River Meadows

River Meadows is a residential home which provides care over three floors to older people including people who have dementia. River Meadows is registered to provide care for 41 people. At the time of our inspection visit there were 34 people living at the home.

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

The provider had systems to assess risks to people before undertaking their care and support. However, we found examples where risks had not been sufficiently monitored or recorded to effectively mitigate that risk. People received their medicines as prescribed, but records to support good medicines administration practices needed to be improved.

There were enough staff to provide safe care. Healthcare professionals told us staff were always available to support their visits which ensured effective communication and sharing of information. Staff understood their safeguarding responsibilities and the registered manager understood their responsibility to follow local safeguarding protocols when required.

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. Staff supported people’s communication by giving people information in a way they would understand.

Staff were responsive to people’s individual needs, although care plans did not always contain detailed information to help staff support people’s emotional needs. There was a lack of physical and emotional stimulation for people but plans were being made to encourage more engagement and activities people enjoyed.

The registered manager understood the needs of the people living in the home, advocated on their behalf and was committed to improving the quality of care people received. However, checks and audits had not always identified when improvements were needed and governance systems were not consistently effective in supporting the management team to improve and maintain standards of care.

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 good (published 21 October 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We looked at the key questions of Safe, Responsive and Well-led.

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 changed from Good to Requires Improvement . This is based on the findings at this inspection.

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

Enforcement

We have identified a breach in relation to Regulation 17 (Good governance).

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full 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.

We found the following examples of good practice.

¿ There was a clear process to allow visitors to meet family members. Visitors were required to provide a negative lateral flow test before being allowed into the home to help keep them and those they were visiting, safe.

¿ Clear instructions and guidance for visitors were prominently displayed and were laminated to ensure they could be cleaned regularly to limit cross infection.

¿ Staff were observed socially distancing and wearing personal protective equipment (PPE) in line with guidance. Staff wore PPE at all times to minimise the risk of infection to people who were unable to socially distance.

¿ Systems were in place to ensure staff received up to date guidance and training to ensure those staff continued to meet government guidelines for safe infection control practices to reduce the risk of cross infection.

¿ There was additional cleaning of touch points in communal areas to mitigate the risk of cross infection.

River Meadows is a residential home which provides care over three floors to older people including people who are living with dementia.

River Meadows is registered to provide care for 41people. At the time of our inspection visit there were 35 people living at the home.

At the last inspection, the service was rated good overall, however effective was rated as requires improvement. This was because people’s mental capacity to make certain decisions, was not always assessed and known by staff. At this inspection we found improvements were made to ensure support was provided in line with people’s capacity to make decisions.

At this inspection visit we found the service continued to be rated as Good overall however we found some improvements were needed to ensure people’s physical and emotional needs were met. People did not always have opportunity to feed into and receive support to pursue their individual hobbies and interests. Activities were planned throughout the month, however there was limited involvement for people to be supported with the things they wanted to do. For the majority of our visit, people spent time in their chairs asleep, watching each other or television with minimal engagement from staff or each other. The regional manager and regional support manager had plans to improve social engagement, especially for those people living with dementia.

There was a registered manager at the home. 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.

People and relatives were complimentary and satisfied with the quality of care provided. People were supported to remain as independent as possible so they could live their lives as they wanted.

People were encouraged to make their own decisions about the care they received and care was given in line with their expressed wishes.

Care plans contained detailed and supportive information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions and reviewing the care provided to ensure it continued to meet their needs.

For people assessed as being at risk, care records included information for staff so risks to people were minimised. Staff understood people’s individual needs and abilities which meant they provided care in a way that helped keep people safe and protected.

Staff received training to meet people’s needs, and effectively used their skills, knowledge and experience to support people. Where training had not been received, training sessions were planned to ensure staff skills and knowledge remained updated.

People’s care and support was provided by a caring staff team and there were enough trained and experienced staff to meet their care needs. People told us they felt safe living at River Meadows and relatives felt involved in their relations care because they were kept informed about important changes. People were supported to maintain important relationships with family and friendships had been built between people living in the home.

Staff knew how to keep people safe from the risk of abuse. Staff and the registered manager understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The registered manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge ensured people received consistent support when they were involved in making some decisions. Staff always gained people’s consent before they provided care and support and families were involved where required, in some decision making.

