to send in a monthly action plan.

This service has been in Special Measures since the last comprehensive inspection undertaken on 27 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a focussed inspection prompted in part due to the long-term sustainability of this service, but also to follow up on multiple breaches and check the accuracy of the current rating. This report only covers our findings in relation to the key questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measure 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 coronavirus and other infection outbreaks effectively.

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

Iceni House is a residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. The service can support up to 75 people over two floors. The units accommodate people requiring residential or specialist dementia care.

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

People were not receiving a safe service and could not be assured that management would address their concerns. The service had poor oversight of risk and was ineffective in taking necessary actions to address shortfalls in the service. Medicines had not always been well managed, and we were not assured people always got their medicines as needed. Environmental risks had not been identified.

Record keeping was very poor and data was not collated to determine where the risks were, and action plans were not developed in a timely way to help mitigate risks.

People’s routines were determined by staffing levels rather than their own needs and preferences. Staff did not always have time to provide person centred care in line with people’s preferences.

Staff recruitment processes were in place but not sufficiently robust and although staff training, and staff supervision was in place there was limited evidence of how staff influenced the service. Training was not firmly embedded, and we could not see how training informed good care.

People did not always have their health care needs met and there was poor follow up. People were not supported to eat and drink in line with their preferences and records were not completed contemporaneously so we were not assured of their accuracy. Care plans and daily notes were poorly written, out of date and not sufficiently personalised.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People did not have choice in their care and routines because staff did not have sufficient understanding of their needs or communicate with people effectively.

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

The last rating for this service was good (published 18 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about Iceni House. We were made aware of specific safeguarding concerns. The local authority quality monitoring team visited on 21 and 28 October 2019 and completed a review of the service and rated it poor. We carried out our inspection on 27 November 2019 because despite regular involvement from the Local Authority safeguarding team and quality team the service was failing to make enough improvement to ensure the health and safety of people using the service.

Enforcement

We have identified breaches in relation to the way people's risks are monitored and mitigated, medicines management, staffing, reporting incidents, consent and governance systems at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider to discuss how they will make changes to ensure they improve the support

people receive. We will work with the local authority to monitor progress.

Special Measures

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement

procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than

12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our most recent inspection, we identified improvements in all areas although there were still some concern about staffing levels and whether there was sufficient skill mix on shift. Staff recruitment remained a difficult area for this service and for the care sector in general.

The service is for older people who require residential care, some of whom may be living with dementia. The home could accommodate up to 74 people in single, en-suite rooms. Accommodation was over two floors with the dementia unit on the ground floor. On the day of our inspection there were 70 people using the service.

There was 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.

We found the home had improved and had worked hard to meet its own action plans. The home was well led and the staff we spoke with were very professional, knowledgeable and provided care centred around the needs of each individual. At the last inspection, we reported on a breach of regulation in regards to staffing levels. At this inspection there were enough staff to provide care people needed in a safe way. However, we saw there were difficulties around the recruitment and retention of staff and agency staff were being regularly used. Ensuring there were staff with sufficient skills and experience was also a challenge for the service given a recent vacancy of unit leader and only a small number of senior staff who could lead and direct the shift.

Staff spoken with were familiar with safeguarding protocols and how to protect people as far as reasonably possible from abuse. The home was proactive in reporting any concerns of alleged or actual abuse. They told us they reported anything of concern and brought it to the attention of the local authority. They worked with other agencies to try to support people with their anxieties and distressed behaviours. We received feedback about this and were told that a consistent approach was not always used and the guidance in people’s care plans not always sufficiently detailed to support staff to work in a consistent way. We observed staff and found their approaches consistent and calm in the way they approached people.

Medicines were well managed and people received them as intended. We identified an issue with recording but were given immediate assurances that this would be addressed.

Risks to people’s safety were managed well and there were enough staff to deliver care as needed. There was sufficient management oversight of risk. This helped ensure people received safe care and treatment.

Robust staff recruitment processes were in place and helped recruit staff with the right attitude and skills for the job

Staff were supported through induction, training and ongoing support to help develop their confidence and competencies. A lot of staff had transferable skills and qualifications from their country of origin. For staff new to care, a nationally recognised induction, the care certificate, was used by way of introduction and covered all the key skills and competencies.

People were supported according to their preferences but engagement with people, their relatives and staff in the planning of care needed further consideration. Staff acted lawfully in terms of supporting people who lacked capacity to make informed decisions for themselves. Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process.

