Riversdale Nursing Home

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

People and their family members told us they felt safe at the home. One person said, “I feel safe here. Staff are nice to me.” One person’s family member told us about their relative, “We are not worried about anything here, she is safe.” People were safeguarded from the risk of abuse.

People praised the approach of staff at the home. There was a warm, friendly, and good-humoured atmosphere at the home. It was clear that people were relaxed and comfortable; and they had positive relationships with staff members.

The provider had been effective in managing risk at the home. A series of checks took place that helped ensure the building, environment and equipment used was safe and fit for purpose. The home was clean, and we were assured that the provider was supporting people living at the home to minimise the spread of any infections.

We have made a recommendation regarding fire doors at the home.

Any risks that were anticipated during people’s stay at the home and arising from their care and support were assessed and plans were in place to reduce these risks. The risk assessments in place were person centred, thorough and gave clear information for staff on how to support people to reduce these risks.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People told us they felt listened to and were consulted regarding choices at the home. One person told us, “[The manager] helps me; she sits down and explains things and works them out with me.”

There were enough suitably qualified and experienced staff deployed at the home. People told us there was enough staff; they were provided with care when they needed it.

The provider had effective oversight of the safety and quality of the service being provided for people; and the provider and interim manager were responsive if anything went wrong at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 11 October 2021). 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

We carried out an unannounced comprehensive inspection of this service on 16 September 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; ‘Is the Service Safe?’ And ‘Is the Service Well-led?’ which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Riversdale Nursing Home is a residential care home providing personal and nursing care to 32 people at the time of the inspection. The service can support up to 40 people in an adapted building over three floors.

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

Medicines were not always managed safely. Guidance was not in place for the use of cream medications, medication patches and ‘as and when needed’ medications. Health needs of people were not always monitored in their care records. We have made a recommendation about the management of recruitment.

There were a range of provider and manager audits in place, however, some of these where not effective due to the issues we found.

We could not be certain that people were supported to have maximum choice and control of their lives or that staff supported them in the least restrictive way possible and in their best interests; this is because there was no appropriate documentation in place to show the systems in the service supported this practice.

Care plans and risk assessments were not clear or detailed how people wished and needed to be cared for. They had not been regularly reviewed or updated.

People told us they felt safe living at the service. Accidents, incidents, safeguarding and complaints were managed appropriately and monitored by the management and other health professionals such as GP’s were accessed when needed. The manager and provider had worked with other professionals such as infection control and the local authority and followed advice to improve aspects of the service.

Observations of staff indicated warm and caring relationships had developed with people living in the home and interactions were respectful and familiar.

Rating at last inspection

The last rating for the service under the previous provider was good, published on 17 August 2019.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the management of medicines and people’s care needs. 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. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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 Riversdale Nursing Home 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 have identified breaches in relation to governance, medicines management and risk management 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 for 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.

We were assured the provider and staff at the home were taking appropriate action and had responded to recommendations following visits from the IPC team. This helped minimise any possible spread of infection and helps to ensure people were safe during the COVID-19 pandemic.

The provider had introduced a new system of checking and auditing their practises in response to the COVID-19 pandemic. There was an appropriate plan in place to support people safely in the event of an outbreak within the home.

The home and the equipment used within the home was clean. There was an ongoing programme in place of replacing some furniture and equipment used in line with IPC guidance.

The service was making use of available COVID-19 testing for both people living at the home and staff members; in line with government guidance.

We made a recommendation about recording COVID-19 rapid testing.

Staff supported people in a safe manner making effective use of personal protective equipment (PPE) and changing into a uniform on site. PPE was situated at convenient locations for staff around the home and at the home’s entrance for visitors to use.

When we visited, people having visitors within the main building was restricted. Arrangements had been made for visits to take place using a safe visiting pod. We saw that this was being used. Arrangements were being made for people to receive visits within the home at an upcoming date in line with government guidance.

