• Care Home
  • Care home

Archived: Riverview Residential Home

Overall: Inadequate read more about inspection ratings

1 Heyfields Cottages, Tittensor Road, Tittensor, Stoke On Trent, Staffordshire, ST12 9HG

Provided and run by:
Mrs Rishpal Singh

Important: We are carrying out a review of quality at Riverview Residential Home. We will publish a report when our review is complete. Find out more about our inspection reports.

All Inspections

7 April 2017

During a routine inspection

We completed an unannounced inspection at Riverview Residential Home on 4 April 2017. At the last inspection on 25 August 2016, we found there was a breach in Regulation 17 and improvements were needed to the way the service was monitored and managed risk and governance. We received an action plan from the provider, which stated that the required improvements would be made by the 29 September 2016. At this inspection we found that the action plan had not been met and we identified further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Riverview Residential Home is registered to provide accommodation with personal care for up to eight people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported seven people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service did not require a registered manager because they are registered as an ‘individual’. 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. The provider was managing the service, and there was also an assistant manager and a deputy manager.

Risks to people’s health and wellbeing were not consistently identified, managed or followed to keep people safe.

We found improvements were needed to ensure staff were deployed across the service effectively to ensure they were available to provide support when people needed it.

We found that medicines were not consistently managed in a safe way.

People were protected from the risks of abuse because swift action had not been taken by the provider to ensure people were protected from possible harm.

Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff understood and were competent to support people safely and effectively.

People were not always supported in line with the requirements of the Mental Capacity Act 2005, because staff and management did not have a clear understanding of their responsibilities.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the provider.

Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.

Advice was not always sought from health professionals in a timely manner to ensure people’s health needs were met effectively.

Improvements were needed to ensure that people were able to access hobbies and interests that were important to them.

People’s care records did not contain an up to date and accurate record of people’s individual needs and reviews that had been undertaken were not effective in identifying changes to people’s care needs. This meant that people were at risk of receiving inconsistent care.

People were supported to eat and drink sufficient amount and staff understood people’s nutritional risks.

People knew how to complain about their care and the provider had a complaints policy available for people and their relatives.

People and staff told us that the registered manager was approachable and staff felt supported to carry out their role.

People told us they were treated in a caring way and staff promoted their dignity. People were supported to make choices about their day to day care.

25 August 2016

During a routine inspection

We completed an unannounced inspection at Riverview Residential Home on 25 August 2016. At the last inspection on 04 January 2016 we identified multiple breaches in regulations. We found that the service was not safe or well-led and we asked the provider to take action to make improvements. The provider sent us an action plan which showed how they planned to make improvements and we found that some of these actions had been completed.

Riverview Residential Home are registered to provide accommodation with personal care for up to eight people. People who use the service may have physical disabilities and/or mental health needs such as dementia. At the time of the inspection the service supported 7 people.

The service did not require a registered manager because they are registered as an ‘individual’. 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. The home had a manager, assistant manager and a deputy manager.

The provider did not always have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that inappropriate care was not always identified and rectified by the provider.

People’s risks had been assessed, but we found improvements were needed to ensure these were consistently monitored and managed to protect people from the risk of harm.

We found improvements to the way medicines were managed in a safe way and people received their medicines in a safe way.

People told us they felt safe with the care provided by staff. Staff understood how to protect people from the risk of abuse.

There were enough suitably qualified staff available to keep people safe and the provider had effective recruitment procedures in place.

People were supported by staff who had received training, which gave staff the knowledge and skills to provide appropriate care that met people’s needs.

People consented to their care and the provider followed the requirements of the Mental Capacity Act 2005 (MCA) where people lacked the capacity to make certain decisions about their care. Staff understood their responsibilities and followed the requirements of the MCA and Deprivation of Liberty Safeguards (DoLS) when they provided support.

People were supported with their nutritional needs and to drink and eat sufficient amounts. Action had been taken where concerns were raised about people’s nutritional intake.