People received meals and drinks that met their individual dietary requirements. Anyone identified at risk of malnutrition or dehydration, were monitored over a short period of time so if concerns were identified, advice and treatment could be requested.

People’s feedback was collected from surveys and actions were taken in response to areas identified for improvement.

People said the registered manager and staff team were accessible and people were happy to share their concerns and feedback. The registered manager had an ‘open door’ for people, relatives, staff and visitors to the home which provided opportunity for people to speak with them, as well as, reducing complaints from escalating.

The registered manager’s systems were effective to make improvements which were identified by a programme of regular audits and checks. The registered manager had submitted a Provider Information return (PIR) to us and they understood their legal responsibility to notify of us of important and serious incidents.

Further information is in the detailed findings below.

If you wish to look at our findings in detail please see the full report.

We used this evidence to answer the questions below. If you wish to look at our findings in detail please see the full report.

Is the service safe?

There were sufficient staff to meet the needs of the people in the service. Staff were trained to recognise safeguarding alerts and had the skills and experience needed to support people well.

Staff personnel records contained all information required. This meant the provider could demonstrate that the staff employed to work at the service were suitable and had the skills and experience needed to support people who used the service.

Staff were trained to recognise safeguarding alerts and confident to raise concerns to the manager.

Care records were retained in secure areas and only accessed by authorised staff.

The premises were secure and the environment was people were living in was clean.

Is the service effective?

Each person had an individual care plan which detailed their needs. People said they were happy. Staff had a good understanding of people's welfare. One relative told us, "They are all so very kind and good at their jobs.' Staff training was designed to meet the needs of the people living at the service.

People told us that they were happy with the staff support that was in place. Staff had a good understanding of people's care and welfare and knew people well. One relative told us, "They are all so very kind and good at their jobs here, I cannot speak highly enough of them.'

There was a safe procedure for recruiting staff and for making sure they had the skills and knowledge to support people in this service.

Is the service caring?

People were supported by kind and attentive staff. Staff demonstrated patience and respect when supporting people.

People told us they were able to do things at their own pace and were not rushed. Our observations throughout the visit confirmed this.

One person told us, 'They never rush me, even when I'm a little slow sometimes.'

A relative told us "We have no concerns at all, because everyone is so kind.'

A survey that had been sent to families was complimentary, with comments such as, 'Staff are always helpful and polite' and, 'the care given by everyone is wonderful'.

Is the service responsive?

People's needs had been assessed before they moved into the service.

Care records reflected people's individual needs and described staff interventions. This ensured that care and support was provided in accordance with people's wishes.

People told us they met with their key workers once a month to update their care plans if necessary.

People had access to activities that were important to them and had been supported to maintain relationships with friends and relatives whenever possible.

Is the service well-led?

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Staff had a good understanding of the aims of the service.

Clear quality assurance processes were in place, including regular audits, monitoring of complaints and surveys.

People's personal care records were accurate and complete. All risks had been assessed, and safeguards put in place where necessary.

Staff told us they were clear about their roles and responsibilities.

Staff were regularly supervised by senior staff.

We also spoke with a visiting professional, the manager and five care staff on the day of our visit.

We saw people's care files contained detailed information about people. These were up to date and had been regularly reviewed.

People told us they felt safe at River Meadows. One person said 'Oh yes, I feel safe here.' Staff demonstrated good knowledge about how to keep people safe.

We saw training records and we found care staff had received up to date training in key areas such as how to move someone safely. Staff told us they were well supported by their manager.

We saw systems were in place to monitor the quality of care at River Meadows.

Some of the people who lived at River Meadows were unable to express their views verbally, so we spent time observing how staff supported them. We were however able to speak with six people who used the service to obtain their views.

We also, spoke with three relatives, a visiting professional, the manager, the operations manager and five care staff on the day of our visit.

We saw consent to care and treatment had been signed by either the person who used the service or their representative.

People who used the service and their representative told us they had been involved in their care planning or that of their relative.

We saw people's care files contained up to date information and these had been regularly reviewed.

People and their relatives told us they felt safe at River Meadows. They said 'Care staff are nice to me and not rude.'

We looked at training records and we found care staff had received up to date training in key elements such as safeguarding vulnerable people. We were told by care staff that they met regularly with their manager. We saw records which confirmed this.

Systems were in place to monitor the quality of care at River Meadows. These included a weekly 'drop in' surgery operated by the manager and regular monthly audits, for example medication checks.