The inspection was carried out on 5 and 12 September 2018 and was unannounced on both days.

Riverview 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. Riverview accommodates up to 60 people in one adapted building. Accommodation is over four floors. At the time of our inspection there were 33 people living at the home.

There was a registered manager in place. 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 last inspection took place in December 2017 and January 2018. The report was published in March 2018. At that time the service was rated inadequate and placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People told us they felt the service was safe. The registered manager understood their safeguarding responsibilities and staff knew how to recognise and report concerns about people’s safety and welfare. All the required checks were done before new staff started work. This helped to protect people from the risk of being cared for by staff unsuitable to work in a care setting.

There were enough staff on duty to keep people safe. Staff were trained and supported to carry out their roles.

Risks to people’s safety and welfare were assessed but the records did not always show who had carried out these assessments. Therefore, we could verify they had been done by a suitably trained person.

The home was clean. Inside it was well maintained and safe and improvements had been made to create a more dementia friendly living space for people. The outside patio area had uneven flags which potentially created a trip hazard.

People’s medicines were managed safely.

The service was working in line with the requirements of the Mental Capacity Act (2005) and acting in people’s best interests. However, this was not always clearly recorded.

People were offered a variety of food and drink which took account of their cultural and religious dietary needs and preferences. We recommended the service look at the timings of meals with the aim of supporting people to have their meals at regular intervals.

The service worked with other agencies to support people to meet their health care needs.

People told us staff were kind and caring and most of the interactions we observed were good. However, people’s dignity was not always respected. Improvements were needed to the way meal times were managed.

People’s care needs were assessed and care plans were in place to guide staff. People were supported to plan for their end of life care.

People had the opportunity to take part in a range of social activities. Doll and pet therapy was used to support people to engage with their environment and others.

Complaints were dealt with. The provider had systems and processes in place to assess and monitor the quality and safety of the services provided. They need to show they can sustain these improvements and continue to develop the service before we can be assured people will consistently experience safe and effective care which is responsive to their needs.

We found the provider remained in breach of one regulation. This related to their quality assurance and governance systems. You can see what acti

The inspection took place on 19 December 2017 and 4 & 24 January 2018. All the visits were unannounced. On 19 December 2017, there were 47 people who used the service; on 4 January 2018, there were 45 and on 24 January 2018, there were 44.

Riverview 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 care home accommodates 60 people in one adapted building. Accommodation is provided over four floors.

The last inspection was carried out in June 2017 and the overall rating for the service was ‘requires improvement’. The provider was in breach of four Regulations. These related to staffing (Regulation 18), staff recruitment (Regulation 19), meeting people’s nutritional needs (Regulation 14) and good governance (Regulation 17). We took enforcement action and issued warning notices in relation to the breaches of Regulation 14 (nutrition) and Regulation 17 (good governance). We issued requirement notices in relation to the breaches of the staffing and recruitment Regulations. We met with the provider to discuss their plans for making the required improvements to the service. We informed the provider we were concerned this was the second consecutive inspection when the overall rating was ‘requires improvement’. The service was rated ‘requires improvement’ in June 2016. We asked the provider for an action plan and they have sent the Commission monthly updates on their action since then.

During this inspection, we found improvements had been made in relation to supporting people to meet their nutritional needs. However, we found other areas of the service had not improved. In addition to two continued breaches of Regulations in relation to staffing, and good governance we identified five new breaches of Regulations. These related to safe care and treatment, consent to care and treatment, person centred care, dignity and respect and the cleanliness of the home.

Since the last inspection in June 2017, there had been a change of registered manager. The new manager was registered by CQC 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.

There were not enough staff deployed to meet people’s needs. On the first day of our inspection, we found staff were routinely getting people from 5am without any evidence to show this was what people wanted or was in their best interests. This improved over the course of the inspection. However, we were concerned the provider had not identified or addressed this, particularly as we had made then aware of concerns about staffing levels at the last inspection.

We found care was not always delivered in a way which was appropriate to people’s needs and people were at risk of receiving care which was not safe. People’s care records were not up to date and did not provide staff with information about their individual needs and preferences.

People told us they felt the service was safe. Staff had received training on safeguarding; however, they needed more support to understand how to apply this training in their day to day work.

There were recruitment procedures in place but we were unable to test how well they worked because no new staff had been employed since our last inspection.

On the first day of our inspection, we found the home was not kept free of unpleasant odours. We found risks to people’s health and safety were not always identified and managed. More needed to be done to create a ‘dementia friendly’ environment; the provider told us they had started work on this.

