Archived: Riverside Care Centre

Riverside Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Riverside Care Centre provides accommodation and care and support for up to 40 people, most of who were living with dementia. The service does not provide nursing care. There were 26 people accommodated in the home at the time of the inspection.

The service is located in the village of Sawley near Clitheroe in Lancashire’s Ribble Valley. It is not on a bus route and people would need to walk a distance to get to the home. Accommodation is provided in two houses, which are joined by a link corridor. Riverside House is an older type property with facilities on two floors, which are accessed by a stair lift. Riverside Court is purpose built on one level with a secure courtyard and plenty of walking space for people. There are well maintained gardens and a car park for visitors.

The registered manager started working in the service in October 2017 and was registered with the Care Quality Commission (CQC) in April 2018. 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.

At our last inspection on January 2017 we found there were no breaches of legal requirements.

During this inspection, our findings demonstrated there were two breaches of the regulations in respect of record keeping and the safety of the premises. You can see what action we told the provider to take at the back of the full version of the report. We also made a recommendation regarding the safe management of people’s medicines.

We saw records to indicate regular safety checks were carried out on systems and equipment either by service engineers or by the maintenance person. However, fire safety recommendations made in the independent Fire Risk Assessment of January 2018 had not yet been fully addressed, this was also noted by the Lancashire Fire and Rescue Service and included in the fire safety enforcement notice served at the time of the inspection. We also found the water temperatures in some bedrooms and bathrooms were not maintained at the recommended temperatures.

We found the provider had failed to maintain accurate records in relation to people’s care and the overall management of the service. We found shortfalls in the records relating to medicines management, care and support records and maintenance and servicing records. Some of the shortfalls had been recognised as part of the quality assurance monitoring and appropriate action was being taken.

People told us they felt safe and staff were kind. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. The registered manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting. People and their relatives felt there were enough staff available and staff had been recruited safely.

People had choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff respected people's diversity and promoted people's right to be free from discrimination. People's dignity and privacy was respected and upheld and staff encouraged people to be as independent as possible.

People were happy with the care and support provided. Each person had an individual care plan, which was sufficiently detailed to ensure they were at the centre of their care. People's care and support was kept under review and they were involved in decisions about their care. However, we found the records did not always reflect the care being given to people. Records supported that the registered manager was aware of the shortfall and action was being taken. Risks associated with people’s health and safety had been identified, assessed and managed safely.

People had access to a range of appropriate activities. People's nutritional needs were monitored and reviewed. People were offered a varied and healthy diet, and their likes and dislikes were known by staff. People’s healthcare needs were met and they had access to healthcare professionals when they needed them.

People told us they were happy and did not have any complaints. They knew how to raise their complaints, concerns and compliments and were confident they would be listened to.

People received their medicines when they needed them. Staff administering medicines had received training to do this safely. However, further improvements were needed to ensure people’s medicines were managed safely at all times.

People were happy with the way the home was managed and we received positive feedback about the registered manager. There were systems in place for assessing, monitoring and developing the quality of the service being provided to people; there was goo evidence that shortfalls had been identified and acted on. People and their relatives were consulted around their care and support and the day to day running of the home.

Riverside Care Centre provides care, support and accommodation for up to 40 people, most of who are living with dementia. The service does not provide nursing care. There were 35 people accommodated in the home at the time of the inspection.

The service is located in the village of Sawley near Clitheroe in Lancashire’s Ribble Valley. It is not on a bus route and people would need to walk some distance to get to the home. Accommodation is provided in two houses which are joined by a link corridor. Riverside House is an older type property with facilities on two floors. Riverside Court is purpose built and has ground floor facilities with a secure courtyard and plenty of walking space for people. There are well maintained gardens and a car park for visitors.

At the time of our inspection visit the service was not being managed by 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. There was a manager in day to day charge of the home. An application to register her with the Care Quality Commission (CQC) had been forwarded.

At the previous inspection on 7 July 2015 we found the service was not meeting the relevant legal requirements. We asked the provider to take action to make improvements in respect of medicines management, infection control practices, maintaining a safe environment and failing to operate an effective quality assurance system.

During this inspection we found improvements had been made and the service was meeting the current regulations.

People and their relatives told us they did not have any concerns about the way they were cared for. They told us they felt safe and well cared for. Staff could describe the action they would take if they witnessed or suspected any abusive or neglectful practice and had an awareness of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had knowledge of the principles associated with the legislation and people’s rights.

People considered there were enough suitably skilled staff to support them when they needed any help and they received support in a timely and unhurried way. The manager followed a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people. Arrangements were in place to make sure staff were trained and supervised.

Medicines were managed safely and people had their medicines when they needed them. Staff administering medicines had been trained and supervised to do this safely.

We found people lived in a clean, comfortable and well maintained environment. Appropriate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them to maintain the homeliness.

Each person had a care plan that was sufficiently detailed to ensure they were at the centre of their care. People’s care and support was kept under review and, where appropriate, they were involved in decisions about their care. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

We found staff were respectful to people, attentive to their needs and treated people with kindness and respect in their day to day care. We observed good relationships between people. The atmosphere in the home was happy and relaxed. From our observations it was clear staff knew people well and were knowledgeable about their individual needs, preferences and personalities.