People were supported to access other health professionals to maintain their health and wellbeing.

People were supported by staff that were caring and respected people’s dignity. Choices on how people wanted their care and support provided were promoted, listened to and acted on.

People were able to access hobbies and interests that were important to them and people’s wishes to spend time alone were respected.

People were supported in a way that met their communication needs and people received support in line with their preferences. People and their relatives were involved in the planning and review of their care.

The provider had a complaints policy available and people knew how to complain and who they needed to complain to.

People were given the opportunity to feedback on the quality of their care and actions were in place to make improvements.

People and staff told us the provider was approachable and staff felt supported in their role.

The manager was aware of their responsibilities to notify us (CQC) of any incidents that occurred at the service.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

4 January 2016

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 11 February 2015. During that inspection we found that the service was not always safe because guidance was not always available for staff on how people should receive medicines that should be administered on an ‘as required bases. We also found that the service was not always effective because people’s dietary supplements were not always managed appropriately.

We undertook this follow-up inspection to check if improvements had been made following the previous inspection of the service. After last inspection we received concerns in relation to staff training and skills, fire safety and over-all management of the service. As a result of these, we also focused on these areas of concern. This report only covers our findings in relation to these concerns and areas of concern from the last inspection. However, we did not assess the effective question during this inspection because no one who used the service required dietary supplements and therefore there were no dietary supplements at the service. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

We inspected Riverview on 4 January 2016 and the inspection was unannounced. The service is registered to provide accommodation and personal care to a maximum of eight people. They are not registered to provide nursing care. At the time of our inspection, eight people used the service.

Staff did not always recognise abuse and/or take appropriate action when abuse was suspected. People did not always have risk assessments or risk management plans in place to guide staff on how they should receive care. People’s risk assessments and management plans were not updated when their needs changed.

We found that people’s medicines were not always managed safely. This meant that people were at risk of receiving inappropriate doses of medicines that did not meet their needs and they did not always have their medicines when they needed them.

People were at risk of harm because they did not always have the skills to provide people the care they required. People had not been trained effectively on how to support people with their mobility safely.

The provider did not always notify us (the CQC) of events and incidents that had occurred in the service, of which they were required to notify us about.

The provider did not have effective systems in place to regularly monitor the quality of service provided. People’s care records did not always reflect the care they required or received.

We identified that the provider was not meeting some of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we inspect against and improvements were required. You can see what action we are taking at the back of the full version of the report.

20 August 2014

During an inspection looking at part of the service

We visited Riverview Residential Home on a planned unannounced inspection, which meant that the service did not know we were coming.

We wanted to check that improvements had been made since our last visit to the service on 10 June 2014, which led to us issuing warning notices to the provider on 1 July 2014. Warning notices tell the registered person that they are not complying with a regulation, or any other legal requirement that we think is relevant. It includes a timescale by when compliance must be achieved. If the registered person is still not complying with the requirement when the timescale expires, we will consider our response with reference to the Health and Social Care Act (2008) and any other Acts of Parliament that we consider are relevant.

We issued warning notices to the provider because we found that where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. We also found that the provider did not have effective systems in place to assess and manage risks relating to the welfare and safety of people who used the service.

During this inspection, saw that the provider had made improvements. The provider had arrangements in place to ensure that they acted in accordance with legal requirements when people did not have the capacity to consent. The provider also made improvements that ensured that risks were assessed and managed effectively.

Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them, from looking at records and speaking with local authority staff. If you wish to see the evidence supporting our summary, please read the full report.

Is the service safe?

The provider had ensured that the flooring in the lounge area was repaired. We noted that there were no loose fittings and the floor was non-slip. This meant that the risk of trips or falls were minimised. Systems were in place to ensure that the premises were safe and secure. A member of staff was now responsible for ensuring that necessary maintenance checks and repairs took place.

Sufficient staff were available to provide care and newly recruited staff had received the necessary training required for them to provide safe care.

