Archived: Five Rivers Living

About the service

Five Rivers Living is a residential care home providing personal care to 23 people, at the time of the inspection. The service can support up to 50 people.

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

Right Support: 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 and in their best interests; the policies and systems in the service did not support this practice.

Medicines were not always managed safety.

People were not always referred to relevant healthcare professional when needed and the provider failed to ensure advice and guidance from healthcare professionals was followed.

Right Care: People’s care was not always person-centred. A lack of care planning, registered manager awareness of people’s individual needs and staff training, meant care did not always promote people’s dignity, privacy and human rights.

There was no effective process in place to ensure people were protected from the risk of abuse, as staff were not always trained in safeguarding and did not all know the processes of escalating a concern if they had one.

Staff were not appropriately skilled to meet the needs of people and keep them safe.

People’s care, treatment and support plans had not reflected their range of needs and this therefore had not promoted their well-being and enjoyment of life.

Right Culture: People did not live inclusive and empowered lives. For example, where Deprivation of Liberty Safeguards (DoLS) conditions were in place, these were not always followed.

People were not supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people had not received compassionate and empowering care that was tailored to their needs.

People and those important to them, including advocates, were not involved in planning their care.

The provider had not enabled people and those important to them to work with staff to develop the service. There was a lack of structured feedback sought through questionnaires and meetings.

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 20 May 2022) and there were breaches of regulation. 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 the provider remained in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to care plans and risk assessments not containing up to date information to guide staff how best to care for people and mental capacity act assessments not always being in place. Additionally, we carried out an inspection of this service on 5 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the dignity and respect, and consent practices at the service. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Five Rivers Living on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to need for person-centred care, consent, dignity and respect, safe care and treatment, good governance and staffing at this inspection.

Our regulatory response has concluded and will be published at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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 time-frame 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.

Five Rivers Living is a residential care home providing personal care to up to 50 people. The service provides support to people living with dementia. At the time of our inspection there were 27 people using the service. Accommodation is set out over three floors, with two lifts to facilitate people moving between floors.

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

There was an absence of a robust, meaningful and effective quality assurance process to improve people’s care, safety and welfare. The registered manager failed to ensure full oversight of the service. Concerns during the inspection had not been identified. The culture in the service did not promote openness and inclusivity. Staff and people’s feedback were not acted upon, and staff did not feel supported in their role.

Risks associated with people’s care had not always been identified and recorded thoroughly. Timely action was not always taken to ensure the risk of harm to people was minimised. Medicines were not always managed safely. People and staff were not always protected from the spread of infection. Information regarding staffing levels in the service was inconsistent.

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 and in their best interests; the policies and systems in the service did not support this practice.

People were not always supported with dignity and respect during mealtimes. Mental capacity assessments were not always completed for specific decisions relating to people’s care. Staff received training relevant to their role. However, specialised training relating to people’s health conditions need further improvement. Staff had access to equipment to support them with people’s care needs. Staff worked with other professionals to ensure people had access to ongoing support. The service design met people’s needs. Staff understood their responsibilities to report safeguarding concerns.

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

Rating at last inspection

The last rating for this service was requires improvement (published 29 January 2021).

Why we inspected

This inspection was prompted by concerns in relation to training, diabetes management, medicines, governance and overall quality of care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider took immediate action following the inspection to mitigate any significant concerns we had relating to people’s safety and welfare.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Five Rivers Living on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, people's dignity, consent and good governance at this inspection.

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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Five Rivers Living is a purpose-built home offering residential care for individuals both over 65 and under, those with dementia related needs and physical disabilities. The home can accommodate and care for up to 50 people who require accommodation and support with personal care. Nineteen people were living at the service at the time of our visit.

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

We have made a recommendation about promoting communication between people and their relatives.

People who lived in the service told us they felt safe. Arrangements for assessing risk, safety monitoring and management within the service had improved since the last inspection. People's medicines were now managed safely and Infection control measures had been increased since COVID-19. People were protected from abuse. Staff understood how to recognise and report any concerns they had about people's safety and well-being. The provider followed safe recruitment processes to ensure the right people were employed and there were enough staff to keep people safe.

