Archived: The Cookham Riverside

We found the following examples of good practice.

A new admission took place the day before our visit. The person had been tested for Covid-19 (negative result) before they came in. They were being cared for in their room for 14 days.

Visitors could see their family and friends in a safe way. Visitors could book face to face time to see people in the garden. Hand gel, face masks and a plastic screen were in place to protect people from the risk of infection. Staff also facilitated contact via social media, for those family or friends who could not visit the home.

Laundry was well organised. Contaminated items were placed directly into bags by care workers. These bags went straight into the washing machine, removing the need for laundry workers to handle the items. The building was kept clean, with regular disinfection of high-touch areas, such as grab rails and light switches.

All service users and staff were tested for coronavirus at the end of June, with no evidence of infection. The registered manager had signed up for further testing kits; these would not be available until September due to a national shortage. The risks to the health and safety of staff working during the pandemic had been assessed, to ensure they were kept safe.

Staff had received training on infection prevention from the Clinical Commissioning Group. There were good stocks of personal protective items (PPE) on the premises.

Adjustments had been made to the numbers of people who could be in shared areas at any one time and maintain social distancing. For example, the dining room and lounge. Staff handover was also taking place in a different area to usual, to enable workers to keep apart.

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.

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 safety standards. People had access to and looked out over a very well maintained garden. Equipment was serviced to make sure it was in safe working order.

Various audits were carried out to check the quality of care at the home. Improvement had been made to the recording of complaints. These were now documented with a note kept of actions taken. We found the home had not always notified us of important events which had occurred. For example, incidents to which the police were called. This meant we were not able to see in a timely manner the action taken by the service.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to recruitment practice. We also found a breach of the Care Quality Commission (Registration) Regulations 2009, as the service had not notified us of events which they were required to. You can see what action we told the provider to take at the back of the full version of this report.

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.

On the 17 September 2014, the provider told us they had made the required improvements and were fully compliant with the requirements of the regulation.

The provider sent us information to evidence the improvements they had made and how they were going to ensure the improvements were sustained.

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.

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."