Riverview Nursing Home

Riverview is a residential nursing home situated in Ilkley. The home provides accommodation, personal care and nursing care for up to 45 older people and people living with dementia. On the first day of the inspection there were 26 people living at the home. On the second day there were 27 people living at the home.

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

People’s care needs were assessed, and they received good quality person centred care from staff who understood their needs well. People and relatives said they felt safe. They praised the standard of care and said staff were caring and kind.

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. Improvements were needed to documentation to fully evidence compliance with the Mental Capacity Act (MCA).

The home and grounds had been designed to meet people’s needs. The environment had recently had a major refurbishment and creative improvements to the communal space included a tea room, sensory area and dementia friendly activity spaces. The changes provided people with a wider range of choices and opportunities. Staff told us this had a positive impact on people’s health and wellbeing.

Staff were knowledgeable about people and the topics we asked them about. They received a range of training, supervision and appraisal. The home had recently introduced ‘champion roles’ on a range of subjects and the staff team were empowered and enthused about ongoing quality developments.

Medication was managed safely. There were close links with health professionals and other agencies to ensure people’s health needs were met and changes responded to promptly.

The registered manager provided people with leadership and promoted an inclusive and supportive team culture. They maintained good oversight through communication with people and the team and a detailed schedule of audits. They were passionate about continuing to improve the service. There was an inclusive and welcoming atmosphere throughout.

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 13 November 2018) and there was one breach of regulation. The provider completed an action plan 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.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Riverview 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. Riverview accommodates up to 60 people in one adapted building. Accommodation is over four floors. At the time of our inspection there were 33 people living at the home.

There was a registered manager in place. 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 last inspection took place in December 2017 and January 2018. The report was published in March 2018. At that time the service was rated inadequate and placed in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

People told us they felt the service was safe. The registered manager understood their safeguarding responsibilities and staff knew how to recognise and report concerns about people’s safety and welfare. All the required checks were done before new staff started work. This helped to protect people from the risk of being cared for by staff unsuitable to work in a care setting.

There were enough staff on duty to keep people safe. Staff were trained and supported to carry out their roles.

Risks to people’s safety and welfare were assessed but the records did not always show who had carried out these assessments. Therefore, we could verify they had been done by a suitably trained person.

The home was clean. Inside it was well maintained and safe and improvements had been made to create a more dementia friendly living space for people. The outside patio area had uneven flags which potentially created a trip hazard.

People’s medicines were managed safely.

The service was working in line with the requirements of the Mental Capacity Act (2005) and acting in people’s best interests. However, this was not always clearly recorded.

People were offered a variety of food and drink which took account of their cultural and religious dietary needs and preferences. We recommended the service look at the timings of meals with the aim of supporting people to have their meals at regular intervals.

The service worked with other agencies to support people to meet their health care needs.

People told us staff were kind and caring and most of the interactions we observed were good. However, people’s dignity was not always respected. Improvements were needed to the way meal times were managed.

People’s care needs were assessed and care plans were in place to guide staff. People were supported to plan for their end of life care.

People had the opportunity to take part in a range of social activities. Doll and pet therapy was used to support people to engage with their environment and others.

Complaints were dealt with. The provider had systems and processes in place to assess and monitor the quality and safety of the services provided. They need to show they can sustain these improvements and continue to develop the service before we can be assured people will consistently experience safe and effective care which is responsive to their needs.

We found the provider remained in breach of one regulation. This related to their quality assurance and governance systems. You can see what action we told the provider to take at the back of the full version of the report.

Riverview 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. The care home accommodates 60 people in one adapted building. Accommodation is provided over four floors.

The last inspection was carried out in June 2017 and the overall rating for the service was ‘requires improvement’. The provider was in breach of four Regulations. These related to staffing (Regulation 18), staff recruitment (Regulation 19), meeting people’s nutritional needs (Regulation 14) and good governance (Regulation 17). We took enforcement action and issued warning notices in relation to the breaches of Regulation 14 (nutrition) and Regulation 17 (good governance). We issued requirement notices in relation to the breaches of the staffing and recruitment Regulations. We met with the provider to discuss their plans for making the required improvements to the service. We informed the provider we were concerned this was the second consecutive inspection when the overall rating was ‘requires improvement’. The service was rated ‘requires improvement’ in June 2016. We asked the provider for an action plan and they have sent the Commission monthly updates on their action since then.

