Riverside

Riverside is a nursing and residential care home providing accommodation, nursing and personal care to 78 people at the time of the inspection. The service can support up to 90 people.

We found the following examples of good practice:

Staff had received additional training on infection control, the safe use of personal protective equipment (PPE) and hand washing. Information posters were placed around the home and we observed staff wearing appropriate PPE. Hand sanitising stations and trolleys full of PPE were available to staff throughout the home.

The home was clean. Comprehensive cleaning schedules were in place and carried out daily and weekly. Windows were opened to provide ventilation and people had access to outdoor space. Staff regularly cleaned frequently touched areas, such as light switches.

The service had detailed policies and procedures in place to manage the risks of Covid-19. Risk assessments had been completed for the service, staff and people living in the home.

The registered manager was supporting visits for people living in the home in accordance with the current guidance. The service was meeting the requirement to ensure non-exempt staff and visiting professionals were vaccinated against Covid-19.

The service participated in the regular Covid-19 testing programme for both staff and people living in the home.

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

Within the context of areas reviewed as part of this targeted inspection, 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 best practice.

As part of CQC’s response to the coronavirus pandemic we are also conducting a thematic review of infection control and prevention measures in care homes. As part of the inspection we looked at the infection control and prevention measures the provider had in place. Risks to people who used the service and staff relating to infection prevention and control, and specifically Covid 19, had been assessed and appropriate action taken.

People were protected from the risk of harm, abuse and discrimination. Staff were aware of their responsibilities with regard to safeguarding and whistleblowing procedures.

Care plans and risk assessments gave clear guidance to staff on what needed to happen to keep people safe. People’s health and nutritional needs were met. Staff had a good understanding of the need for oral care and were aware of people’s individual needs.

Staff spoke compassionately about providing good end of life care. People had been asked about their wishes for end of life care.

There was a range of auditing and monitoring to ensure managers and the provider had oversight of the quality of the 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 21 May 2020).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to check on specific concerns we had about safeguarding people from abuse, management of risks relating to nutrition and hydration, personal care and oral care and access to health care professionals and end of life care.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, responsive and well-led sections of this full report.

We also 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has not changed following this targeted inspection and remains good.

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

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.

People’s experience of using this service:

Improvements to medicines management and quality audits have been made since our last inspection in March 2018. The service is now rated as good in all areas.

Staff were kind and caring and there were sufficient numbers to keep people safe and to meet their care needs.

People were supported by staff who were motivated, enjoyed their job and felt well supported through supervision and training.

Care plans were up to date and detailed exactly what care and support people wanted and needed.

Risk assessments were in place and showed what action had been taken to mitigate any risks which had been identified.

People felt safe at the home and appropriate referrals were being made to the safeguarding team when necessary.

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.

Medicines were being administered safely and people’s health and dietary needs were met.

Activities and outings were arranged to keep people occupied.

The home was clean and tidy.

There was a complaints procedure available which enabled people to raise any concerns or complaints about the care or support they received.

The registered manager provided staff with leadership and was approachable. Audits and checks were used to drive improvements to the service people received.

People’s feedback was used to make changes to the service, for example, the development of a private family room.

Rating at last inspection: Requires improvement (report published 7 June 2018). The overall rating has improved to good following this inspection

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

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per 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 the CQC website at www.cqc.org.uk

This inspection was carried out over three days between 19 and 21 March 2018. Our visit on 19 March was unannounced.

We last inspected Riverside in January 2017. At that inspection we rated the service as ‘Good’ in caring and responsive domains and ‘Requires Improvement’ in the safe, effective and well-led domains. At that inspection we found four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. These previous breaches were around a failure to notify CQC of all incidents that affect the health, safety and welfare of people who use the service, the registered provider had not protected people against the risks associated with the safe administration and management of medicines and appropriate risk assessments were not in place for oral hygiene. The registered provider had failed to ensure people were not deprived of their liberty without the legal safeguards in place and systems to monitor the safety and quality of the service required improvements to ensure compliance with the regulations were not robust and had not identified the breaches found at that inspection. As a result of these breaches we issued requirement notices to the registered provider and they supplied us with action plans on how they were now compliant with the regulations. At this inspection we reviewed the information in the action plans that had been sent to us.