Arrangements were made for people to come to live at the home safely, this included a period of isolation. Steps had also been taken to ensure that staff and any essential visitors came into the building safely. All essential visitors were recorded and had a rapid test for COVID-19, a temperature check and hand sanitiser and PPE was made available as appropriate.

People we spoke with told us they had been well supported during the pandemic. One person told us they had, “Been kept safe during troublesome times.” Another person told us they had been, “Well looked after during the pandemic.”

Staff were receiving a programme of refreshment training in infection prevention and control and the effective use of PPE. Staff were knowledgeable about people’s needs and safe infection control practices and described to us recent improvements in relation to infection prevention and control at the service.

We found the following examples of good practice.

¿ The provider had made appropriate use of regular testing for people living at the home and staff members.

¿ The home was clean, with multiple PPE stations in convenient locations.

¿ Safe procedures were in place for when people moved into the home.

¿ Staff were knowledgeable about procedures for keeping people safe and knew who was isolating within the home.

¿ The provider had limited visitors to the home; except for exceptional circumstances or essential visits. They had recently put steps in place to facilitate future visits to the home in a safe manner.

Further information is in the detailed findings below.

Riversdale Nursing Home is a care home, providing nursing and residential care to up to 40 people, some of whom are living with dementia. At the time of the inspection, there were 29 people living in the home.

The home is situated on a residential road in West Kirby. Bedrooms are situated over three floors, with lift access between all floors.

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

People experienced high quality support that was compassionate and caring, from staff they had developed meaningful relationships with and who knew them well. We found some examples of how staff had gone the extra mile for people. Staff supported people in ways to promote their dignity and enable them to be as independent as they could be.

People told us they felt safe living in Riversdale. They were supported by sufficient numbers of staff who had been recruited safely. Staff were aware of safeguarding procedures and referrals had been made appropriately. Risk to people had been assessed and measures put in place to reduce identified risks.

People’s consent to care and treatment was sought in line with the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported/ did not support this practice. People’s nutritional needs and preferences were known and met and we received positive feedback regarding meals available. When there were concerns regarding people’s health, the service worked closely with other health professionals to meet people’s needs.

Detailed and personalised plans of care were in place that were reflective of people’s needs and had been reviewed regularly. People were supported to access activities both within the home and in the local community, and to maintain relationships that were important to them.

Systems were in place to monitor the quality and safety of the service. People, staff and relatives were able to share their views to inform changes and improvements within the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 26 July 2018) and there were breaches of regulation identified. 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.

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.

Riversdale Nursing Home is a ‘care home’. 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. Riversdale Nursing home accommodates up to 40 people at the time of this inspection 32 people were accommodated at the home. Accommodation is provided over three floors with some shared bedrooms available. Communal areas include a dining area, sitting areas and an enclosed back garden. The home is located near to the seafront and promenade. It is a converted detached house that fits in well with other houses in the local area.

The service did not have a registered manager. 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 last inspection of the service was carried out in October and November 2015 and the service was rated ‘good’. No breaches of regulation were identified at that inspection. During this inspection we found breaches in relation to Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014.

Records at the home were not always accurate, well maintained or up to date. This meant that it was difficult to locate accurate records of some of the care and support people had received and to check that any issues identified had been followed up by staff. This included records relating to people’s wound care which did not reflect the care staff told us they had provided. Other records including staff training records and complaints records were similarly difficult to follow and not always accurate.

Equipment was not always used safely and in line with instructions. For example people did not always have their mattress at the correct setting to support their healthcare.

Communications with outside health professionals had not always been effective leading to concerns people had not received the care recommended. People’s private information was not always kept confidential. This was because staff sat in lounge areas whilst having discussions regarding people’s care.

The home has not had a registered manager for some time. An appointed manager was in place. However it was not always clear who was overseeing clinical practice within the home as the manager was not a registered nurse.

Systems within the home for checking the quality of the service provided were ineffective. They did not identify the areas of concern we noted during the inspection. These included records management, wound care records, DoLS applications and communication with outside professionals. The manager and nominated individual did acknowledge during the inspection that improvements were required and had begun to take action on these by the second day of the inspection.

