Riverside House

We found the following examples of good practice.

The manager had identified, assessed and mitigated all COVID-19 related risks to people, staff and visitors.

Comprehensive policies and procedures were in place to manage any risks associated with the COVID-19 pandemic. This included the management of people with a COVID-19 positive diagnosis. The policies and procedures were updated regularly following any changes in national guidance.

A programme of regular COVID-19 testing for both people in the home, staff, essential carers and visitors to the home was implemented. All visitors, including professionals were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

There was an ample supply of PPE for staff and visitors to use. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control from the provider. We observed staff wearing it correctly during the inspection.

Increased daily cleaning schedules were implemented including regular touchpoint cleaning. Hand sanitiser was available throughout the service.

People living in the home and their relatives were supported to maintain contact.

Riverside House is a residential care home which is provides personal care for up to 46 people, some of whom may be living with dementia. At the time of the inspection there were 45 people living there.

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

People said they were well cared for at this home and made positive comments about the “friendly, caring” staff. People and relatives told us staff were kind, respectful and treated them well. They said there was plenty to do and they enjoyed going out into the local community.

People felt safe and comfortable with staff. Staff were trained in safeguarding people and there had been improvements in the way issues were reported and acted upon.

The home was warm, clean and well-maintained.

There were enough staff to support people’s needs and staff were deployed in an effective way. There had been improvements to care and medicines record.

People’s needs were assessed and regularly reviewed to make sure their care could be provided by this service. Staff said they had good training and support to carry out their roles.

People said the meals were good and there were plenty of choices. Staff worked closely with other care professionals to support people’s health needs.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People now received personalised care. Staff respected people’s choices. People could lead their own lifestyle whenever they wanted.

Staff knew people’s needs and their preferences for how they would like to receive their care. Care records now clearly provided staff with the information they needed to care for people. There were a range of activities and events on offer for people to take part in.

Staff and care professionals said the home had improved since the registered manager returned to their post.

People, relatives and staff said the service was well-run and their views were listened to. The provider had systems in place to monitor the quality of care provided and continuously improve the service.

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 22 August 2018). 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 and the provider was no longer in breach of regulations.

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.

This was the first inspection since the location registered with a new provider in March 2017. Riverside House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. There were 46 beds and 44 people living in the home at the time of the inspection.

A registered manager was in post who as on extended leave at the time of the inspection. Their post was being covered by an interim manager who supported us during the inspection. They are referred to as ‘the manager” in the remainder of the report.

We checked the management of medicines and found records did not always provide clear instructions about how people’s medicines should be administered. Homely medicines were not always recorded.

There were ample staff present during the inspection but we found deployment was not always effective. People and staff told us things could be chaotic, and staff said they would like more direction. We have made a recommendation that the provider monitors the deployment of staff.

Safeguarding procedures were available and staff were aware of these. We found they were not always followed and the manager told us staff would be reminded of the correct procedure should they have any concerns of a safeguarding nature.

Accidents and incidents to people were recorded and monitored. Risks to people were assessed and measures put in place to mitigate these. We found that some records were not up to date or there was conflicting information about the risks posed to some people.

A falls analysis had resulted in action being taken to support one person and the number of falls recorded had reduced as the result of this intervention.

Safe recruitment processes were followed to help ensure people were cared for by staff that had been correctly vetted.

Maintenance records were well organised and up to date. We saw checks to the safety of the premises were carried out regularly and procedures to control the spread of infection were followed by staff. A number of improvements had been made to the building.

People were nicely supported at mealtimes by staff who gently encouraged people to eat. Most people told us they enjoyed the food. Records relating to food and fluid intake and dietary needs had gaps and omissions. People’s weights were monitored and where they were found to be losing weight advice was sought form their GP or dietician.

The service was not always operating within the principles of the Mental Capacity Act [MCA] and the regional manager had identified gaps in staff knowledge and issues with care records which they were addressing. We have made a recommendation to monitor the consistency of the quality of care planning and application of the MCA.

Staff received regular training. There were some training gaps but plans were in place to address these. Some new staff told us they felt the induction could have prepared them better for working in the home. We passed this back to the manager to enable them to review this with staff.

The health needs of people were met. They had access to a number of health professionals.

There had been a number of improvements to the environment which had been redecorated and new flooring laid.

We observed numerous kind and caring interactions between staff and people. People and relatives gave us positive feedback about the staff.

At times the privacy and dignity of people was compromised through the language staff used which was not always person centred. Some information about people including personal care needs was publicly displayed which also compromised their dignity.

Care plans were in place but these varied in quality and detail. There were gaps and conflicting information in some care records. Communication between staff teams was not always effective. Handover information was vague and lacking in detail.

People’s routines and preferences were recorded but these were not always supported in practice and care was not always provided in an individualised and person centred way.

We observed some activities which people were enjoying during the inspection. There were long periods however, where people sat in lounges with limited interaction. The manager told us they were aware of the need to increase the availability of meaningful activities and we have made a recommendation about this.

People were aware of how to make complaints and a log was maintained of complaints made and action taken.

Staff told us there had been an unsettled period in the home while the registered manager was on leave. There had been two replacement managers in quick succession which they said had unavoidably impacted upon the management of the service.

We received mixed views about the management of the service. Some people said things had improved under the current manager, others felt the opposite. Staff said they felt they needed more direction from senior care staff and would like the manager to be more visible in the home.

We found gaps in records relating to people and medicines. We also found information of a safeguarding nature had not always been acted upon robustly. There were issues with organisation and direction of staff in the home.

Feedback mechanisms were in place to obtain the views of people, relatives, staff and visiting professionals. Audits were carried out and visits by the provider were carried out on a regular basis.

We found two breaches of the Health and Social Care Act 2008. These related to person-centred care and good governance. You can see the action we told the provider to take at the back of this report.