Is the service caring?

People who used the service told us that the staff were very good and they were satisfied with the care and support provided. We observed staff that staff were caring and compassionate. A relative we spoke with said, 'The staff are very friendly and kind'.

People who were unable to comment or did not wish to speak with us looked comfortable, snug and well cared for.

Is the service effective?

People who used the service told us they were able to do whatever they wished to do each day. Staff encouraged and supported people to make choices and decisions about their care. People's wishes and preferences were respected. When people did not have the capacity to make certain decisions, required assessments took place and their families and medical professionals were involved in the decision-making process.

People's care records indicated that their capacity to make decisions had been taken into account in the care planning process. We saw that the provider had made referrals to the local authority for Deprivation of Liberties Safeguards (DoLS) assessments to take place for the people who used the service. This meant that the provider took appropriate steps to ensure that they acted in accordance with legal requirements when people did not have capacity to make certain decisions, to ensure their safety and wellbeing.

Where people had advocates or solicitors, we saw records of this and evidence that these people were involved in important decisions relating to their care. This meant that the provider had suitable arrangements to place for obtaining, and acting in accordance with, the consent of people who used the service in relation to their care and treatment.

Is the service well led?

The provider was involved in the day-to-day management of the home and in providing care. The provider was at the home on the day of the inspection. The relative said, 'I know she [the provider/ manager] is the owner and she works there. She's very approachable and she's got hands on experience'. A professional we spoke with said, 'She [the provider/manager] is making an effort to improve things. She's taken on board what's been said'.

Following the last inspection, the provider had employed five new staff members, this included a person responsible for cleaning the home. The provider was also in the process of recruiting a cook. The provider/ manager told us the recruitment of new staff was in response to concerns identified in the last inspection relating to staff not spending enough time to provide care because they were engaged in other household tasks.

We saw training records of four staff members and noted they had completed the required mandatory training. We saw that newly recruited staff members had completed the required training as part of their induction. Newly recruited staff had to undertake a period of supervisions and competency checks prior to being able to administer medication independently.

We previously had concerns about the monitoring of the quality and safety of the service. We saw that the provider had acted on all the concerns identified within the warning notice that was issued them. The provider had a quality assurance system in place to ensure the necessary quality checks took place.

10 June 2014

During a routine inspection

We visited Riverview Residential Home on a planned unannounced inspection, which meant that the service did not know we were coming.

On the day of the inspection, people who used the service told us they were happy with the care they received. We saw that people looked happy and well cared for. Most of the relatives of people we spoke with were pleased with the care provided and told us that kind and friendly staff cared for people who lived at the home.

Is the service safe?

The required health and safety checks and servicing were completed and we saw records that the provider acted on the recommendations made following environmental safety checks. One relative we spoke with said, 'I think it's quite a safe environment and there aren't many residents'.

Prior to the inspection, we received information of concern relating to the flooring in the lounge area. During the inspection, we noted that the vinyl flooring in the lounge area had lifted and posed a trip hazard. This meant that people who used the service were at risk of trips and falls because the flooring in some sections of the main lounge was unsafe.

People who used the service were at risk of receiving inappropriate care because there were not sufficient numbers of staff during each shift to meet people's care needs and carry out domestic duties in the home.

The staff we spoke with, relatives of people who used the service and other professionals told us that some people who used the service sometimes presented with behaviours that challenged. The staff training records we looked at indicated that none of the staff have received training on how to support and manage people who presented with behaviours that challenged.

The provider had recently recruited four new members of staff. Other than medication management training, no newly recruited staff had undertaken the mandatory training required by the provider.

Is the service responsive?

Most of the relatives of people who used the service told us that the provider responded to the needs of people in a timely manner. A relative we spoke with said staff took appropriate actions when they felt that people needed to be seen by other professionals due to health concerns. We saw records that the care staff sought advice and took appropriate action when they were concerned about the health of people who used the service.

