Iceni House

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The culture within the service was improving but we had concerns about the experiences of everyone using the service over time. A strengthened management team was helping to ensure improved health outcomes for people and a wellbeing team were working hard to establish regular activity across the day. However, from our observations and feedback sought we found whilst there were pockets of good practice there were also pockets of poor practice with issues around teamwork and deployment of staff. This impacted on people’s experiences across the day and the home. Changes in people’s cognition impacted on their abilities to self-care and we had concerns about some peoples disheveled appearances and the explanation that this was people’s choice. Their records did not clearly show how staff were following things up such as refusals of care or making those connections with people to improve their wellbeing. Activities of daily living were the responsibility of the whole team and not just the wellbeing staff, but we found some staff did not engage in meaningful ways.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The culture within the service was improving as reflected from feedback received from relatives. A strong management team had helped to ensure improved health outcomes for people and a wellbeing team were working hard to establish regular activity across the day. However, from our observations and feedback sought we identified pockets of poor practice with issues around teamwork and deployment of staff. This impacted on people’s experiences across the day. Changes in people’s cognition impacted on their abilities to self-care and we had concerns about some peoples disheveled appearances and the explanation that this was people’s choice. Whilst relatives expressed that most staff were caring and knew people well. We found peoples' records did not clearly show how staff were following things up such as refusals of care or making those connections with people to improve their wellbeing. This did not uphold peoples dignity and was a breach of regulation 10 Dignity and respect. Activities of daily living were the responsibility of the whole team and not just the wellbeing staff, but we found some staff did not engage in meaningful ways. Staff had received training in dementia care and other essential training to help them deliver effective care. Care and activity staff did not always work together and support each other and meant some people less able to join in things missed out. We met people who by choice were in their rooms for the majority of the day and therefore socially isolated and the mealtime experience on the ground floor was poor. From the evidence we collated we identified a breach of regulation 9: Person centred care of The Health And Social Care Act 2008 ( Regulated Activities )

Staff spoke of pride in their work and mostly reported positive experiences of their induction and training. One staff member told us, “We have such a close relationship with our residents, they trust us, today for example the lady going into hospital was frightened with the paramedics, but me and my colleague were able to help her calm down and get in the ambulance, she said ‘It’s because I love you’. That is really why we do this job, for people who need us.’” We observed some caring practices, but this was not universal across the whole home with some staff not interacting much with people they were supporting. On the day of our site visit the wellbeing team were not well represented on both floors. There are usually 5 in total. We had previously spoken to them, and they told us they supported with meals and drinks and provided at least three activities a day and this is over 7 days a week. Staff were able to provide a breakdown of activities they provided which included engagement with the wider community and animals and said it usually worked well but at times carers are busy so its difficult to engage everyone. They cited the 1st floor as the most problematic with the highest level of dependency which was opposite to our experience. When asking staff about the care and the culture one staff said, “Whilst I do not have any concerns over the way the home is run, I do feel that call bells are not always answered quick enough and that there needs to be more care staff on. But on the whole, the home has a friendly atmosphere, and the residents are respected and well looked after. I would place one of my relatives here.”

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

The manager was open to feedback and acted appropriately to concerns raised. Relatives were confident that there were processes in place to address their concerns and these were taken seriously. When we spoke with people using the service most were happy with their care and felt able to raise concerns. However on the ground floor people were living with advanced dementia and would not easily be able to give feedback. The resident of the day was an opportunity for heads of department to discuss with each person the care they received and if there was anything they wanted addressing i.e. from a catering perspective, care perspective, maintenance perspective, activity and, or cleaning perspective. From the records we saw key staff had not always been involved in the 'resident of the day' so the process was incomplete. We spoke to one person who shared with us some concerns which had not been shared with the manager, we also spoke to relatives who had raised concerns about the care. Direct observations of staff practice helped determine if peoples needs were being met appropriately but we did not see how feedback collated from staff or people using the service was collated and used to inform wider service improvements. A home wide survey had not been issued since the manager coming into post which would have been helpful in capturing the improvements that had been made and helping to decide what the priorities should be for the home.

The management team had created a culture where people and their relatives could raise concerns including holding weekly surgeries where the manager made himself available for relatives and people to discuss issues so they could be resolved without the necessity to raise concerns formally. The manager also carried out daily walkarounds, held meetings of various kinds at all different levels and held resident, relative meetings. Agendas were discussed and actions including ‘you said we did’ demonstrate that staff listened, and feedback was actioned. A survey had not been widely issued this year because the manager said they were reviewing it, so it was more relevant to people’s experiences. Action plans were seen but it would be helpful if feedback from individuals including from resident of the day was collated and included as part of the action plan.

We did not look at Equity in access during this assessment. The score for this quality statement is based on the previous rating for Responsive.

During our assessment we found the manager was open and willing to provide and give feedback in a timely way. They had realistic expectations about where they were in terms of improving the service having inherited a service which was rated requires improvement. Staffing had been an issue in terms of both recruitment and retention and culture, but this was improving. Relatives described the manager as visible and responsive, and relatives respected their hardline approach in improving care and dealing with staff who were underperforming or not demonstrating the right values. Whilst we recognized improvements in every aspect of the business, we did have concerns about people’s experience and how this was impacted by staffing levels and, or staff not all working effectively. A number of newer staff were in post or new to their senior role and were developing and learning in these roles. Staff felt their initial training was good but the over reliance on eLearning did not consider the individual learning styles of staff . However the manager was keen to point out that all heads of care were doing or had achieved at least a level 4 diploma in care, and seniors had already completed a level 3 diploma or were in the process of doing it. Additional enhanced training in safeguarding and other key areas of practice such as dementia care had also been rolled out and staff competencies assessments were done live and face to face.

Feedback from the manager and from staff about the manager was mostly positive about what had been achieved across the service including better partnership working and engagement with families as stakeholders in care. However this did not match with our observations and the differential experience of care people received over time. Audits were in place to measure people’s experiences and staff had received training in providing dementia care but we identified pockets of poor practice. The manager told us they proactively tried to improve people's expereinces but were not aware of some of the concerns we raised during our site visit such as gloves left out, poor dining room experience and poor recording of people’s daily care needs such as food, fluids etc. This is did not assure us auditing across the service was yet fully effective.

Assessments helped to determine if admissions to the home were appropriate and although reviews were held we noted gaps in reviews. The home was designed with the client group in mind and was accessible throughout and enabled people to move freely about the service. Where restrictions were required these were imposed in the least restrictive way possible and in consultation with the person and relevant others.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.