The Devonshire Also known as 1- 3883899011

River View Care Centre is a residential care home providing personal and nursing care to a maximum of 137 people. At the time of the inspection the service was supporting a total of 70 people.

The service provides facilities over three floors, and six units. Five of the units had recently undergone immense refurbishment. The units had been redecorated to meet the needs of people. For example, one unit had been specifically renovated to successfully support people living with dementia remain independent and able to access their room and communal areas freely. Each bedroom was individualised with en-suite facilities. An enclosed garden to the rear of the property was accessible from the ground floor. Relatives of people used this to visit their loved ones within the home.

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

The service had ensured people were kept as safe as possible by identifying, assessing and reviewing risks. Care plans were kept up to date, with actions identified on how to mitigate risk to people.

Medicines were safely managed and audited. Staff trained and assessed as competent administered medicines only.

Recruitment checks were completed for all staff employed at the service, to ensure they were safe to support and care for people. These were regularly audited to ensure compliance with the regulations.

The service had comprehensive infection and control plans in place to help ensure the service managed the pandemic. We saw robust policies and procedures in place. We spoke with the registered manager to ensure all actions were attainable. Where required amendments were made to ensure compliance with the provider’s internal policy. The service was very clean and free of malodour.

People were supported to eat and drink safely. Where required they had their food and fluid safely monitored. Records indicated staff closely maintained an overview of the nutrition and hydration checks. Where appropriate support from external professionals was sought within a timely manner.

Staff had a comprehensive understanding of the MCA. People were encouraged to make choices and retain as much control as possible over their lives and care.

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.

People were supported by a staff team that in turn was well supported by the registered manager and provider. Staff were compliant with all identified training, and had effective strategies of support with one to one chats and supervisions, team meetings and daily handovers.

The service had undergone extensive adaptations to the environment. These reflected and met the needs of people living at River View Care Centre.

The registered manager worked proactively to ensure an open door, transparent and inclusive method of working was attained at the service. This included staff, external professionals, people and relatives.

Feedback was sought and actioned to ensure care and practice was reflective of meeting the needs of people. People, professionals, relatives and staff were extremely complimentary of the registered manager and staff team.

The service was extensively audited. This meant the registered manager had retained a complete overview of the practice, safety and effectiveness of how the care home operated.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (published 05 September 2019) and there were multiple breaches of regulation. The provider completed monthly action plans after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations 12 (safe care and treatment), 14 (meeting nutritional and hydrational needs), 17 (good governance) and 19 (fit and proper persons employed). We did not focus on the domains of caring and responsive, however we found there to be sufficient improvement within regulation 9 (person centred care) and 10 (dignity and respect) for the service to no longer remain in breach. As the KLOEs related to these domains were not inspected against, we are unable to comment on the entire domains.

This service has been in Special Measures since the September 2018 inspection. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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.

River View Care Centre is a care home with nursing. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides facilities over three floors. There were six units in the home across these three floors. At the time of the inspection, two of the units were closed for refurbishment work. People have their own bedrooms with en-suite facilities and use of an enclosed private garden. Some of the people supported at the home live with dementia and other health related conditions. The service is registered to provide accommodation with personal and nursing care for up to 137 people. At the time of our inspection there were 77 people living there.

People’s experience of using this service and our findings:

The service assessed risks to the health and wellbeing of people who use the service and staff. However, care was not always delivered by staff in line with people’s care plans to mitigate these risks.

Safe recruitment practices were not always followed to make sure, as far as possible, that people were protected from staff being employed who were not suitable.

Staff failed to consistently monitor food and fluid intake or take appropriate action in line with people’s care plan. Care records did not evidence that people’s nutrition and hydration needs were always met.

People were not always treated respectfully or in a way that promoted their privacy and dignity.

People did not always have person-centred plans to guide staff on how to meet people's needs. Some staff practice was not always person centred.

Care records were not always up to date and accurate. Governance systems were not always effective and did not always identify actions for continuous improvements.

There was an activity programme and some people were involved in activities. However, people were not consistently provided with social and recreational activities that met their individual needs and enhanced their lives.

We have made a recommendation that the provider explores all relevant guidance and best practice on how to ensure they make environments used by people living with dementia more dementia friendly.

We have made a recommendation that the provider review staff knowledge and understanding of the Mental Capacity Act (2005) and its application in relation to decision making and consent.

People were assisted to take their prescribed medicines by staff who were assessed as competent to do so. Where people required their medicines at a specific time or with food, this need was met. Storage and handling of medicine was managed appropriately.

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.

Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. People and their relatives knew how to complain and knew the process to follow if they had concerns. People, relatives and staff felt they could approach management with any concerns they may have.

People had their healthcare needs identified and were able to access healthcare professionals such as their GP, when needed. The service worked well with other health and social care professionals to provide effective care for people.

The service had regular residents and relatives' meetings as well as staff meetings to ensure there was opportunity to feedback about the home and that there would be a consistency in action taken. The staff team had handovers and daily meetings to discuss matters relating to the service and people’s care.

Rating at last inspection:

At the last comprehensive inspection which took place in September and October 2018 (report published on 30 November 2018) the service was rated Inadequate. We identified several breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 9 (Person-centred care), Regulation 10 (Dignity and respect), Regulation 12 (Safe care and treatment), Regulation 14 (Meeting nutritional and hydration needs), Regulation 17 (Good governance), Regulation 19 (Fit and proper persons employed) and Regulation 20 (Duty of candour). The service was put into special measures.