We noted that other visiting professionals came to the home on a regular basis. A visiting professional was at the home on the day, to check on the health of a person they visited regularly. Another visiting professional we spoke with told us that they visited the home regularly to review the care of people. This meant people's health needs were responded to.

We observed that people had a main meal offered to them during lunch. Staff we spoke with told us that there was a variety of frozen meals in the freezer, which could be quickly prepared if people did not wish to have the main meal or changed their minds.

Is the service caring?

People who used the service told us that the staff were very good and they were satisfied with the care and support provided. One person who used the service said, 'I've never seen ill things going on here'.

We observed that staff were caring, compassionate and professional. People who were unable to comment or did not wish to speak with us looked comfortable, clean and well cared for. We saw that staff encouraged people to be as independent as possible during meal times.

Visiting professionals told us that the staff were caring. One professional we spoke with told us, 'They've done very well with X [a person who used the service]. They got her changing her clothes herself, because in the past she wouldn't do anything'.

All the relatives we spoke with told us that the staff were very caring. One relative said, 'I think they genuinely care for the residents and the carers are good'.

Is the service effective?

In the previous inspections carried out in June 2013 and February 2014, we found that the provider did not always act in accordance with legal requirements when people lacked capacity to make certain decisions. The provider sent us an action plan of how they will ensure that they complied with regulations. During this inspection, we found that people who lacked capacity to make decisions had still not received an assessment under the Mental Capacity Act 2005. The provider told us that they had requested assessments to take place but had not yet received confirmation of an assessment date.

People's health and care needs were assessed. We saw that most plans were up to date and corresponded with the discussions we held with staff.

Is the service well led?

The provider had carried out necessary maintenance and safety checks to ensure that people who used the service were safe.

The provider did not have an effective system in place to monitor the quality of the service provided. The provider had a complaints procedure in place but we noted that recent complaints made by relatives of people who used the service were not recorded. Staff we spoke with were not aware of how complaints were recorded to ensure that they were resolved effectively and lessons learnt.

The provider did not hold regular staff meetings and the staff we spoke with told us that they had not had a staff meeting for over six months. We saw records that staff received regular supervision. This meant that staff were given opportunities to discuss concerns relating to their roles and have their practice reviewed by the provider.

The provider had service questionnaires, which were placed at the main entrance into the home for relatives and other professionals to provide feedback about the service. We did not see any records of completed questionnaires or analysis of returned questionnaires. This meant that the provider did not have an effective system in place to review the quality of the service they provided.

We saw that all the baths in the home, the flooring in the lounge, and the scales for weighing people were either out of use and/or needed to repairs. This meant that people were at risk of inappropriate or unsafe care because the provider did not have suitable arrangements in place for carrying out necessary maintenance works in the home.

12 February 2014

During an inspection looking at part of the service

We inspected this service on 27 June 2013, and we found the provider was not responsive to people's changing needs. People were not supported to make decisions that were in their best interests and systems were not in place to ensure the quality of the service was reviewed to meet identified risks. We carried out this inspection to check the improvements in this area.

We observed interactions and saw that people were relaxed with staff. Staff had a good knowledge of people's support needs and we saw the staff were respectful to people when they provided support. One person told us, 'The staff here are very helpful and kind.'

People told us they could make choices about their daily activities and how they wanted to be supported. Where people did not have capacity the provider could not always demonstrate decisions had been made in people's best interest.

We saw that the provider had a system in place to regularly assess and monitor the service to ensure service improvement.

27 June 2013

During a routine inspection

People were asked how they wanted to receive care and how they spent their time. People we spoke with told us they were happy with the staff and one person said, 'I'm so thankful that we have such lovely people to look after us.' Another person told us, 'The staff have been very good to me.' We saw the staff were compassionate and they responded to what people said they wanted.

The registered person was not responsive to people's changing needs. Care records did not always reflect how people needed to be supported and not all risks were identified. Where people were identified as having complex needs, they did not always receive the support to meet those needs. This meant not all people were not receiving safe and effective care.

