We carried out an unannounced inspection of Rivington View Nursing Home on 19 and 20 December 2016. We last inspected the service on 24 and 25 June 2015 when we found two breaches of regulations; these were in relation to Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Person-centred Care and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Staffing. At this inspection we found that improvements had been made to meet the relevant requirements previously identified at the last inspection.

Rivington View is a two storey purpose built home that provides nursing and personal care for up to 33 people. The home is situated in the centre of Horwich, Bolton and is close to bus routes, shops and other local amenities. The home has various communal and quiet sitting rooms and provides accommodation in single rooms. At the time of the inspection 31 people were using the service.

There was no 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.

Since the date of the last inspection the registered manager had taken up a different post within the home and another person had been recruited as registered manager but had not fully completed the process of registering with CQC. Due to a change in circumstances they were unable to continue in the role and left the home in August 2016.The provider told us it had been difficult attracting candidates for the role in the past and they intended to review the job package on offer with a view to making it more attractive to potential candidates.

People living at the home said they felt safe.

We looked at six staff personnel files and there was evidence of robust recruitment procedures in place. At the last inspection on 24 and 25 June 2015 we found the service had failed to ensure there were sufficient numbers of staff deployed in all areas of the building to meet the needs of the people using the service and there was no formal process of assessing people’s dependency levels. At this inspection we saw that improvements had been made to meet the relevant requirements of this regulation.

We looked at the staff rotas for October and November 2016 and these demonstrated that there were sufficient care staff on duty to meet the needs of people using the service. Since the date of the last inspection the service had introduced a formal dependency tool which was endorsed by the Department of Health.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The home had a whistleblowing policy in place and this told staff what action to take if they had any concerns. The staff we spoke with had a good understanding of safeguarding, abuse and how they would report concerns.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition. This meant staff had access to a range of information regarding how to manage people’s conditions safely.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use.

Monthly infection control audits were in place. There was an up to date fire policy and procedure. Fire safety and fire risk assessments were in place and fire evacuation drills were carried out regularly. This meant that in the event of the need to quickly evacuate the building staff and people who used the service were familiar with the actions required to do this safely.

Medicines were managed safely. Records of medicines administration (MAR’s) had been completed consistently and accurately. We

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 safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found-

Is the service safe?

Rivington View Nursing Home was safe, clean and hygienic. There were adequate numbers of staff available which helped ensure people who used the service had their needs met in accordance with their care plans.

Accidents and incidents were recorded and audited on a monthly basis. If any shortfalls were identified, further investigation took place and they were addressed appropriately.

Deprivation of Liberty Safeguards (DoLS) become important when a person is judged to lack the capacity to make an informed decision related to their care and treatment. The provider told us no applications for DoLS had been made but knew the procedure to be followed if an application needed to be made. On the day of our inspection, no person who used the service was subject to a DoLS.

Is the service effective?

We spent time in communal areas and saw people received care and support when they needed it. It was clear from our observations and from speaking to staff members they had a good understanding of the care needs of people who used the service.

People`s care needs had been discussed with them during a pre-admission assessment. This helped ensure the person`s choices and preferences were recorded and care was provided in accordance with their care plans.

Is the service caring?

Some people had limited mobility and we saw staff supporting them in between rooms which kept them safe. One person who used the service needed hoisting between chairs and we saw staff providing the support in a sensitive and unhurried manner.

We spoke with two people who used the service and two family members who were visiting the care home. One person told us, "Everything here is absolutely superb. The staff are great." Another person told us, "I am more than happy here. I get a little bored at times but that`s just me. Nothing to do with the staff."

Is the service responsive?

The provider had a complaints procedure displayed on the entrance wall and a copy was also provided to people who used the service when they were admitted to the care home. The last complaint we saw recorded was in October 2013 and it had been managed appropriately.

During our inspection, we saw people taking part in various activities. There was a dedicated activities room in the care home and we saw evidence of work, for example paintings, that had been completed by people who used the service.

Is the service well led?

The provider had a quality assurance procedure in place that helped ensure the quality of care provided to people continually improved. Care plans were audited every three months which helped ensure staff members had up to date information related to the care needs of people.

GP and professional visits and appointments were recorded in care plans which reflected a multi-disciplinary approach to providing care. The manager told us they had a good relationship with other agencies which helped ensure people had their care needs met as and when required.

Staff had policy and procedure guidance for consent and they had a good understanding of why consent to care and treatment was necessary.

