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Inspection Summary


Overall summary & rating

Good

Updated 4 February 2017

We carried out an unannounced inspection of Rivington View Nursing Home on 19 and 20 December 2016. We last inspected the service on 24 and 25 June 2015 when we found two breaches of regulations; these were in relation to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Person-centred Care and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Staffing. At this inspection we found that improvements had been made to meet the relevant requirements previously identified at the last inspection.

Rivington View is a two storey purpose built home that provides nursing and personal care for up to 33 people. The home is situated in the centre of Horwich, Bolton and is close to bus routes, shops and other local amenities. The home has various communal and quiet sitting rooms and provides accommodation in single rooms. At the time of the inspection 31 people were using the service.

There was no registered manager in post. 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.

Since the date of the last inspection the registered manager had taken up a different post within the home and another person had been recruited as registered manager but had not fully completed the process of registering with CQC. Due to a change in circumstances they were unable to continue in the role and left the home in August 2016.The provider told us it had been difficult attracting candidates for the role in the past and they intended to review the job package on offer with a view to making it more attractive to potential candidates.

People living at the home said they felt safe.

We looked at six staff personnel files and there was evidence of robust recruitment procedures in place. At the last inspection on 24 and 25 June 2015 we found the service had failed to ensure there were sufficient numbers of staff deployed in all areas of the building to meet the needs of the people using the service and there was no formal process of assessing people’s dependency levels. At this inspection we saw that improvements had been made to meet the relevant requirements of this regulation.

We looked at the staff rotas for October and November 2016 and these demonstrated that there were sufficient care staff on duty to meet the needs of people using the service. Since the date of the last inspection the service had introduced a formal dependency tool which was endorsed by the Department of Health.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The home had a whistleblowing policy in place and this told staff what action to take if they had any concerns. The staff we spoke with had a good understanding of safeguarding, abuse and how they would report concerns.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition. This meant staff had access to a range of information regarding how to manage people’s conditions safely.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use.

Monthly infection control audits were in place. There was an up to date fire policy and procedure. Fire safety and fire risk assessments were in place and fire evacuation drills were carried out regularly. This meant that in the event of the need to quickly evacuate the building staff and people who used the service were familiar with the actions required to do this safely.

Medicines were managed safely. Records of medicines administration (MAR’s) had been completed consistently and accurately. We saw PRN protocols were in place for these medicines. There were safe systems for ordering, receiving, storage, administration and disposal of medicines. Robust systems for identifying and following up on any errors and omissions to MAR charts were in place and these were audited on a monthly basis.

People told us they felt staff had the sufficient skills, knowledge and training to care for them effectively. Staff training records were in place and staff had completed training in a variety of areas relative to their job role. Staff told us they received an induction when they first started working at the home.

Staff had access to supervision and appraisal as part of their on-going development; however we did not see any evidence of an annual supervision schedule in place.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the authorisations.

Staff were aware of how to seek consent from people before providing care or support and told us they would always ask before providing care.

The people we spoke with told us the food provided at the home was of a good quality. People had nutritional care plans in place and care plans also contained records of visits by other health professionals. The service had achieved a food hygiene rating score (FHRS) of five.

At the last inspection we found the environment was not consistently effective for people living with dementia. At this inspection we found that improvements had been made to the environment to assist people to orientate around the building.

We saw staff showed patience and encouragement when supporting people. The people we spoke with told us staff were kind and caring. Relatives we spoke with were also complimentary about how staff respected people’s dignity. Throughout the course of the inspection we heard lots of chatter and laughter between staff and people and there was a positive atmosphere within the home. People who used the service and their relatives told us that staff listened to them and were approachable.

People’s care files contained end of life care plans, which documented people’s wishes at this stage of life where they had been open to discussing this.

People living at the home told us they received a service that was responsive to their needs and relatives told us they were involved in care planning and reviews. Care plans contained a good level of detail and had a person centred approach.

We saw the home had been responsive in referring people to other services when there were concerns about their health. When people first started living at Rivington View, an initial assessment was undertaken.

At the last inspection we found that the care people received did not consistently meet their needs and reflect their preferences and this was a breach of Regulation 9 (1) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During the inspection we found that the format of the care plans had been amended and they were more person-centred and the provider was now meeting the requirements of this regulation.

Care plans captured details such as family background, education, spouse/partner details, children, employment, interests, travel and religion and there was an overview of each person’s life history. This meant staff had access to a range of information about people’s past lives that was important to them. We saw that there were a variety of ‘thank you’ cards displayed in the home from relatives of people who had used the service.

Visitors were encouraged to provide feedback to the home through questionnaires. There was also a ‘suggestions box’ in the entrance hallway where people could post comments.

People were able to personalise their own rooms. All rooms inspected had personal family photographs and items relevant to the individual and people could use their own bedding if requested.

There was a system in place to handle and respond to complaints and we saw the home had an appropriate policy and procedure in place, which was up to date.

The home employed an activities co-ordinator. Recent activities had included Christmas decoration making, flower arranging, reminiscence, chatterbox, books, games and flash cards. A hairdresser regularly visited Rivington View. During the course of the inspection, we observed activities taking place in the activities room.

At the last inspection we were concerned that people were left alone in the lounge unsupervised for long periods of time. At this inspection we found that staff were vigilant with people in the lounge area and no-one was left alone for any length of time.

We found the nurses were very approachable and engaging and facilitated our requests throughout the inspection, as did the rest of the staff team.

People who used the service were aware of who was in charge. Relatives of people who used the service also told us they felt the home was well-led.

The service undertook regular audits covering areas such as medicines, care plans, nursing notes, the kitchen, people’s rooms, activities, complaints, the overall premises and fire safety. A quality assurance file was in place and contained records of audits that had been carried out. Information was also supplied each month to the CCG using the NHS Safety Thermometer.

Staff had access to a wide range of policies and procedures. There was a service user guide and statement of purpose in place.

The service worked alongside other professionals and agencies in order to meet people’s care requirements where required. Involvement with these services was recorded in care plans and included opticians, social workers, chiropodists, SALT, doctors and NHS health care workers.

The service had a business continuity plan that was recently reviewed in March 2016.

There was an up to date certificate of registration with CQC and insurance certificates on display as required.

Inspection areas

Safe

Good

Updated 4 February 2017

The service was safe.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service and there was evidence of robust recruitment procedures.

People we spoke with who lived at Rivington View told us they felt safe.

Records of medicines administration had been completed consistently and accurately. Accidents and incidents were recorded correctly.

Effective

Good

Updated 4 February 2017

The service was effective.

The service was complying with the conditions applied to DoLS authorisations.

Staff were aware of how to seek consent from people before providing care or support. People’s care plans contained records of visits by other health professionals.

Staff were subject to a formal induction process and probationary period.

Caring

Good

Updated 4 February 2017

The service was caring.

Staff spoken to had a good understanding of how to ensure dignity and respect and staff showed patience and encouragement when supporting people.

We heard lots of laughter between staff and people and there was a positive atmosphere within the home.

The service involved people and their families when developing care plans.

Responsive

Good

Updated 4 February 2017

The service was responsive.

Care files contained information that covered a range of health and social care support needs.

Each person had a care pathway, an assessment of possible risks and a description of the person’s needs for support and treatment.

The home had procedures in place to receive and respond to complaints.

Well-led

Requires improvement

Updated 4 February 2017

The service was not consistently well-led; there was no registered manager in post.

Staff told us they enjoyed their work and that there was a good culture at the home.

We found there were appropriate systems in place to monitor the quality of service.

Team meetings and meetings with relatives did not take place regularly.