People and staff told us they felt the staff team had been well led by the registered manager. The registered manager also known as matron had been in post for 14 years. They were supported by clinical leads, nurses, team leaders, seniors and care assistants.

The registered manager completed a number of audits relating to the monitoring of the service which included falls. They said,” We monitor falls really closely using half-hourly observations, light beams, alarm mats, and crash mats. If a person is at risk of falls, we often provide an ultra-low profiling bed. We carry out an accident audit and analysis to identify trends. These are comprehensive and examine all factors that might cause people to fall.”

The registered manager said, “I believe the trick is to get everyone involved and engaged in the management of the service. For example, we have monthly heads of department meetings, in which the health and safety champion and infection control champion are included. We start with health and safety and discuss all other issues that need to be addressed. This means that the management of the various teams is integrated and work together. This helps us to keep things running smoothly either when things become difficult or when I am not present. An action plan is created out of this meeting. At the next meeting, actions are followed up and any outstanding actions addressed.

Areas identified for improvement were responded to in a timely manner by the management of Riverside Nursing Home. Some issues identified required longer-term actions, however some were quickly addressed. For example, Do not disturb signs were purchased for people’s doors to ensure privacy whilst having their personal care.

Staff held specific responsibilities in regards health and safety, infection control and dignity. They told us, “I cannot guarantee that our staff will never commit errors. However, we as a management team, and I as the registered manager, do try to anticipate issues and also ensure that staff are aware of, and carry out good practice”. The registered manager was confident that “their extensive audits and monitoring of the service” would ensure any issues or concerns would be highlighted and addressed with immediate effect.

People their relatives, staff and professionals felt the service was well led. They all told us the management team were approachable, and they could talk to them at any time. One person said, “We always see the matron around, she is very approachable.” A relative told us, “The home is well run, they think of the resident first, they think outside the box”. “The matron is a good role model, they do so much.” “I definitely like it here, matron is one of the best, I feel safe and well looked after.”

The registered manager told us they received regular support from the provider, they told us, “I normally see them once a month, but would call if I needed any additional support. We have a good working relationship.” The provider sought input from external agencies and organisations to ensure improvements in service delivery. Residents meeting were held to enable people to have information shared and to share ideas.

Feedback from staff about the management team was positive. We were told that management were approachable, listened and took action where this was needed. The registered manager and management team were visible and helpful during our inspection. There was a shared focus on ensuring that people were treated with equality and dignity. The registered manager told us they were proud of their team, they told us, “There are staff incentives in place to recognise the valuable contribution staff make to the home. This includes rewarding staff that share good ideas that will benefit the residents”. “Staff have regular supervision and annual appraisal. We keep staff informed when we have meetings. If there is an issue of poor communication or poor practice we manage this with supervision”. Staff confir

Riverside Nursing home was last inspected on 05 June 2014 where it was found that improvements were required. The provider wrote and told us how they would improve the service provided. At this inspection we found that improvements had been made.

A registered manager was in post that supported us at this 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.

Riverside Nursing home is registered to provide accommodation and personal care for up to 39 people at the time of the inspection there was 31 people living at the home.

The provider had systems in place to ensure the quality of the service was regularly reviewed and improvements were made. The care and support people received was regularly audited and areas for improvement recognised. Staff knew people’s needs; the records relating to people’s care and support were kept in good order.

People told us that the staff met their care needs well. One person told us “I like to spend time on my own but the staff also check on me” another person told us about how staff had arranged for them to visit a local event because they knew they were interested.

Staff knew people’s routines and respected them. Staff knew how to support people when they became anxious and patiently supported them in an empathetic manner.

The provider was meeting the requirements of the Mental Capacity Act 2005 and assessments of people’s capacity had consistently been made. Staff understood some of the concepts of the Act, such as allowing people to make decisions. Staff demonstrated that they could apply this to everyday life.

