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Archived: Riverside Court Inadequate

Reports


Inspection carried out on 17 April 2018

During a routine inspection

The inspection of Riverside Court took place on 17 and 24 April 2018 and was unannounced on both days. At the last inspection in March 2017 the home was rated requires improvement and had six breaches of regulations in dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. Following the last inspection, we met with the provider and asked the provider to complete an action plan to show what they would do and by when to improve the five key questions to at least good.

Riverside Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Riverside Court accommodates 60 people across four separate units, each of which have separate adapted facilities. The home was divided into four units; Shannon unit was for people with nursing needs and living with dementia, Clyde unit was for people living with dementia and Trent and Avon units were for people who needed support with daily living activities, some of whom may be living with dementia.

There was no registered manager in post but a newly appointed manager had recently started at the home and was in the middle of their induction. They were in the process of being registered with the Care Quality Commission. 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.

We found serious concerns within the home. Staff were unaware of how to recognise or report safeguarding concerns and could not appreciate the support they were providing was, in some cases, increasing people’s distress and sense of anxiety.

Risks were identified but then not managed to reduce the likelihood of harm for people. Staffing levels were not sufficient to ensure people had a good quality of life as many remained in their rooms all day with little, or no, interaction. In addition, a lack of continuity of staffing meant people did not know who was supporting them each day and some agency staff displayed little knowledge of how to support people safely or effectively.

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; the policies and systems in the service did not support this practice. Although progress had been made in regards to obtaining legal authorisations to deprive people of their liberty, people were not encouraged to take positive risks and many had unnecessary restrictions placed on them.

Medicines were recorded, stored and administered safely for the most part apart from the use of PRN, or ‘as required’, medication. We found two people where medication had been used to reduce their behaviour which may be seen as challenging themselves or others rather than any evidence of positive behaviour management techniques. Staff appeared unaware of how to support people living with dementia effectively or safely, with minimum restrictions to their liberty.

Care records, although slightly more person-centred than found during the previous inspection, were large and often illegible, and staff readily admitted to not reading them as they did not have time to do so. Nutritional guidance was mixed and people did not have ready access to snacks and drinks throughout either day of the inspection.

We found the provider had not followed advice received from health professionals regarding suitable equipment to prevent pressure damage and other health-related issues. It was only on the second day of the inspection an order was put in for some equipment but this was not reflective of all p

Inspection carried out on 29 March 2017

During a routine inspection

We inspected Riverside Court on 29 and 30 March 2017. The first day of the inspection was unannounced. This meant the home did not know we were coming.

Riverside Court is a care home registered to provide nursing and residential care for up to 61 people. It consists of one building with two floors. All bedrooms are single with ensuite facilities. The home is divided into four separate units, each of which can accommodate 15 people. The home manager told us their office used to be a bedroom, and so the home actually contains 60 single bedrooms, not 61.

Clyde Unit provides residential care for people living with dementia. Shannon Unit provides nursing care for people living with dementia. Trent and Avon Units both provide nursing care; some people on these units were also living with dementia.

On both floors there are communal lounges and dining rooms. Both floors also have shared bathrooms, toilets and shower rooms. The home has an enclosed garden area with seating.

At the time of this inspection there were 55 people living at the home.

Riverside Court was last inspected in October 2015. At that time it was rated as ‘Requires Improvement’ overall. It was deemed to be ‘Requires Improvement’ in the domains of Safe, Responsive and Well-led, and ‘Good’ in the domains of Effective and Caring. We found breaches of regulation in relation to staffing, medicines management, audit and monitoring, and record-keeping.

The home had a registered manager, although they had recently become the manager of a different home run by the same registered provider. A registered manager from another home run by the same provider had commenced employment at Riverside Court two weeks prior to this inspection. The plan was for them to apply to be the registered manager at Riverside Court. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Risks to people were not always assessed fully with care plans put in place to manage them. Risk assessments and care plans were not always updated after incidents had occurred. There were no plans in place to inform staff how to support people to bathe or shower safely.

Medicines administration was person-centred and we saw some examples of good practice in this area. However, we identified concerns with medicines management and recording; this was a breach of regulation identified at the last inspection in October 2015. The home manager was aware of the problems and had already organised an external medicines audit to help create an action plan for improvement.

People’s care files did not always contain a complete and contemporaneous record of their care and support needs. This was a breach of regulation identified at the last inspection in October 2015.

We identified concerns with staff adherence to good practice in infection prevention and control at the home.

Existing staff told us they felt supported by managers at the home and had access to training and supervision. The induction of new staff was not documented, Care Certificate records had not been completed and competency checks on staff new to care had not been done.

Compliance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) across the home was mixed. We saw some examples of good practice in terms of mental capacity assessments and best interest decisions, whereas others were lacking. Applications for DoLS for three people who lacked capacity to consent to living at the home had not been made.

People and relatives told us care staff respected their privacy and dignity and most interactions we saw evidenced this. However, we did observe some occasions whereby people’s privacy and dignity was not maintained.

Feedback from people and

Inspection carried out on 19 October 2015

During a routine inspection

This inspection took place on 19 October 2015 and was unannounced.

We previously inspected the service on 28 July 2014 and at that time we found the provider was meeting the regulations we reviewed.

Riverside Court provides accommodation, personal care and nursing care for up to 60 people some of whom have physical disabilities or are living with dementia

The Registered Manager of Riverside Court had left the service in August 2015 and submitted their application to deregister as manager. A peripatetic manager had been managing the service and a new manager was now in post on a temporary basis until a permanent manager could be appointed. 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 we spoke with told us they felt safe at Riverside Court.

