Archived: River View Care Centre

As part of this inspection we spoke with six people who use the service, six visitors, the relief manager, appointed manager, two clinical managers, three nurses and four care staff. In addition we spoke with four laundry and housekeeping staff. We also reviewed records relating to the management of the home which included; twelve care plans, fifteen personnel files, daily care records, risk assessments, audits, policies and procedures. We also spoke to the local authority commissioners.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were supported in a friendly, kind and patient manner. We saw choices being offered, for example, 'would you like another cup of tea?', 'do you want to get up yet?' We saw people were given encouragement to eat and drink and observed staff sitting with people to assist them to eat. Care was provided in an unhurried yet timely way and there were examples of positive interactions seen. For example, we saw staff engaged with people whenever they entered a room. We noted people smiling and looking happy. One relative said: 'staff are very good, they are always there to help my dad. If he doesn't want something they will respect that, but they always come back later to offer again.' Another person said 'they look after me, make me feel better.'

People's records showed they had access to routine and specialist health services. People regularly saw their GP and when appropriate other specialist health professionals. Directions from professionals were recorded accurately in the care plan and staff we spoke with knew how to access and follow them. Records we looked at were mostly accurate and fit for purpose. We saw they were stored securely and could not be accessed by unauthorised personnel. Staff personnel files contained appropriate pre-employment checks.

We observed the home to be clean and tidy. A relative we spoke with said: 'It's very clean; the rooms are cleaned every day.' A person that uses the service told us they were "very happy" with the standards of cleanliness.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the manager with regard to the Supreme Court ruling which widened and clarified the definition of DoLS. They were aware of the ruling and had been in contact with the relevant local authority team. A number of standard DoLS applications had been made as a result.

Is the service effective?

People all had an individual care plan which set out their care needs. People had access to a range of health care professionals including speech and language therapists, tissue viability nurses and GPs. Staff were observed supporting people in a friendly, kind and patient manner. We saw choice being offered and explanations given. We noted how staff anticipated people's needs when they had difficulty in communicating them. People responded positively and were often seen to smile and laugh.

People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed the lunch time activity and food was well presented. Relatives of people living at the home told us they thought the food was good and there was plenty of choices. However one person commented: 'I haven't had a decent meal since I got here.'

During the inspection we saw staff supported people with activities and noted people smiling, appearing to enjoy the activity. We observed people who became distressed were supported appropriately and responded to in a positive manner. However we noted there was a Iack of sensory stimulation for people with dementia or poor mobility.

Is the service caring?

Relatives we spoke with said their loved ones were supported by kind and attentive staff. Our observations confirmed this and we saw people were spoken to politely and with respect. For example, one person wanted to use the toilet and a member of staff said: 'shall I show you where it is?' then 'Shall I leave you in privacy to use it?' Another person said: 'I like it here, everything is good. You only have to ask and they get it.' A member of staff said: 'It is warm like home, not a nursing home, we try to give person-centred care and look at the individual.'

Is the service responsive?

People's needs were assessed before they moved into the home. People's needs were reviewed with them and their relatives as appropriate. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities and they had been supported to maintain relationships with their friends and relatives.

We spoke with relatives of people who use the service. They told us they could talk to staff if they were unhappy about something. They all said they felt confident they would be listened to. One told us: 'They listen, I asked them to move the bed and it was done straight away.'

Is the service well-led?

Quality assurance processes were in place. Staff told us they felt they could approach the senior staff for advice. They knew and understood their responsibilities and the importance of their role. Regular meetings were held to ensure all staff were up to date with changes to people's care. People and their relatives said they were consulted about their views and they completed satisfaction questionnaires.

Most people who lived in the home, their relatives or representatives were involved in developing the care plans. They were also involved in what was going on in the home and were continually given choices.

Observation of practices during our inspection showed that most people received effective, safe and appropriate care, which was designed to meet their specific needs. One person said "The staff are good to me and I am extremely happy with my care".

People who lived at River View Care Centre were protected from the risk of abuse. This was because staff had received appropriate training and understood how safeguarding principles applied to their roles. The people we spoke with told us that they felt safe living in the home.

There were enough staff to support people's needs. One person living in the home explained that they always received help when they needed it. A few people told us that they sometimes had to wait longer for staff to help them at the weekend.

The provider had appropriate systems in place to assess, monitor and identify risks to the health, safety and welfare of the people. A new audit system to monitor these risks was in the process of being implemented.

We reviewed the care plans of people. We found care plans did not always include information about people's history, likes and dislikes. We noted that risk assessments were not always kept up to date or consistent with care plan records. People were at risk of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

We found staff interacted well with people. One person told us 'the staff are lovely. They always treat me well and I feel well looked after'. However, we observed care that was not always in accordance with people's care plan or their wishes.

People told us they felt safe living at River View. We saw records to confirm that staff had undertaken safeguarding training and were able to tell us how they would report concerns. However, we also found that people were not always protected from the risks of unlawful or excessive restraint.

Staffing levels were appropriate. The provider had implemented a robust training programme for staff following the last inspection. Staff told us that they felt supported in their work.

The home undertook regular surveys to seek people's views and feedback about the service. However, we found that the provider did not always assess, identify and manage the risk to people's health, safety and welfare.

We saw examples of staff providing care to people in a positive way. However, we also found that people were not always cared for in a way that ensured their safety and welfare. One relative told us "I wish the care was more personal and less institutional".

People's nutritional needs were recognised and menus had been created to support these requirements. We found that people were not always supported to be able to eat or drink sufficient amounts to meet their needs.

People told us that they felt safe living at Riverview. We found that people were not always protected from care which could cause injury or harm.

Staffing levels were appropriate for the numbers of people using the service. We found that the skill mix of staff did not always support the people with the highest needs. Consistent staff support and training was not in place.

The home took into account people's views and opinions. However, some quality assurance audits were not consistent or effective.

The care plans we saw provided details of people's needs, wishes and preferences. People's healthcare needs were also met. The home had sought advice from external healthcare professionals where necessary. A range of activities was provided and people could choose whether they wished to take part. The relatives we spoke with were happy with the care and support offered by the home.

People in the home and their relatives said that the staff kept people safe and also supported the family at times. The home had appropriate systems in place to safeguard people from abuse and staff had been trained about safeguarding. Appropriate action had been taken where any concerns had arisen.

Staff received an appropriate induction and the home had made good progress in addressing training shortfalls. Staff were supported through professional supervision meetings, though a system of appraisals had yet to be established. The provider and manager had effective systems in place to monitor the performance of the home.