The Evergreens Lodge

Updated 2 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector, one special advisor (a nurse) and an Expert By Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Riverside Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Riverside Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 23 August 2022 and ended on 29 September 2022. We visited the service on 7 September 2022 and 28 September 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We reviewed the action plan the provider submitted to CQC following the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We met all of the people who lived at the home and spoke with nine of them about their experience of the care provided. We also spoke with two relatives visiting the home to ask them about their view of the service.

We spoke with 11 members of staff including the provider, the care consultant (who was working as the 'acting care manager'), registered nurses (including the clinical lead nurse), care workers, activity staff, the chef and the service manager (who was responsible for the home’s general administration and organisation of auxiliary staff).

We reviewed a range of records. This included nine people's care records and medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures, maintenance records, cleaning schedules, staff rotas, monitoring charts, fire documents and external servicing records were also reviewed.

An Expert by Experience contacted people’s relatives by phone to gain their views on the quality of the service. They spoke with 12 relatives. Following our visits, we continued to seek clarification from the provider to validate evidence found. We looked at the information sent by the provider. This included the current improvement plan for home, audits carried out by staff, health and safety checks, minutes of staff and residents’ meetings, staff training records and the infection prevention and control policy.

Updated 2 December 2022

About the service

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.