Rivermead View

Rivermead View Residential Care Home provides accommodation with personal care for up to 32 older people, some of whom are living with dementia. There were 29 people using the service at the time of our inspection.

Rivermead View is situated in the town of Looe in Cornwall. It is a three-storey building with a range of aids and adaptations in place to meet the needs of people living there. It is close to the centre of Looe, to shops and the beach with links to public transport. People had their own bedrooms and access to a communal dining area, lounge and conservatory. There were a range of bathing facilities designed to meet the needs of the people using the service. There was a garden which people could use if they were being supported.

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

Medicines were managed safely to ensure people received them in accordance with their health needs and the prescriber’s instructions. External creams and lotions, to maintain people’s skin integrity, were applied during personal care. However, the dates of opening the creams were not recorded. This helps staff check creams remained in date and safe to use. We have made a recommendation about this.

People were positive about the care and support that they received. Comments included; “I feel safe here”, “I love it here” and “I couldn’t be happier”.

Relatives were also complimentary about the service. Comments included; “[Person’s name] is very safe here. I don’t have to worry”, “From the word go they were amazing. There was good communication”, “Care is really good I can fault it, the carers are great” and “[Registered manager] has made a real difference there, it’s a job but it’s also a vocation for him. Without [registered managers name] that place wouldn’t have survived COVID.”

There were enough staff to meet people's needs and ensure their safety. People told us; “Staff work hard, they are very attentive”. Appropriate recruitment procedures ensured prospective staff were suitable to work in the home.

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, and their relatives were involved in the development and review of their care plans which detailed their needs and preferences. Staff knew people's care needs well. People were supported to engage in activities.

People were involved in the development of the menus at the service and told us; “The food is on the whole good.” People were supported to eat a balanced diet and drink enough to keep hydrated.

There were processes in place to prevent and control infection at the service, through access to COVID-19 testing where necessary, additional cleaning and safe visiting precautions.

Staff told us that they had received the training they needed to meet people’s needs safely and effectively. The registered manager maintained oversight of training to ensure staff had the necessary training, knowledge and skills to provide consistent care.

Staff felt supported by the management team. Staff were supported in their roles through a plan of supervision. Staff told us they felt supported by the registered and deputy managers.

Staff were proud to work at Rivermead View and had built positive relationships with the people they supported.

The management team maintained oversight of complaints, accidents and incidents and safeguarding concerns. The management team engaged well with health and social care professionals. Systems to assess and monitor the quality and safety of the care provided were in place. They were effective in assessing quality and identifying and driving improvement. The service had clear and effective governance systems in place.

The environment was decorated and furnished to a good standard and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were carried out.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Last rating and update

The last rating for this service was Good (published 12 September 2018). We had carried out two focused inspection since then to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. These inspections were not rated and were published 24 August 2020 and 28 March 2022.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Follow up

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

We found the following examples of good practice.

The management team were continuing to support staff to contain the COVID-19 outbreak at the service. Daily oversight and careful management of staffing levels had meant staff shortages had been managed effectively. Staffing levels were being supported by the use of the services own workforce and their internal agency system, Cornwallis Extra. Staffing absences, due to COVID-19 infections and other issues had not impacted on staffing levels or the quality of support people received.

The service was following current guidance in relation to visiting care homes during outbreaks of COVID-19. Essential care givers and visits to people in receipt of end of life care were possible. We observed people asking staff for support without hesitation and staff responded promptly and sensitively.

The service had a committed staff team to ensure people received care and support in a safe and hygienic environment. People were supported in the service in accordance with national guidance. The staff team supported people and their relatives to understand the policies and procedures surrounding protection against COVID-19.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised.

Personal protective equipment (PPE) was available to all staff and visitors. Staff and people living at the service were regularly tested for COVID-19.

The service had managed well after some of the people who used the service and staff members had caught the virus. Everybody had recovered.

The service reviewed their infection control policy in response to the pandemic. A specific covid-19 policy had also been developed to provide guidance for staff about how to respond to the pandemic. These policies were being updated as changes to government guidance was published.

The providers organisation kept staff up to date through on-line training and the registered manager spoke to staff to update them. The registered manager and deputy manager ensured staff understood why every measure was in place.

Staff were following current infection prevention and control guidance to help people to stay safe. Visitors and staff entered the premises into an area designated for hand sanitising, changing of clothes and putting on PPE. Appropriate waste bins were in place for the deposing of used PPE.

Staff helped people to stay in touch with family and friends through phone and video calls. Recently visitors could also book appointments to visit people in a safe way. The registered manager was communicating with people, staff and relatives regularly to ensure everyone understood the precautions being taken to keep people safe.

