Archived: Riverside Court

Riverside Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Riverside Court accommodates 60 people across four separate units, each of which have separate adapted facilities. The home was divided into four units; Shannon unit was for people with nursing needs and living with dementia, Clyde unit was for people living with dementia and Trent and Avon units were for people who needed support with daily living activities, some of whom may be living with dementia.

There was no registered manager in post but a newly appointed manager had recently started at the home and was in the middle of their induction. They were in the process of being registered with the Care Quality Commission. 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 found serious concerns within the home. Staff were unaware of how to recognise or report safeguarding concerns and could not appreciate the support they were providing was, in some cases, increasing people’s distress and sense of anxiety.

Risks were identified but then not managed to reduce the likelihood of harm for people. Staffing levels were not sufficient to ensure people had a good quality of life as many remained in their rooms all day with little, or no, interaction. In addition, a lack of continuity of staffing meant people did not know who was supporting them each day and some agency staff displayed little knowledge of how to support people safely or effectively.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Although progress had been made in regards to obtaining legal authorisations to deprive people of their liberty, people were not encouraged to take positive risks and many had unnecessary restrictions placed on them.

Medicines were recorded, stored and administered safely for the most part apart from the use of PRN, or ‘as required’, medication. We found two people where medication had been used to reduce their behaviour which may be seen as challenging themselves or others rather than any evidence of positive behaviour management techniques. Staff appeared unaware of how to support people living with dementia effectively or safely, with minimum restrictions to their liberty.

Care records, although slightly more person-centred than found during the previous inspection, were large and often illegible, and staff readily admitted to not reading them as they did not have time to do so. Nutritional guidance was mixed and people did not have ready access to snacks and drinks throughout either day of the inspection.

We found the provider had not followed advice received from health professionals regarding suitable equipment to prevent pressure damage and other health-related issues. It was only on the second day of the inspection an order was put in for some equipment but this was not reflective of all people’s needs.

People’s privacy and dignity was not respected or promoted within the home. We found people’s doors were wide open and no appropriate consent in place, and some staff also spoke openly about people’s conditions while in communal areas.

We found some staff to be uncaring and very task driven, and for those who were more empathetic, were confounded by the over-use of agency staff who sometimes showed little initiative.

There was a lack of transparency and openness within the home’s culture and people were not supported by well-managed staff. Although the new manager was on induction other senior staff were present on both days but did not acknowledge the concerns we found. Quality assurance was poor and did not provide sufficient confidence to evidence people were safe or well cared for.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, five of which were continuing from the previous inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

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

Riverside Court is a care home registered to provide nursing and residential care for up to 61 people. It consists of one building with two floors. All bedrooms are single with ensuite facilities. The home is divided into four separate units, each of which can accommodate 15 people. The home manager told us their office used to be a bedroom, and so the home actually contains 60 single bedrooms, not 61.

Clyde Unit provides residential care for people living with dementia. Shannon Unit provides nursing care for people living with dementia. Trent and Avon Units both provide nursing care; some people on these units were also living with dementia.

On both floors there are communal lounges and dining rooms. Both floors also have shared bathrooms, toilets and shower rooms. The home has an enclosed garden area with seating.

At the time of this inspection there were 55 people living at the home.

Riverside Court was last inspected in October 2015. At that time it was rated as ‘Requires Improvement’ overall. It was deemed to be ‘Requires Improvement’ in the domains of Safe, Responsive and Well-led, and ‘Good’ in the domains of Effective and Caring. We found breaches of regulation in relation to staffing, medicines management, audit and monitoring, and record-keeping.

The home had a registered manager, although they had recently become the manager of a different home run by the same registered provider. A registered manager from another home run by the same provider had commenced employment at Riverside Court two weeks prior to this inspection. The plan was for them to apply to be the registered manager at Riverside Court. 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.

Risks to people were not always assessed fully with care plans put in place to manage them. Risk assessments and care plans were not always updated after incidents had occurred. There were no plans in place to inform staff how to support people to bathe or shower safely.

Medicines administration was person-centred and we saw some examples of good practice in this area. However, we identified concerns with medicines management and recording; this was a breach of regulation identified at the last inspection in October 2015. The home manager was aware of the problems and had already organised an external medicines audit to help create an action plan for improvement.

People’s care files did not always contain a complete and contemporaneous record of their care and support needs. This was a breach of regulation identified at the last inspection in October 2015.

We identified concerns with staff adherence to good practice in infection prevention and control at the home.

Existing staff told us they felt supported by managers at the home and had access to training and supervision. The induction of new staff was not documented, Care Certificate records had not been completed and competency checks on staff new to care had not been done.

Compliance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) across the home was mixed. We saw some examples of good practice in terms of mental capacity assessments and best interest decisions, whereas others were lacking. Applications for DoLS for three people who lacked capacity to consent to living at the home had not been made.

