Riverlee Residential and Nursing Home

Riverlee Residential and Nursing Home provides residential and nursing care for up to 75 older people over three floors and specialises in dementia care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

At the time of our inspection, 68 people were using the service.

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

Risks to people’s health and safety were not always effectively assessed or guidance available to reduce possible risks and maintain people’s safety. Medicines were not always managed safely. The current systems in place were not robust enough to assess and monitor the quality and safety of the services being provided to people.

The service had safeguarding procedures in place. Appropriate recruitment checks had taken place before staff started work. There were enough staff available to meet people’s care and support needs. The service had procedures in place to reduce the risk of infections.

People’s care and support needs were assessed before they started using the service. Staff were supported and received training relevant to their roles. People were supported to maintain a healthy balanced diet and had access to health care professionals. We have made a recommendation about maintenance of the premises. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and relatives told us staff were kind and caring. People's privacy, dignity and independence was promoted.

People and relatives spoke positively about the service. Care records were person centred and reflected their needs and preferences including end of life care. The service had a complaints procedure in place.

The service sought the views of people and their relatives. The service worked in partnership with health and social care providers to plan and deliver an effective service.

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 13 June 2018).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverlee Residential and Nursing Home on our website at www.cqc.org.uk.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to assessing risk, medicines management and good governance.

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

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.

We found the following examples of good practice.

The provider maintained sufficient stock of suitable personal protective equipment (PPE) for staff to use whilst working at the home. Staff followed national guidelines when using PPE to help minimise the risk of the spread of infection.

The service had procedures in place for any visitors, including visiting health and social care professionals when visiting the service. These included screening visitors for COVID-19, providing them with appropriate PPE, and following safe infection control practices.

There were procedures in place to ensure people were safely admitted to the home. This was in line with current national guidelines relating to care home admissions during the pandemic. Staff received infection prevention and control training and demonstrated awareness of how to apply this whilst working.

People and staff were regularly tested for COVID-19. The registered manager and the provider understood and implemented actions to effectively manage any potential COVID-19 outbreak. The registered manager and provider carried out regular health and safety checks to ensure infection control risks were managed safely. The provider had infection prevention and control policies in place.

At the time of our inspection there were 62 people using the service.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the home. 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 home is run.

Staff were caring and knowledgeable regarding the individual choices and preferences of people. However we observed some instances in which staff were more task focused.

We found the home was clean. We observed adjustments had been made in the home in response to people’s specific needs and provided a dementia friendly environment.

People and their relatives informed us that they were satisfied with the care and services provided. On the day of our inspection we observed that people were well cared for and appropriately dressed. People said that they felt safe in the home and around staff. Relatives told us that they were confident that people were safe in the home.

People's care needs and potential risks to them were assessed. Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly by staff and were updated when people's needs changed.

There were sufficient numbers of staff to meet people's individual care needs. Staffing levels were assessed depending on people's needs and occupancy levels. There was a dependency tool in place to assist the home to allocate staff accordingly.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. They had the necessary support, supervision and appraisals from management.

There was a record of essential inspections and maintenance carried out in the home. The home had an infection control policy and measures were in place for infection control.

The home operated within the principles of the Mental Capacity Act 2005 (MCA). People are were supported to have choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the home supported this practice.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met. Food was freshly prepared and presented well. Details of special diets people required were clearly documented and accommodated for.

There was an activities programme in place for people to participate in. During the inspection, we observed some activities taking place. The home also arranged events for people such as Christmas/Easter parties, BBQs, birthday parties, sing a longs and themed events.

The home had carried out an annual resident's satisfaction survey in 2017 and the results from the survey was positive.

Relatives spoke positively about management in the home and staff. They said that the registered manager was approachable and willing to listen. Complaints had been appropriately responded to in accordance with the home’s policy.

The home had a clear management structure in place. Staff told us management was approachable and the home had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

There was a comprehensive quality assurance audit process in place. The home undertook a range of checks and audits of the quality of the home and took action to improve the home as a result.

