River Court Care Home

River Court provides accommodation, personal and nursing care to older people. The care home accommodates up to 120 people in a purpose-built building which was divided into four units. At the time of the inspection 112 people were living there.

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

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 felt safe in the home and staff knew how to identify and report any concerns to their managers or external safeguarding authorities. Risk assessments were developed to give staff guidance in how to mitigate risks and keep people safe from harm. There were enough staff recruited safely to meet people’s needs. Lessons were learnt and improvements made following significant events like safeguarding concerns, accidents or incidents. The environment was clean and fresh. Staff followed current government guidance when wearing their personal protective equipment (PPE).

Governance systems in place identified areas in need of improvement and these were actioned in a timely manner by the registered manager. Regular meetings were in place for staff and people to ensure they were contributing their views about the running of the home. Action plans were developed and checked for completion to ensure improvements were made where needed.

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 requires improvement (published 04 March 2020).

Why we inspected

The inspection was prompted in part due to concerns received about risk management. A decision was made for us to inspect and examine those risks.

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

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 not changed and remained requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for https://www.cqc.org.uk/location/1-3134639224 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.

River Court Care Home provides accommodation with personal and/or nursing care to older people. The service accommodates up to 120 people in a purpose-built building which was divided into four units.

We found the following examples of good practice.

¿ People were supported to stay in regular contact with their families. The registered manager had communicated with families and friends to explain the different options for visiting, including use of the garden and virtual visits through the use of technology.

¿The registered manager spoke about the infection prevention control processes in place. Updates to guidance and procedures were communicated to staff and processes revisited regularly.

¿Staff supported people's emotional wellbeing. Activities were arranged within the home during lockdown to positively support people through the period.

¿Infection control audits and checks were carried out. The manager spoke positively about the dedication which staff had shown.

Further information is in the detailed findings below

River Court Care Home provides accommodation, personal and nursing care to older people. The service accommodates up to 120 people in a purpose-built building which was divided into four units. At the time of the inspection 88 people were living there.

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

Staff developed care plans for each identified support need people had. However, these needed more personalised information about people’s likes, dislikes and preferences about the care they received. Some people felt that staff were not always supporting them in a personalised way. Care plans for people who lived with life limiting health conditions needed developing further. People could choose to participate in the activities provided at the home, however further work was needed to ensure people in their bedrooms benefitted from social interaction.

Staff received training and support to carry out their roles effectively. People’s needs were assessed before admission and care plans were regularly reviewed. 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’s dietary requirements were catered for and they were happy with the meal choices available to them. However, further improvements were needed to ensure people had a pleasant meal time experience and received appropriate support.

People told us they felt safe at the home and their needs were met. Staff assessed risks to people’s health and well-being and measures were in place to mitigate these. There were enough staff effectively deployed to meet people’s needs safely. Staff received safeguarding training and knew how to report their concerns. People’s medicines were managed safely.

People and relatives told us staff were kind and caring towards them. Relatives felt welcome to visit and told us staff were friendly and respectful. People’s dignity, privacy and right to confidentiality was promoted.

The registered manager and the provider carried out regular audits looking for trends, patterns and actions were put in place when needed to improve the service. Regular residents and relatives’ meetings gave an opportunity to gather feedback about the care people received. The registered manager worked in partnership with health and social care professionals to ensure people’s needs were met.

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 inadequate (published 29 July 2019) and there were multiple breaches of regulation. 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.

This service has been in Special Measures since 29 July 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

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.

River Court provides accommodation, personal and nursing care to older people. The care home accommodates up to 120 people in a purpose-built building which was divided into four units. At the time of the inspection 115 people were living there.

People’s experience of using this service:

People had their individual risks assessed but did not always receive care that promoted their welfare. For example, moving and handling where we observed that people were not always supported safely. Some people had unexplained bruises or skin tears that had not been reported to the local authority safeguarding team or investigated to establish the cause.

People told us that they received their medicines when needed. Medicines were managed safely.

