Archived: Riviera Court

We found the following examples of good practice.

Staff had undertaken Restore2 training. People had their temperature taken and Restore2 check twice a day. Restore2 highlights early identifiers of infection or illness, such as reduced blood oxygen. This had already identified a person who required GP intervention for a non Covid 19 related early health need.

Staff were trained to take and give Covid 19 tests and how to keep people safe from transmission of Covid 19 and other viruses. Enhanced cleaning was in place. Staff wore and removed PPE appropriately. The service did not have a clinical waste contract in place, but this has been actioned so should it be needed, the service can ensure safe disposal of contaminated items.

People were supported to be Covid aware and be fully involved in how they could keep themselves and others safe. People were enabled to take their own Covid test supported by staff where possible. Risk assessments had been completed to identify those most at risk.

There was a thorough system in place for checking in professional visitors. This enabled people to maintain important relationships with key professionals. The service was not admitting visiting family at the time we inspected, but safe systems were in place to support this when it resumes.

Riviera Court is a residential care home providing personal care to adults with complex mental health needs. 20 people lived in the service at the time of the inspection. The service can support up to 22 people.

The service is on three floors, with access to the upper floors via stairs. Bedrooms have en-suite facilities. There is an outside shared patio area.

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

People who had lived in the service for many years mainly said they were happy.

Risks in relation to people’s care and lifestyle were not assessed, understood and managed in a way that kept them safe. Some practices in relation to risk did not protect people’s human rights. Medicines were not always managed safely. People told us they felt safe and appeared comfortable when staff were with them.

People did not live in an environment that was well-maintained. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People told us they enjoyed the food at the service.

Most people told us staff were kind and caring. One person said, "I am happy with the service, there has been nearly all the same staff over the years.” Several people told us some staff were not as good as others.

People’s care plans did not evidence how they were involved in the service or their care. Care plans contained limited information on how staff should meet people’s individual needs, preferences, goals, and social activities. Staff knew people well and were able to tell us about their preferences. Complaints that had been made were not always recorded or accessible.

There were some monitoring checks in place, however these had not always been effective in identifying where improvements were needed. The registered manager spoke openly and honestly throughout the inspection process. They were aware improvements were needed within the service. They planned to contact the local authority quality assurance team for support.

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 15 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care, need for consent, safe care and treatment, and governance at this inspection. We also made recommendations in relation to the refurbishment of the environment and complaints management.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Riviera Court supports adults with a range of complex mental health needs. It is registered to provide accommodation and personal care for up to 22 adults. At the time of the inspection there were 21 people living at the service.

The service had a 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.

People were well cared for at Riviera Court. One person told us; “I had thought of moving on, but you won’t get better than the people here”. Interactions we observed between people and staff were kind, compassionate and caring. People were treated with respect and their confidentiality was upheld. One external health professional told us; “Standards of care seem very high”.

Relatives were made to feel important and were warmly welcomed at the service. Staff and managers were considerate towards them and ensured they felt looked after and valued. Relatives were kept informed of any changes and were able to have an open and honest dialogue with staff and managers.

The service was well led. Staff said they felt valued and supported by their colleagues and the managers. The registered manager had a robust quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service, relatives and other agencies. Learning from quality audits, incidents, concerns and complaints was used to help drive continuous improvement across the service.

Systems were in place to deal promptly and appropriately to any complaints or concerns. The registered manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. This reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment. Feedback on the service was sought in creative ways to ensure everybody had their voices heard.

People were kept safe. People had their medicines as prescribed and on time; and were cared for by staff who had undergone checks to ensure they had the correct characteristics to work with vulnerable people. Staff understood their role in safeguarding people and in recognising and reporting signs of abuse.

People were supported by staff who were skilled to meet their needs. They had received training to carry out their roles which was regularly updated and refreshed. Staff were supported by an ongoing programme of supervision, competency checks and appraisals.

People’s consent was sought prior to staff providing them with any assistance. Staff had a sound knowledge of the Mental Capacity Act (MCA) and understood how to apply this to the care and support they provided to people. Staff understood capacity could change over time and was decision specific. This was reflected in people’s care records and observed in the way they interacted with people.

People’s health and social care needs were addressed holistically through access to a range of health and social care professionals. People’s care records were personalised, contained the correct guidance for staff and recognised the person as a whole, including their social history, choices, aspirations and goals.

The service was free from adverse odours, although some areas were not always clean. For example, we noticed dirt and debris on one stairwell and along one corridor. The environment was comfortable and people’s bedrooms were spacious, bright and personalised to suit their preferences.

People enjoyed the meals and were offered choice. People had enough to eat and drink and feedback on the meals was extremely positive, from both people and their relatives.

There was a lack of planned activity at the service. We were told that many people living at Riviera Court lacked motivation, and therefore when activities had been arranged in the past, people had chosen not to participate. However, the registered manager recognised that some people would benefit from regular, scheduled activities and therefore plans were being made to re-introduce them.

We found that people's consent had been obtained for care and treatment provided to them by the service. We saw from care records that some people had signed their care plans to indicate they were happy with the content. Where people did not wish to sign their care plans this was recorded.

We found that care plans reflected the needs of a person as an individual because they contained details of people's personal history, their likes and dislikes and what type of support they required.

Care workers were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring.

People who used the service told us that care workers were not rushed and had time to meet their needs. Comments included 'They see to all my needs'. They also told us that care workers always spoke nicely to them and treated them with respect. Another person told us 'Quality of care is very good here'.

The registered person protected people who used the service, against the risks of inappropriate or unsafe care and treatment. We know this because there was an effective system in operation which was designed to enable the provider to regularly assess and monitor the quality of the services provided.

We observed that the atmosphere appeared relaxed and informal. People are supported by staff that understand their individual needs and the outcomes they are aiming to achieve. The staff we spoke with all demonstrated a good understanding of needs of each person that used the service.

We invited people using the service to opportunity to discuss their experiences with us, many declined feeling uncomfortable. We where able to talk to three people one who had been supported for a long period one who had been living at the service for three years and one who had recently moved to Riviera Court.

We observed staff interacting with the individuals carrying out activities and guiding them through areas of their day such as hospital appointments, or support them to visit the GP.

We spoke to staff who felt they where well supported by both the manager and other team members.

People told us 'I really like it here', and 'some staff are the same age this helps to relate with them'. We observed staff talking to people with respect and dignity.