Riverside Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of the legal regulation in relation to people’s safe care and treatment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall, the provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

While the people we spoke to expressed, they were generally happy with their care, our assessment found elements of care did not meet the expected standards. Lessons were not consistently learnt to identify and embed good practice. We saw when incidents involving people had occurred, some staff actions were documented. However, the relevant person’s risk assessments and care plans were not consistently reviewed in response to incidents, as part of helping people to stay safe. For example, one person had spilt a hot drink whilst in bed resulting in a scald that required that required medical attention. Staff took immediate action following the incident , however had been no review of the risk assessment which meant they may be at increased risk of further scalds.

The registered manager understood their responsibility under duty of candour to be open and transparent with people and their relatives. Where accidents and incidents had occurred, people and relatives were informed.

The provider’s systems supported smooth transitions when people moved to the service. An initial assessment was completed before the person moved in to ensure the provider was able to meet their needs and to identify individual choices and preferences.

Processes were in place to support admissions into the service. Staff worked with partner organisation health professionals who were based at the service during the process. The provider had appropriate processes for new referrals into the service, obtaining a copy of the person’s initial assessment, and then carrying out their own assessment of need, before deciding whether they would be able to meet and provide the care and support required. All new referrals were signed off by the registered manager ensuring the correct process had been followed and there is a smooth transition into the service.

People and their relatives described being involved in planning their care and support. Comments from relatives included, “[Relative] went into Riverside in December. When [relative] went in, they asked about [relative’s] history, medication and preferences. We spent time with their key worker and filled forms in. I also took the opportunity to ask other relatives what they felt about the home, at the beginning.” Another said, “When we first went in, we went through the care plan and respect forms. We sat down and went through things [relative] likes and didn't like such as medication and food.”

Overall, the provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Relatives told us they felt their loved ones were safe living at Riverside Care Home. Comments included. ”I think [relative] is safe there, [relative] talks about staff, [relative] likes them.” Another relative said, ”I feel [relative] is safe. If there is anything, they will always ring and let me know. [Relative] gets a good quality of care.”

The provider had systems in place to safeguard people from the risk of abuse including the training of staff in how to recognise and report abuse.Staff understood their responsibilities to report concerns and told us they felt comfortable to whistle blow on poor practice.

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 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Some people were subject to Deprivations of Liberty Safeguards, (DoLS). The provider had appropriate systems in place to ensure applications for DoLS were made in a timely way and any conditions imposed for DoLS agreements were kept under review. However, we found some people did not have access to call bells in their rooms. We found no records of assessments of capacity or best interest decisions in line with the principles of the Mental Capacity Act (MCA) in relation to this decision. This meant we could not be assured people who could have safely used call bells had been prevented from using them.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

While the people we spoke to said they were generally happy with their care we found, our assessment found elements of care did not meet the expected standards. Risk assessments and care plans were not always accurate or sufficiently detailed to enable staff to support people safely. Staff did not always provide care to meet people’s needs that was safe. For example, some people were at risk of skin breakdown; however, there was limited information in their care plans about any supporting equipment required such as pressure relief cushions or mattresses. Where people did require support to re-position, accurate records were not always maintained by staff. Another person was at risk of choking, and the care records needed further guidance for staff of what to do if the person did choke. The provider's electronic care planning system contained inaccurate information regarding people’s health needs. For example, when people had been admitted to hospital and subsequently returned, the electronic system deactivated the prompt that reminded staff to record the administration of thickeners.Thickeners are used to modify food or drink consistency for people with swallowing difficulties. This meant there was an increased risk staff might serve regular liquids, increasing the chance of choking or aspiration. These findings reflect a lack of consistent care delivery and poor risk management, placing people at unnecessary risk of harm.

Where people were prescribed paraffin-based creams and emollients, there was not always risk assessments in place to assess how people would remain safe from the risk of fire.

Risk assessments were completed, looking at the health and safety of the environment and equipment. Staff had received training in fire safety and there were regular fire drills. An emergency evacuation plan was in place for each person, to describe the support they would need in the event of a fire or other emergency evacuation of the building.

The provider was aware further improvements were required to address the shortfalls in managing risk and told us this would be addressed.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People lived and received care and support in a safe environment. Facilities were maintained appropriately and consistently supported staff to deliver safe and effective care. Staff carried out regular health and safety checks on the environment, including checks on maintenance issues, fire safety and equipment. The service also arranged for inspections by external contractors in relation to gas safety, electrical installation and building fire risk assessment. Staff knew how to report maintenance issues which were monitored by the management team.

The provider did not always make sure there were enough qualified, skilled and experienced staff. While staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Systems were in place to calculate safe staffing levels based on the needs of people using the service. However, feedback from people using the service, relatives and staff indicated staffing levels were not consistently adequate, particularly during nights and weekends. Concerns were raised about delays in care and reduced responsiveness during these times, which impacted the overall quality and continuity of care. Comments from relatives included, “There's not always enough staff, sometimes if they are dealing with a resident who is wanting

attention and another one is dishing out drinks, then there isn’t enough [staff] to do anything else.” Another relative said, “Not always [enough staff], if there’s an incident they [staff] have to attend to the buzzer. Other residents are sat without provision. Then other times I feel there is enough staff.” The service was short of permanent staff, there were a number of staff vacancies, leading to a high use of agency staff across all shifts. Comments from staff included, “No there isn’t enough staff on most shifts lately. We are understaffed quite a lot of the time which impacts the care we can provide. Either that or we have agency staff that aren’t fully trained and don’t help.” And “No. I feel as though you need another extra person especially on the residential side. We have a morning person, when they leave, we don't have anyone who comes on the afternoon, we still have the same number of residents in the afternoon. At the moment we are using a lot of agency staff.” The high use of agency staff meant there was a greater risk of a lack of consistency in staff practice, increased further by the lack of appropriate guidance in people’s care records about their specific care needs.

The provider operated safe recruitment processes. Robust recruitment procedures were in place and appropriate checks were carried out to protect people. Checks had been made on relevant previous employment, as well as identity checks. Disclosure and barring service (DBS) checks had also been carried out. DBS checks are a way a provider can make safer recruitment decisions and prevent unsuitable staff from working with people.

Staff received a range of training to help ensure their knowledge was up to date. Staff were happy with the training they received. New staff completed an induction to ensure they understood what was expected of them. The induction process included shadowing more experienced staff. Staff felt well supported in their roles. Staff had regular supervision discussions with their line managers and received feedback about their performance.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People were protected from the risk of infection as staff were following safe infection prevention and control practices. The home was clean, tidy and odour free. Toilets and bathrooms were equipped with appropriate hand hygiene facilities such as paper towels, liquid soap and foot operated pedal bins. Hand sanitiser was available in the home and posters were displayed about the environment to encourage compliance. Staff were trained in infection prevention and control, including hand hygiene. They used protective equipment, such as disposable gloves and aprons and confirmed these were always readily available.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. There were systems in place to safely store, administer and record the use of medicines. However, these were not always followed. For example, where people with swallowing problems were prescribed thickeners to thicken fluids these were not always recorded when they had been given which means people were at increased risk of choking. Staff were trained in how to manage medicines safely. Their competence to manage medicines was kept under review to ensure their skills and knowledge remained up to date. People’s care plans and medicines records contained clear information, so staff knew what support people needed with their medicines and when. This included detailed information about how to safely support people with medicines prescribed on a “when required” (PRN) basis.