The Evergreens Lodge

Riverside Nursing Home is a residential care home providing personal and nursing care for people aged 65 and over, including people living with dementia. The service is registered to support up to 39 people. At the time of the inspection there were 29 people living at the service.

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

The provider, current management team and the staff team had clearly worked hard to improve the service. Many planned improvements were ongoing.

The provider did not consistently assess, mitigate and monitor the risks people faced to their health and wellbeing.

People’s care needs were assessed. Care was planned, but people’s care plans were not always followed by staff.

The governance systems had been significantly improved however they were not entirely effective and had not identified some shortfalls found at this inspection. We have made a recommendation about reviewing the governance systems currently in use.

People’s medicine management was safe. However, improvements were needed to ensure there were clear instructions for staff to follow in relation to ‘as and when required’ medicines and to ensure medicines had been dated when opened.

Risks relating to infection prevention and control (IPC), including in relation to the COVID-19 pandemic, were assessed and managed. Staff followed recommended IPC practices and safe visiting was supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

People felt safe and were comfortable and relaxed with staff who supported them. Relatives told us they felt their family members were safe and overall were well cared for. Throughout both inspection visits there were kind and caring interactions between staff and people.

There were enough staff to meet people's needs. The staff team knew people well and they were recruited safely. Staff training and support had been improved. Staff morale and teamwork were good.

Relatives expressed concern about changes in management. They felt the home needed more stability over a period of time. Relatives also had mixed views on involvement, such as knowledge of care plans or in giving feedback about the home. Relatives were generally happy with care provided overall.

There was an open, improving culture being created within the home. People, staff and relatives told us both the management team and staff team were open, approachable and helpful.

The provider, service manager, care consultant and nursing staff all took action in response to our feedback and findings during our visits.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found 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 requires improvement (published 23 February 2022) and there were breaches of regulations. 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

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

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 found breaches in relation to risk management and care planning at this inspection. Please see the safe and effective sections of this full report.

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

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

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.

Riverside Nursing Home is a residential care home providing personal and nursing care for people aged 65 and over, including people living with dementia. The service is registered to support up to 39 people. At the time of the inspection there were 25 people living at the service, one of these was staying for a period of respite.

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

At the comprehensive inspection in May 2021 we found the service had not been consistently led and the governance systems in place had not been fully effective in identifying shortfalls in the quality of the service and then improving the quality of the service. At this inspection we found the provider had made improvements, but systems were still not effectively and consistently operated to assess, monitor and improve the quality and safety of the service and ensure regulatory requirements were met.

The providers quality monitoring systems did not identify concerns and ensure the safe running of the service. Most of the provider’s audits had not been completed and therefore had not identified risks and areas of concern found at the inspection. Where audits and checks had been completed, they had not always identified risks.

Oversight of staff recruitment needed to improve to ensure staff were recruited safely. The provider needed to ensure their recruitment process was robust and that relevant records were available and reviewed to ensure prospective staff were suitable to work at the service.

We were not assured by all of the providers infection prevention and control measures. Staff did not always use PPE effectively and safely and in accordance with current government guidelines.

The provider had not ensured staff had been supported through regular supervisions. They had not had the opportunity to discuss their work, receive feedback, and identify further training and development needs. The new manager planned to complete ten-minute supervisions with all staff in January 2022.

Staff had not completed a comprehensive induction and staff new to care had not completed the Care Certificate or an equivalent induction programme. This would ensure they had the relevant knowledge and skills to care for people safely, when they started working at Riverside Nursing Home.

The provider was keen to continuously improve the service and accepted our feedback. They began to make improvements after the inspection and provided CQC with updates on progress made.

Following a recommendation at the May 2021 inspection the provider had been working to improve the dining experience for people and ensure people received their required diets. Improvements were still ongoing with new memory menu’s being developed.

The service had not had a registered manager in post since January 2021. After our last inspection a manager had worked at the home but had not registered with CQC and had since left the service. The providers registered manager from their other service, along with a care consultant, had been supporting the provider in the absence of a manager.

A new manager had been recruited to formally take up the position in January 2022. They had undertaken eight days to familiarise themselves with the service. They had developed a three-month plan of actions they had identified they needed to undertake. Staff expressed confidence in the new manager.

