Riverdale Court

Riverdale Court is a care home providing personal care and accommodation to people aged 65 and over. Riverdale Court accommodates up to 80 people across four separate units in one building, each of which have separate adapted facilities. At the time of our inspection there were 78 people using the service.

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

During this inspection, we found improvement was required in relation to some aspects of medicines management and how the service was being managed. There were systems in place to record accidents and incidents, however sufficient analysis was not in place particularly with regards to the high number of falls at the service. The current systems in place were not robust enough to assess the quality and safety of the service effectively.

The service had safeguarding procedures in place and staff had a clear understanding of these procedures. Risks to people’s health and safety were assessed. Relatives told us they felt people were safe and their needs were being met. There were appropriate numbers of staff deployed to meet people's needs. Appropriate recruitment checks had taken place before staff started work. Staff followed appropriate infection control practices.

The manager and staff 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 5 December 2019)

Why we inspected

We received concerns in relation to the management of medicines, infection control and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverdale Court on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to medicines management and people's safety in relation to falls at this inspection.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

There were appropriate infection prevention and control measures in place. All visitors to the service were asked to complete a health declaration, wear appropriate personal protective equipment (PPE) such as a face covering and wipe their shoes on an antibacterial mat.

The service was visibly clean, and staff used appropriate cleaning materials.

Risks relating to COVID-19 had been fully assessed and action taken to mitigate them where possible. Staff wore appropriate PPE.

If people had tested positive for COVID-19 they were supported to isolate in their room or in an appropriate area of the service.

Further information is in the detailed findings below.

Riverdale Court is a care home providing personal care and accommodation to people aged 65 and over. Riverdale Court accommodates up to 80 people across four separate units in one building, each of which have separate adapted facilities. At the time of our inspection there were 77 people using the service.

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

The service had safeguarding and whistleblowing policies and procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks had taken place before staff started work and there were enough staff available to meet people’s care and support needs. Risks to people had been assessed to ensure their needs were safely met. People’s medicines were managed safely. The service had procedures in place to reduce the risk of infections.

People’s care and support needs were assessed when they moved into the home. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and regular supervision. 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 were supported to maintain a healthy balanced diet and had access to health care professionals when they needed them.

Staff had a clear understanding of people’s needs and had developed positive relationships with them. People and their relatives (where appropriate) had been consulted about their care and support needs. People took part in activities that met their needs and preferences. They were supported to follow their interests. The home had a complaints procedure in place and people and their relatives said they were confident their complaints would be listened to and acted on. There were procedures in place to make sure people had access to end of life care and support when it was required.

There was outstanding leadership at the home. The home had received the providers award for innovation. This was for improving activities and the environment for people living with dementia. They also won a Bexley Caring at its Best award for contribution to older people in Bexley. The home was involved with local community groups and projects for raising awareness of dementia. Senior staff placed a particularly strong emphasis on continuous improvement in their running of the home. The views of people using the service were at the core of quality monitoring and assurance arrangements. Staff were supported to develop their leadership skills through a career progression scheme. The registered manager worked effectively with other organisations to ensure staff followed best practice. Health and social care professionals commented positively about the leadership at the home.

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 November 2018) and there was a breach of our regulations. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverdale Court on our website at www.cqc.org.uk.

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our last inspection on 30 and 31 October 2017 the service was rated requires improvement in all key questions, safe, effective, caring, responsive and well led. We found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that sufficient numbers of staff were not deployed throughout the home to meet the care and support needs of people using the service. Appropriate action had not always been taken to support people where risks to them had been identified. Risk assessments where not always reviewed when people’s needs changed. Advice provided from health professionals was not always followed by staff. Some people’s care plans did not accurately reflect their needs. The provider’s systems for assessing, monitoring and improving the quality and safety of the services were not effective. We found other areas were improvement was required. People’s lunch time experience required improvement on the upstairs units of the home. Improvement was required in supporting people with meaningful activities when the home’s activities coordinators were not at work. The training delivered to staff was not always effective. There were mixed views from staff about the management of the home.

At this inspection we found that significant improvements had been made. Risk assessments where being reviewed when people’s needs changed. Advice provided by health professionals was being followed by staff. People’s care plans accurately reflected their current needs. People’s lunch time experience had improved. People were consistently provided with a range of activities that met their needs. The training delivered to staff was effective. Staff views about the management of the home was positive. Staff were appropriately deployed at the home to meet people’s needs, however further improvement was required to ensure people consistently received prompt support when needed.