We found people’s m

The inspection started on 6 June 2017 with an unannounced visit to the home and continued on 7 June 2017. On 27 June 2017 we visited the home again; this visit was announced at short notice as we needed to make sure the administrator was available. There were 50 people who used the service at the time of our inspection.

The home provides personal and nursing care for up to 60 older people. It is a large converted property and is located close to the town centre of Ilkley. The accommodation is on four floors and consists of shared and single rooms of which 17 have ensuite facilities. There are two passenger lifts giving access to all areas. The communal areas are on the ground floor. There are gardens which are accessible to people.

The last inspection was carried out in April 2016. At that inspection we rated the service as ‘requires improvement’ and there were three breaches of regulations. They were in relation to safeguarding, person centred care and good governance. The provider sent us an action plan showing the actions they were taking to address these concerns. During this inspection we checked to see if the required improvements had been made. While we found some aspects of the service had improved we found the pace of improvement was slow. We found three new breaches of regulations and found the provider remained in breach of the regulation about good governance.

There was a registered manager in place when we carried out the inspection. Following the inspection the provider told us the registered manager had resigned from their 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. The provider told us the clinical lead nurse would take responsibility for the day to day management of the home until such time as a new manager was appointed.

People who used the service felt safe and we found staff knew how to recognise and report concerns about people’s safety and welfare. However, we found the necessary checks on new staff were not always carried out in line with the provider’s policy. This could put people at risk of being cared for by staff unsuitable to work in a care setting.

We found they were not always deployed effectively at busy times of the day.

The home was clean, the environment was generally well maintained and there was evidence of on-going refurbishment. However, we found some working practices were creating risks to people’s safety and welfare. These risks had not been identified by the provider until we brought them to their attention.

People received their medicines as prescribed and medicines were managed safely.

Most people were happy with the food. However, we found there was a risk people were not always getting the right support to make sure they had adequate amounts of food and drink. Our observations of meal times showed this was not a positive experience for people.

People were supported to meet their health care needs and had access to the full range of NHS services. Feedback from visiting health care professionals was positive.

The service was working in line with the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards which helped to make sure people’s rights were protected and promoted.

People received care and treatment from staff who were trained and supported to carry out their roles.

We observed a lot of positive interactions between staff and people living in the home. We found staff to be caring and compassionate. People told us they found the staff to be caring and people’s relatives told us they were involved in decision making and kept informed about changes in people’s needs.

We found there was sometimes a lack of attention to detail when dea

This inspection took place 14 April 2016 and was unannounced.

The home provides personal and nursing care for up to 60 older people. It is a large converted property and is located close to the town centre of Ilkley. The accommodation is on four floors and consists of shared and single rooms of which 17 have ensuite facilities. There are two passenger lifts giving access to all areas. Most of the communal areas are on the ground floor, there is one lounge on the first floor. There are gardens which are accessible to people.

The service had a registered manager in place. 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.

Staff knew how to recognise abuse and report a safeguarding concern. Some recent safeguarding incidents had not been dealt with by management.

We saw sufficient staff deployed to keep people safe. At busy times staff were very task orientated and could not always respond to people’s needs in the most effective way.

Staff had applied for the post, been interviewed and had all relevant background checks completed before starting to work alone.

People were assessed for risk for their health and wellbeing. However as people’s risks changed, this was not always recorded on risk assessment documentation.

Staff had completed mandatory training to enable them to complete their roles effectively. Further training courses were available to support people in a more effective way.

We had positive feedback about the food offered. We observed people had a choice of hot or cold food for breakfast. Menus were only displayed on the ground floor.

People had been referred to health care professionals in a timely fashion. Healthcare professionals told us they had a positive relationship and worked closely with the home.

Deprivation of Liberty Safeguards authorisations had been completed correctly and the home carried the correct paperwork. However there was a cumulative effect for other restrictions on people that had not been referred.

People told us and we saw that people were treated with privacy and dignity. People said staff were very caring and they would help as much as they could.

Relatives told us they had been involved in the planning of care. Care records for people had been signed by relatives. Minutes from best interest meetings were also evident.

We asked staff about the people they supported. They told us specific detail about people and how they liked their support. This showed us a good understanding of the people they supported.

The home benefitted from an activities co-ordinator. One of the communal areas on the ground floor listed activities for the day. The first floor lounge was very quiet with music and TV playing all day.