During this inspection, we found improvements had been made in relation to supporting people to meet their nutritional needs. However, we found other areas of the service had not improved. In addition to two continued breaches of Regulations in relation to staffing, and good governance we identified five new breaches of Regulations. These related to safe care and treatment, consent to care and treatment, person centred care, dignity and respect and the cleanliness of the home.

Since the last inspection in June 2017, there had been a change of registered manager. The new manager was registered by CQC in December 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.

There were not enough staff deployed to meet people’s needs. On the first day of our inspection, we found staff were routinely getting people from 5am without any evidence to show this was what people wanted or was in their best interests. This improved over the course of the inspection. However, we were concerned the provider had not identified or addressed this, particularly as we had made then aware of concerns about staffing levels at the last inspection.

We found care was not always delivered in a way which was appropriate to people’s needs and people were at risk of receiving care which was not safe. People’s care records were not up to date and did not provide staff with information about their individual needs and preferences.

People told us they felt the service was safe. Staff had received training on safeguarding; however, they needed more support to understand how to apply this training in their day to day work.

There were recruitment procedures in place but we were unable to test how well they worked because no new staff had been employed since our last inspection.

On the first day of our inspection, we found the home was not kept free of unpleasant odours. We found risks to people’s health and safety were not always identified and managed. More needed to be done to create a ‘dementia friendly’ environment; the provider told us they had started work on this.

We found people’s medicines were managed safely.

People’s rights were not always protected. The service did not always ensure relatives who made decisions on people’s behalf had the legal authority to do this.

We found the staff were caring and kind. However, we observed some working practices that compromised people’s dignity and were not respectful.

People were supported to meet their nutritional needs and were offered a variety of food and drink. We found people were supported to meet their health care needs and had access to the full range of NHS services.

People were given the opportunity to take part in a range of social activities.

We saw complaints had been investigated. The information given to people in the complaints procedure was not accurate. We had raised this with the provider at the last inspection.

The provider had systems in place to monitor and assess the quality and safety of the service. However, we found these systems were not effective because they had not prevented the issues identified during this inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore ‘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 process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The home provides personal and nursing care for up to 60 older people. It is a large converted property and is located close to the town centre of Ilkley. The accommodation is on four floors and consists of shared and single rooms of which 17 have ensuite facilities. There are two passenger lifts giving access to all areas. The communal areas are on the ground floor. There are gardens which are accessible to people.

The last inspection was carried out in April 2016. At that inspection we rated the service as ‘requires improvement’ and there were three breaches of regulations. They were in relation to safeguarding, person centred care and good governance. The provider sent us an action plan showing the actions they were taking to address these concerns. During this inspection we checked to see if the required improvements had been made. While we found some aspects of the service had improved we found the pace of improvement was slow. We found three new breaches of regulations and found the provider remained in breach of the regulation about good governance.

There was a registered manager in place when we carried out the inspection. Following the inspection the provider told us the registered manager had resigned from their 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 provider told us the clinical lead nurse would take responsibility for the day to day management of the home until such time as a new manager was appointed.

People who used the service felt safe and we found staff knew how to recognise and report concerns about people’s safety and welfare. However, we found the necessary checks on new staff were not always carried out in line with the provider’s policy. This could put people at risk of being cared for by staff unsuitable to work in a care setting.

We found they were not always deployed effectively at busy times of the day.

The home was clean, the environment was generally well maintained and there was evidence of on-going refurbishment. However, we found some working practices were creating risks to people’s safety and welfare. These risks had not been identified by the provider until we brought them to their attention.

People received their medicines as prescribed and medicines were managed safely.

Most people were happy with the food. However, we found there was a risk people were not always getting the right support to make sure they had adequate amounts of food and drink. Our observations of meal times showed this was not a positive experience for people.

People were supported to meet their health care needs and had access to the full range of NHS services. Feedback from visiting health care professionals was positive.

The service was working in line with the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards which helped to make sure people’s rights were protected and promoted.

People received care and treatment from staff who were trained and supported to carry out their roles.

We observed a lot of positive interactions between staff and people living in the home. We found staff to be caring and compassionate. People told us they found the staff to be caring and people’s relatives told us they were involved in decision making and kept informed about changes in people’s needs.