The staffing provided did not always reflect how people could be supported safely. There were two staff on duty and some people needed the support of two staff with personal care. This meant other people may be unsupported or unsupervised during these periods.

Medication was recorded appropriately and systems demonstrated that people received the right medication as prescribed to keep well.

Systems were not in place to ensure the quality of the service was reviewed to meet people's assessed needs and identified risks. This meant the service was not well led because the quality of service provision had not been reviewed to meet people's needs.

2 October 2012

During a routine inspection

The home did not know we were coming to complete our inspection. We spoke with three people living at the home. We spoke with both members of staff on duty. We also spoke with health and social care professionals who had come to visit people living at the home. We reviewed care records and other documents, and observed how people were supported to make decisions, choices and live their life.

People living at the home told us that they were happy with life at the home. One person told us that, 'The staff are always helpful and respond straight away if I need help with anything.' People appeared relaxed and content in each other's company. We observed that staff treated people with respect, communicating in a way that maximised people's involvement in their day to day care. We were told there was not much to do living at the home. One person told us that various activity sessions took place across the day but that, 'There was no choice in things to do.' Another person told us, ' I don't like bingo. None of us like it.' We found that activities were planned and provided but the range was limited and were all home based.

Care plans were in place, setting out people's likes, dislikes and support needs. Risks to people were identified and assessed. Risk management plans were in place to ensure staff had clear information to keep people safe. People were not adequately supported to eat and drink sufficient amounts to stay healthy and well. We found three people had continued and unexplained weight loss that had not been followed up or identified as a risk to people's wellbeing.

People told us they felt safe at the home. The staff on duty demonstrated a good understanding of the types of concerns that could constitute abuse and their responsibilities to help protect and keep people at the home safe. There were a range of processes in place to keep people safe and protect them from the risk of abuse. This included recruitment and selection processes to ensure staff were suitable to be working at the home. There were also formal and informal opportunities for people to raise concerns. The visitors we spoke with told us that they felt people were safe at the home. The social workers told us there was a more responsive approach from staff to identifying and managing risks to people's safety and well being.

The current fire risk arrangements at the home did not ensure that people could evacuate the premises quickly and safely in the event of a fire. We were told by the quality manager that the works required were being organised.

5 January 2012

During an inspection looking at part of the service

A previous inspection of the home had led to compliance actions being made with care records, training, supervision and the environment. The purpose of this follow up visit was to review any improvements that had been made.

There were four people living at Riverview when we visited on 6 January 2012. The visit was unannounced, which means the provider and the staff did not know we were coming. A quality monitoring officer from the local authority joined us on this visit.

On arrival, the home felt warm and welcoming and we saw that communal areas had been decorated since our last visit. We briefly spoke with people living at the home who told us they were comfortable and settled. We spoke with staff members who told us that they welcomed the improvements at the home.

Comments left on relatives questionnaires included, 'Riverview is a welcoming place', 'All staff have been very friendly and helpful' and 'I would like to express my thanks and appreciation.'

The provider/manager was not in the home when we arrived, however the staff contacted the quality manager who shortly after, to assist us with the visit.

We found the home to be compliant on this visit. The improvements made must be maintained and continued at this level. Further monitoring of the service will be made by the quality monitoring office.

11 November 2011

During an inspection in response to concerns

We carried out this review as the local authority had raised their concerns to the CQC after visiting the home. We noted similar concerns although the provider and the home's quality manager had taken action and addressed some issues.

Management of the home is crucial to the overall theme of the concerns raised and compliance actions have been made to promote compliance.

People who live in the home told us they were settled and content living there. They had their own bedrooms which were personalised and tidy.

One person told us she enjoyed the space in her own room and having her possessions around her. She told us the do staff encourage her to be independent and they respect her choice.

One person told us she was comfortable and liked the company of others in the lounge. They said the staff are friendly, she enjoys the meals and she feels safe in the home.