Riverside Court

Riverside Court is a residential care home providing accommodation and personal care to up to 25 people. The service provides support to older people and people living with dementia. Riverside Court supports people across 3 floors, with various communal spaces including pleasant outdoor areas. At the time of our inspection there were 22 people using the service.

People’s experience of using this service and what we found

The service was not safe. Risks to people were not appropriately assessed, monitored, and managed. Daily notes were not always robust. The security of the building had not been reviewed to ensure people and staff remained safe. Some health and safety checks were out of date. Actions to address unsafe water temperatures and fire safety had not been fully addressed. Infection prevention and control was not safely managed. Medicines were not always stored securely, and medicine records were not always completed. Safeguarding concerns were not consistently raised or investigated in a timely manner, and relevant organisations were not routinely notified. Staff absences were not always covered and not all staff had received up to date key training.

Systems were not in place to adequately assess, monitor, and improve the quality and safety of the service. There were no formal provider audits, and audits completed by the registered manager had not identified most of the issues found on inspection. The quality of the service had deteriorated since our last inspection. Systems had not identified that incidents were not always appropriately reported. People, relatives, and staff were not always fully engaged in the running of the service.

Some areas of people’s care plans were person-centred. Staff knew people well. People felt safe and settled and spoke positively about the staff. The registered manager was very responsive following our feedback and took action to mitigate risks identified. A schedule of provider audits was implemented following the inspection. Most relatives, people who used the service, and staff, spoke positively about the leadership of the registered manager. The service was consistently described as friendly, welcoming, and homely. Relatives told us communication was good, and they were kept up to date.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 January 2021).

Why we inspected

We received concerns in relation to safeguarding and a potential closed culture. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

The provider has responded immediately following our feedback to mitigate the risks identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverside Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, staffing and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Riverside court is a care home providing accommodation and personal care to 18 people aged 65 and over at the time of the inspection. The service can support up to 25 people. The service is within one adapted building with accommodation and communal facilities over different floors.

People’s experience of using this service and what we found

People felt safe and well looked after. All areas were clean, tidy and there was sufficient cleaning taking place to keep people safe from the risk of infection. Relatives felt assured their family members were safe and supported well, especially during the pandemic.

Care plans and risk assessments were in place for people's support needs. People and their families confirmed that they were able to contribute their views on care and support.

Systems were in place for the assessment, monitoring and mitigation of risk towards people who used the service. The manager analysed people’s weights, any falls or incidents to ensure learning from events was undertaken. This meant risks to people's health and safety were reduced.

Staff were patient, kind and respectful towards people. Care was person-centred and staff had time to organise activities and talk with people during the day.

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 manager in place wasn’t registered with us. However, steps had been taken to begin the registration process. The manager provided leadership and oversight within the service. One relative told us, “The management have covered the staffing during the pandemic putting measures in place before lock down and maintained them. Allowed me to drop parcels off once a week and visit in the summer. I don’t suppose they could of done any better.”

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (14 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about people’s nutrition, hydration and pressure care. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe effective and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverside Court care home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Riverside Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

Riverside Court accommodates 25 people, some of who are living with dementia. Accommodation is provided in a large, adapted building.

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.

At the last inspection in April 2017 the overall rating for the service was Requires Improvement. At this inspection the overall rating for the service is Good.

We found improvements noted at the last inspection had been sustained and effective management systems were in place to support continuous improvement.

Risks to people’s wellbeing were assessed and reviewed to promote their safety and welfare. Risks associated with the environment and equipment had been identified and managed. Incidents and accidents were investigated. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Robust recruitment processes were in place. There were enough staff provided to meet people's needs. Staff received appropriate training and support for them to fulfil their roles effectively. Staff understood their roles and responsibilities and knew what they should do if they had any concerns they wished to discuss.

People’s dietary needs were met. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were supported to have maximum choice and control over their lives. Staff supported people in the least restrictive way possible. Policies supported this practice.

People spoke positively about staff and they said staff were caring and kind. People’s privacy and dignity was respected. Feedback from relatives and healthcare professionals was equally positive about the quality of care provided and commended the leadership in the service.

