Our inspection of Riverview Lodge took place on 28 November 2018. This was an unannounced inspection.

Riverview Lodge 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.

The home is situated in Kingsbury and is registered to provide care to up to 36 older people living in three units. At the time of our inspection there were 35 people living at the home, many of whom were living with dementia.

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.

At our previous inspection of Riverview Lodge in March 2016 we gave the home a rating of Good.

People who lived at the home told us that they felt safe, and this was confirmed by family members whom we spoke with.

People had care plans and risk assessments which were person centred. However, these had not always been updated to ensure that they fully reflected changes to people’s health needs and the support they required with these. Behavioural charts had not always been completed by staff to show they had followed guidance contained within a person's care plan. This meant that we could not be sure that people always received the support they required.

Daily records of people’s care were otherwise well maintained. Systems were in place to share information between outgoing and incoming staff at shift changes.

There were systems in place to review and monitor the quality of the service, and we saw that action plans had been put in place and addressed where there were concerns. However, the home's quality assurance systems and regular care plan reviews had failed to identify where there had been changes to people's health needs which had not been included in their care plans. There was no regular monitoring of behavioural records which did not always show if staff had followed the guidance contained within a person's care plan. This meant that we could not be sure that people's needs were being safely met. The registered manager told us that there would be an immediate review of people's care records.

People’s nutritional needs were met and their food and fluid intake was recorded and monitored. Choices were available at mealtimes and alternatives were provided to people with religious or cultural needs and preferences. However, we found that the home's menus were designed by the provider and people had not been consulted or involved in making decisions about what they included.The registered manager told us that they would ensure that regular food satisfaction surveys would be conducted in future and these would be used to make changes to menus where required.

People were protected from the risk of harm or abuse. Staff members had received training in safeguarding and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.

Staff at the home supported people in a caring and respectful way and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms for part of the day were regularly checked on.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and respo

Our inspection of Riverview Lodge took place on 16 and 30 March 2016. This was an unannounced inspection.

At our previous inspection of Riverview Lodge in May 2014 we found that the home was meeting the requirements of the outcomes that we assessed. These were: Respecting and involving people who use services; care and welfare of people who use services; cleanliness and infection control; requirements relating to workers; assessing and monitoring the quality of service provision.

Riverview Lodge is a care home situated in Kingsbury. The home is registered to provide care to up to 36 older people living in three units. At the time of our inspection there were 35 people living at the home, many of whom were living with dementia.

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 who lived at the home told us that they felt safe, and this was confirmed by family members whom we spoke with.

People were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.

Medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms for part of the day were regularly checked on.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. Staff members had received training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People’s nutritional needs were well met. Meals were nutritionally balanced and met individual health and cultural requirements as outlined in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day. People’s food and liquid intake was recorded and monitored.

Care plans and risk assessments were person centred and provided guidance for staff about how they should work with people to meet their needs. Daily records of people’s care were well maintained and effective systems were in place to share information between outgoing and incoming staff at shift changes.

The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively in participation in activities. People’s cultural and religious needs were supported.

People and their family members that we spoke with knew how to complain.

Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the su

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spent some time observing the interactions between staff and people using the service in the communal areas of all three floors. We also looked at a sample of care plans on each floor, to check that they provided information so that the staff could understand and meet each person’s individual needs.

We found that the staff showed confidence in understanding and meeting the needs of people with dementia. The interactions that we observed on each floor showed that staff were aware of the guidance on meeting people’s needs in the support plans, and followed the guidance.

On all three floors we noted that there were sufficient staff both to meet each person’s care needs and to spend time talking with them and supporting them with activities. Staff spent time with each person and encouraged them to talk about what they were doing. One person said of the staff, “They have the patience of Job.” This person also told us, “I haven’t got a home, this is my home.”

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We checked the care files for three people and saw that assessments of capacity were in place and decisions were made in the best interests of people who were unable to consent.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person told us, “The staff look after me very well and have taken note of my likes and dislikes.” Another person said, “They couldn’t be kinder. They know what help I need. We wouldn’t be looked after anywhere better.”

The provider took account of complaints and comments to improve the service. The complaints record showed that complaints from relatives about the care provided were investigated and resolved.

The care plans provided details of each person’s health and personal care needs and up to date risk assessments, to provide staff with information on each person's preferences.

However people with dementia did not experience care, treatment and support that met their needs and protected their rights. We noted some good examples of staff interaction with people. But some staff asked a person a question, then walked away without waiting for a response.

