We carried out a review of the data available to us about Riverhead Hall Residential Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Riverhead Hall Residential Care Home, you can give feedback on this service.
Riverhead Hall Residential Care Home is a residential care home providing accommodation and personal care to a maximum of 48 people. At the time of our inspection there were 39 people using the service.
People’s experience of using this service and what we found
People were happy and felt safe at the service. Staff understood their roles clearly and knew what was expected of them. Risks to people were assessed and reviewed on a regular basis. Staff were recruited safely and understood the principles of keeping people safe.
Medicines were appropriately managed and regular checks were completed to ensure that the management of medicines was safe. Staff promoted good infection control practices and the service was clean.
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; the policies and systems in the service supported this practice.
The registered manager and staff had a strong ethos of person-centred care and placed people's wellbeing at the heart of their work. Systems in place to monitor the quality of the service supported the management team to make improvements when needed. Lessons learnt were used as learning opportunities to continuously develop the service.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 8 October 2021) and there were breaches 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 we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We received concerns in relation to visiting at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
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.
The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverhead Hall Residential Care Home on our website at www.cqc.org.uk.
Recommendations
We have made a recommendation regarding the systems in place for recording information at the service.
Following the last inspection, we recognised that the provider had failed to notify CQC of events. This was a breach of regulation and we issued a fixed penalty notice. The provider accepted a fixed penalty and paid this in full.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We found the following examples of good practice:
The provider had made improvements to infection prevention and control (IPC) practices since our last inspection.
The building was clean and well maintained, and the provider had purchased new furniture throughout the communal areas.
People could have visitors in line with national guidance. Should alternative arrangements be required, there was also a visiting pod available in the garden. There was an electronic thermometer at the front door which automatically screened people’s temperature before entering the building, and appropriate checks were conducted.
Staff were vaccinated and took part in regular testing. They wore personal protective equipment to minimise risk of infections potentially spreading.
Risks in relation to COVID-19 were assessed for staff and people.
The provider took prompt action to address a small number of minor areas where aspects of policy or best practice were not being followed consistently, or where cleaning records were not completed fully.
Riverhead Hall Residential Care Home is a 'care home' providing personal care for up to 45 older people in one adapted building. At the time of our inspection there were 27 people living at the service.
People’s experience of using this service and what we found
Safe infection prevention and control (IPC) practices were not followed. The IPC Team had visited the service prior to our inspection and highlighted IPC practices that required improvement. Our inspection identified some of the same issues. The provider took measures to improve these areas during our inspection.
Risks to people were not always managed effectively. Care plans and risk assessments were not always in place or did not reflect people’s current needs. Medicines were not always managed safely. Some people did not receive their medication as prescribed.
Systems in place to monitor the service had not been effective as they had failed to identify and address areas that required improvements. Records were not always accurate and up to date.
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; the policies and systems in the service supported this practice.
We received positive feedback from people's relatives about the care delivered and the caring nature of staff.
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 Good (Published 14 September 2018).
Why we inspected
We undertook this Infection Prevention and Control Inspection to follow up on information received from the Local Authority in relation to a coronavirus outbreak. A decision was made for us to inspect and examine potential risks. We inspected and found there were some concerns with IPC practices, records and the overall management, so we widened the scope of the inspection to a focused inspection which included the key questions of safe and well-led.
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. 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 coronavirus and other infection outbreaks effectively.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverhead Hall Residential Care Home on our website at www.cqc.org.uk
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Since the last inspection we recognised that the provider had failed to notify CQC of serious injuries and allegations of abuse. This was a breach of regulation. We issued a fixed penalty notice which the provider has paid in full.
Follow up
We will request an action plan from 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.
The last inspection took place on 29 June and 5 July 2017 and the service was rated requires improvement. The service was in breach of Regulation 17 Good Governance. Concerns related to inconsistencies within care plans, a lack of regular reviews, poor record keeping and quality assurance systems which were not effective in identifying and rectifying issues.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Responsive and Well-led to at least good.
At this inspection improvements had been made and the service was no longer in breach of Regulation 17 Good Governance.
Riverhead Hall Residential Care Home 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.
Riverhead Hall Care Home accommodates up to 45 older people in one adapted building. At the time of our inspection there were 33 people living at the service.
The service had a registered manager. 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.
