Archived: Riverside Grange - Care Home

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and relatives, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There was insufficient staff on duty at specific times of the day. This placed people at risk of inadequate care and supervision. Staff told us they were 'overstretched' at times and they were particularly short at mealtimes and when delivering personal care. Some staff who worked nights had not had training in how to administer medicines, so if people required them there was a risk of delayed treatment until the manager arrived.

Safeguarding policies and procedures were in place and staff had received training in how to manage safeguarding concerns in order to protect vulnerable people from the risk of abuse or harm. The manager was aware of local protocols in place to guide practice when incidents occurred between people who used the service. The Care Quality Commission and local safeguarding of adults team were informed of any safeguarding incidents. This enabled us to monitor the actions taken to manage risks.

Risk assessments were completed and behaviour management plans were in place and known by staff. This helped to guide staff when supporting people who had behaviours that could be challenging to themselves and other people.

We observed people were treated with dignity and respect.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having sufficient staff on duty at all times.

Is the service effective?

People's health and care needs were assessed and plans of care were in place. However, we could not be sure that people's nutritional needs were fully met. We observed people experiencing disjointed support at mealtimes.

People's mobility needs and other needs were taken into account in relation to signage and building layout, which enabled people to move freely and safely on each floor and into the garden from the ground floor.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's nutritional needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed encouragement and patience when supporting people.

People's preferences, routines, likes and dislikes had been recorded and personal care and support was provided in accordance with people's wishes and choices. Staff demonstrated they knew people's needs and preferences.

Relatives spoken with were happy with the care provided to people. They told us they could visit at any time but avoided mealtimes so staff could provide uninterrupted support to people.

Is the service responsive?

People had access to a range of health and social care professionals such as GPs, district nurses, community psychiatric nurses, dieticians, social workers, dentists, opticians and podiatrists. There was evidence the staff team sought appropriate advice, support and guidance during emergency situations.

Staff responded to people's dementia care needs. They provided visual choices for people in order for them to make decisions about, for example, meals and clothes. Improvements could be made in the provision of activities, social stimulation and in personalising some people's bedrooms.

People were able to make complaints and these were investigated and addressed. Some complaints about laundry had not been recorded but the manager told us they had been addressed.

A visiting health professional told us staff followed their instructions and worked with them to meet people's needs.

Is the service well-led?

There was a quality monitoring system in place that consisted of audits and the seeking of people's views but we found it had not been wholly effective in some areas.

Staff told us they were clear about their roles and responsibilities and they had access to training and support. However, communication and team dynamics could be improved to ensure staff worked together for the benefit of people who used the service.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring the quality of the service provided.

What people who used the service, and those that matter to them, said about the care and support they received: -

We completed observations of staff practice, as people who used the service were not able to express their views about the service they received. We observed positive staff interactions with people and saw them support people and involve them in making decisions about their day to day care. These included asking people if they would like to sit at the table to eat their meals, giving people a visual choice of food and drinks and asking one person if they would like to have a shave.

Relatives said they were happy with the service. Comments about health care included, 'She always looks smart, clean and tidy. Any little thing they call the doctor and they had a dentist out for a check-up; I then took her to the dentist for treatment', 'I attend reviews of his care. They always keep me informed and they call the GP quickly. He was under the CPN (community psychiatric nurse) and social worker but he's been as right as rain here' and 'Oh yes, they definitely look after his health; they have had the doctor out two or three times. He had to go to hospital and a carer went with him.'

Relatives comments about the meals included, 'His appetite has gone down and he has lost a lot of weight. The staff do try and they give him milk in the afternoons. He went to a pub with staff recently and had a meal there; he really enjoyed it and ate it all', 'Some of the meals are fantastic but some things like spaghetti are not so good' and 'The meals are all right but they could be a bit more imaginative. There was bubble and squeak for lunch last week and I tried it and it was tasteless and cold. Food can be a bit repetitive.'

Comments from relatives about staff included, 'The way they care for people is good; they keep their eye on them. I have no cribs at all', 'When I go she gets a bit emotional so staff will come and sit with her', 'When people are creating merry hell the staff are nice and try their hardest to keep things calm', 'Some days there is not enough staff' and 'They are really good with him. They are absolutely wonderful and can read him whereas others can't.'

People had assessments of their needs completed and care plans formulated to guide staff in how to support them. We observed staff speaking to people in a friendly and professional way and they demonstrated knowledge of people's needs. Relatives told us staff were kind and said, 'Yes he always looks clean and shaved. I would tell them if he didn't.'

Since our last inspection there were improvements in the cleanliness and hygiene of the service. Some bedroom flooring had been replaced and a relative told us they visited four times a week and was happy with the service.

Since our last inspection there were improvements in the management of medicines. People received their medicines as prescribed.

We found there were sufficient staff to support people, although there had been some changes recently. The staff confirmed they received training and support and all four staff spoken with said they enjoyed working at the service. Relatives found staff approachable and friendly.

We found accurate records were maintained of people's needs and the care provided to them. The records were stored securely.

People had plans of care and relatives told us they were happy with the care provided by the service. They said they were kept informed of important issues. Comments included, 'They are very good at getting the doctor' and 'She has her hair done weekly. It's a nice and well run home." However, we found that some people had not received their medicines as prescribed.

Staff received safeguarding training and the service had policies and procedures in place to guide staff should they witness any abuse or poor practice. Staff were supported and received training in a range of other subjects, which enabled them to develop their skills and knowledge in how to care for people.

There was enough bedroom and communal space for people and repairs were identified and addressed. Three bedrooms had strong odours of urine and some carpets required cleaning. Some bedrooms were sparsely decorated.

There was a complaints procedure on display and people were made aware of how to complain. We spoke with two sets of relatives during the visit and both said they would feel able to complain and would see the manager or other members of staff.