Medicines were not always administered or stored in a safe way for people. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were not always enough suitably trained staff to meet the assessed needs of people who used the service. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Staff had a good understanding of safeguarding adults from abuse and who to contact if they suspected any abuse.

The provider had effective recruitment and selection procedures in place. Staff had received an induction, supervision, appraisal and specialist training to enable them to provide support to the people who lived at Riverside Court. This ensured they had the knowledge and skills to support the people who lived there.

People’s capacity was considered when decisions needed to be made and support provided when necessary to support and enable people to express their views and make certain decisions. This helped to ensure people’s rights were protected when decisions needed to be made.

People enjoyed the food and had plenty to eat and drink. A range of healthcare professionals were involved in people’s care.

Throughout our inspection we observed staff interacting with people in a caring, friendly, professional manner. Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for was respected and maintained. People were supported to be as independent as possible throughout their daily lives.

People and their representatives were involved in care planning and reviews. Individual needs were assessed and met through the development of personalised care plans. Most people’s care plans detailed the care and support they required and included information about peoples likes and dislikes.

Activities were provided at Riverside Court, but this was not at a level which would meet the needs of all the people who used the service.

People told us they knew how to complain and told us staff were always approachable. Comments and complaints people made were responded to appropriately

Effective systems were not in place to assess, monitor and improve the quality and safety of the service provided to people who use the service. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Accurate records were not always maintained in relation to care that was being delivered. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was an open door policy operated by the manager and deputy manager. People who used the service, staff and visitors had free access to discuss any relevant matters. This helped to create a culture of openness and transparency

The manager held meetings with people who used the service, relatives and staff to gain feedback about the service they provided to people.

Inspection carried out on 5 August 2014

During a routine inspection

Two adult social care inspectors carried out this inspection. At the time of this inspection 59 people lived at Riverside Court. We observed interactions between people living at the home and staff, and spoke with eight people living at the home, in small groups or individually, to obtain their views of the support provided.

We spoke with three relatives and one professional visitor to obtain their views of Riverside Court.

We spoke with the operations manager, the registered manager, one qualified nurse, seven care staff, the activities worker and a domestic staff about their roles and responsibilities.

We gathered evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People supported by the service told us they felt safe.

We observed, and people told us they felt their rights and dignity were respected.

Systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people would be safeguarded as required.

Is the service effective?

Staff were provided with training to ensure they had the skills to meet people�s needs.

People and relatives told us they were happy with the care and support staff provided and people�s needs were met. Staff had a good understanding of people�s care and support needs and they knew how to meet them and avoid unnecessary risks.

Other professionals and individuals were involved in regular meetings and reviews with each individual to ensure their care and support was still appropriate.

Visitors confirmed they were able to see people in private and visiting times were flexible.

Is the service caring?

We asked people who used the service for their opinions about the support provided. Feedback from people was positive, for example, �It�s very good here. The staff are lovely and we�re well looked after� and �It�s a nice place. The girls (staff) are okay and look after me well. I would certainly recommend it�. Comments from relatives were also positive. They included, �I like it here, it gives us peace of mind knowing (my relative) is well looked after� and �I have never seen anything to cause me concern. It is a lovely place and staff look after (my relative�s) best interests�.

We observed that staff communicated and interacted with people in a patient and kind manner.

Relatives of people using the service and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

People�s needs were identified and reviewed so any changes were responded to. People had some opportunities for leisure activities.

People spoken with said they had never had to make a complaint but knew how to make a complaint if they were unhappy. We found appropriate procedures were in place to respond to and record any complaints received. People could be assured that systems were in place to investigate complaints and take action as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

Inspection carried out on 26 November 2013

During a routine inspection

Many people living at the home were not able to communicate their feelings, however those who could communicate told us that they were happy living there. One person said "I am well looked after, I have everything I need". Another person said "I could not have come to a better place, I think the staff are great".

There was good evidence that confirmed people had been formally assessed upon admission with regard to their nutritional and dietary needs. This demonstrated that people were safeguarded from the risk of poor nutrition and hydration and any concerns identified at the earliest possible stage.

Medication was administered, recorded and stored accurately and safely. All staff administering medication were suitably qualified to undertake the task.

People had access to nutritious and appetising food and were supported to maintain a healthy fluid balance. We saw that people were supported by staff at lunch time and that people enjoyed their food.

The provider had taken steps to provide care in an environment that was suitable, adequately maintained and in good decorative order. We found a positive attitude towards planned preventative maintenance of the premises with good record keeping to provide evidence of a safe environment.

We saw records which showed that equipment, such as hoists and associated slings, were regularly serviced by a competent contractor to ensure they were fit for purpose and safe to use.

Inspection carried out on 13 April 2012

During a routine inspection

People say they enjoy living in the home. One person said � Moving into the home was the best thing they had ever done�. Another said the �staff are very good and nothing is to much trouble�.

Another says the food is very good and they can choose what they want to eat�. One person who was baking said they like �doing things that are useful� and �enjoyed the company�. Some people who we could not communicate with were observed to be relaxed and comfortable. One person said they enjoy regular visits from their children who live close by.

People say they like living in the home. One person said �If they have any concerns they can tell someone and its sorted�, One person said they �feel very safe and well cared for�. People we could not communicate with appeared to be happy, very relaxed and comfortable.

People say they like the people caring for them. One person said the carers are very good and they �feel well looked after�.

People say they like the people caring for them. Some people we could not communicate with appeared to be happy and positive relationships were observed being fostered between those living in the home and those caring for them.

People living in the home say they like the people caring for them. People we could not communicate with appeared to be relaxed and comfortable with those supporting them.

Reports under our old system of regulation (including those from before CQC was created)