Care files contained detailed assessments of care or nursing needs. Preferences, likes and dislikes were documented. Risk assessments had also been reviewed when health or care needs had changed. Health professional visits had been recorded. These included visits from GP, dietician, optician and podiatrist.

We spoke with four people who used the service and all comments were very positive. They included:"I am very well looked after here", "The staff here are marvellous, they are like family", "I am very happy here" and "I have everything I need, the girls are lovely, they are so kind".

We noted staff were engaging with and chatting to people who used the service and it was clear they had a professional but very friendly relationship. Staff knew people well and were seen to anticipate people's needs well.

Care was provided in a clean and organised environment. Pictorial signage was noted throughout the building for toilets, bathrooms and pictorial themed corridors.This greatly assisted people who used the service, particularly those who had varying levels of dementia. When we spoke with a relative who was visiting on the day of inspection we were told: "I have always found my X's room clean and tidy, no matter what time of day I come.

Rivington View had effective systems in place to monitor the quality of the service.

Care was provided in either single room or shared accomodation, as agreed. None were en suite, but toilets and bathrooms were adjacent to rooms. The environment was clean and organised.

We found that care was implemented with the agreement of the person involved or with relatives or representatives. Appropriate consent had been obtained for the care plan, data protection, trips out and for the taking of photographs.

Assessments of risk had been undertaken and these included the general environment, mobility, communication, pressure care, fall’s risks and nutrition. Assessments had been reviewed on a monthly basis or when changes had occurred. Care plans had been reviewed and audited.

We observed that when needed people were given assistance during their meal. This was done in a slow and dignified manner, giving the individual time between each potion and drinks were offered at regular intervals. We saw that staff were chatting throughout the meal with people who used the service and generally there was a sociable atmosphere in the dining room.

Rivington View had an appropriate complaints policy in place. This gave staff guidance on how to respond to complaints and about the timescales for responses and closure of complaints. Information for people who used the service and their relatives or representatives on how to make a complaint was displayed in the reception area. A comments and suggestion box was available in the reception area.

One person spoke with said, “I am very happy here, the staff are great”. Another said, “I have no complaints about the care I receive, it’s very good”.

We asked about the choice and quality of the food and were told by one person, “The food is very good, and there is plenty of choice”.

We spoke with relatives who were visiting the home, one said, “You can’t fault the care and commitment given by the staff; they are very good. They keep us informed about what’s going on with our relative”.

Some comments taken from a recent survey included:

The quality of the care provided and the cleanliness of the home was excellent.

I have never had any cause to complain, the meals are good and overall impression of the home was excellent.

A visiting GP stated the quality of care was good, the friendliness of the staff was excellent and the rate of response to our phone calls was excellent.

We carried out an unannounced inspection of Rivington View Nursing Home on 24 June and 25 June 2015. We last inspected the service on 20 August 2014 when we found the service was meeting the standards in all outcome areas inspected.

Rivington View is a two storey purpose built home that provides nursing and personal care for up to 33 people. The home is situated in the centre of Horwich, Bolton and is close to bus routes, shops and other local amenities. The home has various communal and quiet sitting rooms and provides accommodation in single rooms. At the time of the inspection 29 people were using the service.

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 used the service, their relatives and professionals we contacted told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise the risks. Safeguarding policies were in place and staff had an understanding of the issues and procedures.

Medication policies were appropriate and comprehensive and medicines were administered, stored, ordered and disposed of safely.

We saw that people’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Care plans included appropriate personal and health information and were up to date.

The environment was not consistently effective for people living with dementia and provided little stimulation. There was insufficient signage to aid people’s orientation and help them to be as independent as possible.

During the inspection we looked at all areas of the home including people’s bedrooms, the kitchen, bathrooms and communal areas such as the dining room and lounge. We observed the mid-day meal and spent time observing people in the lounge. We spoke with ten staff members, which included the registered manager, five carers, two qualified nurses, the chef and the domestic and a visiting NHS community health worker. We also looked at questionnaires completed by people who used the service and their relatives.

As not everyone at Rivington View was able to tell us about their experiences of living there, we used the Short Observational Framework for Inspection (SOFI.) SOFI is a way of observing care and support to help us understand the experience of people who could not talk to us.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People who used the service and their relatives told us the staff were caring and kind. We observed staff interacting with people who used the service in a kind and considerate manner, ensuring people’s dignity and privacy were respected.

There was an appropriate complaints procedure and we saw that complaints were followed up appropriately.

A number of audits were carried out by the service, issues identified and actions put into place.

Medication policies were appropriate and medicines were administered, stored, ordered and disposed of safely.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to staffing levels and person-centred care.