We found there was sometimes a lack of attention to detail when dealing with people’s toiletries which compromised their dignity.

Although staff knew people well this was not always reflected in people’s care records. The provider had already identified this as an area for improvement and was dealing with it.

There were opportunities for social activity and engagement and most people were satisfied with this aspect of the service. There was accessible, secure outside space but we recommended the provider look at relevant guidance on the provision of dementia friendly outside space to ensure people benefitted from this facility.

The majority of people who made any concerns or complaints told us they were listened to and dealt with appropriately. However, we found the information given to people in the complaints procedure was potentially misleading. We also found that the provider did not always act on the feedback people provided to ensure the quality of care consistently improved.

Everyone we spoke with had confidence in the management team.

There were systems in place to monitor and assess the quality of the services provided but we found they were not operating effectively. The provider was committed to improving the experiences of people who used the service and had engaged a consultant to help them bring about the required improvements.

In addition to an on-going breach of regulation in relation to good governance (Regulation 17) we found three new breaches of regulations in relation to staff deployment (Regulation 18), staff recruitment (Regulation 19) and supporting people with the nutritional needs (Regulation 14).

You can see the action we have asked the provider to take at the back of the full version of this report. In relation to the continued breach of good governance the Commission is considering the appropriate regulatory response. We will publish our actions when any representations and appeals have been dealt with.

The home provides personal and nursing care for up to 60 older people. It is a large converted property and is located close to the town centre of Ilkley. The accommodation is on four floors and consists of shared and single rooms of which 17 have ensuite facilities. There are two passenger lifts giving access to all areas. Most of the communal areas are on the ground floor, there is one lounge on the first floor. There are gardens which are accessible to people.

The service had a registered manager in place. 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.

Staff knew how to recognise abuse and report a safeguarding concern. Some recent safeguarding incidents had not been dealt with by management.

We saw sufficient staff deployed to keep people safe. At busy times staff were very task orientated and could not always respond to people’s needs in the most effective way.

Staff had applied for the post, been interviewed and had all relevant background checks completed before starting to work alone.

People were assessed for risk for their health and wellbeing. However as people’s risks changed, this was not always recorded on risk assessment documentation.

Staff had completed mandatory training to enable them to complete their roles effectively. Further training courses were available to support people in a more effective way.

We had positive feedback about the food offered. We observed people had a choice of hot or cold food for breakfast. Menus were only displayed on the ground floor.

People had been referred to health care professionals in a timely fashion. Healthcare professionals told us they had a positive relationship and worked closely with the home.

Deprivation of Liberty Safeguards authorisations had been completed correctly and the home carried the correct paperwork. However there was a cumulative effect for other restrictions on people that had not been referred.

People told us and we saw that people were treated with privacy and dignity. People said staff were very caring and they would help as much as they could.

Relatives told us they had been involved in the planning of care. Care records for people had been signed by relatives. Minutes from best interest meetings were also evident.

We asked staff about the people they supported. They told us specific detail about people and how they liked their support. This showed us a good understanding of the people they supported.

The home benefitted from an activities co-ordinator. One of the communal areas on the ground floor listed activities for the day. The first floor lounge was very quiet with music and TV playing all day.

Care records had not always been completed or reviewed to reflect people’s current needs. We saw some care records had identified changes, but these changes had not happened.

People and relatives told us they knew how to make a complaint. We saw the registered manager had acted on previous complaints in line with the provider’s policy.

The culture of the environment was different depending on where in the home you were. The ground floor had a livelier atmosphere with more light, contemporary decoration and more happening. The first floor appeared very quiet with not much to do.

Audits had been completed by the provider and the registered manager. Some audits had not been completed in a robust way, or reacted to in a timely fashion. This left some people at potential risk.

People told us they had regular meetings to pass their views on about the home. Staff had team meeting planned in and relatives had four meetings a year in order to constantly improve.

We found three breech’s of the Health and Social Care Act (2008) Regulated Activities Regulations 2014. You can see what action we asked the provider to take at the back of this report.

We saw polices in place to safeguard people from abuse. We spoke to one person who uses the service who said "I have no complaints here".

We saw evidence that staff are recruited appropriately and receive training to complete their role.