7 September 2023
During an inspection looking at part of the service
Riverside Court is a residential care home providing accommodation and personal care to up to 25 people. The service provides support to older people and people living with dementia. Riverside Court supports people across 3 floors, with various communal spaces including pleasant outdoor areas. At the time of our inspection there were 22 people using the service.
People’s experience of using this service and what we found
The service was not safe. Risks to people were not appropriately assessed, monitored, and managed. Daily notes were not always robust. The security of the building had not been reviewed to ensure people and staff remained safe. Some health and safety checks were out of date. Actions to address unsafe water temperatures and fire safety had not been fully addressed. Infection prevention and control was not safely managed. Medicines were not always stored securely, and medicine records were not always completed. Safeguarding concerns were not consistently raised or investigated in a timely manner, and relevant organisations were not routinely notified. Staff absences were not always covered and not all staff had received up to date key training.
Systems were not in place to adequately assess, monitor, and improve the quality and safety of the service. There were no formal provider audits, and audits completed by the registered manager had not identified most of the issues found on inspection. The quality of the service had deteriorated since our last inspection. Systems had not identified that incidents were not always appropriately reported. People, relatives, and staff were not always fully engaged in the running of the service.
Some areas of people’s care plans were person-centred. Staff knew people well. People felt safe and settled and spoke positively about the staff. The registered manager was very responsive following our feedback and took action to mitigate risks identified. A schedule of provider audits was implemented following the inspection. Most relatives, people who used the service, and staff, spoke positively about the leadership of the registered manager. The service was consistently described as friendly, welcoming, and homely. Relatives told us communication was good, and they were kept 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.
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 8 January 2021).
Why we inspected
We received concerns in relation to safeguarding and a potential closed culture. 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.
The overall rating for the service has changed from good to inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
The provider has responded immediately following our feedback to mitigate the risks identified.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Riverside Court on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safe care and treatment, safeguarding, staffing and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.