We carried out a review of the data available to us about Riverside Court Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Riverside Court Care Home, you can give feedback on this service.
We found the following examples of good practice.
The provider had good procedures for preventing visitors from catching or spreading infection. All but essential visiting had been suspended due to localised outbreaks of COVID-19. Any essential visits were individually risk assessed and visitors given a lateral flow test and supplied with personal protective equipment (PPE).
When visits could start again the provider had set up visiting areas external to the building, where people and their visitors could safely communicate. The visiting pods had a glass wall and a microphone system allowing people to communicate safely.
Good arrangements were in place so that people kept a safe distance in lounges and in the dining rooms. The staff understood how to support people to isolate and risk assessments were in place for people living with dementia who might find isolating difficult.
The provider had followed safe procedures when people were admitted to the home. People were expected to have had two negative COVID-19 test result before admission and were supported to self-isolate in their rooms for 14 days after moving to the home.
The staff and the people who lived in the home had been tested routinely. The registered manager had ready access to flow testing and could test people or staff displaying symptoms.
The home was clean and hygienic. Rigorous systems were in place to ensure good levels of hygiene. A deep clean of the home was underway when we inspected. There were cleaning schedules in place and other systems to ensure good infection prevention and control measures. Staff understood how to use and dispose of personal protective equipment.
Staff welfare was seen as being important in the service and staff were supported if they had to isolate or if they were unwell. The provider had arranged for staff to join their 'Happy Hub' that gave incentives and benefits through this difficult time.
People in the home had been protected from catching the virus and there had been no positive cases in the service. Staff were highly motivated and had kept people's spirits up throughout the pandemic. People had grown accustomed to staff wearing PPE. Safe distancing and infection prevention and control had not prevented people being involved in activities. Staff tried to keep things as normal as possible so that people would feel safe and well cared for.
People's experience of using this service and what we found
The entire team put people at the heart of the service delivery. People received care that was individually planned to meet their unique needs.
People were very engaged in activities both within the home and in the local community. The service was creative and innovative in supporting people to actively access interests and activities that were important to them.
Staff excelled in providing compassionate and dignified end of life care. We received exemplary feedback from people's relatives around support they had with planning for the end of life care and the delivery of palliative care.
People we spoke with told us they felt safe and staff had enough time to support them. Safeguarding policies and procedures continued to protect people from the risk of abuse and avoidable harm.
Risk assessments supported people to manage the risks in their daily lives in ways which upheld their rights.
Staff carried out assessments to identify the support people needed and how to promote people’s independence. People were supported by experienced and skilled staff.
People were supported to access relevant healthcare services when they needed them, and they were supported to eat and drink well. People told us they enjoyed the food, which was freshly made and high quality.
Staff were caring and committed to supporting people in ways which upheld their dignity. Staff communicated well with people and respected their decisions. People felt comfortable when staff supported them with their personal care.
Staff were extremely motivated and proud to work at the service. We found an open ethos with a clear vision and values which were put into practice by staff.
The management and staff team were committed to providing high-quality care. The management ensured the quality of the service was maintained by regular checks and monitoring. People were encouraged to provide feedback about the service and take action.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
The last rating for this service was good (published, March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Riverside Court Care Home is a purpose built residential and nursing home situated on the harbour side of Maryport in Cumbria and is within walking distance of the local amenities of the town. Accommodation and communal space is over two floors and all rooms are for single occupancy and have en-suite facilities. There are suitable shared areas and a secure garden. The home provides accommodation for up to 60 older people some of whom may be living with dementia. There were 57 people living at the home when we visited.
The service is run by Tamaris Healthcare (England) Limited. This is a subsidiary of Four Seasons Healthcare and it is run using the staff and the systems of Four Seasons Healthcare.
The home had a suitably qualified nurse who had been the registered manager since May 2016. 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 last inspected this service on 20 and 21 August 2015 where we judged the service to be rated as 'Requires Improvement'. There were no breaches of the regulations at this visit in 2015 but we made recommendations about the application of emollient creams, communication and working with people living with dementia. At this visit we judged that good progress had been made in all these areas.
