Riverside Care Complex

We found the following examples of good practice

• A dedicated activities coordinator organised meaningful activities within the home to prevent isolation. They did this safely and in line with government guidance for social distancing to prevent the risk of the spread of infection. For example, people had attended a 'Derwent Derby’ in the grounds of the home which celebrated the horse racing history of the local area.

• Staff worked to ensure people maintained meaningful contact with relatives. Particularly for those people living with dementia, staff regularly looked at photographs with people and arranged video calls with families.

• Staff praised the effective way in which the registered manager disseminated information to them, through senior carers, about changes in infection prevention and control.

• The layout of the home had been subtly adapted to allow people to socially distance though this did not compromise the warm and homely environment.

Derwent House Residential Home is a care home providing personal care for up to 65 older people. At the time of our inspection 40 people lived at the service across two separate areas. Derwent House supports people with residential care needs and Riverview Lodge supports people living with dementia

People’s experience of using this service

The standards of care provided to people had improved since the last inspection. We received positive views from people and social care professionals about the support provided to people. Care and support was now more tailored to people's needs and preferences.

People were generally safe from risk. However, some risk assessments and care plans needed improving to ensure this. People, staff and relatives raised concerns regarding staffing levels. Staffing levels were increased during the inspection based on our feedback. Although the systems in place to monitor quality had not found these concerns, great improvements had been made in the quality of care provided and the service was no longer in special measures.

People received their medicines on time and their health was well managed. Staff had positive links with health care professionals which promoted people’s wellbeing. Recruitment processes were safe and robust. There were systems in place to safeguard people from abuse and staff demonstrated an awareness of these.

Staff demonstrated effective skills in supporting people with communication. Staff had received training and support to enable them to carry out their role. People were supported to have maximum 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.

People were supported with activities and interests to suit them. Staff knew people’s likes and dislikes well. Staff told us the management team were approachable. The provider had systems in place to safeguard people from abuse.

The registered manager was supported by a management team and the nominated individual. All the management team spoke passionately about improving the service and being committed to raising the quality of care provided. Relatives and staff told us the registered manager was approachable and knowledgeable and was making positive steps to improve the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 19 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

Derwent House Residential Home is a residential care home providing personal and nursing care to 52 people aged 65 and over at the time of the inspection. The service can support up to 65 people across two separate areas. Derwent House supports people with nursing and residential care needs and Riverview Lodge supports people living with dementia.

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

People were not kept safe from harm. Risk assessments were not up to date, specific or followed by staff to ensure individuals were safe.

Processes and records were not maintained to ensure people always received their medicines safely as prescribed. There was gaps in the application of topical creams and a lack of communication meant one person’s medicines were delayed in being administered after being received from the pharmacy.

Some people told us they had to wait for staff support. Staff were not sufficiently supported to fulfil their role. This had impacted on people’s dignity.

Care was not always person-centred. Some staff had good knowledge about people’s needs but this was not captured and reflected in care planning. People’s diverse needs were not always considered.

Staff did not receive appropriate training or assessment of their competency to ensure they had the appropriate skills to meet peoples’ individual needs. Lessons had not been learnt from accidents and incidents to reduce the likelihood of reoccurrence.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People, their relatives and health care professionals had mixed views about the care provided. Person-centred care was not reflected within people’s care plans and associated records.

The provider failed to have adequate oversight of the service during periods when there was no registered manager. This had impacted on the quality of care being provided.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Rating at last inspection

The last rating for this service was Good (published 23 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about medication issues, fire safety, staff training, staff knowledge, lack of staffing, poor moving and handling procedures and a lack of up to date care planning. A decision was made for us to inspect and examine those risks.

The inspection was also prompted in part by two notifications of specific incidents. Following which, one person using the service died and another sustained a serious injury. These incidents are subject to a criminal investigation. As a result, this inspection did not examine the circumstances of these incidents.

The information CQC received about the incidents indicated concerns about the management of falls and falls from moving and handling equipment. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see the full report.

The provider had taken action to mitigate the immediate risks to people.

Enforcement

We have identified breaches in relation to keeping people safe, not working within the principles of the MCA, staff not trained and supported, people not treated with dignity and respect, a lack of systems to investigate and take action following complaints, a lack of oversight, monitoring and learning.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection in November 2016 we rated the service as 'Requires Improvement'. There was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014, because record keeping within the service needed to improve. We saw evidence that care files and risk assessments were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. At this inspection we found record keeping had improved and the service was now meeting legal requirements.

Derwent House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service is registered to support up to 65 older people and people living with dementia. The service is divided into two different areas; Derwent House supports people with nursing and residential care needs and Riverview Lodge supports people living with dementia. The service is set in a rural position, to the east of the city of York. There is a large car park to the front of the building providing ample parking on-site for staff and visitors. On the day of the inspection 53 people were using the service.

The registered provider is required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of the inspection there was a new manager in post who had been working at the service for about four months; they had submitted their application to register as the manager of the service. Shortly after the inspection their application was accepted. We have therefore referred to them as the ‘registered manager’ in this report.