Riverside is a care home that provides accommodation, nursing and residential care. The home is registered to provide care for up to 90 people, who may be living with dementia, physical disability or require nursing care. Riverside is owned by Care UK.

The home is located in a residential area of Tameside and caters for young people over the age of 18 as well as older adults.

The home is split into four units over two floors and there is a passenger lift serving both floors. On the ground floor there is the Shelley unit which is a 20 bedded unit providing care to younger adults and Bronte unit which is an 18 bedded unit providing residential dementia care. On the first floor there is the Nightingale unit, which is a 22 bedded nursing care unit and the Lowry unit which is a 27 bedded unit providing dementia nursing care. All rooms are single.

At the time of our inspection 73 people were living at Riverside. At this inspection we were unable to visit the Nightingale unit due to a suspected outbreak of illness.

The service had a registered manager in place. 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.

This was a scheduled comprehensive inspection; however, this had been prioritised as we had received information of concern around safeguarding people from the risk of harm. These concerns were regarding the provider ensuring people were protected from potential abuse. We found the registered manager was managing these allegations and taking appropriate action.

We identified continued breaches of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were around medication errors and management oversight. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the safe management and administration of medicines and found medication was not always managed safely. We found regular checks and balances were carried out by senior staff; however, we found medication errors during our audit of safe medication management. We were unable to ascertain if people had received the right medicines in the right amounts at the right time. As a result, we sent an alert to the local safeguarding authority. We checked with the registered manager who took immediate action and found no-one had come to harm as a result of the errors. This is a repeated breach from the previous inspection in January 2017.

There were systems and checks in place to monitor the quality of the service to ensure people received safe and effective care. However, these checks had failed to address the concerns we found during our inspection. This is a repeated breach from the previous inspection in January 2017.

People, their relatives, visiting professionals and staff spoke highly of the service; one person told us, “Staff have kindly been allowing me to come here many times. I think it’s better than a 5-star hotel.” Another person told us, “All care staff are brilliant; they are very caring.”

During this inspection we found that there were enough staff available to meet people’s needs and they were being cared for by people who knew them well. Staff we spoke with were aware of each person’s individual care needs.

Mealtimes were sociable and food was of high quality. People and their relatives told us they were happy with the menu and food choices provided at the home. Kitchen and care staff were aware of peoples specific dietary needs; the chef paid particular attention to people who required modified diets.

Care records at the home showed us that people received input from other health care professionals, such as opticians and podiatrists. We found people had received the necessary care and support when they needed it. For example, we found the home worked with the community dentistry service to ensure people had dental check-ups. Alongside these dental checks, the home ran a ‘Resident of the day’ scheme where people’s oral health was checked. The need for increased oral care checks had been identified as a requirement during the last inspection.

Activities at the home were varied and a comprehensive programme of scheduled and ad-hoc activities took place, both inside and outside the home. People benefitted from both group and personalised activities.

During our initial tour of Riverside on the first morning of our inspection, we saw that the home was clean and some attention had been paid to the décor and lay out to make the home dementia friendly on the dementia units.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The registered manager was meeting their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected. This had been identified as a requirement during the last inspection.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. There was an equalities policy in place and people were supported with their individual communication needs.

Individual care records contained risk assessments and care plans that were person-centred, detailed and regularly reviewed. Although, not all risks had been addressed.

There was a complaints policy in place and we saw that complaints were acted upon. The registered manager also regularly sought the views of people living at the home and their relatives. They were able to demonstrate action taken at the home as a result of this feedback.

The service had completed statutory notifications to CQC of any accidents, DoLS, serious incidents, and safeguarding allegations as they are required to do. This had been identified as a requirement during the last inspection.

The required safety checks and maintenance for the building and equipment were in place and regularly monitored.

