About the service Riverside Nursing Home is a residential care home providing personal and nursing care for people aged 65 and over, including people living with dementia. The service is registered to support up to 39 people. At the time of the inspection there were 25 people living at the service, one of these was staying for a period of respite.
People’s experience of using this service and what we found
At the comprehensive inspection in May 2021 we found the service had not been consistently led and the governance systems in place had not been fully effective in identifying shortfalls in the quality of the service and then improving the quality of the service. At this inspection we found the provider had made improvements, but systems were still not effectively and consistently operated to assess, monitor and improve the quality and safety of the service and ensure regulatory requirements were met.
The providers quality monitoring systems did not identify concerns and ensure the safe running of the service. Most of the provider’s audits had not been completed and therefore had not identified risks and areas of concern found at the inspection. Where audits and checks had been completed, they had not always identified risks.
Oversight of staff recruitment needed to improve to ensure staff were recruited safely. The provider needed to ensure their recruitment process was robust and that relevant records were available and reviewed to ensure prospective staff were suitable to work at the service.
We were not assured by all of the providers infection prevention and control measures. Staff did not always use PPE effectively and safely and in accordance with current government guidelines.
The provider had not ensured staff had been supported through regular supervisions. They had not had the opportunity to discuss their work, receive feedback, and identify further training and development needs. The new manager planned to complete ten-minute supervisions with all staff in January 2022.
Staff had not completed a comprehensive induction and staff new to care had not completed the Care Certificate or an equivalent induction programme. This would ensure they had the relevant knowledge and skills to care for people safely, when they started working at Riverside Nursing Home.
The provider was keen to continuously improve the service and accepted our feedback. They began to make improvements after the inspection and provided CQC with updates on progress made.
Following a recommendation at the May 2021 inspection the provider had been working to improve the dining experience for people and ensure people received their required diets. Improvements were still ongoing with new memory menu’s being developed.
The service had not had a registered manager in post since January 2021. After our last inspection a manager had worked at the home but had not registered with CQC and had since left the service. The providers registered manager from their other service, along with a care consultant, had been supporting the provider in the absence of a manager.
A new manager had been recruited to formally take up the position in January 2022. They had undertaken eight days to familiarise themselves with the service. They had developed a three-month plan of actions they had identified they needed to undertake. Staff expressed confidence in the new manager.
There were improvements in staff training. The provider and management team had been working with staff to complete the required mandatory training through online courses and in-house training. Additional training specific to people’s needs was also scheduled.
People said they felt safe. Staff had received safeguarding training and recognised signs of abuse. There were enough staff to meet people's needs. There was a pleasant atmosphere at the home, staff were not seen to be rushing and were observed interacting positively with people and taking their time to chat with them.
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 in practice; the policies and systems in the service supported this practice.
The provider had continued to make improvements to the environment. This included the outdoor space which offered a nice, secure place for people to use. A new summer house which offered people and their relatives an alternative space to meet and socialise in.
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 Requires Improvement (published 22 June 2021) and there was a 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 enough improvement had not been made and the provider was still in breach of regulation.
Why we inspected
We received concerns from the local authority Quality Improvement team in relation to, fire safety at the service, staff levels, staff training, people’s nursing care needs and care planning. As a result, 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.
The overall rating for the service has remained the same, requires improvement. This is based on the findings 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 COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverside Nursing Home on our website at www.cqc.org.uk.
Follow up
We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.