Despite these positive improvements, we found a breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicines management. The provider’s systems for assessing, monitoring and improving the quality and safety of the services had not identified these issues. This is therefore the second time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Following the inspection the registered manager confirmed with us that immediate action had been taken to address these areas.

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. The registered manager was aware of their responsibilities about the Health and Social Care Act 2014. Notifications were submitted to the CQC as required. They were aware of the legal requirement to display their current CQC rating which we saw was displayed at the home.

The service had safeguarding and whistle-blowing procedures in place and staff had a clear understanding of these procedures. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met. The home had procedures in place to reduce the risk of the spread of infections.

Staff completed an induction when they started work and they received training relevant to people’s needs. Assessments of people’s care and support needs were carried out before they started using the service. People’s care files included assessments relating to their dietary support needs. 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 support this practice.

Staff treated people in a caring and respectful manner. People had been consulted about their care and support needs and they were supported to maintain relationships with people that were important to them. They could communicate their needs effectively and could understand information in the current written format provided. People were confident their complaints would be listened to and acted on. People were being supported according to their diverse needs. There were processes in place to support people with care at the end of their lives when this was required.

The provider recognised the importance of monitoring the quality of the service provided to people. They took people’s views into account through satisfaction surveys and residents and relatives meetings. The registered manager worked with other health care providers and professional bodies to make sure people received good care. Staff said they enjoyed working at the service and they received good support from the management team. There was an out of hours on call system in operation that ensured management support and advice was always available for staff when they needed it.

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 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.

At our last inspection on 5 and 6 October 2015 the home received a rating of good in all of the key questions. At this inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that sufficient numbers of staff were not deployed throughout the home in order to meet the care and support needs of people using the service. Appropriate action had not always been taken to support people where risks to them had been identified. Risk assessments where not always reviewed when people’s needs changed. Advice provided from health professionals was not always followed by staff. Some people’s care plans did not accurately reflect their needs. The providers systems for assessing, monitoring and improving the quality and safety of the services that people were receiving were not effective. You can see what action we told the provider to take at the back of the full version of the report.

We found other areas were improvement was required. People’s lunch time experience was poor on the upstairs units of the home. Improvement was required in supporting people with meaningful activities when the homes activities coordinators were not at work. The training delivered to staff was not always effective. There were mixed views from staff about the management of the home. Some staff said they were well supported by the registered manager and their line managers; however other staff said communication was not always good.

There were safe staff recruitment practices in place. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. People had individual personal emergency evacuation plans which highlighted the level of support they required to evacuate the building safely.

Staff monitored people’s health and wellbeing and people had access to a GP and other healthcare professionals when needed. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People were provided with sufficient amounts of nutritional foods and drink to meet their needs.

People’s privacy was respected. People and their relatives, where appropriate, had been consulted about their care and support needs. People received appropriate end of life care and support when required. People and their relatives were provided with appropriate information about the home. They knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary. The provider took into account the views of people and their relatives through residents and relatives meetings and satisfaction surveys.

We found the provider had made the required improvements in relation to the management of medicines and staff support including training since our last inspections, and we found that the provider had increased the numbers of staff on duty following concerns that had been raised.

People and relatives we spoke with were happy with the care on offer in the home. One person told us "the staff are kind and the food is good". One relative told us that staff "all seem very caring and genuine" and that they found the care their loved one received to be "excellent". Another relative told us that overall staff were very good and that any minor issues they'd raised had been addressed.

We found that people's needs had been appropriately assessed and their care delivered in line with their care plan. Records relating to their care were stored safely and were accurate and fit for purpose. There were enough staff on duty to meet people's needs and staff were supported in their roles through supervision. The provider had made progress in ensuring staff had undertaken training in key areas although some training remained outstanding. We also found that people had a choice of suitable food and drink and were supported to ensure they were eating and drinking in sufficient amounts.

We found that people were involved in making decisions about their care and that they were supported by staff to maintain their independence. However we also found that care had not always been carried out in the way that it had been planned and that people's records, including medication administration records were not always accurate or fit for purpose.

Staff we spoke with showed a good understanding of safeguarding of vulnerable adults but had not always been supported adequately in their role through training and supervision, in line with the providers own requirements. Medication was also not always stored securely and there were not always enough staff available to meet people's needs.