Suitable activities were not always available as the service still did not have an activities person employed specifically for this role. Action was being taken to improve this. People told us they enjoyed the meals. People were offered a nutritionally balanced diet and alternatives to the menu had been provided. We saw people being sensitively supported and encouraged to eat their meals. Hot and cold drinks, fresh fruit, home baking and snacks were offered throughout the day.

People we spoke with had no complaints but were aware of how to raise their concerns and were confident they would be listened to. Action had been taken to respond to people’s concerns and suggestions. This showed that people were able to influence developments at the service.

People considered the service was managed well. There were effective systems in place to monitor the quality of the service to ensure people received a good service that supported their health, welfare and well-being.

As part of this inspection we decided not to visit the home but asked the provider to send us copies of the previous 4 weeks rotas. The records confirmed staffing levels had been increased and had been consistently maintained. We also spoke with a member of staff who confirmed this.

The registered manager told us staffing levels were now kept under daily review by the regional manager and that agency staff had been used for emergency cover. Staff had been reminded that any incidents of aggression, towards people living in the home or staff, needed to be reported. This should help to monitor whether staffing levels were appropriate to meet people's needs.

We were confident there were sufficient staff to meet people's needs in a safe way. We were confident staffing levels were being monitored and would be adjusted to ensure people's needs were met.

We considered the evidence we had gathered under the outcomes we inspected. We spoke with four people using the service, three relatives and four members of staff. We also spoke with the local authority contracts monitoring team.

This is a summary of what we found:

Is the service safe?

Staff had received appropriate training and had access to 'safeguarding adults' and 'whistle blowing' procedures to help them recognise and respond to any signs of abuse or neglect. We were confident the management team was clear about reporting incidents in line with local guidance and that staff would report any poor practice.

Staff had received training and there were proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. This should ensure people's best interests were safeguarded. No applications had been submitted since our last inspection.

There were appropriate arrangements in place to manage people's medicines safely which were administered in line with prescribed treatments.

There was training and guidance in place to support staff to deal with difficult behaviours. This should help to keep people safe. During our visit we observed staff responding to and resolving 'challenging' situations in an appropriate and sensitive way.

The staff team was skilled and experienced. However, staffing levels had been insufficient at times to meet people's needs. Whilst we were confident the staffing levels were reviewed following our visit we were concerned they had previously not been increased in line with people's changing needs. A compliance action has been set in relation to this. The provider must send us an action plan advising how they will ensure staffing levels will be tailored to meet people's needs.

Is the service caring?

We observed staff treating people in a kind, friendly and respectful way. People told us they were happy with the staff team and said, "Staff are very friendly, I have no concerns" and 'They are grand'.

Staff had received training to meet the needs of people living in the home. It was clear from our observations and discussions with staff that they had a good understanding of people's needs.

Care records contained useful information about people's preferred routines and likes and dislikes. This would help staff to look after people properly and ensure they received the care and support they needed and wanted.

Is the service responsive?

There were opportunities for involvement in a range of suitable activities. Comments included, "We decide what we want to do and they sort it out" and "We had a quiz this morning; there is always something to do". The programme varied from day to day dependent on people's needs, preferences and abilities.

People using the service and their relatives had completed an annual satisfaction survey. The results from this were used to improve the service.

People were confident they could raise any concerns with the staff or managers. Comments included, 'I am happy with everything but I would tell them if I wasn't' and 'They ask us if we are happy I know they would sort things out if I needed'. However we found that whilst people's concerns had been responded to they had not always been recorded clearly. This meant it was difficult to determine whether there were recurring problems or whether the information had been monitored and used to improve the service.

Is the service effective?

People were involved in discussions about care and regular reviews had been carried out to respond to any changes in people's needs. We found some good examples of effective and timely communication with relatives, however, we also found an example where family had not been informed following incidents involving their relative.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. The service had good links with other health care professionals to make sure people received prompt, co-ordinated and effective care.

People told us they were consulted with and listened to. One person told us they were involved in discussions and decisions about the activities they would prefer. They said, "We decide what we want to do and they sort it out".

Is the service well led?

There were systems in place to regularly assess and monitor how the home was managed and to monitor the quality of the service. However, records seen by us showed not all of the shortfalls, such as recording of concerns and staffing levels, had been clearly identified. This meant the systems were not as effective as they needed to be.

The service had a registered manager responsible for the day to day management of the home. Staff were clear about their responsibilities and were able to raise their views and concerns.

The service worked in partnership with other agencies, including the local authority and safeguarding teams, to ensure people's safety and well-being.

We observed staff treating people in a patient, friendly and respectful way. People told us they were happy with the care and support they received. People were involved in discussions and decisions about the activities they would prefer and activities were arranged for small groups of people or on a one to one basis.

People told us they enjoyed the food. Comments included, "The food is very nice" and "The food is very good; very tasty". Staff were aware of people's dietary preferences and were able to provide specialist diets as needed.

People were encouraged to express their views and opinions of the service and were encouraged to discuss any concerns. People told us they had no complaints about the service but felt confident they could raise any concerns with the staff or managers.

Records confirmed that a safe and effective recruitment process had been followed which should help to make sure only suitable staff were employed. We found there was an in depth induction and training programme for staff which should make sure they were confident, safe and competent. People were happy with the staff team. Comments included, "Staff are very proficient" and "The staff are lovely; so kind and helpful".