Medication was safely stored and administered and records maintained. People told us they were happy with the way their medication was looked after by the home.

Systems were in place and followed for safely recruiting staff to check they were suitable to work with people at risk of abuse and neglect. People felt safe living at the home and staff knew what action to take if they had any safeguarding concerns.

Staff felt supported by senior staff. Staff told us that they had received training and supervision to enable them to carry out their role effectively. People living at the home knew senior staff well and felt comfortable approaching them.

People living at the home liked the staff team and had confidence in them. They found staff caring and friendly and this opinion was shared by people’s relatives who told us they found staff caring and willing to ‘go the extra mile.’ People told us, “Staff are lovely. They do a lot for me” and “It’s very nice here, caring.” Staff knew people well and spent time talking with them as well as meeting their care needs.

Mealtimes were sociable occasions where people had time to sit and enjoy their meal. A choice of menu was provided and people’s food and drink intake was monitored when required.

The home worked well with other authorities when people moved into or out of the home. They supported people to move back to their own home or to a more suitable location when needed. This included working with the local authority to support people to rehabilitate once they have left hospital.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found:'

Is the service safe?

We spoke with five care staff who told us that they felt the staffing levels were sufficient to meet people's needs. Staff told us they were busy and four out of the five people told us they would prefer to have one more care assistant throughout the morning and afternoon shift. When we asked if they felt rushed in providing care they said they did on occasion.

The people who used the service told us they felt safe. The visiting professional we spoke to told us they had no concerns over the welfare of any of the people living at Riversdale and felt they were safe.

Is the service effective?

All care files contained a range of risk assessments, for example, skin integrity, bed rails and nutrition. We saw care plans were regularly reviewed. Files contained daily records and records from visiting professionals. We saw evidence and were told that staff liaised with professionals such as, GPs and social workers.

The people who used the service and the visiting professional we spoke to confirmed that staff were very knowledgeable about the people. Staff told us they felt they received adequate training and managers were obliging if they made suggestions on training that might be beneficial.

Is the service caring?

We spoke with four people who lived at the home. They all said that they were "Happy" at the home and described the staff as, "Helpful" and "Friendly". The three relatives told us that the staff communicate well with them and that the staff were "Always happy to help". During our observations we saw staff were polite and caring.

Is the service responsive?

We saw evidence that people who lived at the home, their representatives and staff were asked for their views about their care and treatment and the manager was responsive. We saw the provider sent out annual feedback questionnaires to people who used the service and staff.

Is the service well-led?

We asked people who lived at the home and staff about the manager and their ability to deal with concerns. They all felt the manager dealt with any issues very promptly and everyone we spoke with gave positive comments about their management style and personality for example, 'She is always available', 'Very nice and kind' and 'Good manager'.

We saw the manager conducted monthly audits in order to review the service. This allowed care plans, medication sheets and accidents to be scrutinised. Although the actions were not always documented on the audit forms so it was not clear what the provider was doing about any actions that needed taking.

"I am well but when I am not I can see a Doctor"

"Staff are alright"

"I am happy here"

"They let me be as independent as possible"

"It took a while for my relation to settle but staff were so helpful"

"They always let me know what is going on"

"Staff are friendly and helpful"

"The care is very good and there is always plenty to do"

"I have got no complaints but I would know who to speak to if I did and they would sort it out"

"I try to be as independent as possible and they let me"

"They have been so kind and so helpful"

"They are very patient"

"I feel so safe here, safer than I did at home"

"Staff are very knowledgeable"

"There is nothing that can be improved here, we work well as a team and I feel supported by the management team"

We found that the health needs of people were being promoted by the actions of staff, care planning and the safe management of medication. We found that people were being supported by trained and knowledgeable staff who felt supported in their role. People were protected from harm and systems were in place for people to feel confident that any complaints they had would be investigated and acted upon.