Archived: River Court Care Home

There were 116 people living at the service on the day of our inspection. River Court consists of four units, Hampermill, Gade, Chess and Colne. We did not visit one of the units due to an outbreak of infection of which 10 people had been affected.

The service has a registered manager in post although they were not present on the day of this visit. They were registered with the Care Quality Commission (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 and associated Regulations about how the service is run. However, a relief manager provided the management support and guidance on the day of our visit.

We last carried out an inspection of the service on 18 October 2013 due to concerns raised regarding the administration of medicines. At this inspection we found the service was meeting this standard. The last scheduled inspection carried out at this service was 24 May 2013 where the service was found to be meeting the required standards.

At this inspection we found some areas of the environment were poorly maintained and found to be dirty. This included soiled armchairs and a strong smell of urine in one of the units where people lived.

People told us they felt safe and secure living at River Court. Generally we found staff were knowledgeable in recognising signs of potential abuse and knew how to report concerns both within the organisation and externally if required.

Assessments were undertaken to identify any risks to people who received a service and to the staff who supported them. There were sufficient numbers of staff available to meet people’s individual support and care needs at all times, including during the night and at weekends. People received appropriate support from staff to enable them to take their medicines.

People and their relatives felt confident to raise any concerns and told us they were confident any concerns would be resolved without delay. People received their care and support from a staff team that fully understood people’s health and care needs and who had the skills and experience to meet them.

We found that people who used the service were not always treated with dignity and respect but their privacy was maintained.

The activities programme provided did not always reflect the individual needs of people who used the service and could benefit from being improved.

Safe and effective recruitment practices were followed to make sure that all staff were of good character, and were suitable to work in a care home environment as well as being fit for the roles they were being employed to carry out. Staff records confirmed checks had been made which ensured they were safe to work with vulnerable adults before a position was offered to them.

Staff were well supported by the management team and received an induction from senior staff when they first started working at the home. They received on going training and support to enable them to perform their roles effectively. Staff had regular individual supervision meetings, team meeting and had an annual appraisal to review their development and performance.

People were supported to maintain good health and had access to health and social care professionals when necessary. They were provided with a healthy balanced diet that met their individual needs.

People’s views about the service were gathered using surveys and verbal feedback. Feedback was used in a positive way to improve the quality of the overall service. The majority of people we spoke to were positive and complimentary about all aspects of the service.

Relatives, staff and professional stakeholders were complimentary about the staff and how the home was run and operated. The monitoring the quality of services provided, reduce potential risks and drive improvement could be further improved to ensure all aspects of the service which require attention are indentified at the earliest possible stage.

At our previous visit, we found there were concerns relating to the administration and record keeping relating to medication. We revisited the location early in the morning to check that the required improvements had been made. We carried out the visit to check that people had not been given their 8am medication between 5.30am and 7.30am or too early in the morning. We reviewed the records and spoke to staff, and we were able to see that the required improvements had been made and the morning medication round commenced as close to 8am as possible. The Medication Administration Record (MAR) charts confirmed that people were being administered their medication at the prescribed times.

We noted that medication that was being administered at the times detailed on the MAR charts. We did however see that on one unit an error had occurred where a medication had been signed as given. However when we spoke to the staff concerned they explained the error and said the medication had not been given but it had been signed in error. The provider may wish to note that that the mistake should have been crossed out and the correct information recorded. This lack of remedial action meant that the person may not have received their medication as prescribed and recorded on the MAR chart and this could have put the person at risk of adverse effects associated with not receiving their medication at the correct time.

We found that people did not always have their medicines at the times they needed them and in a safe way. People were at risk of 'adverse effects' associated with receiving their medication at times other than those prescribed and the effects and changes to their condition including side effects and or adverse reactions. Medication that was being administered was not recorded accurately and did not reflect the 'actual times' people were given medication. This meant that people could have suffered 'ill effects' as a result of this practice.

During our visit on 24 May 2013 we spoke with people who used the service and visiting relatives who told us they were happy with the service they received.

We spoke with two relatives who felt that the staff were very kind and helpful towards their relatives. However, another relative we spoke with on a different unit felt that the home did not always attend to the personal care of their relative in a way that promoted their wellbeing.

We observed that the home looked clean, and many of the rooms had been personalised with people's own furniture, and personal items. This showed that people were respected as individuals and that the staff had taken the time to explore people's life experiences and interests.

We noted that there were appropriate arrangements in place for people to receive their prescribed medicines.

People told us that they enjoyed their meals, and could have hot or cold drinks whenever they wished. We observed that soft drinks and a variety of snacks were available for people to help themselves, and staff also offered them to people who were less mobile.