People were consulted about their care and support and their preferences were recorded. Care plans were kept under review and updated in a timely way so staff would know about people’s changing needs.

Complaints raised were responded to appropriately and any issues raised were used as learning to improve the service provided.

The management team operated an ‘open door’ policy and were available for help and advice at any time. Quality monitoring checks and audits took place and people were asked for their opinions about the service. Feedback received was acted upon.

Further information is in the detailed findings below.

At the last inspection on 26 and 27 April 2016 the service was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12, Safe care and treatment; and Regulation 18, Staffing. At this inspection we found the provider was no longer in breach of the previously identified regulations and had made improvements to the service and the care people received.

Riverside Court is registered to provide personal care and accommodation for up to 25 older people, some of whom are living with dementia. At the time of our inspection there were 21 people living there.

There was 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.

During the inspection, we found some concerns regarding quality monitoring which had resulted in shortfalls being missed through the auditing process. Whilst we acknowledge there was a programme of repair and refurbishment, the audits required further improvement to ensure that actions had been implemented and to provide assurance of the continuing effectiveness of agreed actions.

Management systems needed improvement to ensure that best practice guidance was taken into account and guided management decisions. In the past year staffing levels had increased and the improvements in activity and stimulation noted at the last inspection had been sustained. Changes to night staff had been made after consultation with night staff who agreed to the changes and both the provider and the registered manager worked some nights to review the deployment needed. No concerns were raised with us about staffing levels at night. The registered manager gave us assurances that staffing levels would continue to be kept under regular review.

Despite these issues we identified improvements overall. The registered manager followed the principles of the Mental Capacity Act (2005) and we observed staff asked people’s consent before they provided personal care and support. Effective systems were in place to ensure staff received appropriate support and development and were encouraged to develop their knowledge and skills, to provide effective care that met people’s care needs.

People told us staff were kind and caring and they said they were treated with dignity and respect. They were supported to access healthcare through ‘doctor’s surgeries’ held fortnightly at the service. We saw families were kept informed of these and could attend if they wished.

Most people told us they enjoyed their meals and the quality of the food was good.

Care plans were detailed and people were involved in the development and review of their care. Policies and procedures were in place and these were discussed at staff meetings, and at staff supervisions and appraisals.

People using the service, relatives and staff spoke positively about the service. People told us that they had seen further improvements over the past year and thought this was largely due to the appointment of the registered manager and increased staff training. It was evident that the registered manager had worked hard to improve the service and, together with the other members of the management team, they were providing a united management team that worked well together. Although we identified further areas for improvement clear progress was being made.

This inspection was unannounced and took place on 26 and 27 April 2016.

Riverside Court is registered to provide personal care and accommodation for up to 25 older people; some people are living with dementia. The home is located in the market town of Boroughbridge. The building which is over three floors is a former hotel, which overlooks the River Ure. The service has been undergoing renovation over the last few years, and is working towards all bedrooms being en suite. At the time of our inspection there were 19 people living there.

During this inspection we found the provider was no longer in breach of the previously identified regulations and had made improvement to the service and the care people received.

However some areas continued to require further improvement and we identified new breaches of regulations in relation to safe care and treatment.

Since our last inspection the provider had appointed a manager who had registered with the CQC. 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 following the principles of the Mental Capacity Act (2005) and we observed staff seek consent on a routine basis. Training and support had been provided to staff. Staff now understood the legislation and how this applied to people who lived at the service.

Arrangements for quality assurance and leadership within the service had improved.

Despite these improvements we found the service was not providing safe care and treatment to people who lived there. One person who required constant supervision, due to their dementia, had managed to leave the service and was missing overnight. We also identified environmental risks within the service, which, while they were addressed by the registered manager when pointed out, had not been identified and acted upon by the services own auditing and checking. This left people at risk of harm.

Although there were sufficient staff on duty during the day, and evidence of staff being deployed more effectively which had led to an increase in activity and stimulation for people we were concerned about whether the level of staffing available overnight was sufficient to ensure safe care and treatment people using the service.

People told us the food was good and we saw lunch was a pleasant and enjoyable experience for people who lived at the service.

Staff told us they felt well supported and had seen improvements within the service.