Staff had sufficient understanding of legislation underpinning human rights, equality and diversity and mental capacity. They demonstrated this through their approach to person centred care.

People were supported to stay healthy and to receive health care as and when required. Staff had an understanding of long-term conditions people had and monitored these so they could identify any changes, which might require medical intervention.

People were supported to eat and drink enough for their needs and there was monitoring of people’s weights, which provided information staff could act upon if unintentional weight loss was identified. There were good systems in place but the occasional gap in audits and records could potentially mean that actions taken to support a person would not be timely.

People received care based around their needs and wishes and this was documented. Some restrictions were observed due to available staffing, for instance planned activities were not yet available seven days a week and some people were requesting to go outside and were reliant on staff to facilitate this. We did not observe staff offering to do this. There was no transportation at the service to enable trips to take place. We noted good engagement with relatives but less so with the local community which would enhance people’s experiences and help them live well. The activities we saw taking place were good, and increased people’s well- being.

Staff were observed enhancing people’s health and well- being. They were polite, considerate and knew people well. There was a lovely atmosphere throughout the home with staff supporting each other and providing unhurried, timely care. Care was provided on an individual basis but people had limited opportunities to feedback their experiences. Surveys were used for feedback and issued every six months. Regular relative meetings also took place and some people had good input from other health care professionals. People were involved in their plan of care where they were able. However there were no resident meetings and it was not clear how some people would articulate any concerns or improvements they may wish to see.

The environment had been created to provide stimulation for people living there. The layout helped people walk with purpose without restrictions. There were areas of interest and lots of tactile objects and things to stimulate people visually. The environment was clean and personalised for each individual. People on the ground floor had access to the gardens and people upstairs could access the garden with support.

There was a robust complaints procedure and other means for people to feedback including regular audits of the service. The director was at the home during our inspection and visited each week and informally audited the service although the outcome of their visit was not always recorded so we could not see what actions had been identified. All the staff knew the director and said they were friendly and approachable.

The home was well-led with most staff expressing confidence with the manager and reporting positively on the changes they had seen. The biggest threat to the service was recruitment and retention of staff especially given the high level of need and supervision required by some people using the service.

There were systems in place to try and continuously improve the service and ensure people’s needs were met. We found systems robust but did find gaps in the frequency of audits and found not all records as robust as we would expect. However, we did not see any evidence that this had reduced the quality of service.

The home was well supported by health care professionals and relatives of people using the service. The manager also attended a number of forums and had contact with other home managers in the county. This helped them keep up to date with best practice and share ideas in a mutually supportive setting

Iceni House provides accommodation and personal care for up to 74 older people, some of whom may be living with dementia. There were 67 people living in the home on the day of our inspection.

This inspection took place on 7 and 9 September and was unannounced on both days.

The previous registered manager had left the home in May 2016. A new manager had been appointed who had previously been working at the home as the deputy manager. They were in the process of completing a CQC registered manager’s application. A registered manager is a person who has registered with the CQC 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 the last inspection the home was rated good in each of the key questions is it ‘safe’, ‘caring’, ‘responsive and well led. We rated the key question of ‘effective’ as requires improvement. However the home was rated good overall. At this inspection the home has been rated requires improvement in each of the key questions and overall. This means that there were more concerns at the home now than at the previous inspection.

The provider had a recruitment procedure in place; records did not however reflect that this was always followed when new staff were recruited. Staff were not always supported in their role through regular training and supervision.

There were insufficient numbers of staff on duty. Staff were not always deployed effectively in order that they could meet people’s needs effectively.

Infection control monitoring within the home was in need of improvement. Staff did not always follow safe procedures to protect people from the risk of cross infection.

Staff had not always received the required training to enable them to meet people’s needs. Staff were not familiar with the principles of the Mental Capacity Act 2005 (MCA).

People received support from staff that were mainly kind and caring. However, people were not always treated with dignity and respect because staff were task focussed and care took place in a manner that was not centred on them with hurried or little interaction.

There were systems in place for managing medicines in the home. A medicine procedure was available for staff and staff had completed training in relation to safe medicine administration. Medicines were stored safely and records showed they were administered as prescribed. Healthcare professionals such as chiropodists, opticians, GPs and dentists were involved in people's care when necessary.

People were supported to maintain a healthy balanced diet. Dietary and nutritional specialists' advice was sought so that people with complex support needs with their eating and drinking were supported effectively. Records of support provided however did not always show that this care had been delivered.

We found the home was in breach of three regulations 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 the report.