Staff supported people to occupy themselves whilst maintaining their safety. Most people preferred to spend their time in the communal lounge and staff supported them to do this whilst maintaining physical distancing.

The premises looked clean and hygienic. Additional cleaning processes had been put in place and there was a clear audit trail to check these were being completed.

The registered manager worked with the housekeeping team and care staff team to ensure infection prevention and control measures were followed.

Suitable audit systems were in place to check infection control standards, and ensure people stayed safe. These were being monitored and reviewed weekly. The service looked very clean.

Further information is in the detailed findings below.

Rivermead View is situated in the town of Looe in Cornwall. It is a three-storey building with a range of aids and adaptations in place to meet the needs of people living there. It is close to the centre of Looe, to shops and the beach with links to public transport. The service continued to undergo major environmental changes and therefore people had access to only one of the two lounges whilst work was being completed. Some bedroom areas were also not in use due to the refurbishment that was occurring. All bedrooms are for single occupancy. People had access to a communal dining area. There were a range of bathing facilities designed to meet the needs of the people using the service. There was a garden which people could use if they were being supported.

The last inspection took place on the 2 August 2017. The service was rated as Requires Improvement at that time. There were concerns around how risks for people were managed, how staff supported people who may become anxious, care plan records were not accurate and records had not been completed satisfactorily.

This unannounced comprehensive inspection took place on 6 August 2018. Since the previous inspection there has been several changes in the management team. From January 2018 a new manager has been in post and worked with the staff team to implement the necessary changes. At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection. The service is now rated as Good.

The service is required to have a registered manager and at the time of the inspection there was no registered manager in post. 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 and associated Regulations about how the service is run. The manager had been in post since January 2018. They had submitted a valid registered manager application and this was being considered.

Staff told us with the change of manager there had been a number of positive changes for the people they supported and for them as a staff team. Staff told us the improvements were in record keeping, care planning and support for the staff. Staff felt this had a positive impact for the people they supported as care records clearly identified how a person needed support. Staff were clear about how they needed to record information to evidence how they supported and monitored a person’s health and the process to follow if a person had an incident. We found records were up to date and reflected the person’s individual needs. Accident and incident records were also completed and audited by the management team.

People, relatives and staff all told us they found the new management structure more open and approachable. They felt their views on the running of the service were sought and were complimentary about the changes to the service. A person told us, “I attend the resident’s meetings and my daughter comes too, my daughter will tell the Manager if I am not happy and I am not afraid to talk to staff if I need anything”. A relative told us ““We can visit at any time, the care is very good, better since the new management, the staff are lovely and helpful, we have no issues”. Visiting health and social professionals also commented on the managers approach and stated there had been “Vast improvements” in the overall service.

Care plans were well organised and contained personalised information about the individual person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

Some people were at risk of becoming distressed or confused which could lead to behaviour which might challenge staff and cause anxiety to other people. Care records contained information for staff on how to avoid this and what to do when incidents occurred.

The service held handover meetings between each shift on duty. Information about people’s care would be shared, and consistency of care practice could then be maintained. This meant that there were clearly defined expectations for staff to complete during each shift. However senior carers told us they attended their shift earlier than their start time to ensure sufficient time for a handover to exchange information, as it was not built into the staff rota. We recommend that staff handover is accounted for in the shift planning to ensure staff attend this meeting.

There were systems in place for the management and administration of medicines. People had received their medicine as prescribed. Immediate action was taken to ensure that all medicines in the service were accounted for to prevent possible medication errors.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. The principles of the Deprivation of Liberty Safeguards (DoLS) were understood and applied correctly

People were protected from abuse and harm because staff understood their safeguarding responsibilities and were able to assess and mitigate any individual risk to a person’s safety.

People and their relatives told us staff responded to people’s needs promptly. However, they were aware that there were staff vacancies and agency staff were being used to cover these shifts. The manager and operational director told us there had been some staff turnover and continued to recruit for more staff. They used regular agency staff to cover the staffing shortfalls which provided some continuity of care for people by staff who know them. The manager reviewed people’s needs regularly. This helped ensure there was sufficient skilled and experienced staff on duty to meet people’s needs.

The manager was on call every day. We recommend that the on-call arrangements are reviewed to ensure that the manager has appropriate rest periods to enable them to work at their full potential.

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. Where needed, staff monitored people’s food and drink intake to ensure everyone received sufficient each day. People told us, “The food is excellent.”

The care we saw provided throughout the inspection was appropriate to people’s needs and wishes. Staff were patient and discreet when providing care for people. They took the time to speak with people as they supported them and we observed many positive interactions that supported people’s wellbeing.

Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time. People had access to some activities both within the service and outside. A Health and Wellbeing co-ordinator was employed and organised a planned programme of activities/events. They were passionate about making sure activities were fun for people.

Staff were supported by a system of induction training, supervision and appraisals. Staff meetings were held regularly.

There was a system in place for receiving and investigating complaints. People we spoke with had been given information on how to make a complaint and felt confident any concerns raised would be dealt with to their satisfaction.

There were effective quality assurance systems in place to monitor the standards of the care provided. Audits were carried out regularly by both the registered manager and members of the senior management team.

Rivermead View is a care home which offers care and support for up to 30 predominantly older people. At the time of the inspection there were 25 people living at the service. Some of these people had a diagnosis of dementia.

The service is required to 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 registered manager had left their post. There was an acting manager who had been in post for two months. They told us they were in the process of applying to become the registered manager.

Risks associated with peoples’ care and support needs were identified and assessed but not always managed effectively. Changes to peoples’ needs were not always recorded effectively. For example, one person had experienced many falls in a short period of time. The accident audit did not show what action had been taken to address the many falls recorded and the falls risk assessment for this person had not been reviewed. Staff we spoke with were knowledgeable about the circumstances around this person’s falls and told us they had been unwell. We judged the person had their needs met as the falls had stopped. Another person’s care needs had increased over the weeks prior to this inspection. Permanent staff were aware of this person’s care needs and they were being met. However, the service were using some agency care staff, to cover for holiday absence, and this person’s care plan did not contain current accurate direction and guidance for staff who were unfamiliar with people’s needs. This meant the person may not have had their needs met effectively.

The service was in the process of transferring care plan documentation over to a new format. Some people’s care plans had been completely reviewed and contained easy to access current information in the new format. Other care plans had undated assessments on a mixture of formats which did not make it easy for staff to find current information. Some monitoring records contained gaps where staff had not recorded care provided. Fluid intake monitoring charts were not totalled each day to ensure people had sufficient fluids to keep them well.

Mattresses provided for people who had been assessed as being at risk from skin damage were not always set correctly for the person using the equipment. People’s weight records held by the manager did not contain the names of all the people living at the service and were not up to date. This meant it was difficult for staff to ensure pressure relieving mattresses were always set correctly. Senior care staff told us there had been a recent audit carried out which checked the settings of the mattresses but this could not be found.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People were asked to sign to consent to their care plan and photographs being displayed in their files. However, some people did not have the capacity to do this for themselves, requiring others to do so on their behalf. Only people with a Lasting Power of Attorney can do this. Some consent forms were signed by healthcare professionals and family members who did not hold this legal power. The manager was aware of this issue and consents were being reviewed at each care plan review.The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. A Deprivation of Liberty Safeguard authorisation had been appropriately sought and was in place for one person. The conditions of this authorisation were being met by the service. This had been authorised before the current manager took up their post, however, the service had not notified the Care Quality Commission as they are legally required to do. The manager assured us this would be done immediately.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

Medicines were managed safely and regular medicine audits were being effective. Prescribed creams and liquids were dated when opened. Medicines that required stricter controls were safely recorded, stored and administered.

Staff were supported by a system of induction and training. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Most staff received training relevant to their role and there was a plan for providing on-going training and support and development. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service. Staff told us; “Things are getting better, we have more staff now, when people don’t go sick, and the support is good” and “I am happy here, it is a nice home.”

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. The new provider had increased the number of staff working on each shift. However, there was a concern amongst the staff about repeated short notice sickness absences leading to extra pressure on some shifts. Some staff were working extra hours and morale was being affected. The manager was aware of this concern and was addressing the issue through supervision with specific staff members.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

The premises were in the process of being re-furbished. A new roof had been added and scaffolding was in place to replace gutters and drainpipes. There was a programme of re-decoration and carpeting which was in progress. The service had some pictorial signage to meet the needs of people living with dementia. Some bathrooms were not in use due to failure of the equipment. There was a plan to replace some of this equipment with more accessible wet rooms.

People had access to a range of activities. An activity co-ordinator was in post who arranged regular events for people. These included one to one activities with people who remained in their rooms. Records were kept by the activity co-ordinator of when people joined in an activity.

The acting manager was being supported by the provider and other managers in the group. Visitors and healthcare professionals' comments included; “It is a lovely place, we are always made to feel very welcome at any time, they call us when necessary, no problems at all” and “The new manager is very approachable and seems to know people well here.”

Many positive changes had taken place at the service since the new registration.

We found breaches of the regulations found at this inspection. You can see the action we have told the provider to take at the end of this report.