Our inspection of Riverview Lodge took place on 28 November 2018. This was an unannounced inspection.Riverview Lodge 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 home is situated in Kingsbury and is registered to provide care to up to 36 older people living in three units. At the time of our inspection there were 35 people living at the home, many of whom were living with dementia.
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 our previous inspection of Riverview Lodge in March 2016 we gave the home a rating of Good.
People who lived at the home told us that they felt safe, and this was confirmed by family members whom we spoke with.
People had care plans and risk assessments which were person centred. However, these had not always been updated to ensure that they fully reflected changes to people’s health needs and the support they required with these. Behavioural charts had not always been completed by staff to show they had followed guidance contained within a person's care plan. This meant that we could not be sure that people always received the support they required.
Daily records of people’s care were otherwise well maintained. Systems were in place to share information between outgoing and incoming staff at shift changes.
There were systems in place to review and monitor the quality of the service, and we saw that action plans had been put in place and addressed where there were concerns. However, the home's quality assurance systems and regular care plan reviews had failed to identify where there had been changes to people's health needs which had not been included in their care plans. There was no regular monitoring of behavioural records which did not always show if staff had followed the guidance contained within a person's care plan. This meant that we could not be sure that people's needs were being safely met. The registered manager told us that there would be an immediate review of people's care records.
People’s nutritional needs were met and their food and fluid intake was recorded and monitored. Choices were available at mealtimes and alternatives were provided to people with religious or cultural needs and preferences. However, we found that the home's menus were designed by the provider and people had not been consulted or involved in making decisions about what they included.The registered manager told us that they would ensure that regular food satisfaction surveys would be conducted in future and these would be used to make changes to menus where required.
People were protected from the risk of harm or abuse. Staff members had received training in safeguarding and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.
Medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.
Staff at the home supported people in a caring and respectful way and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms for part of the day were regularly checked on.
Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision from a manager, and those whom we spoke with told us that they felt well supported.
The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. However, we found that some people's capacity assessments had not always identified the decisions that they were able to make. The registered manager told us that this would be addressed. Staff members had received training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.
The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively in participation in activities. People’s cultural and religious needs were supported but this was not always identified in people’s care plans.
The home had a complaints procedure. People and their family members told us that knew how to complain if they were unhappy with anything.
Staff at the home liaised with health professionals to ensure that people received the support that they needed. Local health professionals visited the home regularly.
We saw that the registered manager and deputy manager spent time supporting people. People who lived at the home, their relatives and staff members spoke positively about the management of the home.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and made one recommendation.
Further information is contained in the full report.