There were improvements in staff training. The provider and management team had been working with staff to complete the required mandatory training through online courses and in-house training. Additional training specific to people’s needs was also scheduled.

People said they felt safe. Staff had received safeguarding training and recognised signs of abuse. There were enough staff to meet people's needs. There was a pleasant atmosphere at the home, staff were not seen to be rushing and were observed interacting positively with people and taking their time to chat with them.

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

The provider had continued to make improvements to the environment. This included the outdoor space which offered a nice, secure place for people to use. A new summer house which offered people and their relatives an alternative space to meet and socialise in.

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 22 June 2021) and there was a breach 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 enough improvement had not been made and the provider was still in breach of regulation.

Why we inspected

We received concerns from the local authority Quality Improvement team in relation to, fire safety at the service, staff levels, staff training, people’s nursing care needs and care planning. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same, requires improvement. This is based on the findings at this inspection.

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 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.

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

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.

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

People were not protected from unsafe and unsuitable premises. In particular, we highlighted scald risks from the hot water supply and a window on the first floor which were not restricted to prevent people from the risk of falling out. During the inspection, the operations manager and provider took immediate steps to mitigate the risks of both concerns.

Safety and quality issues had not been identified or recognised in a timely way, which meant people's care and treatment needs were not always managed safely. Following a period of change made to the service, the new provider's quality monitoring systems had lapsed. This meant they had not been used to monitor the quality and safety of the service people received or identify improvements needed. The lack of quality auditing of the service placed people at harm.

Systems were not in place to oversee all checks and records completed to ensure they were completed robustly. This meant the provider's quality assurance processes were not fully effective and had not identified the shortfalls found at this inspection.

There was a risk that people were being supported by staff who had not been assessed as having the correct skills and knowledge to support them as training was out of date.

Staff were aware of the importance of good nutrition/hydration. However, risks associated with eating and drinking were not sufficiently managed as people’s ‘safe swallow’ plans were not always followed. The governance systems in place had not been fully effective in identifying shortfalls in the quality of the service and then improving the quality of the service.

We have made a recommendation about mealtime experiences and nutrition support.

People told us they felt safe at the service and relatives were confident people were protected from harm. There was a calm atmosphere in the home, staff had a pleasant approach with people and were respectful and friendly.

People received the medicines they required and any risks specific to them were identified and guidance in place for staff to help keep them safe. People had their healthcare needs met. Health professionals told us timely and appropriate referrals were made to specialist teams.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; The policies and systems in the service supported this practice. Where people lacked capacity, mental capacity assessments were undertaken. People's legal representatives, relatives and professionals were consulted and involved in best interest decisions.

People were supported by adequate numbers of staff to meet their needs and ensure their safety. There were safe recruitment processes in place to ensure people were supported by suitable staff. Checks such as references from previous employers and checks through the disclosure and barring service (DBS) were made for new staff.

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

This service was registered with us on 20 November 2019 and this is the first inspection.

The last rating for the service under the previous provider was good, published on18 January 2019.

Why we inspected

The inspection was prompted in part due to concerns in regards risks to the management of the service. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements. 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 Riverside Nursing Home on our website at www.cqc.org.uk.

Follow up

We have requested 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

How well are people protected by the prevention and control of infection?

¿ We were assured that the provider was preventing visitors from catching and spreading infections.

¿ We were assured that the provider was meeting shielding and social distancing rules.

¿ We were assured that the provider was admitting people safely to the service.

¿ We were assured that the provider was accessing testing for people using the service and staff.

¿ We were assured that the provider was promoting safety through the layout and hygiene practices of the premises.

¿ We were assured that the provider was making sure infection outbreaks can be effectively prevented or managed. The registered manager was unsure if agency staff were working at other services and stated they would seek assurances from the relevant agency provider.

¿ We were assured that the provider’s infection prevention and control policy was up to date.

¿ We were assured that the provider was using PPE effectively and safely. We discussed with the registered manager some improvement were required in regards a designated area for donning and doffing. They stated they would address this issue.

We have also signposted the provider to resources to develop their approach