Team meetings were held and all levels and staff received a programme of induction, supervision, appraisal and training.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been completed by management to satisfy themselves that suitable staff were employed to care for vulnerable people.

Staff we spoke with were aware of how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.

People and relatives we spoke with were complimentary regarding the management team and all staff working at Riverside.

We last inspected Riverside on 22 September 2014. At that inspection we found the service was meeting the regulation we assessed.

Riverside is a care home that provides accommodation, nursing and residential care. The home is registered to provide care for up to 90 people, but provides care for up to 87 people, who may be living with dementia, physical disability or require nursing care.

The home is located in a residential area of Manchester and caters for young people over the age of 18 as well as older adults.

The home is split into four units over two floors and there is a passenger lift serving both floors. On the ground floor there is the Shelley unit which is a 20 bedded unit providing care to younger adults and Bronte unit which is a 18 bedded unit providing residential dementia care. On the first floor there is the Nightingale unit which is a 22 bedded nursing care unit and the Lowry unit which is a 27 bedded unit providing dementia, nursing care. All rooms are single.

At the time of our inspection 79 people were living at Riverside.

The service did not have a registered manager in place. The manager took up post in December 2015 and was in the process of applying to the Care Quality Commission (CQC) for registration and had received a date for interview. A registered manager is a person who has registered with the CQC 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.’

During this inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009.

Some medicines were not managed safely for example we found instructions for care staff to administer topical creams did not accurately reflect the directions of the GP. This meant there was a risk that prescribed creams may not have been applied when required, which could have resulted in unnecessary discomfort for the person.

In addition we saw that the covert medication policy was not being appropriately adhered to for five people receiving their medication covertly. Covert medication is the administration of any medical treatment in a disguised form. This usually involves disguising medication for example by administering it in food and drink; as a result, the person is unknowingly taking medication.

We saw that risk assessments were not being undertaken for oral hygiene and people did not have a plan of care to direct staff how to meet this this care need.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act. The application procedure for this in care homes is called the Deprivation of Liberty Safeguards (DoLS). During this inspection it was identified that the provider had not complied with their duty to notify us of all authorised DoLS. We saw evidence that during 2016 there were 11 authorised DoLs but the service had only notified us of four. This is a failure to notify the Commission of required events. In addition we saw that two of the DoLS authorisations had expired and had not been reapplied for. This meant two people were deprived of their liberty for the purpose of receiving care and treatment without lawful authority. The applications were made during the course of the inspection.

There were systems in place to monitor the quality of the service to ensure people received safe and effective care. However these audits had failed to identify the issues and concerns we found during our inspection and therefore required improvements.

Although the service employed a number of registered mental nurses (RMN’s) and accessed community psychiatric nurse’s (CPN’s) as needed we noted that staff had not received training in understanding and managing particular mental health conditions such as depression and schizophrenia. We recommend that the service reviews training provided to staff in relation to the specialist needs of people who have mental health problems, to ensure staff provide care that reflects current best practice.

The home was clean and well maintained. However, we saw there was a risk of cross infection because hoists and some shower chairs were not clean and there was inappropriate storage of the hoist slings. This was addressed during the course of the inspection.

The service had good recruitment processes to ensure only suitable staff were employed.

Staff were receiving regular supervision and annual appraisals to enable them to carry out the duties they are employed to perform.

Staff understood how to recognise and report abuse which helped make sure people were protected. We saw any allegations of abuse had been dealt with appropriately and reported to the local authority safeguarding team.

People had access to healthcare services and we saw specialist advice was sought in a timely manner. For example, referrals had been made to the speech and language therapists when it had been identified that people were having difficulty swallowing.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs. For example people were asked about their personal preferences and special diets such as diabetic or soft diets were provided accordingly.

People received person-centred care and we saw privacy and dignity was respected.

The home employed the services of designated activity coordinator and we saw a range of activities were available and based on the personal preference of people living at Riverside.

The visitors we spoke with told us they thought Riverside was a lovely, friendly care home and they were happy their relatives were well looked after.

