Riverside

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered service. At our last assessment, under the previous provider registration we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place to support learning when things went wrong. Staff shared insights through meetings and supervision, and accessed additional training when needed. Staff felt confident to raise concerns and told us that action would be taken in response.

The registered manager and staff team were responsive to feedback and took steps to address identified issues. However, further work was required to ensure that good practice and learning were consistently embedded into day-to-day operations.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People were supported to access both external appointments and in-house services when needed. Where emergency support was required, information, such as a hospital passport, was shared with medical professionals to ensure needs were effectively communicated. Staff would attend appointments to support individuals, although this was not always possible.

Appropriate referrals to healthcare services were made when needs were identified, helping to ensure timely and effective care.

The provider did not consistently work well with people or healthcare partners to understand what safety meant to individuals and how best to achieve it. There was not always a clear focus on improving people’s lives or protecting their right to live safely without restriction where possible.

Where people lacked capacity, action was taken to assess their ability to make decisions and to act in their best interests. While these assessments generally covered areas of restriction and involved the appropriate individuals, they were not always completed correctly, particularly where a registered Lasting Power of Attorney was in place. In decisions involving covert administration of medicines, it was not always clear that each medicine had been considered separately, or that records were maintained to demonstrate the ongoing need for covert administration as part of a least restrictive approach.

Where people were subject to restrictions, appropriate authorisations were sought to safeguard them, and conditions were complied with once implemented.

Despite these concerns, people and families felt the service was safely run and spoke highly of the kindness shown by staff. The registered manager had oversight of safeguarding concerns and used systems, including meetings, to ensure learning was implemented. They worked alongside the local authority to investigate safeguarding concerns when necessary. Staff understood their responsibilities to keep people safe and felt confident raising concerns when needed.

The provider did not consistently work well with people to understand and manage risks. Staff did not always deliver care that was safe, supportive, or responsive to people’s individual needs and preferences. As a result, care did not always enable people to do the things that mattered most to them.

Although care plans and risk assessments were in place, they were often generic and lacked the specific detail needed to guide staff in mitigating risks effectively. There was limited evidence of meaningful involvement from people and their families in these discussions. One family raised concerns about how falls were being managed. While appropriate action had generally been taken, including the use of suitable equipment, it was not always clear that accurate and detailed records were maintained. At the time of our visit, a mix of electronic and paper records was being used inconsistently.

The provider was in the process of testing a new electronic care planning and recording system, which was intended to be rolled out across all homes. Despite the issues identified, most people and families reported that they were happy with the service and felt it was safely run.

Where people were at risk of falling out of bed, appropriate assessments had been completed and action taken to mitigate risks. This included the use of equipment such as bed rails, low-rise beds, and crash mats. Systems were in place to ensure that equipment was regularly checked and reviewed for safety.

The provider did not always detect and control potential risks in the care environment, nor did they consistently ensure that equipment, facilities, and technology supported the delivery of safe care.

At the time of the inspection, a redecoration programme was underway, and certain areas of the home required attention. During our visit, we observed that not all large items of furniture were securely fixed to prevent them from falling, and we requested that this be addressed.

On the first day of our visit, some fire doors were being held open by furniture, and several fire door retainers required battery replacements. These issues were resolved by the time we returned. People’s rooms were personalised, and the home was generally clean and free from odours.

The provider did not always ensure there were enough qualified, skilled, and experienced staff. Staff did not consistently receive effective support, supervision, or development. Teamwork was not always effective, and staff did not consistently work together to provide safe care that met people’s individual needs.

Staff were not always effectively deployed, and people did not consistently receive timely support. For example, some people did not receive the encouragement they needed to eat meals while they were still hot, or to maintain continence. Although call bells were generally responded to promptly, there were occasions when people were left waiting for extended periods. Staff were often very busy and task-focused, which meant they did not always have time to engage in meaningful conversation or provide reassurance to people when needed.

We received mixed feedback from staff about staffing levels. While some felt there were enough staff, many reported being consistently very busy and unable to fully support people’s psychological and emotional needs.

Staff were recruited safely, with appropriate checks on their character, experience, and knowledge. They received a variety of training and competency assessments in key areas such as medicines administration and moving and handling. Staff told us they felt supported in their roles and had access to the training they needed.

The provider assessed and managed the risk of infection effectively. They identified and controlled the risk of it spreading and promptly shared concerns with the appropriate agencies.

Domestic staff worked throughout the day, and the home was generally clean. Staff used personal protective equipment (PPE) appropriately. Although some areas of the home had damaged fixtures and fittings, such as cracked or broken tiles and damaged cupboard doors, there was an ongoing redecoration programme in place to address these shortfalls.

The home had recently received a positive report from the local infection prevention and control team.

The provider did not always ensure that medicines and treatments were safe or tailored to meet people’s needs, capacities, and preferences. Staff did not consistently involve people in planning their care.

Medicines were not always stored appropriately. There was insufficient space to securely store surplus medicines and those awaiting return to the pharmacist. We were also not confident that the fridges used to store medicines at low temperature were functioning correctly.

While most people had guidance in place for medicines taken occasionally, such as pain relief, these lacked person-centred detail to guide staff on how to recognise when someone might need them. Although staff were able to describe this clearly, the written guidance was limited. Records were not sufficiently robust to demonstrate that manufacturer guidance was being followed, for example, in the rotation of medicated patches or injection sites for people receiving insulin.

Where medicines were administered covertly (hidden in food or drink), documentation was not always clear. There was often a lack of guidance on how to administer them in this way, and appropriate advice from a pharmacist was not always in place or reviewed when medicines changed.

Guidance for medicines that needed to be given at specific times was not always followed. Records for the application of topical creams or the use of thickening powder in drinks were not consistently completed to show they were administered as prescribed. Although we found no evidence that people had come to harm, improvements were needed in recordkeeping.

Staff supported people to take their medicines in a kind and caring manner. Medicine counts were mostly accurate and the management team were very responsive to addressing the concerns we raised.