About the service:

Riverside Care Home Limited is a care home that accommodates 41 people in one adapted building, support is provided on two floors. The home is registered for up to 42 people. There are various communal areas, including lounges and dining rooms that people can access. The home also has an adapted garden.

People’s experience of using this service:

The service met the characteristics of good in all areas.

At the last inspection in September 2017, the service was rated as Requires Improvement overall. At this inspection, we found that the provider had made improvements. The home had improved and is now rated as Good.

The care people received was safe. There were safeguarding procedures were in place and these were followed. Individual risks to people were considered and reviewed. Medicines were managed in a safe way. There were enough staff available for people. Infection control procedures were implemented. Lessons were learnt when things went wrong in the home.

The care that people received was effective. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff received both an induction and training that helped them support people. People received support from health professional and referrals were made when needed. People enjoyed the food available and were offered a choice. The environment was adapted to meet people’s needs.

People and relatives were happy with the staff that supported them and were treated in a kind and caring way. People were offered choices, encouraged to remain independent and their privacy and dignity was maintained.

People received care that was responsive to their needs. The care they received was individual to their needs. Their likes and dislikes were considered. People had the opportunity to participate in activities they enjoyed. There was a complaints procedure in place.

There were audits in place which were effective in continually developing the quality of the care. Feedback was sought from people and relatives who used the service, this was used to make changes. There was a registered manager in post and staff felt supported and listened to.

More information is in the full report.

Rating at last inspection:

Requires Improvement (Last report published 11 September 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 10 July 2017 and was unannounced. Riverside Care Home provides residential and nursing care for up to 42 older people, some of whom may be living with dementia. There were 41 people resident at the time of our inspection. On our previous inspection on 3 February 2017 we rated the service as Requires Improvements

There was a registered manager in the service. 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.

On our previous inspection we saw that medicine management systems were not always safe; we found that the way staff were deployed meant that staff were busy and were not always able to meet people’s needs in a timely manner. The care records did not always have the information needed for staff to provide effective care for people and where some people may lack capacity, assessments had not always been completed to ensure decisions were only made by others when they lacked capacity to make decisions themselves. Applications to authorise restrictions to keep people safe were not always appropriate where people had capacity. On this inspection we saw improvements had been made but further improvements were still required.

Where people lacked capacity to make certain decisions, some capacity assessments still needed to evidence how these decisions were being made in people’s best interests. When people moved into the home, sufficient information had not always been obtained in a dignified way to ensure staff could provide the care people wanted. Staff felt further training would benefit them in how they could provide support to some people who used the service.

There were now enough staff on duty to meet people’s health care and social needs. People’s medicines were now managed, stored and administered safely.

People were supported to eat and drink and staff understood the importance of helping people to maintain a balanced diet. People were cared for by kind and compassionate staff who understood them. Staff knew about people’s individual preferences for care and their likes and dislikes. Activities were organised to reflect people’s interests and people were encouraged to take responsibility for arranging these activities.

People felt able to raise concerns. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health or when their needs changed. The registered manager checked staff’s suitability to work in social care during the recruitment process.

The provider’s quality monitoring systems included consulting with people, their relatives and other health professionals to ensure planned improvements were focussed on people’s experience. There were quality checks of people’s care and health, medicines management, meals and suitability and management of the premises.

This inspection took place on 3 February 2017 and was unannounced. Riverside Care Home provides residential and nursing care for up to 42 older people, some of whom may be living with dementia. There were 38 people resident at the time of our inspection. This was the first inspection of this service.

The manager had submitted an application to us and this was in the process of being reviewed so they could become the 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.

Medicine management systems were not always safe. Information about medicines was not always available to ensure people received their medicines. Medication records were not completed to ensure checks could be made that people had received their prescribed medicines.

The provider had reviewed the staffing levels provided. We saw there were sufficient staff working although at certain times of the day, especially at lunch time, the way staff were deployed meant that staff were busy and were not always able to meet people’s needs in a timely manner.

The care records did not always have the information needed for staff to provide effective care for people. Staff had not received all the necessary training they needed to support people. New staff were not provided with an opportunity to gain experience and get to know people before working as a member of the staff team.

Staff sought people’s consent before they provided care and support. However, where some people may lack capacity, assessments had not always been completed to ensure decisions were only made by others when they lacked capacity to make decisions themselves. Applications to authorise restrictions to keep people safe were not always appropriate where people had capacity.

Quality assurance systems were in place, however these were not always effective as they had not identified concerns with medicine management, how decisions were made, how staffing was deployed and how people agreed and developed their support plans.

People were able to comment about the quality of the service. However, where concerns had been identified with gaining entry to the home, this had not always been resolved to people’s satisfaction.

Staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Where harm or abuse was suspected, the staff knew how to respond to protect people.

Where people needed to have their food and drink monitored, systems were in place to ensure health support was sought promptly. Staff liaised with people’s GP’s and other healthcare professionals to meet people’s changing needs.

People had opportunities to take part in a variety of activities and could choose if they wanted to be involved. People had developed good relationships with staff and were treated with kindness, compassion and respect. People maintained relationships with their families and friends.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.