The inspection of Riverside Residential Home took place on 13 and 14 December 2018. We previously inspected the service in March and April 2018, at that time we found the registered provider was not meeting the regulations relating to person centred care, dignity and respect, safe care and treatment, nutrition and hydration, staffing and good governance.

We rated them as requires improvement. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people.

Riverside Residential 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.

Riverside Residential Home accommodates a maximum of 50 people; there are two separate units providing accommodation and communal areas, all on the ground floor. The home provides care and support to people who are assessed as having personal care and support needs. Oakwell unit provides care and support to people who are living with dementia. There were 29 people living at the home at the time of the inspection.

The service had a registered manager in place; they were no longer working at the home but had yet to submit their application to the Care Quality Commission to de-register. 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. A new manager had been in post since August 2018, they told us they had begun to complete their application for registration.

Relatives felt their family members were safe.

Care records contained a variety of risk assessments. Where a risk was identified, action was taken to reduce the possibility of future risk.

There was a system in place to ensure the premises and equipment were safe, although we identified two hoist slings which had not been checked in line with current regulations. Fire doors between a corridor and a dining room were wedged open by staff at mealtimes.

The recruitment of staff was safe and there were sufficient staff to meet people’s needs.

Staff who were responsible for the administration of people’s medicines were appropriately trained. Medicines were stored and administered safely. Improvements were needed to the management of creams, the recording of medicine patches and staff’s understanding of the electronic system for managing stock.

Improvements had been made to the cleanliness of the home although we identified three pressure cushions which were soiled and a bedroom which was malodourous.

New staff received an induction although we found some induction records had not been fully completed. There was an ongoing programme of training and management supervision.

People had a choice of food at each meal, staff supported people to choose the meal they wished to eat. Snacks and drinks were available although on the residential unit people did not get a hot drink until 11.30am following breakfast. At tea time, on the residential unit, people were not offered the opportunity to sit at a dining table to eat.

There was a daily ‘flash’ meeting for staff from each department within the home. A daily handover was also provided for staff before they commenced their shift, although not all care workers were present when this began therefore they missed some of the information.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Where people had capacity to consent to the care and support they received, we saw consent forms had not been signed.

People told us staff were caring and k

We inspected Riverside Residential Home on 12, 23 March and 5 April 2018. The first two days of the inspection was unannounced which meant the home did not know we were coming.

Riverside Residential Home is registered to provide accommodation and personal care for up to 50 people. The home comprises one building, containing two units. One unit is named Oakwell and is a designated unit specialising in providing dementia care and the other unit provides residential care. All bedrooms on the Oakwell unit are ensuite, there is a communal dining room/lounge and access to secure gardens. Some of the bedrooms on the residential unit are ensuite, there is a large communal dining room/lounge, shared bathrooms and toilets and kitchen.

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

At the last inspection in May 2017 we rated the home as ‘Requires Improvement’ in four of the five key questions and overall and as ‘good’ in the key question of caring. We identified breaches of the regulations relating to staffing and fit and proper persons employed.

Following the last inspection, the registered provider submitted two action plans to show what they would do and by when to ensure improvements would be made. The purpose of this inspection was to see if improvements had been made and to review the quality of the service provided for people.

At the time of our inspection the home did not have a registered manager. The last registered manager had left in December 2017. 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 home was currently being managed by an improvement team alongside an interim manager who had joined Riverside in February 2018.

There were insufficient staff levels during our inspection. Feedback from people, their relatives and staff regarding staffing levels was mainly negative. The numbers of staff on some shifts were not at the levels stated by the interim manager and improvement team.

Recruitment processes were adequate. Interview notes were missing from one recruitment file.

Medicines were managed and administered safely. This was an improvement from the last inspection. Staff had received training in safe administration of medicines and had their competency assessed to administer medicines.

Risks to people were not always well managed. Accidents and incidents were not always reported. Effective systems were not in place to reduce the risk and spread of infection. Soap and/or hand gel was missing from 50% of toilets. There was an infection control outbreak between day two and three of inspection.

People were not always supported to ensure their nutritional and hydration needs were met. Activities and daily pastimes were limited and we found the activity co-ordinator was on occasions taken away from this role and asked to support the care team.

Records showed staff had access to training and supervision to carrying out their role effectively.

The principles of the Mental Capacity Act were applied. Although some care plans did not contain a full list of decision specific assessments. DoLs applications were made timely following the completion of some of the mental capacity assessments.

People and their relatives generally spoke positively about the staff who cared for them. Some people did not look well cared for. People were supported with their preferences.

We observed people’s confidentiality, privacy and dignity was not always respected. Staff were reminded to refer to people using initials only in public areas. Staff d

This was an unannounced inspection carried out on 23 May 2017. This was our first inspection at this location since a change in its registration in August 2016.

Riverside residential Home specialises in care for elderly residents with a wide range of needs, including people living with dementia. The care provider, Indigo Care Services is registered to provide accommodation for up to 50 people at this location.

At the time of our inspection the service had a manager registered with the Care Quality Commission, although they were no longer in post. Since March 2017, two relief managers had been put in place to manage this 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.

The registered provider used a dependency tool to determine staffing levels. Staff told us there weren’t sufficient staffing levels to meet people’s needs. Rotas we looked at showed there were occasions where shifts were not staffed as stated. Day shifts did not always have adequate senior staff cover.

Recruitment checks were not found to be robust as the registered provider had not taken references from last employers. The identity of staff had been verified and background checks had taken place with the Disclosure and Barring Service.

Medicines were mostly well managed. However, we looked at the administration and recording of topical creams and found this needed strengthening. We recommended the registered provider review these arrangements.

A system of audits was in place which covered a range of topics. We saw evidence of appropriate action being taken in response to the relief management team’s service action plan. However, some concerns identified during our inspection regarding staffing levels, topical creams and recruitment had not been appropriately managed.

Risks to people had been identified, assessed and reviewed on an ongoing basis. Fire safety checks had been carried out on a regular basis. All maintenance certificates were found to be up-to-date.

Notifications had been submitted by the registered provider to the CQC. Evidence of staff, ‘resident’ and relative meetings as well as surveys was seen during the inspection.

Although staff had commented on low morale and feeling under-valued, at our inspection they spoke more positively about the support they received from the relief management team.

Mental capacity assessments which were decision specific had been completed and applications had been made to the local authority for Deprivation of Liberty Safeguards. Staff were aware of the importance of offering people choice.

People had a positive mealtime experience and were well supported by the staff team. People’s nutritional needs were being met and evidence showed staff supported people to access healthcare services. People spoke positively about the care they received from the staff team. We saw warm interactions between people and staff. Some concerns had been raised by relatives about accessing the service on a weekend.

Care plans were in the process of being updated by the relief management team as these required improvement. We saw audits of care plans had identified the same issues we found.

Complaints were managed appropriately as concerns had been recorded, investigated and responded to. The complaints procedure was on display.

The service did not have an activities coordinator at the time of our inspection. Staff were expected to provide stimulation until the new activities coordinator started in June 2017.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.