We carried out a comprehensive inspection on 25, 26 and 28 April 2017. At our last inspection in May 2016, we found three breaches of the legal requirements. This was because risks to people’s health were not always assessed or mitigated and some equipment was not used correctly. The provider sent us an action plan following the inspection. At this inspection we found sufficient actions had been taken to address the breaches.

The inspection was unannounced. Riversway Nursing Home provides nursing and personal care for up to 69 people. At the time of our inspection there were 62 people living in the home.

There was a registered manager in place 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.

People told us they felt safe in the home. They were cared for by staff that had been trained and understood their responsibilities with regard to keeping people safe from avoidable harm and abuse. Risk assessments were completed and risk management plans were in place.

People were supported to make decisions on a day to day basis. Staff identified when people’s needs changed and they obtained support and guidance from external health care professionals.

Staff demonstrated a kind and caring approach and they treated people with dignity and respect. Staff knew people well and were able to tell us about people’s likes, dislikes and preferred routines which were reflected in their care records.

There was a range of activities that people could participate in and people were enjoying group and one to one activities on the days of our visit.

People, staff and relatives told us the home was well-managed. People and relatives told us the registered manager was readily accessible and available to them. Staff told us they were well-supported and that the home was a good place to work.

The inspection took place on 10 May 2016 and was unannounced. The care home was last inspected on 12 September 2014 and met with legal requirements.

Riversway Nursing Home is registered to provide nursing and personal care for up to 69 people. There were 61 people living in the home on the day of our visit.

There was 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.

People were assessed before they moved into the home to ensure their needs could be met.

Risks to people were assessed, and where identified, actions were taken to reduce the risks and keep people safe. Some risks had not been identified and sufficient actions had not been taken when a person’s condition changed or deteriorated. For example, two people had developed pressure ulcers. These had not been recognised or identified by staff. They were identified by a visiting GP.

People received personalised care that was responsive to their needs. Care plans reflected that people’s individual needs, preferences and choices had been considered.

People were supported to have their nutritional needs met. The dining experience was relaxed, and people received the support they needed.

Governance systems were in place to monitor and mitigate most of the risks relating to the health, safety and welfare of people.

The rights of people who did not have the capacity to consent to care and treatment were protected because the service worked in accordance with the Mental Capacity Act 2005.

People who were supported by the service felt safe. Staff had a clear understanding about how to safeguard people, and knew the actions they would take if they suspected abuse.

We found three breaches of the Health and Social Care 2008 (Regulated Activities) Regulation 2014.

A single inspector carried out this inspection and spoke with two people who used the service, one visitor, the registered manager, one service manager and three nurses. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were cared for in a clean environment. There were enough staff on duty to meet the needs of people who used the service. The staff we spoke with were knowledgeable about their roles and demonstrated a good understanding of the needs of people.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. During our inspection we saw evidence that people had been assessed in accordance with these safeguards in line with procedures and we found the provider was compliant. The registered manager and the service manager both demonstrated an in-depth knowledge of the safeguards which showed us they understood their responsibilities to the people who used the service.

Most of the staff had received safeguarding training and all demonstrated knowledge of their responsibilities to keep people safe from abuse.

Is the service effective?

Care records we saw were generally well documented and up to date. Care plans had been reviewed and updated to reflect when people's needs changed. However, daily care records had not always been fully completed to reflect the care people had received.

People who used the service told us their needs were met. People told us "I can't cope at home on my own, so this place suits my needs" and "This is my second experience of care homes and it's the best".

Is the service caring?

Staff that we spoke with and observed were kind and caring. We observed staff being respectful of people and offering people choice in what they wanted to eat and what they wanted to do. People told us "The staff are very attentive" and "I can't fault the staff".

Is the service responsive?

People's needs had been assessed prior to living at Riversway. Records confirmed people's preferences had been documented and that care reflected their wishes.

People had access to support services when required such as a GP. When people's health deteriorated, advice and support was accessed quickly.

Is the service well-led?

Staff told us they felt well supported in their role. The registered manager was a dementia specialist and was knowledgeable about the specialist needs of people with dementia. They also provided support to families of people with dementia.

There were effective systems in place to monitor the quality of services provided. People and their representatives were regularly asked for their feedback on the service they received.

At our inspection on 31 July 2013 we found that people were not protected from the risks of unsafe care and treatment because accurate and detailed records were not consistently maintained. The provider wrote to us and told us that they had put in place actions to address the failings that had been identified. The provider told us that they were fully compliant by 31 October 2013.

At this inspection we found that people were protected from the risks of unsafe care. This was because accurate and suitable records were maintained. Staff understood the importance of accurate record keeping. They were aware that this was to ensure people received safe and effective care and assistance with their needs.

Our observations of the care and support that was provided showed care plans were accurate. They provided clear guidance for staff to follow. This meant that people who used the service received consistent and effectively planned care and support.

We spoke with three people who used the service. Each person we spoke with had positive views of the care and support they received. One person told us that it was “excellent”.

People appreciated the care and support that they received from staff. They said that the staff were caring and went about their work in a friendly manner. One person. for example described staff as “very attentive” and another commented “we’re well looked after”. We were also told that staff could be very busy at times and that this had an impact on the support that people received and the time it took for staff to respond to their needs.

The provider had systems in place for monitoring standards in the home and the quality of service that people received. The manager was already aware of shortcomings in relation to the deployment of staff and how these affected the service that people received. We were told that action was being taken to address these.

People were provided with food and drinks which met their individual needs. A chef prepared food to meet people’s dietary requirements and people told us that they enjoyed their meals.

Procedures were in place which helped to ensure that people were protected from abuse and concerns were followed up with the relevant agencies.

People had positive opinions to share with us about their experiences of life at Riversway. Examples of comments we were told included, “It's the attention the staff show you, they come round and check on you”. “Everybody is all right, they are all ok”. “The staff are nice”. “The place is excellent”. “I can't grumble”. “The home is 100 per cent”.

People were treated with respect by the staff and their nursing and personal care needs were being effectively met at Riversway.

People told us they were happy with the care and support they were receiving. They said that their care needs were assessed prior to them taking up occupancy in the home and they were involved in developing their care plans. People told us that they felt safe at the home. They said that they would talk to the staff first if they were not happy with the service. People said that they had no complaints.

People told us that staff were kind and would go out of the way to support them. People told us that sometimes when staff were busy, they would take a long time to answer the call bell. People told us that they were satisfied with the care and support they were receiving.

We carried out this inspection in order to check on the arrangements being made for people’s care in the evenings. This was in response to information we had received about the care that people were being given and how staff went about their work.

We received a range of feedback about the service. One person commented that they were “very happy” with the care and we met with people who were appreciative of the support they received from staff. However, we also heard that there could be an inconsistent approach in how staff responded to people’s needs. This meant that there could be delays in time before people's needs were met.

We found shortcomings in the recording of care and the information that was available to staff about people’s individual needs. This meant that it would be difficult to evaluate the care that people received and to be confident that effective care had been provided as agreed.