From our observations of staff interactions and conversations with people, we saw staff had good relationships with the people they were caring for and respected their privacy and dignity. The atmosphere felt friendly and relaxed.

The home’s statement of purpose included information about how to make complaints, which people were provided a copy of when they moved into the home. There was a system in place for receiving, handling and responding to concerns and complaints. One relative we spoke with told us they had raised a concern and were satisfied with the way it was handled.

Staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken and staff were seen to obtain consent prior to providing care or support.

We looked at the staff duty rosters in place for nurses, care and ancillary staff and saw these had been planned three weeks in advance. We saw where there was a need to cover unallocated shifts due to staff absence, gaps identified in advance were filled by agency staff, casual workers or existing staff who had volunteered to cover the shifts. During the inspection we saw that there was appropriate numbers of care staff and nurses providing care, but there were only two kitchen staff and one laundry worker to provide an ancillary service for 85 people.

We recommended that a review of kitchen and laundry staff is undertaken so the registered provider can be satisfied they have sufficient numbers of ancillary staff.

We considered the evidence collected under the outcomes which were reviewed and addressed the following questions: is the service safe; is the service effective; is the service well led; is the service caring?

Is the service safe?

Improvements had been made to the management processes by the introduction of robust auditing systems. We looked at these audits and saw that they were carried out on each unit on a regular basis. The staff we spoke with told us that they found these helpful as it enabled any shortfalls to be identified quickly and addressed in a timely manner.

We found that care plans were in place and included the relevant information to help staff to provide care and support to people in a safe and appropriate way.

People we spoke with and their relatives spoke highly of the staff team and all the relatives we spoke with told us they felt confident in the staff and the way they provided care. They told us that they were confident that their relative was safe.

Is the service effective?

Care plans and risk assessments were up to date and regularly reviewed. This meant staff had information on the current health care needs of people living in the home. Each person had a support plan in place to monitor all aspects of their health and well-being.

Is the service responsive?

We saw that people's care plans were reviewed regularly and when any concerns were identified the relevant healthcare professional was involved. When we spoke with families they told us that the service always ensured that people saw a general practitioner or other health care professional if it was necessary.

Is the service caring?

During our visit people spoke highly of the care that was provided to people living in the home. We spent time observing the interactions between staff and people living in the home. We saw that there was good communication used by staff and we saw that people were cared for in a way that promoted their privacy and dignity. One relative told us, 'I haven't got any complaints at all. I feel I can talk to the manager or staff about any problem. My relative had a few medical problems but the staff got in contact with the relevant people and the problems were solved. The staff are really good and they listen to me. I can talk with them and they answer all my questions. If they don't know the answer, they always find out for me. I know my relative is well looked after and if there is ever an incident they always let me know.'

Is the service well led?

When we spoke with the staff team they told us that the manager was very supportive and had introduced a series of auditing tools to help ensure the provision of a safe service. The systems we looked at demonstrated that key aspects of care practice were being monitored on a regular basis.

We spoke with the manager via the telephone following our inspection visit and she confirmed that she had submitted an application form to the Care Quality Commission to become the registered manager for the service.

It is a legal requirement that a manager is registered with the Care Quality Commission for this service. Registration ensures a manager shares legal accountability for the service with the service provider. At the time of our visit to Riverside the manager was not registered with us. However, we were told that their application was due to be submitted following receipt of all their Disclosure and Barring Service (DBS) checks.

The inspection was undertaken by two inspectors. This summary addresses five key questions; is the service safe; is the service effective; is the service caring; if the service responsive and is the service well led?

This is a summary based on a visit to the home where we spoke with the manager, the regional director, and a number of staff on duty at the time of the visit. We looked at records and talked in private with some people using the service and some of their families.

The full report contains evidence to support this summary.

Is the service safe?

People who used the service and the staff we spoke with told us they believed people living in the home were safe. Staff training included safeguarding. When we spoke with staff they had a good knowledge and understanding of safeguarding procedures and what to do in the event of any allegations of abuse. One member of staff told us that they would not hesitate to report any concern where it had an impact on a person health and well being.

