Archived: River View Care Home

Updated 28 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 17, 18, 20, 24 and 27 October 2017. We also attended on the 19 to give specific feedback on one person. The first and last day were unannounced. This first inspection date was carried out in the evening due to concerns we had about the safety of people in the service.

The inspection team varied across the five days and included three inspectors, a pharmacist and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed the information of concern we had from whistle-blowers, families and the local authority that told us there were immediate concerns. From this information, we decided to carry out an inspection. We also reviewed our records such as notifications which are specific events registered people have to tell us about. We also looked at past inspection reports.

During the inspection, we looked at the care of 15 people to ensure they were receiving the necessary care and treatment. We visited all the people and spoke to as many as we could over the days we were there. We spoke with seven visitors who were relatives or friends. We observed how staff interacted with people in the communal areas. This included the use of a SOFI (Short Observational Framework for Inspection) which is a tool to observe the care of people who cannot otherwise communicate with us.

We looked at five staff personnel files, training records and how training, support and supervision was being planned and overseen. We spoke with 10 staff. There was a temporary manager, regional manager and nominated individual who we spoke to as needed for more information.

We reviewed the records used to reflect on the quality of the service and records on maintenance of equipment and the premises. We requested a questionnaire was given to family and visiting friends and we received five of these back.

During the inspection we spoke with three community nurses, a tutor of further training and two social care workers.

As we had concerns raised about fire safety, we notified the local Fire Safety Officer who attended on the 18 October 2017 and found issues that have been communicated to the provider. During or immediately following the inspection, we have also contacted the district nursing service, the police, the local GP surgery, the local Environmental Health Officer, Health and Safety Executive and local authority safeguarding department.

Updated 28 April 2018

The inspection took place on the 17, 18, 20, 24 and 27 October 2017. On the 19 October we also visited the service to give some specific feedback. The first and last day was unannounced. We had received information of concern from whistle-blowers, families and the local authority that told us there were immediate concerns. The information included concerns about the leadership the service, staffing levels, continence care, medicine management and staff training. Concerns raised by staff had not being addressed in a timely, supportive way and a person had left the building when they were not safe.

Following receiving this information, we carried out a comprehensive inspection and found these concerns to be valid. The first inspection visit was carried out in the evening due to the safety for people in the service. We also found several other concerns which are summarised below.

We had concerns raised about fire safety, we notified the local Fire Safety Officer who attended on the 18 October 2017 and found concerns that have been communicated to the provider. During and following the inspection, we have also contacted the district nursing service, the local GP surgery, the police, the local Environmental Health Officer, Health and Safety Executive and local authority safeguarding department. Not everyone had Personal Emergency Evacuation plans in place. Not all maintenance concerns had been addressed as needed. Not all staff knew how to evacuate people safely in the event of a fire.

The service was registered under this provider on the 5 November 2014. The inspection was inspected on 26 August 2015 and rated Requires Improvement in all key questions and overall. Breaches of regulations in respect of Regulation 9, 12 and 17 were found. Requirement notices were served. The service was re inspected on 21 September 2016. The service was then rated Good in all key questions and overall.

River View Care Home (referred to as ‘River View’) is registered to accommodate up to 80 older people who may be living with dementia and/or have a sight impairment and physical impairment. People can receive nursing care at the service. On the first day of the inspection, there were 37 people using the service (with one in hospital) and 32 people using the service on the last day, with one person in hospital. River View has four floors but two were currently not being used.

A registered manager is registered for the service but last worked in the service at the end of September 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. A temporary manager had been placed in the service by the provider. They and the regional manager were at the service daily (Monday to Friday) with duty cover provided over the weekend.

Staff were not always treating people with respect and dignity. Staff were task focused. Although some positive feedback was received, the concerns had raised with us told us people were not in control of their care, and were not being treated in a way that showed the service was compassionate and caring. This included people at the end of their life. People’s religious and cultural needs were not being planned for at the time of the inspection.

