This inspection took place on 26 October 2017. It was an unannounced visit to the service.

We previously inspected the service in October 2016. The service was not meeting all of the requirements of the regulations at that time. At the last inspection we found breaches of the regulations in relation to recruitment practice and notifying us of events which they were required to. We asked the provider to take action to address these breaches. They sent us an improvement plan which outlined what they would do to remedy matters. During this inspection we saw the required improvements had been made.

The Cookham Riverside is a nursing home which provides nursing and personal care for up to 35 older people. Twenty five people were living at the service at the time of our visit.

The service had 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. The service was managed well overall. However, we have needed to put a limiter on the rating of the ‘well-led’ domain due to a condition of registration not being fully met. This needs attention by the provider and registered manager.

We received positive feedback about the service. Comments from people included “Lovely people here, very good, no complaints at all. Staff treat me very well indeed,” “The staff are nice and talkative” and “Carers are very good.” Feedback from a community professional included “I have no concerns regarding the standard of care available and wish all the homes I visited were as welcoming and caring as the staff at Cookham Riverside. If I had an elderly relative I would happily place them in this home.”

People were cared for by staff who had been recruited appropriately. Staff received support to help them meet people’s needs. This included training and meeting with their managers to discuss practice.

People were safeguarded against the risk of abuse. Staff knew how to raise any concerns. There were procedures for them to follow if they felt people were being harmed in any way. People received the healthcare support they needed; their medicines were managed well and given to them in accordance with their prescriptions.

The care and support people needed had been recorded in care plans. There were risk assessments to reduce the likelihood of people being harmed or injured whilst they received support. Both types of document had been reviewed regularly to make sure they kept pace with changes to people’s circumstances.

People knew how to raise any concerns and were relaxed when speaking with staff and the registered manager. Complaints were responded to appropriately. People were asked for their views about the home in reviews and via surveys. The quality of people’s care was regularly monitored.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The building was well maintained and complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

This inspection took place on 7 and 10 October 2016. It was an unannounced visit to the service.

We previously inspected the service on 20 and 26 November 2015. The service was not meeting the requirements of the regulations at that time as we found a breach of one regulation. This was in relation to recruitment practice. We also recommended improvements were made to the staff induction process, to training for staff who assess people for hoist slings and to the recording of complaints.

The Cookham Riverside is a nursing home which provides nursing and personal care for up to 35 older people. Twenty four people were living at the service at the time of our visit.

The service had 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.

We received positive feedback about the service. Comments from people included “It’s a good place; I’m very pleased with mum’s care,” “It’s very nice indeed,” “All the staff are very good; they’re kind and caring” and “The food is excellent.” Health and social care professionals spoke positively about standards of care. One told us “I always find the staff very approachable and welcoming. The staff are always very receptive to any feedback regarding the clients.” Another said “I have always found Cookham Riverside extremely professional, friendly and welcoming in my dealings with them. I have used them frequently…and I recommend them to families very warmly. This home is the one I prefer to use above others in the area due to the smoothness with which the processes work and the feedback I have from families after their loved ones are admitted.” A third healthcare professional told us “They are so attentive...I find them excellent.”

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Risk was managed well at the service so that people could be as independent as possible. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. People’s medicines were handled safely and given to them in accordance with their prescriptions. Improvement had been made to moving and handling practice since the last inspection. Staff who assessed people for hoist slings had completed relevant training to make sure people had the right equipment to meet their needs.

We found there were sufficient staff to meet people’s needs. People told us staff were around when they needed them at all times of day or night. Improvement had been made to the induction of new staff. Staff now completed the nationally-recognised Care Certificate. The Certificate consists of an identified set of standards that health and social care workers need to demonstrate in their work. Staff received the support they required through staff meetings, supervision and training.

The home had made an improvement since the last inspection to how they recruited staff. We saw information was now sought about health conditions, to make sure prospective staff members were fit to perform their duties. However, we found inconsistency regarding the level of screening for criminal convictions. In some cases a basic check had been requested, rather than an enhanced one. This meant checks of the full range of databases had not been carried out by the Disclosure and Barring Service.

Care plans had been written to document people’s needs and their preferences for how they wished to be supported. People told us there were lots of activities arranged at the home, including trips out and visiting entertainers.

The building was well maintained and complied with gas and electrical s

This inspection took place on 20 and 26 November 2015. It was an unannounced visit to the service.

