Riverside House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of the legal regulation in relation to good governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

An effective system to assess people’s needs was not fully in place.

We found shortfalls in the assessment of risk and care planning for medicines, nutrition, 1 person’s fluids, falls management, and catheter care. Inaccurate falls analysis and inconsistent recording of diet levels posed a risk to theeffectiveness of care. Diet levels refer to the prescribed texture or consistency of food and drink for people with swallowing difficulties, based on theInternational Dysphagia Diet Standardisation Initiative (IDDSI) framework.

By the end of the assessment, the new manager had begun addressing these issues. She showed us actions being taken to strengthen care planning and risk assessment, including reviewing and updating care plans, improving falls analysis, and organising staff refresher training.

An effective system was not fully in place to ensure staff delivered evidence-based care and support.

Information relating to people’s nutrition and fluids was not always accurate. Care plans and daily records showed conflicting information about diet textures and choking risks, and risks associated with eating and drinking in the community were not documented. The dining experience on the first floor, did not always promote engagement. However, the mealtime experience in the main dining room on the ground floor was positive. Staff were present and interacted well with people.We also identified that catheter care and medicines management were not fully aligned with best practice.

By the end of the assessment, the new manager had begun addressing these issues. She showed us actions being taken to review and update nutrition and hydration care plans and improve dining experiences on the first floor to promote engagement. She was also addressing catheter care and medicines management to align practices with best standards.

An effective system was not fully in place to ensure staff worked well across teams and services to support people.

Feedback from staff was mixed about how well staff collaborated. We identified shortfalls in communication and coordination, including delays in making a referral to the dietitian for 1 person and not contacting a speech and language therapist when risks relating to eating and drinking in the community were identified. These gaps meant people did not always receive timely specialist input to manage their needs effectively.

The local authority safeguarding team told us that referrals were not always made in a timely manner, and the correct process was not always followed.

The new manager had begun addressing these issues by introducing clearer referral processes, arranging refresher training, and monitoring compliance.

An effective system was not fully in place to support people to manage their health and wellbeing. We identified shortfalls with medicines management, nutrition, risks relating to 1 person’s fluids, falls management and catheter care. These issues meant people’s care was not always aligned with best practice or their individual needs to manage their health and wellbeing.

By the end of the assessment, the new manager had begun addressing these issues. Actions included reviewing and updating care plans, improving falls analysis, organising staff refresher training, and strengthening processes for nutrition and fluids to ensure risks were clearly documented and managed.

Despite these shortfalls we identified areas of good practice. People and relatives gave positive feedback in relation to oral hygiene. One relative told us, “Dad’s needs are quite complex at the moment, so I regularly see them performing oral hygiene and other bits of personal care that ensure he is comfortable at all times.” We also saw staff supporting people to live healthier lives through the activities programme, which helped meet people’s social needs and promote their wellbeing.

An effective system was not fully in place to monitor and improve people’s outcomes.

We identified shortfalls in several areas, including medicines management, falls management, catheter care, nutrition, risks relating to 1 person’s fluids and the referral process to health and social care professionals. These gaps meant risks were not always addressed promptly, and people did not consistently receive care aligned with best practice or their individual needs.

The new manager had begun implementing improvements such as reviewing care plans, strengthening audit processes and introducing clearer referral systems.

An effective system to demonstrate how staff were following the Mental Capacity Act was not fully in place.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

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 MCA. In care homes, and some hospitals, this is usually through MCA applicationprocedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met.

DoLS applications had been submitted to the local authority for authorisation, in line with legal requirements. However, records did not always demonstrate how staff were following the Mental Capacity Act.

The new manager told us she would review mental capacity assessments and implement clearer processes to ensure staff understood and applied the principles of the Mental Capacity Act in practice.