Quality audits were in place and the manager was further developing these systems with the regional manager so that there was a system in place to promote the health and well being of people living in the home.

Is the service effective?

People who used the service had their needs assessed. The assessment included assessments of potential risks posed by the behaviours or abilities of the individual. The care plan was developed from these assessments. People using the service were encouraged to be involved in their care planning and influence the way in which care and support was provided to them.

Is the service caring?

During our visit we saw staff working well with people living in the home. We saw several examples of good practice and good communication between people. People living in the home told us they were happy with the way they received care and support from staff and that they felt safe. They told us they could express their views and that they felt listened to. Family members we spoke with gave mixed views about the quality of the care and support delivered by staff. Some people thought that the staff were slow to respond to concerns and that on occasions any investigations into concerns were slow.

All people we spoke with spoke highly of the kind nature of staff and that they felt staff were well trained and qualified to do their job.

Is the service responsive?

During our visit we saw staff respond to the needs of people living in the home in a timely manner. We saw staff engaging in meaningful conversations with people.

Care plan records showed that when a new care need was identified the staff reported this appropriately and that the relevant health care professional was contacted. This meant that people were supported to access the relevant healthcare service to meet their specific health care needs.

We saw that meetings were arranged to listen to the views of the people using the service and we saw that the service had systems in place to seek the views of the people. The manager told us that service user feedback forms were sent from head office and that she intended to use any finding to look at issues of concern and look at ways in which to improve the service.

Is the service well led?

The new manager had been in post since April 2014. When we visited the home she told us about the auditing systems she had implemented. There was an understanding from the manager that these required further development so that a detailed and comprehensive audit trail was in place to check that all aspect of the running of the home were monitored in an effective and meaningful way. We spoke with the regional manager who told us that there would be support for the manager to support her in establishing strong infrastructures of quality monitoring systems.

We saw evidence of quality monitoring systems which covered all aspects of the service delivery, and we saw that where appropriate the manager had sought help or listened to advice from other professionals. We also saw examples where communication between the manager and senior clinical lead staff required attention so that people using the service received the right care at the right time.

During discussions with the manager and regional director we were told that the service would benefit from a structured support plan and that an action plan would be put into place internally to address the shortfalls.

We spoke with two people who used the service their comments included: 'I feel staff treat me like an individual'. And: 'They know that talking makes me tired. The staff are very good'.

We spoke with five relatives of people who used the service and their comments included: 'I've been very unhappy with the care he got but now things have improved a lot'. 'We're both treated with respect'.

We found that relatives we spoke with did not feel involved with care planning and some legal requirements in respect of people's human rights were not being followed.

We found care plans were person centred and contained daily recordings. However we found some people left unattended for periods of time whilst some had not had their weight checked for over three weeks.

We found people who used the service received their medication in a safe manner.

We found that overall the home was clean but did find areas which would benefit from refurbishment.

We had received concerning information about staffing levels at Riverside prior to our inspection. We found that there were sufficient numbers of staff on duty at the time of our visit.

We found information during our visit which showed that not all care records had been updated.

The home had systems in place to monitor the quality of their service provision.

People told us they had been happy with the care and support they had received. We were told ''They couldn't do anything better" and "The best bit is the carers".

We spoke with relatives of people who use services. Comments included "People are looked after well", "They're smashing, he gets looked after and they love him to bits'

We spoke with a member of staff from each unit and the manager. Staff told us that were well supported by the new manager and thought that the home provided a good service. The records we saw confirmed when people's care had been explained or when people's care had been reviewed.

We found that the home was compliant against the six outcomes we inspected. Although we have asked the provider to take note of some findings. The interior lacked natural light and appeared dark. On one unit we found a slight smell. We saw evidence that the carpet was being cleaned and people told us that this was unusual. The manager told us that there are plans for Riverside to undergo major refurbishment in 2013. The issue of light will be addressed.