We previously inspected the service on 27 January 2014. The service was not meeting the requirements of the regulations at that time in one area of practice: assessing and monitoring quality of care. The provider wrote to us and told us what action they would take to make improvements at the home. We carried out a desktop review in September 2014, when we found the home was meeting the regulations.

The Cookham Riverside is a registered nursing home which provides nursing and personal care for up to 35 older people. Twenty seven people were in residence at the time of our inspection.

The service had 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.

We received positive feedback about the service. Comments from people included “They look after you pretty well,” “They listen to any ideas or concerns,” “Staff are lovely,” and “They’re very caring and friendly here.”

Healthcare professionals told us the home referred people appropriately and staff were responsive to any advice or recommendations they made.

There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. Risk was managed well at the service so that people could be as independent as possible. Written risk assessments had been prepared to reduce the likelihood of injury or harm to people during the provision of their care. People received their medicines safely and in accordance with their prescriptions.

There were sufficient staff to meet people’s needs. There was an on-going training programme to provide and update staff on safe ways of working.

Care plans had been written, to document people’s needs and their preferences for how they wished to be supported. These had been kept up to date to reflect changes in people’s needs.

The building was well maintained and complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order.

The service was managed well. The provider regularly checked quality of care at the service through visits, audits and attending staff meetings.

We have made recommendations about the induction format for new staff, how people are assessed for hoist slings and the recording of complaints or any issues raised by people who live at the home.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was in relation to staff recruitment. You can see what action we told the provider to take at the back of the full version of this report.

During our visit we saw that staff treated people with dignity and respect. Staff were seen to knock on doors before entering and provided assistance in a kind and discreet manner. People that we spoke with were very positive about the home and staff team and comments included, “I like it here I get on well with staff," "always respond to requests" and "don't think you will find any better than here."

There was a relaxed and comfortable atmosphere within the home and the staff we spoke to understood how to support people, assisted them to make choices and maintain as much independence as possible. A member of staff told us "there's a team approach to care," "another said "we encourage independence, no matter how little."

In order to protect the people who used the service, we saw that the home carried out a rigorous staff recruitment process. We saw that staff were knowledgeable regarding safeguarding and about people's needs and preferences. Staff were observed to treat people as individuals and delivered care in a personalised way.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires, reviews and one to one discussions.

Relatives we spoke to told us they were very happy with the standard of care. "Comments included "never had any cause for concern, care is extremely good," "Won't get any better care," and "care plan's are consistent, I see it and sign and can always add to it."

People we spoke with said they were treated with respect. They told us that staff respected their wishes if they wanted to spend time in their rooms. They said they could have their meals in their rooms and we saw evidence of this during our visit. They said there were always choices at mealtimes and the day's menu was written on the board in the dining room.

People told us the library could be used if they wanted to see their visitors in there. We saw staff responding patiently and politely to people who asked questions about their care.

People told us there were activities they could take part in, including going out in the minibus to go shopping and on trips.

People that we spoke with said they received good care. Comments included 'marvellous', 'no complaints', 'perfectly happy here' and 'I've got everything I want'. A regular visitor to the service said 'you get love, care and compassion here.' People said there were staff around when they needed them and that call bells were answered within reasonable times. One person told us that personal care was carried out sensitively and in a dignified manner.

People that we spoke with said they knew who to speak with if they had any concerns about the service. None of them said they had needed to make a complaint about their care.

We spoke with people who lived at the home and observed care being given. We spoke to a visitor who was very complimentary about the home. Staff we spoke with were motivated and felt valued and supported. We carried a follow-up visit to explore further a finding from the initial visit.

Care plans were detailed and personalised, and some people had been involved in writing them, but the reviews did not always contain the information needed to determine how the care plan needed to change to best meet the person's needs. People felt involved in their care and were also able to make choices in respect of their care and support.

People were treated with dignity by staff and we saw evidence of good attention to detail in the dining room where the tables were nicely laid for meal times.

Staff demonstrated a good understanding of their responsibilities in relation to safeguarding. Staff appeared calm as they carried out their work and there were enough staff to meet people's needs.

The home appeared clean and we saw that some areas had been refurbished whilst other areas were due to be refurbished. People living in the home were satisfied with the cleanliness but one person felt that greater attention to detail was needed in relation to decor.

There were no formal processes in place to monitor the quality of the service. There was little evidence that routine audits and quality monitoring checks were carried out and staff confirmed that these were not done.