We inspected The Riverside Nursing Home on the 9 and 16 May 2018. The first day of the inspection was unannounced. The Riverside Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

The Riverside Nursing Home is a detached two-storey converted and extended building situated in the centre of the village of Littleborough, close to shops, local amenities and public transport. It has a car park to the front of the home which can accommodate up to eight cars. At the back of the home there is a small enclosed patio area.

The Riverside Nursing Home is registered to care for up to 25 older people, caring mainly for people living with dementia. There were 18 people using the service at the time of the inspection.

We last inspected The Riverside Nursing Home on 16 and 17 August 2017. During that inspection we found there were six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; unsafe and unclean premises, the privacy and dignity of people who used the service was compromised, suitable and sufficient activities and community involvement were not provided and there was no staff training in caring for people living with dementia.

Following the last inspection of 16 and 17 August 2017 we asked the provider to take action to make improvements. The provider sent us an action plan informing us that they had taken action to ensure the regulations had been met.

Following the last inspection of 16 and 17 August 2017 we also took enforcement action in respect of the provider failing to comply with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 20014 (an ineffective system in place to assess, monitor and improve the quality and safety of the service and records necessary for the management of the home were either not in place or were not accurate). A Warning Notice was served on the registered provider requiring them to comply with the relevant regulations within 14 days from the date of the Warning Notice. During this inspection we found that the provider had complied with the requirements of the Warning Notice.

The service was also placed into Special Measures following the last inspection which meant it was kept under regular review and inspected within six months of the last inspection report being published. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

During this inspection we found there had been a significant improvement and the provider had met some of the previously breached regulations. Due to the improvements seen on this inspection the provider has been taken out of Special Measures.

Although we found that improvements had been made we found further breaches of the Health and Social Care Act 2008 (Regulated-Activities) Regulations 2014. We found there had been a significant improvement in the safety and cleanliness of the environment. Fire exits remained free of obstruction, restrictors had been fitted to most of the windows, most wardrobes were now secured to the wall, the patio areas were litter free and a lock had been fitted to the laundry door. We also saw that most, but not all, of the broken furniture had been repaired or removed. We found however that some safety issues still needed to be addressed, such as; not all wardrobes were secured to the wall, there remained one unguarded radiator and one window remained without a restrictor.

We also found the following; the provider was not compliant with the legal requirements of the Mental Capacity Act 2005 (MCA), there was no risk assessment in place for a person at risk of choking, no pressure ulcer prevention plan for a person at risk

We inspected The Riverside Nursing Home on 16 and 17 August 2017. The first day of the inspection was unannounced. The Riverside Nursing Home is a detached two-storey converted and extended building situated in the centre of Littleborough, close to shops, local amenities and public transport. It has a car park to the front of the home which can accommodate up to eight cars. At the back of the home there is a small enclosed patio area.

The Riverside Nursing Home is registered to care for up to 25 older people, specialising in care for people living with dementia. There were 22 people using the service at the time of the inspection.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the 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.

We last inspected The Riverside Nursing Home on 01 December 2016 when we found there were four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to an unsatisfactory recruitment system, a lack of staff training, support and supervision, no systems in place to monitor the quality of the service provided and a failure to send the required notifications to the Commission. Following the inspection the provider sent us an action plan informing us of what action they had taken to put things right.

During this inspection we found the provider was meeting the requirements of two of the four previous breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found however there was a continued breach of Regulation 17 (1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of the lack of an adequate quality assurance system. There were no systems in place to obtain feedback from people about the facilities and services provided.

There was also a continued breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we found that the most of the necessary training had been provided however the majority of staff had not received training in dementia care to ensure that the needs of people living with dementia were met.

We also identified further breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. Where regulations have been breached information regarding these breaches is at the back of this report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is complete. Where providers are not meeting the fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service.

When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

The breaches were in relation to the safety of the premises, inadequate infection control procedures, failing to protect the privacy and dignity of people who used the service, the lack of suitable activities for people and failing to have records that are accurate and necessary for the management of the home.

The provider had failed to ensure the premises were kept safe, especially in relation to fire safety. Due to the issues of concern identified in relation to fire safety the Greater Manchester Fire and Rescue Service were asked to visit the home. Following the visit by the Greater Manchester Fire and Rescue Service we were informed that the service had bee

The Riverside Nursing Home is a detached house in the centre of Littleborough close to shops and amenities. It is registered to provide accommodation for up to 25 people who require personal or nursing care. At the time of our inspection there were 22 people living in the home. The service was last inspected on 23 March 2015 when it was rated ‘Good’ in all areas.