The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and showed a sensitive and practical approach to any concerns. Good risk assessments and risk management plans were in place to support people. Suitable arrangements were in place to ensure that new members of staff had been suitably vetted and were the right kind of people to work with vulnerable adults. Any accidents or incidents had been reported to the Care Quality Commission (CQC) and suitable action taken to lessen the risk of further issues.
The home had increased the staffing levels and the registered manager was keeping this under review as people's dependency changed. Staff were suitably inducted, trained and developed to give the best support possible.
Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. People in the home saw their GP and health specialists whenever necessary.
The registered manager was aware of her responsibilities under the Mental Capacity Act 2005 when people were deprived of their liberty for their own safety. We judged that this had been done appropriately and that consent was sought for any interaction, where possible.
People told us they were happy with the food provided. We saw that the staff team made sure people had proper nutrition and hydration. We noted that snacks and drinks were available for people to help themselves.
Riverside court was a purpose built nursing home and the new manager had ensured that the environment was as homely as possible. There were nice touches around the home that made the environment comfortable for people living there. There had been redecoration in all areas and things like floor covering and furniture had been replaced as necessary. The provider had replaced some windows with more refurbishment work planned. The registered manager had plans to improve the outside space by creating a hen run, a vegetable garden and workshop/shed for people to spend time in.
We observed kind, patient and suitable care being provided. Staff made sure that confidentiality, privacy and dignity were adhered to. People were encouraged to be as independent as possible. Staff were trained in end of life care and we saw evidence to show that this was being done with sensitivity and good nursing.
Assessments and care plans were up to date and met the meets of people in the service. Staff were very centred on the needs of individuals. Nursing processes were being carried out appropriately. Dementia care delivery had improved and staff were starting on a new training package for dementia care.
People were happy with the activities and entertainments on offer. Some people went to day centres. Everyone was given the opportunity to follow their own interests, where possible. There were plans to widen the options for people with dementia.
The provider had a suitable quality monitoring system in place and action had been taken where improvements were needed. The service had improved greatly and the new registered manager was keen to maintain and update all aspects of the care delivery and services.
This was an unannounced inspection that took place on 20 & 21 August 2015. We carried out this inspection to check that improvements had been made following our previous inspections of the 23 & 24 February 2015. The findings of these previous visits led us to rate the home as inadequate as the provider failed to meet all the requirements of the regulations.
At the inspection in February 2015 we found the home was in breach of the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010:
Regulation 9: Care and welfare of service users
Regulation 10: Assessing and monitoring the quality of service provision
Regulation 11: Safeguarding of people who use services from abuse
Regulation 13: Management of medicines
Regulation 14: Meeting nutritional needs
Regulation 16: Safety, availability and suitability of equipment
Regulation 18: Consent to care and treatment.
Regulation 19: Complaints
Regulation 20: Records
Regulation 21: Requirement relating to staffing
Regulation 22: Staffing
Regulation 23: Supporting workers
In addition the home was failing to notify us of events they are required to by law. Which was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009: Notification of other incidents.
The above regulations have now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We had asked the provider to make improvements in meeting people’s health and welfare needs, records, nutrition needs, safeguarding, safety and suitability of equipment, assessing and monitoring the quality of service and completing statutory notifications appropriately. We received an action plan from the provider detailing how these improvements would be made. We received regular updates on progress towards meeting these improvements.
At this inspection of 20 & 21 August 2015 we looked at all the areas where the home had breached the regulations set out above, and other areas to ensure that we carried out a fully comprehensive inspection. We found that there had been improvements across all areas that we looked at.
We found that the home was no longer in breach of the above regulations.
Tamaris Healthcare (England) Limited is a subsidiary of Four Seasons Healthcare and it is run using the staff and the systems of Four Seasons Healthcare. We will refer to the organisation running the home as Four Season Healthcare (FSHC) throughout this report.