Access to support from health care professionals was sought in a timely manner and the registered manager had also arranged fortnightly ‘doctor’s surgeries’ within the service so people could have a health care check and, where appropriate, relatives were encouraged to attend.

Staff knew people well and we saw care was kind, compassionate and dignified. People told us they felt well cared for. Care plans were person-centred and people and their relatives were involved in the development and review of their care.

Despite the challenges at the service over the last 12 months staff morale was good and the staff team, along with people and their relatives spoke positively about the registered manager and gave a sense of confidence in their ability to run a good service.

The provider had updated the policies and procedures within the service and staff were working their way through these. Alongside this the statement of purpose had been updated. People and their relatives were kept informed of the progress the service was making and the provider had ensured a transparent culture within the service.

The service had recently introduced an extensive range of audits to monitor and improve the service people received. In most cases these identified where improvements were needed or lessons learnt, and action was taken. However, the environmental audits had not identified the issues we found.

The service had also, in consultant with an external consultant, developed a robust action plan which identified the improvements which had already been made along with any outstanding actions. However these systems were at an early stage and not all were yet working effectively. Their ongoing impact on maintaining safety and quality needs to be monitored over time.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been cared for in an environment that was well maintained and staff followed infection control procedures to ensure that the environment was kept hygienic. There were some checks that had been carried out but these were not always recorded. Adjustments had been made to the environment to ensure it was safe for those with mobility issues.

A member of the management team was available on call in case of emergencies. Records were detailed and included individual risk assessments where needed. Documentation was stored safely and securely.

When people who used the service had involvement from other services this was recorded in detail to ensure that information could be shared where needed. Referrals were made on a regular basis to medical professionals and specialist services to ensure people were cared for safely and appropriately.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One relative told us. "My relative is very happy here. It's like a real home and I have always been extremely happy with the care received'. Staff had received training to meet the needs of the people living at the home.

There were various systems in place to monitor the quality and effectiveness of the support being provided. The manager and staff used processes and procedures effectively to ensure that the support being provided was right for each individual person.

People told us that they felt the support they were given was always right for them and was effective in meeting their needs. The management checked with people regularly to ensure that the support remained individualised and appropriate.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us 'The communication from staff is excellent. They are such a comfort and provide such caring support". Another person told us "The staff help me with everything I need'.

The atmosphere in the home was relaxed and calm throughout our inspection and staff were attentive in checking that each person was okay and had their needs met throughout the day. When we spoke with staff they explained the ethos of the home and praised the staff team as a whole, with several telling us 'We are a strong team and we work together'.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded. People had access to different types of activities. One person told us 'We go out for trips, do singing and chair exercises. These are things that I enjoy and are good for me'.

Where medical assistance or intervention was required this was sought appropriately and staff followed instructions from medical and social care professionals when caring for people.

There was evidence of the provider gathering feedback from staff and people who used the service and action planning and feedback were shared with people through newsletters and updates. Some of the systems in place for monitoring and auditing required further development to ensure that they were being used effectively to ensure that the service responded to people's needs.

Is the service well-led?

Staff had a good understanding of the ethos of the home. People told us that they could talk to the manager or staff about any issues. Staff told us they were clear about their roles and responsibilities. They said the management were approachable and that they felt well supported by the manager and other senior staff. One person told us 'The management feels like a real family'. Another person told us 'My daughter talks to the manager regularly. They are all very approachable'.

There were senior roles in place to act as manager when the manager was not in the home. The manager was on leave at the time of the inspection.

We found that appropriate systems were in place for assessing, planning and reviewing people's care needs. This included involving people in making decisions about their care. Records we saw showed that some people's consent had been obtained and some people's representatives had been involved, if the person was unable to give their consent. Systems were also in place to provide help with medication, should this need arise.

Records we looked at also confirmed that staff received good training in areas such as medication, basic first aid and safeguarding. Staff we spoke with told us 'They enjoyed their jobs' and that they received good training.

The home had systems in place to monitor the quality of the service and to identify, assess and manage risks to the health, safety and welfare of people using the service. However, minor improvements were needed to some records kept by the home, to make sure that they continually met people's care needs and people were not put at risk.