Staff demonstrated a caring and compassionate approach to people living at the home. People were offered choices at mealtimes such as where to sit and what to eat. Where people had difficulty in making choices staff supported them. The provider had a system to offer choice of what to eat during mealtimes that was effective.

People told us there was enough staff to meet their needs. The provider was able to demonstrate that extra staff were available to support people should their needs change or if extra support was required. The people and staff were also regularly supported by a dedicated group of volunteers and were involved in community life.

People told us they felt supported at the home and safe in the company of staff. The staff told us they worked well as a team and felt listened too. They told us they had enough time to sit and talk with people in a relaxed manner.

People were treated with consideration and respect and their privacy, dignity and independence were maintained. People were able to make choices about their daily life.

All people we spoke with told us that staff did everything them needed them to do for them. One person told us it was “very good, the kindness of the staff and the care they give you.” One relative told us their relative was “well looked after” and that the person was “so happy.”

People’s needs were assessed and care was planned and delivered to meet their needs.

People were protected against the risk of abuse because staff understood about safeguarding issues and whistle blowing and knew how to report concerns.

There were sufficient numbers of staff. The home had systems in place to regularly assess and monitor the quality of the service and people’s views were sought.

People that we spoke with told us staff were respectful to them and asked for their consent to the care they received daily. One person told us "If I want to stay in bed, I tell them to leave me longer and they do."

People and their representatives told us staff provided the care and support that they needed. One relative told us “I am absolutely delighted with the care. They can’t do enough.”

People who used the service were not safeguarded against the risk of abuse because the provider had not responded appropriately to some allegations of abuse.

There were effective recruitment and selection processes in place for staff to work in the home.

We checked the care records of four people and saw that records had been updated to reflect people’s needs and care plans were accurate to direct staff to what care people required. One member of staff told us, “I am responsible for completing observation charts and daily care records for the care that I have provided.”

The people who use the service informed us that they felt the staff were kind to them and supported them with their day to day needs. They said they were encouraged to express their views and make or participate in making decisions relating to their care and treatment

A visiting relative told us that they were very satisfied with the care and attention their relative received. They also commented that they considered that people were well cared for and gave examples of how their relative received a good service such as always having clean clothes and help with daily routines.

A visitor told us that they considered that the home keeps them regularly informed of any changes in their relative’s needs and that they are regularly asked for their thoughts into the care offered. They told us that they had been involved in the planning for admission to the home of their relative and felt that all the staff were approachable.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People's care and treatment was not always planned and delivered in a way that ensured some people's safety and welfare. People were not always protected against the risks of unsafe care as people's care records were not always accurate.

We found that there were not enough staff to meet people's needs. A person who used the service told us,“There is not enough staff at times.” One member of staff told us, “There are not enough staff for the dependency here.”

We found that people were protected from the risks associated with medicines because medicines were handled appropriately.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's safety, staffing levels and accurate record keeping.

Is the service effective?

People's health and care needs were not always assessed which meant there was a risk care would not meet people's needs effectively. Care and treatment provided did not always follow people's care plans. There were not enough staff to meet people's

needs. For example, we saw two people required staff to spend time with them to support them with their mental health needs. Staff told us that both people became very anxious and distressed on a regular basis and this was reduced when staff spent time with them. Staff told us they generally did not have enough time to do this when not meeting their physical care needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing people's needs and following people's plan of care.

Is the service caring?

People were supported by kind and attentive staff. We observed respectful and caring interactions between care workers and people. One person told us, "They couldn’t be more caring." Another person told us, "I am looked after well."

Is the service responsive?

The service responded to some changes in people's health and care needs. We spoke with a visiting nurse who told us staff followed the advice given and pressure ulcers had improved.

We found that the service did not always respond to people’s needs. For example, some people were cared for in bed when there was no reason for them to be.

People had access to activities in the home and trips outside of the home. People that used the service spoke very positively about the activities arranged by the home.

Is the service well-led?

The provider had a system to regularly assess and monitor the quality of service but the system did not review staffing levels and monitoring charts completed by staff to ensure people’s needs were met.