There was further room for improvement of records being kept about the care being delivered to people. Some records contained gaps. We were confident this was a record keeping issue and not about the delivery of care.
The registered manager had failed to notify the commission about approved Deprivation of Liberty Safeguards being in place. This is being addressed outside of the inspection.
Quality assurance systems were in place and had been effective in identifying required improvements. However, the actions identified were not always rectified which meant the systems needed to be more rigorous to embed service improvement.
Care plans provided care staff with important information about people’s preferences and the support they required. People and their relatives had been involved in the planning and review of their care. Reviews were taking place on a regular basis.
Although we received differing views about staffing levels we found there were sufficient staff available to meet people’s needs. Staff had been recruited safely.
Staff understood how to safeguard people from avoidable harm. Accidents and incidents were analysed and action taken to reduce occurrence. Risk assessments and measures to mitigate risk were in place.
People were provided with a good standard of care. Care staff were knowledgeable about people’s needs they understood people’s preferences and respected these.
Staff had the skills required to deliver effective care. New care staff had an induction before they started work and ongoing training was available for staff. Some staff supervision and appraisals were overdue but the registered manager had a plan to rectify this.
People had access to a range of activities to promote their emotional wellbeing. Overall people were satisfied with the food provided. People’s nutritional needs were met.
The service sought appropriate advice and support from health and social care professionals to ensure people’s care needs were met.
People described kind and compassionate staff. We observed positive interactions between staff and people. Families were welcome to visit whenever they wished and relatives gave us positive feedback about the service.
People knew how to make complaints and when they did so these were appropriately investigated and responded to. Feedback from people about the service was sought on a regular basis in a variety of forms.
Staff described feeling well supported. Regular team meetings took place.
At our last inspection in April 2015, we asked the provider to take action to make improvements to capacity assessments because they were not fully completed and lacked information. At this inspection we found evidence of activity to improve the quality of mental capacity assessment paperwork. One file we viewed still lacked clarity in relation to the decisions that were being assessed, but this was addressed during our inspection and further training was planned for staff. Deprivation of Liberty Safeguards (DoLS) applications had been submitted, or were in the process of being completed, for people who required an authorisation to deprive them of their liberty, where this was in their best interests. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice
The service had a manager, who had taken up a permanent position as the manager in April 2017, after having worked at the service in different roles for over 10 years. The manager had submitted their application to the Commission to become the registered manager of the service, this application was being processed at the time of our inspection. 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 that recent changes at the service, in relation to the service provision, staffing and management had impacted on the quality of record keeping and care plans at the service. Quality assurance systems had not been effective in ensuring that standards in relation to record keeping had been consistently maintained over recent months. Risk assessments and care plans were not always accurately completed and cross referenced, or regularly reviewed. This was a breach of legal requirements.
Staff were knowledgeable about people’s needs and we found that people were receiving the care they required. However, the lack of accurate, up to date information in some care files meant there was a risk that staff were relying on their own knowledge, as they did not have all the information they needed to ensure that people received consistent and responsive care in line with their preferences.
Staff were recruited safely and appropriate checks were completed prior to people commencing work, to ensure they were suitable to work with vulnerable people. There were sufficient staff to meet people’s care needs safely. However, we received some feedback that a recent reduction in the staffing levels at the service due to a change in the needs of people using the service, meant that staff felt more rushed with people and had less time available to ensure care plans were updated. Staff received an induction, appropriate training and supervision.
People who used the service told us that staff were caring and we found that staff supported people in a way that promoted their dignity and independence. We observed positive, friendly interactions between people and staff. We saw positive feedback from relatives about the end of life care people had received.
There was a variety of activities available at the service and visitors were welcome at any time. People were supported to practice their religious beliefs if they wished.
There was a system in place to respond to complaints. Staff knew how to identify and report any safeguarding concerns.
People received appropriate support with their nutritional needs and systems were in place to ensure that people received their medicines safely. People had access to a range of healthcare professionals, to support them in maintaining their health. Healthcare professionals we spoke with told us that staff sought their advice promptly whenever needed, and acted on any instructions and advice they gave.
You can see what action we have told the provider to take at the back of the full version of the report.
Riverhead Hall provides nursing care and residential support for up to 45 residents. The service provides support for adults over the age of 18 including older people, people living with dementia and people with a physical disability. The service has 45 single en-suite bedrooms provided over three floors with separate bedroom areas located for the nursing and residential resident’s. At the time of our inspection there were 34 residents living at the service eight of which were nursing care residents and 26 residential.