The service had a registered manager. 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. However the registered manager had notified CQC that they were leaving the service on the 30 November 2016. The registered manager was present on the first day of our inspection. The business manager told us that they had recruited a new manager who would, once in post, apply for registration with CQC. They told us that until the person came into post the business manager would be temporarily managing the service.

This was an unannounced inspection which took place on the 30 November and 1 December 2016. The inspection was undertaken by two adult social care inspectors, an inspection manager and an expert by experience.

During this inspection, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of Care Quality Commission (Registration) Regulations 2009. This was because there were not robust recruitment procedures in place, staff did not received all the training they needed to carry out their roles effectively, systems to monitor the quality of the service were not robust enough and the service had failed to make the required notifications to CQC.

You can see what action we have told the provider to take at the back of the full version of the report.

The safety of people who used the service was placed at risk as the recruitment system was not robust enough to protect them from being cared for by unsuitable staff. Records were not available to show that the required checks had been made before ataff started to work at the servcie.Two staff files did not contain references and one other staff file did not detail a full employment history, including a written explanation for any employment gaps.

Staff felt supported and received an induction to the service, but did not receive all the training they needed to carry out their roles effectively. Staff we spoke with and the records available showed that not all staff had received all mandatory training. Most staff had not completed training in; first aid training, manual handling, MCA and DoLS, challenging behaviour, health and safety, nutrition and dementia awareness.

Systems were in place to monitor the quality of the service, but they were not robust enough and had not highlighted incomplete records and issues with cleanliness in some areas of the building.

The service had not notified CQC of all events they are required to. They had notified CQC of safeguarding concerns, serious incidents and events but had not notified CQC when DoLS authorisations were authorised.

We received mix views on staffing levels at the home. During our inspection there were sufficient staff present to meet people’s needs. We have made a recommendation that the service explores a formal process for assessing staffing levels.

There was a limited programme of activities and social events on offer to reduce people’s social isolation. We have made a recommendation that the provider considers current good practice guidance on suitable activities for people living with dementia.

On the first day of our inspection some people appeared unkempt. People we spoke with told us the staff were caring and knew them well. We observed staff offering support and found staff interaction with people to be caring, re

The Riverside Nursing Home is registered to provide nursing and personal care for up to 25 older people. The home is situated in the centre of Littleborough close to shops and other amenities. This was an unannounced inspection which took place on 23 March 2015. This was the first inspection following the registration of a new owner on 26 September 2014. There were 21 people living in the service at the time of our inspection.

The home 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.

People who used the service and the visitors we asked told us that The Riverside Nursing Home was a safe place to live. Staffing levels were sufficient to meet the needs of people who used the service.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We found that recruitment procedures were thorough so that people were protected from the employment of unsuitable staff.

We saw that medicines were managed safely and people were supported by registered nurses to take their medicines as prescribed.

Appropriate procedures were in place for the prevention and control of infection.

Members of staff told us they were supported by management and received regular training to ensure they had the skills and knowledge to provide effective care for people who used the service.

Senior members of staff had also completed training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they should know when an application to protect a person’s best interests should be made and how to submit one.

All the people we asked told us the meals were good. Snacks and drinks were available between meals. We found that people’s weight and nutrition was monitored so that prompt action could be taken if any problems were identified.

People were registered with a GP and had access to a full range of other health and social care professionals.

We saw that an extensive programme of refurbishment and redecoration of the home was in progress. The written plan of the refurbishment compiled by the business manager stated that most of the work would be completed by the end of 2015. However, we recommend that the registered manager and provider look for a best practice solution to audit the ongoing environmental improvements and how and when they expect to complete them. It would be good practice to record when improvements have been completed to show to the CQC and other organisations how they are meeting their targets. Plans for 2016 included further development of the premises and providing training for the staff team.

Throughout the inspection we saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

We saw that care plans included information about people’s personal preferences which enabled staff to provide care which was person centred and promoted people’s dignity and independence.

Leisure activities were routinely organised within the home and in the local community. These included individual and group activities. People who used the service were accompanied people to the local shops, café and pub. Local clergy regularly visited the home and offered Holy Communion for people who wished to practice their faith in that way.

People who used the service and their representatives were given a copy of the complaints procedure. There had not been any complaints made to the CQC or local authority since the last inspection.

The registered manager was approachable and supportive and regularly sought the views of people who used the service and their representatives in order to identify areas for improvement.

We saw that systems were in place for the registered manager to monitor the quality and safety of the care provided. Audits completed regularly covered all aspects of the service provided.