People gave mixed views about whether care always met their individual needs and feedback from people about the service provided was mixed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this practice. Complaints and feedback were managed in the home in accordance with their policy to give the provider an overview of the issues being raised by people and their relatives.

Records reviewed of people’s weight indicated people were supported to eat and drink enough. There were management plans for people who were losing weight. However, the information readily available at meal service relating to dietary needs, modified consistencies and cultural needs needed to be more robust. The dining experience also needed improving.

The provider had systems in place to help them identify and resolve any issues in the home. For example, audits and action plans, which included involvement from the provider’s quality team. However, these were not used always used effectively. We found the issues found at this inspection had not been identified by the providers quality monitoring.

Feedback about who the registered manager was varied throughout the home. People, relatives and staff told us that the unit managers were very approachable and supportive.

People were not always happy at the service. Feedback about the delivery of care varied. Privacy and dignity were not always promoted. People told us that they were not always able to choose how to spend their time or encouraged to make decisions about their care. People’s care plans were detailed and person centred, however, this was not always the case with care delivery.

People gave mixed views about the activities available. People who were in their rooms were at risk of being isolated.

People, relatives and staff told us that there were not enough staff. On the day of inspection, we saw people were still receiving morning care on the approach to lunchtime. Care plans did not reflect that this was people’s choices. There were systems in place to help ensure staff were trained and received regular supervision and staff felt supported by the management team. The recruitment process helped to ensure that people were supported by staff who were suitable to work in a care setting.

The service met the characteristics for a rating of “Inadequate” in two key questions and the rating of "Requires Improvement" in three key questions.

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 Good (28 August 2017). At this inspection the rating had deteriorated, and the provider was in breach of some regulations.

Why we inspected:

This inspection was brought forward based on information we had received.

Enforcement:

We have identified breaches in relation to people’s safety and welfare, safeguarding people from abuse, nutritional management, governance systems, working in accordance with the Mental Capacity Act, and the lack of person-centred care and dignity promoted at this inspection.

For requirement actions of enforcement which we are able to publish at the time of the report being published:

Please see the action we have told the provider to take at the end of this report.

Follow up:

We may meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

River Court is a purpose built nursing and residential care home. The home is located on the outskirts of Watford Town Centre. It has the capacity for up to 120 older people, some of whom live with dementia and it also provides nursing care/palliative care.

There were 106 people living at the service on the day of our inspection. River Court consists of four units, Hampermill, Gade, Chess and Colne.

The service had a manager who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

People told us they felt safe and secure living at River Court. We found that staff were knowledgeable in recognising signs of potential abuse and knew how to report concerns both within the organisation and externally if required.

Assessments were undertaken to identify any risks to people who received a service and to the staff who supported them. There were sufficient numbers of staff available to meet people's individual support and care needs at all times, including during the night and at weekends.

People received appropriate support from staff to enable them to take their medicines.

People and their relatives knew how to raise concerns and told us they were confident that these would be resolved without delay. People received care and support from a staff team that fully understood people's health and care needs and who had the skills and experience to meet them.

We found that people who used the service were treated with dignity and respect and their

privacy was maintained.

The activities programme in place required improvement as it did not always reflected accurately or meet the individual needs of the people who used the service.

The environment requires further adaptation with regard to supporting people who are living with dementia.

People were involved in the planning of their care and we found that people had access to independent advocacy services. Care plans were clear and gave staff enough information to meet people’s needs.

Safe and effective recruitment practices were followed to make sure that all staff were of good character, and were suitable to work in a care home environment as well as being fit for the roles they were being employed to carry out. Staff records confirmed checks had been made which ensured it was safe for them to work with vulnerable adults before a position was offered to them.

Staff were well supported by the management team and received an induction from senior staff when they first started working at the home. They received on going training and support to enable them to perform their roles effectively. Staff had regular individual supervision meetings, team meetings and had an annual appraisal to review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

People's views about the service were gathered using surveys and verbal feedback. Feedback was used in a positive way to improve the quality of the overall service. The majority of people we spoke with were positive and complimentary about all aspects of the service.