Riverlee Residential and Nursing Home provides residential and nursing care for up to 75 older people over three floors and specialises in dementia care. The home is located in the Royal Borough of Greenwich. At the time of our inspection there were 72 people using the service. The home 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 protected from the risk of abuse because staff followed the provider’s policy and procedure and had received appropriate support and training which enabled them to identify abuse and take appropriate actions to report and escalate concerns. Risks related to the health and safety of people using the service were identified, assessed and reviewed in line with the provider’s policy. There were arrangements in place to deal with foreseeable emergencies and environmental and maintenance checks were conducted on a regular basis. Accidents and incidents involving the safety of people using the service and staff were recorded, managed and acted on appropriately. There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work to ensure they were suitable to be employed in a social care environment. Medicines were managed, stored and administered safely.

Premises were kept clean and were adequately maintained. There were adequate numbers of suitably qualified, experienced and appropriately trained staff to meet people’s needs in a timely manner. There were processes in place to ensure staff new to the home had appropriate skills and knowledge to deliver effective care. Staff were appropriately supported through regular supervision and an annual appraisal of their performance. There were systems in place which ensured the service complied with the Mental Capacity Act 2005. This provides protection for people who do not have capacity to make decisions for themselves. People were supported to eat and drink suitable healthy foods and sufficient amounts to meet their needs.

People told us staff were kind and caring. Staff showed good knowledge of people’s personalities and behaviour and were able to communicate effectively with them. Staff took time to build relationships with people and their relatives and there was a keyworker system in place to allow this. People were supported to maintain relationships with their relatives and friends and visitors were seen coming and going throughout the course of our inspection with no restrictions placed upon them. Staff respected people’s dignity and privacy and treated people with respect. Staff were knowledgeable about people's needs with regards to their disability, race, religion, sexual orientation and gender and supported people appropriately to meet their identified needs and wishes.

People received care and support that was responsive to their needs and respected their wishes. People were assessed to receive care and treatment that met their needs and care plans were reviewed on a regular basis to ensure this. Health and social care professional’s advice was sought when required and recorded in people’s care plans to ensure that people’s needs were met. People were supported to engage in a range of activities that reduced the risk of people feeling Isolated and that met their needs and reflected their interests. There was a complaints policy and procedure and information on how to make a complaint was on display in a well-designed ‘compliments and complaints’ information book which was easily available at the reception area. There were also suggestion boxes aimed at people using the service and their visitors which was located in the main reception area.

People and their relatives told us the atmosphere in the home was friendly and welcoming and the registered manager and staff were supportive and approachable. Staff spoke positively about the registered manager and the support they received to enable them to do their jobs. The registered manager was knowledgeable about the requirements of a registered manager and their responsibilities with regard to the Health and Social Care Act 2014 and notifications were submitted to the CQC as required. There were systems and processes in place to regularly monitor and evaluate the service provided and people, their relatives and staff were provided with opportunities to provide feedback about the service.

We found that there were enough staff to meet people's care needs.

We found that people were involved in making decisions about their care and treatment. People's care and support needs were assessed and regularly reviewed. Staff understood people's care needs and knew how to protect them from risk and harm. We saw there were not enough staff to meet people's needs in a timely manner. There was evidence that quality monitoring audits had taken place on a regular basis, and that learning from the audits and necessary changes were implemented.

We found that people were asked to consent before care was provided to them, and the provider acted in people's best interests where they were unable to make their own decisions. People's needs were assessed and care and treatment was planned and delivered to ensure their care needs were met, and people received appropriate input from relevant professionals. Staff were adequately trained to identify any safeguarding concerns and staff knew how to report any issues.

We found the provider had appropriate arrangements in place to manage people's medication safely. The provider's recruitment procedures were adequate to ensure people were cared for by appropriately vetted staff, and staff were inducted, trained in key relevant areas, and appropriately supported. The provider had suitable arrangements in place to monitor the quality of the service and responded appropriately to any complaints received.