People’s care was not personalised and people’s basic needs were not always being met. People were also not being given the opportunity to have a say about their care on all occasions and where they could not communicate, family were not involved in planning and designing bespoke care.

People’s capacity was not assessed in line with the Mental Capacity Act 2005. Decisions had been made in respect of people’s care without detailing if this had been in people’s best interest. Staff had minimal understanding of the legal processes they were required to follow to respect people’s human and legal rights.

People had risk assessments in place but these were out of date, not reflective of the risks they presented and not clearly linked to their care plans. People’s risks associated with specific needs to that person were not always in place and guidance was not then available to staff. For example, there were no records for people with diabetes of how staff could identify when their blood sugar was too high or low and what action to take. People experiencing several falls were not being reviewed in a timely way. There was no analysis of incidents including falls to reduce the likelihood of further injury to people.

People’s health, nutritional, hydration and care needs were not always met. People’s health needs and the support required were not always identified quickly enough to prevent them experiencing further harm. We found one person left in faeces, and others where their hydration status was not clear. Staff did not always notice changes in people’s health needs, did not pass on health concerns to ensure people were checked and reviewed by health professionals.

People were not always partners in planning their own care. People’s preferences were not always recorded or acted on. People told us they could only have a bath when staff told them. People were also happy that they could have the choice of food they liked.

The administration of medicines was unsafe. We found that when people had medicines prescribed to be taken “when required” that the care plans on how these were to be managed were not complete. We found that a number of people had covert medicines agreements in place. This means that people may be given their medicines disguised in either food or drink. These agreements did not follow either best practice guidance or the provider’s own policy. This meant that people may not have their wishes respected about how they wish to take their medicines. We saw that some medicines were left in an unattended area where they were accessible to people who may have a diagnosis of dementia. Medicines requiring refrigeration were not guaranteed to have been kept at the optimum temperature. The application of prescribed creams was not recorded consistently.

Training identified by the provider as mandatory training had not been completed. This included ensuring all staff were up to date with their medicines training and competency checks. For example, in respect of people living with dementia and presenting behaviour that may challenge. This impacted directly on people where staff were required to assess a person in respect of “as required” sedative medicines. The lack of training for staff in dementia care may have contributed to the reasons why staff did not appear to understand the needs of people living with dementia. Also, it failed to ensure a good basic standard of care among all staff new to care. Staff were not being supported to maintain good standards of care through supervision, appraisals and checks on their competency.

Staffing the service safely had been an issue prior to and during the start of the inspection. There had not always been sufficient staff on duty to deliver care safely. People were not protected by staff and systems which would ensure abuse was identified and reported. Staff on duty were not deployed based upon their skills and experience. Nursing staff were frequently called to advice on residential people at the service, rather than the district nursing team.

People were not being supported to be socially stimulated or physically active. Activities were not provided in groups or on a one to one basis. During the first week of the inspection the activities co-ordinator was on annual leave. On the second week the activities co-ordinator provided activities on floor two, however, we did not observe them on floor one until the last day of the inspection. People’s links with the community were not maintained. People’s religious needs were not being met.

Staff were not always following safe infection control practices to ensure people were protected from the likelihood of cross infection. Floor one smelt of urine on the first two visits which was addressed but the floor remained sticky under foot. However, the provider has advised,

cleaning processes were in place, and the stickiness may have been caused by non-slip safety treatment. We found people were not kept clean and on two occasions found one person nearing the end of their life lying in faeces. One staff member was allocated on some days to work in the laundry and to do the cleaning. They told us they struggled to cope with all that was required in the time available.

We found there had been poor leadership and governance. Poor auditing and a lack of action led to multiple breaches of the regulations. Where concerns had been identified, they had not been acted on. Staff described how they hoped things would now change with the new managers or in the future. Other staff and relatives were wary as they had seen so many managers come and go.

There was a complaints process in place but complaints were not recorded and acted on since the last inspection. Those wishing to raise a concern did not receive the required feedback and resolve.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the