People's needs were assessed before starting with the service. People said they received care from staff who they felt were skilled and experienced. Staff received an induction and the mandatory training, however we found staff had not always undertaken all of the relevant training to meet the needs of the people at the service. People were supported to receive the nutrition and hydration they needed to stay healthy. Observations of the dining experience during the inspection was positive. People were supported to access a range of healthcare support. People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.

People told us staff were kind and treated them well. Staff we spoke with were knowledgeable about people's individual needs and preferences and took account of this when they provided support and assistance. People and their relatives told us they had a say in the care provided, daily routines and how their needs were met. People's records were kept secure.

Care plans provided staff with the information they needed to meet people's needs. People could choose how they wanted to spend their time. People and relatives gave mixed feedback with regards to meaningful activities available at the service. We saw some activities taking place in lounge areas on the day of our inspection. People and their relatives told us they would be happy to raise a concern if they had one. The provider had a comprehensive end of life care planning policy, however we found improvements were needed to ensure staff practice reflected what was in the providers policy.

Improvements had been made to the providers quality assurance systems and the management oversight, however these needed more time to be fully embedded into the culture of the service to ensure these were effective for people. Senior care staff had been recruited to support the registered manager and the provider was now supporting the registered manager with the quality monitoring and communications with external professionals. Staff understood their roles and felt supported by the registered manager. Relatives felt communication could have been better during COVID-19. Staff spoke positively about working at the service. The staff were supportive of people's cultural needs and people were openly encouraged to follow their faith. The provider and registered manager were working through a service improvement plan and took an open and transparent approach when incidents occurred. Staff worked with other agencies to provide timely care. We saw evidence the staff and management worked with other organisations to meet people's assessed needs.

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 inspected but not rated (published 9 September 2020). 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

The inspection was prompted in part by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Five Rivers Living on our website at www.cqc.org.uk.

Five Rivers Living is a purpose-built home offering residential care for individuals both over 65 and under, those with dementia related needs, physical disabilities or end of life care. The home can accommodate and care for up to 50 people who require accommodation and support with personal care.

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

The provider did not have robust systems in place to ensure people were protected from avoidable harm. Risks to people's health and safety were not always regularly reviewed, for example in relation to pressure area care. Care plans and risk assessments did not contain adequate information for staff to know how to support people to manage their behaviours safely.

Improvements were required in relation to medicines management to ensure this was safe and people received their medicines as prescribed.

There were mixed views about staffing levels at the service. Some people and staff felt there were not always sufficient numbers of staff, particularly at weekends, others felt staffing was adequate to meet people’s needs. There was no dependency tool in place to assess people’s needs on a regular basis to determine staffing levels were appropriate to meet people’s needs safely.

Following accidents and incidents there was a lack of analysis and there was no debrief for staff so that lessons could be learnt. This meant that opportunities to learn from incidents could be missed.

Quality assurance systems were not always effective at identifying any areas of concern for example, areas of medicines management. There was a clear lack of provider oversight to ensure systems in place were being followed and used to drive improvement at the service and to ensure the registered manager was fully supported in their role.

People and staff felt confident about the leadership of the service and the registered manager who they described as respectful, professional and responsive. However, some comments we received referred to the registered manager as often being very busy and preoccupied so people and staff did not always feel they were available to talk to her.

Relatives felt their family members were safe living at the service. Most staff told us they had completed training in safeguarding vulnerable people from abuse. Staff we spoke with understood what safeguarding was and how to recognise abuse, but two staff did not understand what the term whistleblowing meant. This did not assure us that all staff knew how to report concerns to the relevant people.

Robust recruitment checks had been completed to ensure only suitable people were employed to work at the service.

The service had sufficient and safe infection prevention and control measures in place. Government guidance in relation to COVID 19 had been followed consistently.

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

Rating at last inspection

This service was registered with us on 01 May 2019 and is the first inspection since their registration.

Why we inspected

We received concerns in relation to the management of medicines, people’s care needs, staffing and leadership of the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-Led only.

We have found evidence that the provider needs to make improvements. We have not rated this service, as a comprehensive inspection is required of the service, covering all the domains, before a rating can be given. Please see the Safe and Well-Led sections of this full report.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted as part of our Thematic Review of infection control and prevention in care homes.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to the safe care and treatment of people, in particular regarding the safe management of people’s medicines and risk management to ensure people are kept safe. We also found a breach of regulation regarding effective governance arrangements.

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.