We conducted a focused inspection in December 2018 (report published 18 January 2019). We looked at the domains of safe and well led to check the progress the provider had made and if they had now met regulations 12 (Safe care and treatment and 17 (Good governance). We found the provider continued to be in breach of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be rated Inadequate in these domains.

At this inspection the rating has improved to Requires Improvement.

Why we inspected:

At the last comprehensive inspection the service was rated as Inadequate and was put into special measures. Services in special measures are kept under review are required to inspected again within six months. This inspection was undertaken to ensure that improvements had been made by the provider.

Enforcement:

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

Follow up:

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

No additional risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

River View Care Centre is a care home with nursing, which provides services across three floors that are further split into seven units. The care home specialises in providing a service to older adults who may be frail due to age or disability as well as individuals living with dementia. 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 service is currently registered to provide accommodation to a maximum of 137 residents. Following the last inspection rating of Inadequate, the service was placed in special measures. A restriction was placed on new admissions, which meant the service was unable to accept any new people to River View Care Centre. CQC imposed a further three conditions on the service. Two of these were met within the stipulated time frame. One condition remains outstanding, with the Commission accepting the reason presented for the delay. The restriction on admissions remains in place until agreed otherwise by CQC.

The service has a registered manager. A registered manager is a person who has registered with CQC 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 remained unsafe. People were not kept safe from the risk of harm. Documentation was poor and conflicting in information, and staff were unable to provide assurances as to their understanding of the individual risks associated with people's care and support needs.

People were not appropriately monitored for adequate food and fluid intake and weight checks. As a result, potentially people did not have referrals made to external professionals in a timely way. Where bedrails were required to keep people safe, these were not always used. Staff attended to people, but failed to recognise the risk the lack of bedrails presented.

Staff were unaware of people’s changing health needs. Documentation, although stated as reviewed and therefore up to date, was inaccurate and not reflective of people’s needs. This meant that people were potentially exposed to unsafe care and treatment.

Governance of the service remained inadequate. Current systems and processes used as part of the audit process by the service were not effective in monitoring, assessing and improving the quality of the service. Where audits had been carried out in relation to people's care plans and risk assessments, these had failed to identify inaccurate and misleading information.

Poor staff knowledge of people and safe practice, in addition to inaccurate documentation, raised concerns in relation to staff professionalism. These issues were discussed during the inspection with management.

The service remained in breach of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service remains in Special Measures.

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

The service was taken over by MMCG (2) Limited in August 2017, prior to which the care was provided by another service provider. Some of the previous staff transferred as part of the acquisition, however, some previous members of senior management within the service left.

River View Care Centre is a 137 bed service that provides facilities over three floors to older adults with varying needs, including living with dementia. The service is broken down into seven units, that are distributed as: two on the ground floor, three on the first floor and two on the second floor. River View Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. MMCG (2) Limited are responsible for the operation of the service, with Lifestyle Care Management Limited holding responsibility for the property. During the first two days 115 people used the service. By the third day the numbers had reduced to 113. Two people on end of life care passed away during the inspection process.

A registered manager had been in post since the service was taken over by MMCG (2) Limited. The manager was previously registered with the CQC in April 2017, under the old provider, with a new application since made by the new provider. 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 rated Inadequate.

People were not kept safe. Risk assessments and comprehensive documentation was not in place to ensure people were offered responsive safe care and treatment. Care plans contained minimal information, with crucial information missing. The lack of information meant people were put at risk of harm.

Medicines were not always managed safely. Whilst we found that medicines were generally stored safely and appropriately administered, guidelines were not in place for two people who were given medicines covertly. Nurses spoken to were unclear of the correct protocol that was to be followed prior to covert medicines being administered.

People were not being kept safe due to a failure in appropriate monitoring and recording of the environmental risks and risks to people. A leak in the roof gave cause for serious concern around safety to people and staff. The service did not have robust recruitment processes in place, to ensure staff employed were safe to work with people.

Staff did not appropriately record information. Incidents were not always reported or understood to be reportable, therefore information was not accurately updated in daily records. Nutrition and hydration records were maintained for all people; however information was not cross referenced or analysed as required. As a result some referrals were not made to health professionals to seek further clarity on change in people’s hydration and nutrition.

Neither the provider nor the registered manager had effective systems in place to audit care documentation. Such systems would monitor the care provided in relation to the care plans, therefore highlighting any errors as and when these were occurring. This was specifically important given the number of discrepancies noted between day and night records.

People's care was not always delivered in a dignified way. Their independence was not promoted nor their privacy protected. On occasions it was found that staff did not maintain confidentiality, by speaking about people in front of others. Care was found not to be responsive to their needs, and often not effective. People were not always consulted about how they wished to have care delivered, or were not consulted prior to being assisted. This meant that whilst staff had received training in the Mental Capacity Act, they did not practice the fundamental standards of the legislation.

The registered manager completed ad hoc audits. This meant that they did not have a comprehensive overview of the service. Whilst a management structure existed, this was not effective in ensuring governance of the provision. Information was not always analysed or passed to the correct people, leading to errors in care delivery and poor management. The service, although specialising in delivering care to people living with dementia, did not environmentally meet the needs of the people.

The service was operating at 100% in all company mandatory training. Staff were receiving supervision as per the provider's policy guidelines. Team meetings took place frequently.

People were safeguarded from abuse. Staff had received training and understood what measures needed to be implemented to appropriately investigate and monitor safeguarding issues.

During the inspection we identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action