This inspection took place on the 9 and 10 August 2018. The first day of the inspection was unannounced.

The last inspection took place on 29 June and 5 July 2017 and the service was rated requires improvement. The service was in breach of Regulation 17 Good Governance. Concerns related to inconsistencies within care plans, a lack of regular reviews, poor record keeping and quality assurance systems which were not effective in identifying and rectifying issues.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Responsive and Well-led to at least good.

At this inspection improvements had been made and the service was no longer in breach of Regulation 17 Good Governance.

Riverhead Hall Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Riverhead Hall Care Home accommodates up to 45 older people in one adapted building. At the time of our inspection there were 33 people living at the service.

The service had 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.

There was further room for improvement of records being kept about the care being delivered to people. Some records contained gaps. We were confident this was a record keeping issue and not about the delivery of care.

The registered manager had failed to notify the commission about approved Deprivation of Liberty Safeguards being in place. This is being addressed outside of the inspection.

Quality assurance systems were in place and had been effective in identifying required improvements. However, the actions identified were not always rectified which meant the systems needed to be more rigorous to embed service improvement.

Care plans provided care staff with important information about people’s preferences and the support they required. People and their relatives had been involved in the planning and review of their care. Reviews were taking place on a regular basis.

Although we received differing views about staffing levels we found there were sufficient staff available to meet people’s needs. Staff had been recruited safely.

Staff understood how to safeguard people from avoidable harm. Accidents and incidents were analysed and action taken to reduce occurrence. Risk assessments and measures to mitigate risk were in place.

People were provided with a good standard of care. Care staff were knowledgeable about people’s needs they understood people’s preferences and respected these.

Staff had the skills required to deliver effective care. New care staff had an induction before they started work and ongoing training was available for staff. Some staff supervision and appraisals were overdue but the registered manager had a plan to rectify this.

People had access to a range of activities to promote their emotional wellbeing. Overall people were satisfied with the food provided. People’s nutritional needs were met.

The service sought appropriate advice and support from health and social care professionals to ensure people’s care needs were met.

People described kind and compassionate staff. We observed positive interactions between staff and people. Families were welcome to visit whenever they wished and relatives gave us positive feedback about the service.

People knew how to make complaints and when they did so these were appropriately investigated and responded to. Feedback from people about the service was sought on a regular basis in a

Riverhead Hall is registered to provide nursing and residential care for up to 45 people, although the provider had recently taken the decision to cease providing nursing care. They had commenced discussion with CQC about removing their registration for the provision of nursing. At the time of our inspection 44 people used the service, all of whom received a residential care service. The service provides support for adults over the age of 18 including older people, people living with dementia and people with a physical disability. The service has 45 single en-suite bedrooms provided over three floors. There are three communal lounges, a large dining area, a conservatory and large landscaped gardens and outdoor seating areas.

At our last inspection in April 2015, we asked the provider to take action to make improvements to capacity assessments because they were not fully completed and lacked information. At this inspection we found evidence of activity to improve the quality of mental capacity assessment paperwork. One file we viewed still lacked clarity in relation to the decisions that were being assessed, but this was addressed during our inspection and further training was planned for staff. Deprivation of Liberty Safeguards (DoLS) applications had been submitted, or were in the process of being completed, for people who required an authorisation to deprive them of their liberty, where this was in their best interests. 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

The service had a manager, who had taken up a permanent position as the manager in April 2017, after having worked at the service in different roles for over 10 years. The manager had submitted their application to the Commission to become the registered manager of the service, this application was being processed at the time of our inspection. 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.

We found that recent changes at the service, in relation to the service provision, staffing and management had impacted on the quality of record keeping and care plans at the service. Quality assurance systems had not been effective in ensuring that standards in relation to record keeping had been consistently maintained over recent months. Risk assessments and care plans were not always accurately completed and cross referenced, or regularly reviewed. This was a breach of legal requirements.

Staff were knowledgeable about people’s needs and we found that people were receiving the care they required. However, the lack of accurate, up to date information in some care files meant there was a risk that staff were relying on their own knowledge, as they did not have all the information they needed to ensure that people received consistent and responsive care in line with their preferences.

Staff were recruited safely and appropriate checks were completed prior to people commencing work, to ensure they were suitable to work with vulnerable people. There were sufficient staff to meet people’s care needs safely. However, we received some feedback that a recent reduction in the staffing levels at the service due to a change in the needs of people using the service, meant that staff felt more rushed with people and had less time available to ensure care plans were updated. Staff received an induction, appropriate training and supervision.

People who used the service told us that staff were caring and we found that staff supported people in a way that promoted their dignity and independence. We observed positive, friendly interactions between peopl

Riverhead Hall provides nursing care and residential support for up to 45 residents. The service provides support for adults over the age of 18 including older people, people living with dementia and people with a physical disability. The service has 45 single en-suite bedrooms provided over three floors with separate bedroom areas located for the nursing and residential resident’s. At the time of our inspection there were 34 residents living at the service eight of which were nursing care residents and 26 residential.