The provider, had after the last inspection, ensured that support had been made available to assist the home in meeting safe standards of care through improved quality monitoring and input from senior managers within the organisation.
Since the last inspection a new interim manager had been appointed and plans were in place for them to become registered with the Care Quality Commission (CQC).
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.
Riverside Court Care Home is a purpose built residential and nursing home situated on the harbour side of Maryport in Cumbria and is within walking distance of the local amenities of the town. Accommodation and communal space is over two floors and all rooms are for single occupancy and have en-suite facilities. There are suitable shared areas and a secure garden. The home provides accommodation for up to 60 older people some of whom may be living with dementia. There were 47 people living at the home when we visited.
On this inspection in August 2015 we found that people’s care and health needs were being met. People looked well cared for with good attention to detail to ensure people were well dressed and to their own taste. We saw staff being attentive and considerate to people’s needs and feelings. Call buzzers were answered promptly, and everyone we spoke to said they were well cared for by staff that were kind and caring.
We judged the home to be safer because the provider had ensured that all staff had been given training to identify and report any potential harm or abuse of vulnerable adults. We had evidence to show that senior staff understood how to report, and where appropriate, manage any issues related to possible abuse.
Risk assessments related to the environment and the delivery of care were up to date. Accidents and incidents were managed correctly and reported to the appropriate authorities, including ourselves, CQC.
The home was now staffed to safe levels that gave care to people in a timely way from staff that were well led and suitably trained and experienced in meeting people’s needs.
Since the last inspection new staff had been recruited at all levels, including general nurses, mental health nurses, care staff and other support staff. A new interim manager and a new deputy had been recruited.
These new staff were recruited safely and disciplinary action had been taken when staff were not fulfilling their job role.
We saw that the way staff were being utilised and deployed in the home had improved, with the addition of a senior care worker on each shift. We saw how these senior staff were giving more of a lead and direction to staff to ensure people’s needs were met in an orderly and timely manner.
We found that the provider had significantly improved the way medicines were managed. People received their medicines at the times they needed them and in a safe way. We did however find the way people’s creams were managed required improvement.
We recommend that the service consider how they ensure that people are receiving appropriate support with the application of emollient creams and how this may be more accurately recorded.
Infection control measures in the home were good. The staff team had been suitably trained and had access to personal protective equipment. The home was clean and orderly.
All new staff had received induction training. This had been followed up by training in all the core subjects the provider felt the team needed. Some staff had received further specialist training.
Staff told us they now received good levels of both formal and informal supervision which had helped them to develop. Staff said that communication at all levels had improved.
A new style care plans had been introduced which were intended to make people’s needs clearer to staff and easier to monitor people’s changing healthcare needs. We found that these were still a “work in progress” as staff needed time to familiarise themselves with how they worked. We saw that as each person’s new plan was introduced that that people were becoming increasingly more involved in them.
We saw that for some people with more complex communication needs that staff were having difficulty in communicating with them effectively.
We recommend that the service seek advice and guidance from a reputable source, about supporting people to communicate and express their views.
We saw that good nutritional planning and practice was now in place. People who had been quite seriously underweight at our last visit had put on weight and were no longer undernourished.
People we spoke to were happy with the food provided. We observed mealtimes being much more orderly and staff were spending time and giving appropriate support and care to those people who needed more help.
We saw evidence to show that the staff team sought support and advice from local GPs, community nurses, dieticians and mental health workers to promote people’s health and well-being.
Healthcare and social services professionals told us that they had seen a marked improvement in the care and treatment of people in the home, and in the way people’s healthcare needs were being managed.
However, we found that overall the home lacked a cohesive strategy for supporting people living with dementia for whom a consistent approach is essential.
We recommend that the service develops a dementia care strategy for the home, based on current best practice, in relation to the specialist needs of people living with dementia.