The home features three communal lounges, a large open plan dining area, kitchen, conservatory and ample outdoor space which includes landscaped gardens, flower beds and seating areas.
The inspection was unannounced and took place on 22 April 2015. The service had 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.
The last inspection took place on 17 June 2013. At that inspection we found the provider was compliant with all the standards we assessed.
We found the service to be safe in its delivery of care. Staff were recruited safely and appropriate checks were completed prior to working with vulnerable people. Staff had good knowledge and an understanding of the needs of the people who used the service. People who used the service told us they felt safe. Although staff told us they were short staffed on occasions they also told us they all pulled together and worked as a team.
Staff supervision was not as frequent as the organisations policy suggested but the registered manager told us they were working on this to ensure supervisions were delivered more frequently. There was a full training programme in place which ensured staff were equipped with the knowledge and skills required to carry out their role effectively.
We observed that staff spoke in a positive way to people and treated them with respect. Staff and the people who used the service interacted in a positive way and observations showed good relationships between them. The people who used the service participated in a wide variety of in house and community based activities. The service was respectful of people’s religious beliefs and encouraged religious practice in the home environment for people who wished to participate.
The registered manager was following the principles of the Mental Capacity Act 2005 (MCA) and we saw that applications, where required, had been submitted in respect of people being deprived of their liberty. The Mental Capacity Act 2005 (MCA) legislation is designed to ensure that when an individual does not have capacity, any decisions are made in the person’s best interest. We saw that the paperwork to support the MCA was not always completed or as comprehensive as it should be. The registered manager told us they would seek ways to address this and make improvements.
People who used the service had personalised care plans in place and individual’s likes and dislikes were clearly documented. Risk assessments were in place along with life history, medical conditions and professional contact records. Family and friends were always welcome to visit the service and people living at the service told us they were encouraged to maintain family contact. Relatives told us they were “Generally happy” with the care their loved one received living at the service.
The registered manager encouraged feedback from the people who used the service, relatives and staff members to improve practice and the overall standards of the service. The service had established good community links with a local school and this has resulted in positive experiences for the people who used the service. The registered manager promoted transparency and staff told us the registered manager has an ‘open door’ approach which staff felt was positive.
People felt staff respected their privacy and dignity. One visitor said 'My parent has a care plan and it has been discussed with both of us'.
We found people were being looked after by friendly, supportive staff within a warm and homely environment. One person told us, 'Staff are friendly and give us the support and help we need' and another said 'There is a lovely atmosphere in the home, very friendly and welcoming.'
People told us 'We get our medicine on time and when we need it'. We found that appropriate arrangements were in place in relation to safely administering medicines to people who used the service.
The home was designed to meet the needs of people who lived there and the provider ensured equipment used to assist people with their daily lives was regularly maintained, safe and fit for purpose.
We saw the service had an effective recruitment policy and procedure, which ensured staff working in the home had the right skills and qualifications to meet people's needs.
The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary.
When we visited the service in November 2012 people who used the service were satisfied with the care they received and their homely environment. We chatted briefly with people during this visit but their comments to us did not relate to the outcomes we were inspecting.
We found that improvements had been made to medication practices and record keeping within the service. The provider and staff had acted on the information in the report from November 2012 and made positive changes to working practice, staff training and the medication system.
People told us that their experience was a positive one. They were involved in the decisions about coming into the service and staff discussed their care and treatment with them. They were able to make choices and decisions about their daily lives, and the staff respected their wishes and supported their independence. One person said 'I cannot praise the staff enough. They work hard but always listen to you and make time for a chat.'
We spoke with relatives who told us 'The staff are supportive' and 'There is a lovely atmosphere in the home, very friendly and welcoming.'
People understood about safeguarding of adults and told us that they felt safe within the service. They told us there was an open door policy within the service which worked well and they were confident of using the complaints system if they needed to.
We found through talking to people that care in the service was meeting people's needs, however staff were not keeping care records and associated documentation up to date. We also had concerns about the management of medication within the service.
The person that we spoke with told us that they had no complaints and said, 'I don't know what I would do without the staff ' they are wonderful'. They said that they felt safe living at the home.