Medicines were stored and administered safely by staff. The recording of medicines received by the service was not always clear and protocols for ‘as required’ medicines were required for some people. We have made a recommendation about this in our report.

People told us they felt safe living at the home. Risks were appropriately assessed and managed. There were sufficient staff available to meet people’s needs and the provider had employed a number of new staff recently, in order to reduce the usage of agency staff. Robust recruitment procedures were followed in order to ensure the suitability of workers.

There were cleaning schedules in place and the service was clean, tidy and free from malodours.

People were supported to have 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 were supported in their role; they received induction, training and supervision. We found staff were knowledgeable about people’s needs.

People were able to access healthcare professionals, such as GPs, when they needed to. Information about people’s health needs and contact with healthcare professionals was recorded in their care files. We received positive feedback about the quality of meals provided and people were appropriately supported with their nutrition and hydration requirements.

People and relatives we spoke with told us that staff were caring, pleasant and helpful. We observed positive, warm interactions between people and the staff that cared for them. People’s privacy and dignity was respected.

Activities were available to people, such as crafts, music sessions and games. The service built links in the community.

Care plans were in place which gave staff the information they needed to understand people’s needs and support them appropriately. There were some occasional gaps in monitoring documentation, but generally records were well completed and showed that care was provided in line with people's needs and wishes. Care plans contained information about people’s wishes in relation to end of life care.

People we spoke with told us they would know how to raise a concern and felt confident they would be listened to and action taken. We saw complaints records which showed that concerns had been investigated and responded to.

There were quality assurance systems in place to enable the provider to monitor the quality and safety of the service and drive improvement. This included a range of audits, satisfaction surveys and ‘residents meetings’. Accident and incidents were analysed in order to learn from incidents that had occurred and prevent recurrence.

At our last inspection on 8 September 2015 we rated the service as ‘Requires Improvement’. There were no breaches of regulation but there were a number of recommendations within the report.

Derwent House Residential Home provides personal care and support for 65 older people and people living with dementia, some of whom may be assessed as needing nursing care. The service is divided into two different units; Derwent House supports people with nursing and residential care needs and Riverview lodge supports people living with dementia. The service is set in a rural position, to the east of the city of York. There is a large car park to the front of the building providing ample parking on-site for staff and visitors. On the day of the inspection we found there were 40 people using the service.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the time of the inspection the registered manager was not at the service, but we were given assistance by the Human Resource manager for the company and we have referred to them as ‘the manager’ throughout this report.

Record keeping within the service needed to improve. We saw evidence that care files and risk assessments were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm. These findings evidence a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

You can see what action we told the registered provider to take at the back of the full version of this report.

We found that the service was clean, tidy and free from malodours, but there were areas where infection prevention and control practices could be improved to demonstrate that staff were aware of hygiene and cross infection risks. We have made a recommendation in the report about this.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.

Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust.

Some people who used the service were subject to a level of supervision and control that amounted to a deprivation of their liberty; the registered manager had completed a standard authorisation application for each person and these had been reviewed by the supervisory body of the local authority. This meant there were adequate systems in place to keep people safe and protect them from unlawful control or restraint.

People were able to talk to health care professionals about their care and treatment. People told us they could see a GP when they needed to and that they received care and treatment when necessary from external health care professionals such as the District Nursing Team or Diabetic Specialists.

People had access to adequate food and drinks and we found that people were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate. People who spoke with us were satisfied with the quality of the meals.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

People knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with. People had access to complaints forms if needed and the registered manager had investigated and responded to the complaints that had been received in the past year.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the registered manager was making progress in improving the quality of the service.

During our visit people told us they were asked for their views. A person we spoke with said 'Staff ask if everything is okay for me. I have no issues with the service at all. I would say if there were any issues, they would be dealt with.' A visitor we spoke with said 'It is a fabulous place X and I am looked after well. There are no issues with the service we receive.'

We found improvements had been made to the way medicines were managed, in order to promote people's health and well-being.

The service had better systems in place to identify and manage the needs of people who were at risk from not eating and drinking sufficient amounts.

Overall people's care records were well maintained however these could be updated in a more timely way when people's care needs changed.

We found some improvements had been made for monitoring how the service was operating. However this needs further development and needs to be sustained. This would enable the provider to demonstrate that the quality of service was being kept under review and changes to the way the service was operating were being made when necessary.

Despite these positive comments we found -

Medication systems were not robust, so the service couldn't evidence that people were always being given their prescribed medicines safely and at the times they needed them.

The service did not have a robust way of monitoring and supporting people who were identified as at risk of becoming malnourished. This meant healthcare support may not be requested appropriately or in a timely way.

The service did not have systems in place to monitor and assess the way the home was operating. This meant there was no evidence to show the service was being kept under constant review to ensure the health, safety and welfare of the people who live in, work in and visit the home.

Records describing people's care needs were not always accurate and up-to-date. Other records to demonstrate the service was running well were also not well maintained. Accurate records were needed to evidence the service is running well as well as for staff to check they were providing the right care.