We found that the home was now meeting the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Assessments were being carried out of people’s capacity to make decisions. Where people lacked the ability to make a decision about living at the home or when restrictions had been placed on them in their best interests we saw that appropriate application had been made for a DoLS assessment. Staff had received training in this area.
Activities and entertainments within the home had improved significantly, with activity coordinators engaging people in activities they found interesting and stimulating. People were having the opportunity to access the garden more frequently as well as more support to go out into the local community.
The home’s environment had improved with new furniture purchased and suitable redecoration and refurbishment being done. The home looked well maintained, homely and welcoming. The garden areas were now a particular feature of the home, with raised flower and herb beds, and these too were well maintained.
We found that the complaints were being better managed. There was now an effective system in place for identifying, receiving, handling and responding appropriately to complaint and concerns.
The service had developed a more robust quality assurance system. Measures had been put in place to improve the running of the service.
Record keeping had improved and staff had received some training on this. However, we did continue to see some recording errors.
The home was now notifying us, CQC, of events they were required to by law.
Overall we found the home was being well-led with the strengthened, more effective management structure that was in place. The north director for FSHC gave assurances of the organisation’s commitment in terms of budget, expertise and continuing support to continue to “put things right.”
This unannounced inspection took place on 23 & 24 February 2015 and a pharmacy inspector visited the home on the on the 9 March 2015. Riverside Court Care Home provides accommodation and nursing care for up to 60 people who have nursing needs or who are living with dementia. There were 53 people living at the home when we visited.
Tamaris Healthcare (England) Limited is a subsidiary of Four Seasons Healthcare and it is run using the staff and the systems of Four Seasons Healthcare. We will refer to the organisation running the home as Four Season Healthcare (FSHC) throughout this report.
During the visit, we spoke with 23 people living at the home, eight relatives, six nurses, ten care staff, the registered manager and the regional manager and the senior regional 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.
People told us contradictory things about the service they received. While some people were happy, others were not. We received mixed views from relatives about the care. In addition, our own observations and the records we looked at did not always match the positive descriptions some people had given us. Both health professionals and social services reported concerns about the standard of care in the home prior to our visit.
While some people told us they felt their privacy and dignity was respected and made positive comments about staff, they also told us that staff were often rushed. People told us that at times there were not enough staff available to answer their call bell and provide the support they needed. From our own observation we saw that care was mainly based around completing tasks and did not take account of people’s preferences. Staff told us that they had little time to spend “just chatting to people.”
People’s safety was being compromised in a number of areas. This included how well equipment was provided and maintained, how well medicines were administered, and the support for people who had more complex healthcare needs.
We found that people’s needs were not consistently assessed. This led to care plans and risk assessments that did not identify all the health and social care needs of people. For some people with behaviours that maybe challenging, or for those with mental health needs, there were no care plans or risk assessments to instruct staff on these needs, or how to meet them.
Staff members were not always following the Mental Capacity Act (2005) for people who lacked capacity to make decisions. For example some people’s mental capacity was not assessed and other people’s was assessed only once. Sometimes the decision on a person’s capacity had been made by only one member of staff in the home, there were no details of who had been consulted or involved in this decision.
We saw inconsistent approaches from staff with some staff explaining to people before they undertook a care process. Other staff failed to give the person any information about the care and support they were about to deliver. We also noted unsafe moving and handling practice being carried out by staff that put people at risk. We saw that people were sat in wheelchairs for long periods.
People were not always supported to eat and drink enough to meet their nutrition and hydration needs. We saw that some people were losing weight and did not have appropriate monitoring and interventions in place to support them. Those people who needed little support with their meals told us that the food in the home was good and that they had plenty of choice.
We found that advice from outside agencies, such as healthcare professionals was not always routinely sought. When it was, it was often not recorded or followed by staff in the home. This had resulted in people receiving inappropriate and unsafe care and treatment. Such as people not having the right moving and handling equipment in place to move them safely.