People and relatives told us care staff respected their privacy and dignity and most interactions we saw evidenced this. However, we did observe some occasions whereby people’s privacy and dignity was not maintained.

Feedback from people and their relatives about the food served at the home was positive. We observed people received support to eat and drink when they needed it. Records kept of people’s food intake lacked the detail required to make them meaningful.

Audit and monitoring at the home had failed to address breaches of regulation identified at the last inspection in October 2015 and the additional breaches identified at this inspection.

People’s care files could not clearly evidence how they had been involved in designing and reviewing their care and treatment. Not all care files contained people’s personal histories and those we did see had not been used to individualise people’s care plans.

Records showed all the appropriate checks had been made to establish staff recruited to the home were suitable to work with vulnerable people. People told us they felt safe at Riverside Court and staff could describe how they safeguarded people from harm.

A full range of checks had been made on the building, its utilities, facilities and equipment in 2017. There was a gap in records of three months at the end of 2016 when there was no maintenance worker in post. No issues had arisen as a result of this.

The home had been adapted to better meet the needs of people living with dementia using current good practice in dementia care environments.

People told us they had access to a range of healthcare professionals to help meet their wider health needs. The home was part of the local Vanguard project, which meant people had greater access to a range of healthcare professionals.

People and their relatives told us the staff at Riverside Court were kind and caring. We observed lots of friendly and supportive interactions between care staff and people; there was a homely atmosphere and plenty of laughter was shared.

People had access to advocacy services if they needed them. An independent advocate visited people at the home on a regular basis.

Staff could describe what was important in terms of end of life care. The home manager planned to review and update people’s end of life care plans with them and their relatives to make sure they contained their personal preferences.

People told us they had enough to keep them busy. We saw the home provided a range of meaningful activities for people to take part in.

A formal complaint received since the last inspection had been investigated and responded to appropriately. People and their relatives felt happy to complain if they needed to, which suggested the culture at the home was open.

People and their relatives told us the home was well-led. Staff gave us positive feedback about the new home manager. Since joining the service, the home manager had used audit, monitoring and feedback to generate an action plan for the service.

People, their relatives and staff had regular meetings with management at the home. They told us they were asked for ideas and feedback. A ‘You said, we did’ board explained how feedback had been used to make positive changes at the home.

The registered provider had merged with another healthcare provider and were adopting their vision and values, what they called their ‘purpose and behaviours’. These included ‘putting people first’, ‘being a family, and, ‘acting with integrity.’

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, staffing, safeguarding service users, consent, dignity and respect, and good governance. You can see what action we have told the provider to take at the back of the full version of the report.

We spoke with three relatives and one professional visitor to obtain their views of Riverside Court.

We spoke with the operations manager, the registered manager, one qualified nurse, seven care staff, the activities worker and a domestic staff about their roles and responsibilities.

We gathered evidence against the outcomes we inspected to help answer our five key questions; 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.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People supported by the service told us they felt safe.

We observed, and people told us they felt their rights and dignity were respected.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people would be safeguarded as required.

Is the service effective?

Staff were provided with training to ensure they had the skills to meet people's needs.

People and relatives told us they were happy with the care and support staff provided and people's needs were met. Staff had a good understanding of people's care and support needs and they knew how to meet them and avoid unnecessary risks.

Other professionals and individuals were involved in regular meetings and reviews with each individual to ensure their care and support was still appropriate.

Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

We asked people who used the service for their opinions about the support provided. Feedback from people was positive, for example, 'It's very good here. The staff are lovely and we're well looked after' and 'It's a nice place. The girls (staff) are okay and look after me well. I would certainly recommend it'. Comments from relatives were also positive. They included, 'I like it here, it gives us peace of mind knowing (my relative) is well looked after' and 'I have never seen anything to cause me concern. It is a lovely place and staff look after (my relative's) best interests'.

We observed that staff communicated and interacted with people in a patient and kind manner.

Relatives of people using the service and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People's needs were identified and reviewed so any changes were responded to. People had some opportunities for leisure activities.

People spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

There was good evidence that confirmed people had been formally assessed upon admission with regard to their nutritional and dietary needs. This demonstrated that people were safeguarded from the risk of poor nutrition and hydration and any concerns identified at the earliest possible stage.

Medication was administered, recorded and stored accurately and safely. All staff administering medication were suitably qualified to undertake the task.

People had access to nutritious and appetising food and were supported to maintain a healthy fluid balance. We saw that people were supported by staff at lunch time and that people enjoyed their food.

The provider had taken steps to provide care in an environment that was suitable, adequately maintained and in good decorative order. We found a positive attitude towards planned preventative maintenance of the premises with good record keeping to provide evidence of a safe environment.

We saw records which showed that equipment, such as hoists and associated slings, were regularly serviced by a competent contractor to ensure they were fit for purpose and safe to use.