Riversway Nursing Home

Riversway is a care home that provides accommodation, for 63 people who require nursing and personal care. The service is provided in accommodation over two floors. At the time of this inspection 53 people were living at the home.

We found the following examples of good practice

There was a Covid outbreak at the time of the inspection. Whilst we were walking around the home we saw that most people who did not have Covid had chosen to spend time in their personal rooms to help them keep safe. There were two people who were sat socially distanced in one of the lounges. Although they were not able to communicate through questions and answers, they appeared happy and relaxed in their home.

The emotional wellbeing of people, their families and staff had been supported throughout the pandemic. We read comments sent to the registered manager which she had received from relatives. These included, “I wanted to thank you and all the fantastic office staff for the times given to me to see my relative through these tricky Covid times”, “We know the pandemic is not over but thank you for an outstanding job of shielding our relative and other residents in your care”, “We know its not been easy but all your hard work and dedication in safeguarding everyone has made a huge difference” and “You are taking care of our loved ones, please take care of yourselves, you could not have done more”.

All visiting arrangements followed government guidance, and these were adjusted dependent on whether there was an outbreak. In the event of an outbreak the manager had ensured every person living in the home had access to a nominated Essential Care Giver (ECG). This was usually a family member, but an alternative significant other would be nominated for those who did not have family. Enhanced risk assessments ensured this was managed safely and that all relevant testing and the use of PPE was maintained at all times. End of life visits had also been supported and respected so that people could spend time with those people who were important to them.

We spoke with five staff who spoke positively about their safety and how they worked together. Comments included, “I feel safe here. When Covid hit us, I was anxious and worried, but we just got on with it”, “I do feel supported and safe here. I wear my PPE and take extra precautions entering rooms where people have Covid”, “We have no choice but to just pull together and care for people” and “We are slowly returning to normal now. I did panic at the start of this outbreak, but everything is ok. We have a nice team here and we support each other”.

The registered manager and deputy spoke with us about staff and the positive impact working alongside each other had progressed and changed during the pandemic. They were very proud of all staff and told us they had worked incredibly hard during challenging times. Staff were encouraged to consider and celebrate positive outcomes. Motivational support had been key to promote and improve camaraderie, closeness and bonds with each other.

The providers workforce contingency plan had ensured people’s safety and quality of care had not been compromised. People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained strong. When people were admitted to the home, risk assessments were completed, and people isolated in line with current guidance. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

Audits were complicated, and actions would be taken to ensure improvements were made if necessary. Staff had received IPC training and regular updates were provided. There was effective, supportive communication between the provider, managers, staff, people using the services and their relatives.

Riversway Nursing Home is a care home that provides personal and nursing care for up to 69 older people. The service is provided in accommodation over two floors. At the time of the inspection, 66 people were living in the home.

What life is like for people using this service:

People who used the service and relatives spoke positively and told us they felt safe in the home.

Medicines were safely managed, and people received their medicines when they needed them.

Quality assurance risks systems identified shortfalls and actions plans were in place to mitigate risks and make improvements.

Staff had received sufficient training to carry out their roles. Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.

People were supported to access health care services and regular visits were undertaken by their GP.

People’s dietary needs were assessed, and people were offered choices at mealtimes. People received the support they needed with food and fluids.

People and relatives were asked for feedback and knew how to complain.

People received care that was kind and respectful. Care plans were detailed and reviewed each month.

The service met the characteristics of Good in the key questions Safe, Effective, Caring, Responsive and Well-led. Therefore, our overall rating for the service after this inspection has remained Good.

More information is in detailed findings below.

Rating at last inspection:

Good (report published in June 2017).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people receive.

Follow up:

We will monitor information received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

The inspection was unannounced. Riversway Nursing Home provides nursing and personal care for up to 69 people. At the time of our inspection there were 62 people living in the home.

There was a registered manager in place at the time of our inspection. 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 told us they felt safe in the home. They were cared for by staff that had been trained and understood their responsibilities with regard to keeping people safe from avoidable harm and abuse. Risk assessments were completed and risk management plans were in place.

People were supported to make decisions on a day to day basis. Staff identified when people’s needs changed and they obtained support and guidance from external health care professionals.

Staff demonstrated a kind and caring approach and they treated people with dignity and respect. Staff knew people well and were able to tell us about people’s likes, dislikes and preferred routines which were reflected in their care records.

