Archived: Riverside Court

Updated 13 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 and 24 April 2018 and was unannounced on both days. The inspection team consisted of four adult social care inspectors and one expert by experience on the first day. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert’s experience was in dementia care. ON the second day three adult social inspectors visited the home.

Before the inspection we requested a Provider Information Return (PIR) which was returned to us. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We checked information held by the local authority safeguarding and commissioning teams in addition to other partner agencies and intelligence received by the Care Quality Commission.

We spoke with 10 people using the service and eight of their relatives. In addition, we spoke with 16 staff including six care staff, two nurses, the maintenance man, a member of the domestic team, an activity co-ordinator, the deputy manager, the clinical lead, the quality manager, the manager and the operations director.

We looked at four care records including risk assessments in depth and other sundry records, three staff files including all training records, minutes of resident and staff meetings, complaints, safeguarding records, accident logs, medicine administration records and quality assurance documentation.

Updated 13 June 2018

The inspection of Riverside Court took place on 17 and 24 April 2018 and was unannounced on both days. At the last inspection in March 2017 the home was rated requires improvement and had six breaches of regulations in dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and staffing. Following the last inspection, we met with the provider and asked the provider to complete an action plan to show what they would do and by when to improve the five key questions to at least good.

Riverside Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Riverside Court accommodates 60 people across four separate units, each of which have separate adapted facilities. The home was divided into four units; Shannon unit was for people with nursing needs and living with dementia, Clyde unit was for people living with dementia and Trent and Avon units were for people who needed support with daily living activities, some of whom may be living with dementia.

There was no registered manager in post but a newly appointed manager had recently started at the home and was in the middle of their induction. They were in the process of being registered with the Care Quality Commission. 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 found serious concerns within the home. Staff were unaware of how to recognise or report safeguarding concerns and could not appreciate the support they were providing was, in some cases, increasing people’s distress and sense of anxiety.

Risks were identified but then not managed to reduce the likelihood of harm for people. Staffing levels were not sufficient to ensure people had a good quality of life as many remained in their rooms all day with little, or no, interaction. In addition, a lack of continuity of staffing meant people did not know who was supporting them each day and some agency staff displayed little knowledge of how to support people safely or effectively.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. Although progress had been made in regards to obtaining legal authorisations to deprive people of their liberty, people were not encouraged to take positive risks and many had unnecessary restrictions placed on them.

Medicines were recorded, stored and administered safely for the most part apart from the use of PRN, or ‘as required’, medication. We found two people where medication had been used to reduce their behaviour which may be seen as challenging themselves or others rather than any evidence of positive behaviour management techniques. Staff appeared unaware of how to support people living with dementia effectively or safely, with minimum restrictions to their liberty.

Care records, although slightly more person-centred than found during the previous inspection, were large and often illegible, and staff readily admitted to not reading them as they did not have time to do so. Nutritional guidance was mixed and people did not have ready access to snacks and drinks throughout either day of the inspection.

We found the provider had not followed advice received from health professionals regarding suitable equipment to prevent pressure damage and other health-related issues. It was only on the second day of the inspection an order was put in for some equipment but this was not reflective of all people’s needs.

People’s privacy and dignity was not respected or promoted within the home. We found people’s doors were wide open and no appropriate consent in place, and some staff also spoke openly about people’s conditions while in communal areas.

We found some staff to be uncaring and very task driven, and for those who were more empathetic, were confounded by the over-use of agency staff who sometimes showed little initiative.

There was a lack of transparency and openness within the home’s culture and people were not supported by well-managed staff. Although the new manager was on induction other senior staff were present on both days but did not acknowledge the concerns we found. Quality assurance was poor and did not provide sufficient confidence to evidence people were safe or well cared for.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, five of which were continuing from the previous inspection.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.