Care plans contained limited information on the needs of people living with dementia. There was no information on how each person communicated their wishes or on understanding and assisting people with challenging behaviours.

We spoke with a visiting relative who visited the home every day, and frequently took their relative out because of the lack of activities in the home. This person said, “The staff are very kind, but they always seem very busy.”

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience, people who have experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

People who use the service told us that staff understood their needs and provided them with the care and support they needed in the way that they wanted. People confirmed that staff were kind, respected their privacy and promoted their independence. They told us their religious and cultural needs were met by the home.

People spoke positively about the home, comments included “I came to see the home, I chose it”, “I am asked about my care and I tell them what I want”, and “they pay attention to our likes and dislikes”.

People told us that they had sufficient and suitable food and drink which met their dietary needs and preferences. People’s comments included “the vegetables are fresh which is very good”, “I am happy with the food it is lovely”, “I can choose what I want”, and “I have been asked for my views of the food.

People told us “I feel safe, if I had a concern I would tell the staff” and “it’s lovely here, we have no complaints at all, it’s like home from home.”

As part of this review, we spent time talking to all the people using the service to gain their views about living in Riverview Lodge. They told us that; they were happy living in the home, they liked their bedrooms, the food was good, they had their health needs met, the staff were approachable, listened to them, and they had the opportunity to participate in a range of activities of their choice.

People told us that they were aware of their plan of care and support. They confirmed that they were consulted and participated in the review of their care plan.

People were positive about the care and support they receive at the home. People spoke of the staff being ‘nice’, as well as approachable. They told us they felt safe living in the home and they knew who to talk to if they had any worries or concerns. People told us about that they could choose what to eat and generally enjoyed the meals provided.

People said they saw a doctor when they needed to, and had contact with a variety of other health care and social care professionals. A person spoke of having had her eyes ‘tested’ recently.

People confirmed that they were happy with the environment of the home, and were happy with their recently decorated and refurbished bedrooms. They told us that they had brought personal items including some items of furniture with them, when they moved into the home.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? We received information that a few people who used the service disturbed other people during the night and caused them distress. Our visit to the home took place during the late afternoon and evening in order to check how staff managed this situation.

We used a number of different methods to help us understand the experiences of people who used the service, because many of them had complex needs which meant they were not able to tell us their experiences. We spoke with eight people who used the service and with the two visiting relatives. We spent some time observing the interactions between staff and people using the service in the communal areas of the home. We spoke with six members of staff and the Registered Manager.

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.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

There were sufficient staff available to ensure the welfare and safety of people who used the service. However at night there was a lack of support for staff to give attention to people who may be causing a disturbance.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety. Risk assessments were carried out for each person and included, for example, pressure sores, nutrition, mobility and the risk of falls.

There were effective systems in place to reduce the risk and spread of infection. The home was clean in all the areas that we visited. The allocated infection prevention and control lead for the home told us that they ensured that staff were aware of the procedures for infection control and followed them.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS) which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with told us that they felt well supported and received appropriate training and supervision to enable them to carry out their responsibilities and to care for people appropriately.

People attended hospital appointments and received advice and support from healthcare and social care professionals.

Is the service caring?

The care and support plans contained detailed information about each person's specific needs for staff to follow.

People expressed their views and were involved in making decisions about their care and support. Support plans were written from each person's point of view, and they showed how people preferred their care to be provided. One person who used the service said, “It’s good here really. We get the help we need and we can talk to any staff if we have any questions. We can go to bed and get up when we like.”

We observed that staff interacted with people in a respectful and sensitive manner. A visiting relative of a person who had recently moved to the home told us that the person was settled and that the staff were, “very caring and very patient.”

Is the service responsive?

People who used the service, their representatives and staff were asked for their views about their care and support and they were acted on. The provider carried out an annual satisfaction survey and followed this with an action plan to address any concerns. There were regular meetings for both people who used the service and for their family members.

We saw that staff carried out monthly evaluations of each person’s individual support plans. However any changes needed following the evaluation were not recorded in the original support plan. This meant that staff would need to read through all the monthly evaluations for each support plan to ensure that they had the most up to date information on how to understand and support the person.

Is the service well-led?

The management team supported and encouraged staff to understand the ethos of the home and to improve the quality of the services they provided.

Staff we spoke with said that managers provided them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They carried out a quarterly assessment of compliance with their corporate standards and an annual satisfaction survey. These were both followed with action plans to address any concerns.