We were concerned that some people living in the home felt isolated. We found people who had not been out of the home for a long time, these were people who with staff support would be able, and wish to do so. We found there was a lack of stimulation with people spending long periods in bedrooms alone. There were not enough meaningful activities for people either in a group or as individuals. The activities recorded for some people in their notes were described as having a shave or a shower.
Whilst the organisation had a programme of training available for staff we saw evidence that the learning was not always put into practice. We had concerns about how staff were recruited and found that this was not always carried out according to the organisation’s policies on recruitment.
We also found staff lacked supervision and guidance from senior staff. Records in the home were of a poor quality, and some people’s changing care and health needs were not always updated. This meant that staff were not always up to date with a person support needs. This placed vulnerable people at risk of receiving unsafe care and treatment.
A number of people living in the home, and their relatives told us that their complaints and concerns were not listened to, and not responded to in an open and positive way. People in the home, relatives and staff told us that there was not an open culture in the home and this made it difficult to make complaints or to raise concerns.
The system the provider had for monitoring the quality of the service had not identified the significant problems that we found on this inspection.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and this corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The inspectors had serious concerns regarding the health, safety and well-being of those people living at Riverside Court Care Home.
We informed the provider, Four Season Healthcare, that we were considering the use of the section 31 power under the Health and Social Act 2008. This is one of the most draconian enforcement powers it holds, that allows it to serve a Notice of Decision to remove a location condition, on the basis that unless the Notice is issued, persons will or may be exposed to the risk of harm. In effect it removes the registration of Riverside Court Care Home from the provider’s certificate and the home would no longer be able to operate.
We set out all the areas of non-compliance with the regulations in a letter to the provider. We asked them to respond within 24 hours with an urgent action plan setting out how they intended to address the concerns the inspectors found in relation to the unsafe provision and risks to people in the home. The urgent action plan was received, within the timeframe, and we judged that it addressed the immediate concerns of safety and risk of harm.
We have since asked that the action plan be up dated on a weekly basis. We have visited the home to monitor progress towards meeting the action plan. This will be fully assessed at the next inspection of the home. Health professionals and social services have been carrying out reviews of all individuals in the home to ensure that people are receiving safe care and treatment.
You can see what action we told the provider to take at the back of the full version of this report.
We found the service to be appropriately staffed for the needs of the people living in the home. The staff team were experienced and well trained with specialist skills in caring for people with dementia. The home had developed a good working relationship with the local healthcare teams in order to ensure people had access to expert healthcare advice. The local social work team reported an improved working relationship with the home.
The organisation had good systems in place to ensure standards of care were maintained and we saw that the team monitored quality, consulted the people in the home and made improvements as necessary.
Overall we judged that the new manager had continued to improve the quality and the delivery of care offered to people in the dementia units through targeting staffing arrangements, training, and improving the environment. All these measures had helped to increase people's choice and involvement in their care.
Following our inspection the provider wrote to us and told us that they would review the way medicines were managed and this would be achieved by 28 February 2013.
As part of this inspection we looked at medicines records, supplies and care plans relating to the use of medication. We found that people who used the service received their medicines at the times they needed them and in a safe way.
When we spoke with people they told us they were happy with the support they received with their medication. People told us:
'All the girls are lovely and look after me'.
'I always get my tablets morning, lunchtime and evening'.
'Staff stand there while I take them [tablets]'.
'They don't like you missing your tablets'.
We saw very good records of communications between staff and healthcare professionals. Medicines were prescribed and given to people appropriately. There were appropriate arrangements in place in relation to the recording of medicines. We saw weekly audits, or checks, of medication handling. Staff told us that they had regular meetings to discuss medication handling and to manage issues that arose from audits to improve the quality of medicines management.
Overall, we found that medicines were managed in a safe way.
The home had under-gone a major refurbishment earlier this year, this was especially evident on the dementia units. We saw newly refurbished bedrooms and communal areas and all of the bathrooms had been refurbished.
