Riverside Court is registered to provide personal care and accommodation for up to 25 older people; some people are living with dementia. The home is located in the market town of Boroughbridge where there is a wide range of shops. The building which is over three floors is a former hotel, which overlooks the River Ure. The service has been undergoing renovation over the last three years, and is working towards all bedrooms being en suite. At the time of our inspection there were 18 people living there.
At the last inspection on 29 May 2015 we found the service was breaching four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 9 Person centred care, Regulation 11 Consent, Regulation 12 Safe care and treatment, and Regulation 17 Good governance.
The Care Quality Commission (CQC) received an action plan from the service on 13 August 2015. This contained information about the corrective action the provider would take or had taken to address the issues we raised at the last inspection.
This inspection was unannounced, and took place on 2 November 2015. We found the service had improved in relation to safe care and treatment and person centred care and was no longer in breach of these regulations. However, it had not made sufficient improvements in the areas of consent and good governance. This meant the service was in continued breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 11 Consent and Regulation 17 Good Governance.
The overall rating for this provider is ‘Inadequate’. The means the service has been placed into ‘Special Measures.’ The purpose of special measures is to:
1. Ensure that providers found to be providing inadequate care significantly improve.
2. Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
3. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
On 2 November 2015 the service continued to run without a registered manager. It is a condition of the registration of the service that there is a registered manager employed. This condition is applied in accordance with section 5 of the Care Quality Commission (Registration) Regulations 2009. 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 provider must ensure that the regulated activity of accommodation for persons who require nursing or personal care is managed by an individual who is registered as a manager in respect of the activity, as carried on at Riverside Court. The registered provider has failed to provide a registered manager. As a result the registered provider is carrying on the regulated activity in breach of the condition imposed upon their registration contrary to section 33 (b) of the Health and Social Care Act 2008.
There had been some improvement in safe care and treatment for people. Medicines were now safely managed. Risk assessments and risk management plans contained the basic information staff needed to support people to remain safe. However, there was room for continued improvement in both of these areas of care.
There were sufficient staff on duty to meet people’s needs. Staff knew how to protect people from avoidable harm. However they continued to operate without an up to date safeguarding policy that incorporated recent guidance and legislation. This meant the provider could not be assured staff were following best practice guidance.
This meant safety and the delivery of care was reliant on an established staff team. Although they knew people well and demonstrated a commitment to caring for people, they were not working within a well led service which had effective leadership and robust systems and processes in place to keep people safe and provide effective care.
People, their relatives and health and social care professionals spoke positively about the care they received. We were told relatives were made to feel welcome and could visit when they wanted.
Care plans contained information to guide staff about the support people needed. They contained information about people’s likes and dislikes.
The service was still not following the principles of the Mental Capacity Act. Staff had not received training about the legislation and did not understand the principles of the legislation. Assessments of people’s ability to make decisions had not been completed when it was judged that they may lack the capacity to do so; there was no evidence of best interest decisions being made on people’s behalf. A best interest decision is made on behalf of a person who lacks mental capacity with the involvement of, their family or representatives, and the relevant health and social care professionals who take account of what the person’s wishes would have been.
We found leadership within the service was poor. Record keeping was poor and confidential records were not stored securely. There was a lack of quality monitoring which meant we could not be assured people received the care they needed.
Policies and procedures were out of date, this meant staff did not have access to up to date good practice guidance. In addition to this the manager had not completed any recent training; they lacked awareness of the relevant legislation and therefore were unable to effectively lead the staff team.
The service did not display the CQC rating which meant people, their relatives and visitors did not have easy access to this information.
We saw one complaint had been appropriately responded to. However, the complaints policy was not displayed within the service. This meant the information about how to make a complaint and the provider’s responsibility to investigate this was not easily accessible for people and their visitors.
We found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.