There was a range of activities that people could participate in and people were enjoying group and one to one activities on the days of our visit.

People, staff and relatives told us the home was well-managed. People and relatives told us the registered manager was readily accessible and available to them. Staff told us they were well-supported and that the home was a good place to work.

Riversway Nursing Home is registered to provide nursing and personal care for up to 69 people. There were 61 people living in the home on the day of our visit.

There was 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 assessed before they moved into the home to ensure their needs could be met.

Risks to people were assessed, and where identified, actions were taken to reduce the risks and keep people safe. Some risks had not been identified and sufficient actions had not been taken when a person’s condition changed or deteriorated. For example, two people had developed pressure ulcers. These had not been recognised or identified by staff. They were identified by a visiting GP.

People received personalised care that was responsive to their needs. Care plans reflected that people’s individual needs, preferences and choices had been considered.

People were supported to have their nutritional needs met. The dining experience was relaxed, and people received the support they needed.

Governance systems were in place to monitor and mitigate most of the risks relating to the health, safety and welfare of people.

The rights of people who did not have the capacity to consent to care and treatment were protected because the service worked in accordance with the Mental Capacity Act 2005.

People who were supported by the service felt safe. Staff had a clear understanding about how to safeguard people, and knew the actions they would take if they suspected abuse.

We found three breaches of the Health and Social Care 2008 (Regulated Activities) Regulation 2014.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were cared for in a clean environment. There were enough staff on duty to meet the needs of people who used the service. The staff we spoke with were knowledgeable about their roles and demonstrated a good understanding of the needs of people.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. During our inspection we saw evidence that people had been assessed in accordance with these safeguards in line with procedures and we found the provider was compliant. The registered manager and the service manager both demonstrated an in-depth knowledge of the safeguards which showed us they understood their responsibilities to the people who used the service.

Most of the staff had received safeguarding training and all demonstrated knowledge of their responsibilities to keep people safe from abuse.

Is the service effective?

Care records we saw were generally well documented and up to date. Care plans had been reviewed and updated to reflect when people's needs changed. However, daily care records had not always been fully completed to reflect the care people had received.

People who used the service told us their needs were met. People told us "I can't cope at home on my own, so this place suits my needs" and "This is my second experience of care homes and it's the best".

Is the service caring?

Staff that we spoke with and observed were kind and caring. We observed staff being respectful of people and offering people choice in what they wanted to eat and what they wanted to do. People told us "The staff are very attentive" and "I can't fault the staff".

Is the service responsive?

People's needs had been assessed prior to living at Riversway. Records confirmed people's preferences had been documented and that care reflected their wishes.

People had access to support services when required such as a GP. When people's health deteriorated, advice and support was accessed quickly.

Is the service well-led?

Staff told us they felt well supported in their role. The registered manager was a dementia specialist and was knowledgeable about the specialist needs of people with dementia. They also provided support to families of people with dementia.

There were effective systems in place to monitor the quality of services provided. People and their representatives were regularly asked for their feedback on the service they received.

At this inspection we found that people were protected from the risks of unsafe care. This was because accurate and suitable records were maintained. Staff understood the importance of accurate record keeping. They were aware that this was to ensure people received safe and effective care and assistance with their needs.

Our observations of the care and support that was provided showed care plans were accurate. They provided clear guidance for staff to follow. This meant that people who used the service received consistent and effectively planned care and support.

We spoke with three people who used the service. Each person we spoke with had positive views of the care and support they received. One person told us that it was 'excellent'.

We received a range of feedback about the service. One person commented that they were 'very happy' with the care and we met with people who were appreciative of the support they received from staff. However, we also heard that there could be an inconsistent approach in how staff responded to people's needs. This meant that there could be delays in time before people's needs were met.

We found shortcomings in the recording of care and the information that was available to staff about people's individual needs. This meant that it would be difficult to evaluate the care that people received and to be confident that effective care had been provided as agreed.

The provider had systems in place for monitoring standards in the home and the quality of service that people received. The manager was already aware of shortcomings in relation to the deployment of staff and how these affected the service that people received. We were told that action was being taken to address these.

People were provided with food and drinks which met their individual needs. A chef prepared food to meet people's dietary requirements and people told us that they enjoyed their meals.

Procedures were in place which helped to ensure that people were protected from abuse and concerns were followed up with the relevant agencies.

People were treated with respect by the staff and their nursing and personal care needs were being effectively met at Riversway.