Care records had not always been completed or reviewed to reflect people’s current needs. We saw some care records had identified changes, but these changes had not happened.

People and relatives told us they knew how to make a complaint. We saw the registered manager had acted on previous complaints in line with the provider’s policy.

The culture of the environment was different depending on where in the home you were. The ground floor had a livelier atmosphere with more light, contemporary decoration and more happening. The first floor appeared very quiet with not much to do.

Audits had been completed by the provider and the registered manager. Some audits had not been completed in a robust way, or reacted to in a timely fashion. This left some people at potential risk.

People told us they had regular meetings to pass their views on about the home. Staff had team meeting planned in and relatives had four meetings a year in order to constantly improve.

We found three breech’s of the Hea

We spoke with four family members who were happy with the care being given at Riverview. One family member said, "The staff are amazing" and another one said, "They are well cared for". We saw people were wearing appropriate clothing and footwear and were supported by staff in a respectful manner.

We saw polices in place to safeguard people from abuse. We spoke to one person who uses the service who said "I have no complaints here".

We saw evidence that staff are recruited appropriately and receive training to complete their role.

People we spoke with were happy with the care they received at Riverview. We saw people were wearing appropriate clothing and footwear, were supported by staff in a respectful manner and we saw the staff supporting people to be independent. The home had conducted a resident / family survey in October 2012 and all the people who had completed the questionnaire said they were happy with the level of dignity and respect shown to the people who used the service.

We spoke with five people who were using the service and they all told us they were happy with the care they were receiving at Riverview Nursing Home.

One person told us that "They look after me really well. I have no complaints about the care I have received". and another person told us "They are good to me here" and another that "I wouldn't be able to go home regularly for visits now if it weren't for the good care I get here".

We used different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant that they were not able to tell us their experiences.

We observed people using the service whilst we looked around the whole home and saw that whilst some had remained in their rooms, most people were sitting in the lounges. There were televisions on in both of the lounges and we saw some activities in the downstairs lounge including dominoes and a game with a soft ball. The people using the service looked to be enjoying the activities.

Although many of the people using the service could not communicate with us, one person told us "It's alright here."

People told us they were satisfied with the care and support provided at Riverview Nursing Home. Visitors told us they were able to visit when they wanted to and said they were kept informed about their relatives care and any changes in their needs or condition. Visitors told us that if they had any concerns they talked to the manager or staff and their concerns were dealt with.

The inspection was unannounced. At the last inspection in November 2013 the home met all the national standards that we looked at.

The home provides personal and nursing care for up to 60 older people. It is a large converted property and is located close to the town centre of Ilkley. The accommodation is on four floors and consists of shared and single rooms of which 17 have en-suite facilities. There are two passenger lifts giving access to all areas. Most of the communal areas are on the ground floor, there is one lounge on the first floor. There are gardens which are accessible to people. On the date of the inspection 58 people were living in the home.

A registered manager had not been in place since March 2014. 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. We spoke with the manager running the service about the lack of registered manager in place. They told us they had tried to recruit but struggled so had decided to become the registered manager themselves. We saw confirmation that an application had been made by the manager to become registered with the CQC.

Feedback regarding the quality of the service was positive from people, their relatives, and care professionals. They all told us people had their needs met and were encouraged to do as much as they could for themselves. They also said the service was good at dealing with any risks which emerged.

We found sufficient food was available to people. People told us they enjoyed the food and could request a different option if they didn’t like the food on the menu. We observed one dining area over lunch time. One member of staff supported four people with their meals. This meant some people had food in front of them but did not have support to eat it and some peoples food would have started to go cold.

Systems were in place to ensure medicines were safely managed. Medication was stored in line with guidance and nurses administered the medication.

We spoke with people and their relatives and they felt people were respected and treated in a dignified way.

Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA) and how to ensure the rights of people who lacked mental capacity when making decisions was respected. We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards (DoLS).

We found care records were written in a person centred way for each individual. People’s plans contained specific information staff needed to be aware of in order to work effectively with that person. Plans had people’s likes and dislikes as well as their history. This helped staff get to know people using the service and build up a professional relationship with them.

Relatives and staff told us the manager was understanding and supportive and said they believed they would take concerns seriously. Systems were in place to continuously improve the quality of the service. This included a programme of audits and satisfaction questionnaires. We saw complaints had been recorded appropriately, managed and responded to. The manager had liaised with the appropriate authorities when dealing with complaints.