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Inspection carried out on 19 November 2020

During an inspection looking at part of the service

About the service

River Garden Care is a domiciliary care agency registered to provide personal care to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection about 70 people were receiving personal care from the service.

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

There were enough staff available to deliver care to people. There was an effective system in place for planning and monitoring care visits. People received their medicines safely. Staff had received training in safeguarding adults and knew actions to take to protect people from abuse. Risks to people were managed effectively to reduce harm to them. Lessons were learned from incidents and accidents. Staff followed infection control procedures to reduce risks of infection.

People and their relatives knew how to contact the office if they had concerns or complaints. The registered manager and members of the management team shared information with people about the service. There were effective systems in place to assess and monitor the quality of the service. The provider worked in partnership with other organisations to develop the service. The registered manager met their statutory responsibilities to the CQC.

For more details, please see the full report which is on the CQC website at

Rating at last inspection (and update): The last rating for this service was requires improvement (published 30 July 2019) and there we found two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating. We carried out a focused inspection to check they had followed their action plan and to confirm they now met legal requirements in the areas we had concerns at our last inspection. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for River Garden Care on our website at

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.

Inspection carried out on 16 May 2019

During a routine inspection

About the service: River Garden Care is a domiciliary care agency. It provides personal care to people with a range of conditions including physical disabilities and people living with dementia. At the time of the inspection there were 94 people receiving personal care from the service.

People’s experience of using this service:

People were not supported by effectively deployed staff. Staff did not always attend people’s care calls as agreed.

Staff rostering records showed staff were not always given enough time to travel between the calls, which impacted on their ability to arrive promptly or stay the full time with people.

The provider’s quality assurance systems were not effective. The provider was not effectively monitoring people’s calls to make improvements.

There were effective recruitment and selection procedures in place to ensure people were safe and not at risk of being supported by staff that were unsuitable.

People and their relatives gave us positive feedback about their safety and told us that staff treated them well.

The provider had a policy and procedure for safeguarding adults from abuse. The registered manager and staff understood what abuse was, the types of abuse, and the signs to look for.

Staff completed risk assessments for every person who used the service. These included manual handling risks, oral care, eating and drinking and home environment.

There was a system to manage accidents and incidents to reduce them happening again. Staff completed accident and incident records.

Staff administered prescribed medicine to people safely.

People were protected from the risk of infection.

People’s needs were assessed to ensure these could be met by the service. Where appropriate, staff involved relatives in this assessment. The provider trained staff to support people and meet their needs.

Staff supported people to eat and drink enough to meet their needs and staff supported people to maintain good health. The provider worked with other external professionals to ensure people received effective care.

People’s capacity to consent to their care and support was documented. People told us staff obtained consent from them before delivering care to them.

Staff supported people and showed an understanding of equality and diversity and people were treated with dignity, and their privacy was respected.

People and their relatives were involved in the planning and review of their care and people were supported to be as independent in their care as possible.

Care plans were person centred and contained information about people’s personal life and social history, their health and social care needs.

The provider had a clear policy and procedure for managing complaints and this was accessible to people and their relatives.

The provider had a policy and procedure to provide end-of-life support to people. However, people did not require end-of-life support at the time of the inspection.

The nominated individual, the registered manager and staff worked well together as a team.

People who used the service completed satisfaction surveys. The provider developed an action plan in response to the feedback from the survey to show how the identified concerns were addressed.

The provider completed checks and audits on accidents and incidents, complaints, staff training, and safeguarding.

The nominated individual and the registered manager remained committed to working in partnership with other agencies and services to promote the service and to achieve positive outcomes for people.

Rating at last inspection: Good (report published on 9 November 2016).

Why we inspected: This was a planned inspection based on the last inspection rating.

Follow up: We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on t

Inspection carried out on 8 September 2016

During a routine inspection

We carried out an announced inspection on the 8 September 2016. This was first inspection of this service.

River Garden Care is a domiciliary care service that provides personal care to people in their own homes. They may have a range of conditions including physical disabilities and people living with dementia. There were 35 people using the service at the time of the inspection.

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.

The management team at River Garden Care provided excellent leadership and, in particular, the registered manager was a very good role model for staff at the service. She provided clear direction and always sought the views and feedback of people, their relatives and professional involved with the service.

There was a strong emphasis on continually striving to improve and this was reflected in the feedback from a ‘client survey’ undertaken in April 2016. The overall satisfaction rate was 96%. As a result of the survey and to seek ways to further improve communication, a client newsletter was introduced. This was to ensure people were kept updated of the outcome of surveys and any actions planned as a result, as well as other important issues in relation to the organisation. People and their relatives were also encouraged to contribute to the newsletter.

There were regular audits undertaken, including, care records, the recruitment process, staffing levels, training and whether people had been involved in decision making. These were checked in line with the CQC five domains, Safe, Effective, Caring, Responsive and Well-led to ensure a high quality service was being delivered.

The complaints process was included in the information book given to people when they started receiving care. People and their relatives were satisfied with outcomes of the complaints recorded and we saw that concerns and complaints were viewed very much as part of driving further improvements.

The safety of people using the service as well as staff was taken very seriously and procedures were in place to safeguard people from abuse as well as ensuring that risks to people’s safety and wellbeing were identified and addressed.

Care plans were detailed and people and their relatives were involved in their development. Staff had a full understanding of people’s care needs and received training and supervision to ensure they had the skills and knowledge to fulfil their roles. People received consistent support from care workers who knew them well.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to support people who lacked the mental capacity in line with the principles of the act and particularly around decision making. People were asked what they liked to eat, how they wanted to dress and their preferences for care delivery. People’s consent was obtained about decisions regarding how they lived their lives and the care and support provided.

Positive, caring relationships had been developed with people, based on compassion and kindness. The registered manager was motivated and committed to providing person centred care that made a positive difference to the wellbeing of people and their relatives that supported them. This commitment was shared by the staff team and we saw this in their enthusiasm for the way they cared for people and their desire to go the extra mile.

Staff had a good understanding of equality and diversity and understood the need to treat people as individuals. There were equality and diversity policies and procedures in place that included clear explanations of the Equalities Act 2010 to ensure staff understood their respo