The home features three communal lounges, a large open plan dining area, kitchen, conservatory and ample outdoor space which includes landscaped gardens, flower beds and seating areas.

The inspection was unannounced and took place on 22 April 2015. The service had a 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 2008 and associated Regulations about how the service is run.

The last inspection took place on 17 June 2013. At that inspection we found the provider was compliant with all the standards we assessed.

We found the service to be safe in its delivery of care. Staff were recruited safely and appropriate checks were completed prior to working with vulnerable people. Staff had good knowledge and an understanding of the needs of the people who used the service. People who used the service told us they felt safe. Although staff told us they were short staffed on occasions they also told us they all pulled together and worked as a team.

Staff supervision was not as frequent as the organisations policy suggested but the registered manager told us they were working on this to ensure supervisions were delivered more frequently. There was a full training programme in place which ensured staff were equipped with the knowledge and skills required to carry out their role effectively.

We observed that staff spoke in a positive way to people and treated them with respect. Staff and the people who used the service interacted in a positive way and observations showed good relationships between them. The people who used the service participated in a wide variety of in house and community based activities. The service was respectful of people’s religious beliefs and encouraged religious practice in the home environment for people who wished to participate.

The registered manager was following the principles of the Mental Capacity Act 2005 (MCA) and we saw that applications, where required, had been submitted in respect of people being deprived of their liberty. The Mental Capacity Act 2005 (MCA) legislation is designed to ensure that when an individual does not have capacity, any decisions are made in the person’s best interest. We saw that the paperwork to support the MCA was not always completed or as comprehensive as it should be. The registered manager told us they would seek ways to address this and make improvements.

People who used the service had personalised care plans in place and individual’s likes and dislikes were clearly documented. Risk assessments were in place along with life history, medical conditions and professional contact records. Family and friends were always welcome to visit the service and people living at the service told us they were encouraged to maintain family contact. Relatives told us they were “Generally happy” with the care their loved one received living at the service.

The registered manager encouraged feedback from the people who used the service, relatives and staff members to improve practice and the overall standards of the service. The service had established good community links with a local school and this has resulted in positive experiences for the people who used the service. The registered manager promoted transparency and staff told us the registered manager has an ‘open door’ approach which staff felt was positive.

Since our last visit to the service in January 2013 the provider had appointed a new manager whose application to be registered with the Care Quality Commission was being processed. At the time of this visit the manager was on leave. However, an area manager was at the home and able to answer our questions.

People felt staff respected their privacy and dignity. One visitor said “My parent has a care plan and it has been discussed with both of us”.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. One person told us, “Staff are friendly and give us the support and help we need” and another said “There is a lovely atmosphere in the home, very friendly and welcoming.”

People told us “We get our medicine on time and when we need it”. We found that appropriate arrangements were in place in relation to safely administering medicines to people who used the service.

The home was designed to meet the needs of people who lived there and the provider ensured equipment used to assist people with their daily lives was regularly maintained, safe and fit for purpose.

We saw the service had an effective recruitment policy and procedure, which ensured staff working in the home had the right skills and qualifications to meet people’s needs.

The provider had an effective quality assurance system in place and people’s views and opinions of the service were listened to and acted on where necessary.

The home was without a registered manager at the time of this visit. There was a manager from a sister service filling the post until a new manager was appointed. We have referred to them as the “Acting manager” throughout this report.

When we visited the service in November 2012 people who used the service were satisfied with the care they received and their homely environment. We chatted briefly with people during this visit but their comments to us did not relate to the outcomes we were inspecting.

We found that improvements had been made to medication practices and record keeping within the service. The provider and staff had acted on the information in the report from November 2012 and made positive changes to working practice, staff training and the medication system.

The home was without a registered manager at the time of this visit. There was a manager from a sister service filling the post until a new manager was appointed. We have referred to them as the “Acting manager” throughout this report. At the time of our visit the acting manager was not on site but we spoke with them on the telephone to discuss our visit during the inspection and the following day.

People told us that their experience was a positive one. They were involved in the decisions about coming into the service and staff discussed their care and treatment with them. They were able to make choices and decisions about their daily lives, and the staff respected their wishes and supported their independence. One person said “I cannot praise the staff enough. They work hard but always listen to you and make time for a chat.”

We spoke with relatives who told us “The staff are supportive” and “There is a lovely atmosphere in the home, very friendly and welcoming.”

People understood about safeguarding of adults and told us that they felt safe within the service. They told us there was an open door policy within the service which worked well and they were confident of using the complaints system if they needed to.

We found through talking to people that care in the service was meeting people’s needs, however staff were not keeping care records and associated documentation up to date. We also had concerns about the management of medication within the service.

We spoke with one person who lived at the home and observed staff interacting with other people. The person we spoke with said that they were encouraged to make decisions about their day to day lives, such as when to get up, when to go to bed and where to spend the day and that these times were flexible. They said that staff were respectful and mindful of the need for privacy and dignity, and that staff were also kind and supportive.

The person that we spoke with told us that they had no complaints and said, ‘I don’t know what I would do without the staff – they are wonderful’. They said that they felt safe living at the home.