Most staff were engaging people in pleasant conversations and providing support with personal tasks in a sensitive way and treating people in a dignified manner. Overall the people we spoke with were complimentary about the care workers. One person said, 'The staff are very nice, that's when you see them.' We saw a few staff not carrying out tasks as well as others and the manager showed us plans to tackle 'under performance' of staff.
People continued to be offered a varied and interesting programme of events and activities by the activities co-ordinators employed by the home with the support of relatives who acted as volunteers. One person told us "You can join in if you want. We had a lovely Halloween party. And we get lots of visitors"
A new way of writing people's care plans had been introduced and whilst these looked very comprehensive staff were struggling with them and were awaiting training on how to use them effectively. Some care plans did not give staff clear instructions on how to help people. We found that people who used the service did not always receive their medicines at the times they needed them and in a safe way.
We observed an activities session and lunch time on both dementia units.
Some of the people we saw in the dementia care units had fairly advanced dementia however we did speak to a number of people who had conversations with us.
We also observed from body language, that people responded well to the staff on duty. One person we spoke with said 'Its like a hotel here- I can have a cooked breakfast and the dinners are always good. They always give you a choice'.
The activity session involved using a large colourful parachute with 5 residents who looked to be having a great deal of fun, with lots of laughter and lively conversations between residents, staff and visiting relatives.
Overall the people we spoke to were complimentary about their care.
People told us that they were 'asked about the care and support they would like' before they came to live at the home. People confirmed that end of life plans had been discussed with them. This is a particularly sensitive subject and they did not wish to discuss these matters further with us.
Relatives told us that their relative is not always able to make decisions for themselves. They told us that the manager and staff at the home have included them in decision making processes and in the preparation of care plans to help ensure their relatives wishes and needs are met.
One of the people we spoke to told us that there were 'activities in the home' but that they 'choose not to join in' and that this is respected.
One of the people we spoke to told us that the food was 'alright' but missed 'proper fish and chips'.
Another person said 'the food is OK and I can have a cooked breakfast if I want. There are plenty of choices for meals and I get sufficient portions.' This person was waiting for their morning coffee to arrive, they added 'although there are set times for drinks and snacks, you can have something when you want'.
One person told us that staff were' generally OK' and would help if asked. They also said that some staff were 'not so nice as others' but declined to provide us with any further information.
One person told us that they were asked about the care and support they would like before they came to live at the home. However, they did not know that they had care records kept about their needs.
A relative told us 'staff ensure our relative is always given choices and that their wishes are respected.'
The people we saw in the dementia care units had fairly advanced dementia and only one or two wished to engage in conversation. However, we observed from body language, that people responded well to the staff on duty.
One of the people we spoke to during our visit told us that they were 'well looked after'. They had been 'very poorly' and were now 'on the way to recovery.'
Another person told us that staff adhered to their wishes regarding elements of their personal care support.
We spoke to people about the food at the home. They told us that the food had improved recently but that there were now less choices available. Another person said 'we have really good dinners, especially on Sunday'.
During our conversations with some of the people who live at the home, they said that they 'were happy with their rooms' and that they had been able to bring in some of their possessions from home to help make their rooms 'more personal and homely'.
People told us that they were generally 'quite satisfied' with the capabilities of the staff although one relative said 'that staff sometimes did not seem to pay much attention to details that had previously been important parts of my relative's lifestyle'.
We were told that staff were 'usually available when needed' and that they were 'kind and helpful' and attended to peoples needs 'quickly' when called.
There were no specific comments regarding medication from people living in the dementia care unit. People in the nursing unit told us that they had 'no concerns' with the way that medication was managed. They were happy for staff to look after their medicines. They said that when they needed painkillers staff brought them right away.
The people we spoke to also told us that staff would contact their doctor or social worker for them when requested.
People said that they could discuss matters with the manager 'if need be'. They were confident that she would listen to what they had to say.