Rivendale Lodge EMI 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. Rivendale Lodge provides accommodation for up to 27 older people, some of who were living with dementia, in one adapted building. At the time of the inspection there were 25 people living at the home.

We inspected Rivendale Lodge on 8 and 9 October 2018. The first day of the inspection was unannounced, this meant staff did not know we were coming. We had previously carried out an inspection in June 2015 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in August 2016 where we found that some improvements had been made however there were still some breaches in regulation. We inspected the home again in August 2017 where we found there was a breach of regulations remained. This was because people’s records were not consistent and did not contain all the information staff needed. This had not been identified through the quality assurance system. We also found that where people did not have the capacity to consent, the registered person had not always acted in accordance with legal requirements.

We served a warning notice as part of our enforcement process in relation to people’s records. We also met with the provider to confirm what they would do and by when to improve the key questions of effective and well-led to at least good. The provider sent us an action plan and told us they would address these issues by December 2017. At this inspection we found improvements had been made and the provider was now meeting the regulations. However, further time was needed to ensure improvement and changes made to people’s records and the quality assurance system are embedded into every day practice.

There was a registered manager at the service. 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.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were looked after by staff who were kind and caring. They treated people with dignity and respect. Staff were committed to promoting people's independence, supporting them to make choices and enjoying themselves. Staff ensured care and support was provided in a way that met people’s individual needs and wishes. Staff knew people well and understood their care and support needs. There was an activity programme which people enjoyed participating in as they wished. This was adapted to suit people’s individual needs.

The registered manager was well thought of by people, relatives and staff. They were supportive to people and staff. They had a good understanding of what was needed to improve and develop the service. Systems were in place to gather feedback from people and staff and this was used to improve the service. Complaints had been recorded, investigated and responded to appropriately.

Staff had a good understanding of the risks associated with the people they looked after. Risk assessments were in place and provided the guidance staff needed. Staff understood how to safeguard people from the risk of abuse and discrimination. They were aware of their own responsibilities and what steps to take if they believed someone was at risk.

There were systems for the safe management of medicines. People were supported to receive their medicines in a way that met their individual needs and preferences. Only care st

We undertook an unannounced inspection at Rivendale Lodge EMI Care Home on 29 and 30 August 2017. Rivendale Lodge EMI Residential Home provides care and support for up to 27 older people who are living with a dementia type illness. At the time of this inspection 23 people were living in the home. Everyone was living with a dementia type illness and some had additional health care needs associated with their age and fragility.

There was 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 and associated regulations about how the service is run.

We had carried out an inspection in June 2015 where we found the provider was not meeting all the regulations. The provider sent us an action plan and told us they would address these issues. At our inspection in August 2016 we found the some improvements had been made however there were still some breaches in regulation. The provider sent us an action plan and told us they would address these issues by October 2016.

At this inspection we found some improvements had been made however the breach of regulation 17 was not fully met and we found further areas that needed to be improved.

The quality assurance systems had not identified the shortfalls we found in people’s records. Records did not always reflect the care and support people required and received.

Staff had a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, there was no information about how people who lacked capacity were able to make decisions or how any restrictions may affect them.

Staff knew people well. They had a good understanding of people’s individual needs, preferences and choices. They supported people to ensure they received the care and support they needed in a way that suited each person. Staff treated people with kindness, compassion and understanding.

Staff had a good understanding of providing person-centred care. They knew and understood people as individuals and supported them to make individual and everyday choices. People were supported to engage in a range of activities of that suited their individual needs.

People received their medicines as prescribed. There were systems in place to ensure medicines were ordered, stored administered and disposed of safely. Risk assessments were in place and staff had a good understanding of the risks associated with the people they looked after. They supported people safely whilst helping them to maintain their independence.

There were enough staff to meet people's needs. Recruitment records demonstrated there were systems in place to ensure staff were suitable to work at the home. Staff received the training and support they needed to enable them to meet people’s needs. Staff were able to recognise different types of abuse. They told us what actions they would take if they believed someone was at risk of harm or abuse.

People’s nutritional needs were met. They were supported to eat and drink a variety of food that they enjoyed and met their individual needs and preferences.

People were supported to have access to healthcare services when they needed them. This included the GP, district nurse and chiropodist.

Rivendale Lodge was clean and tidy. There was ongoing maintenance and redecoration which ensured the home was maintained to an appropriate standard.

We found a number of breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have

We undertook an unannounced inspection at Rivendale Lodge EMI Care Home on 2 and 4 August 2016 to check that the provider had made improvements to previous concerns and to confirm that legal requirements had been met.

At the last inspection on 2 and 5 June 2015 we found the provider was not meeting the legal requirements in relation to consent. There had been no assessment to confirm people’s level of capacity and their understanding and ability to consent to everyday care. The provider sent us an action plan and told us they would address these issues. At this inspection we found the provider is meeting this regulation.

Rivendale Lodge EMI Residential Home provides care and support for up to 27 older people who are living with a dementia type illness. At the time of this inspection 24 people were resident in the home. Everyone was living with a dementia type illness and some had additional health care needs associated with age and fragility. This included people with limited mobility and people with behaviours that may challenge others.

People, relatives and staff spoke highly of the service. However, we found people’s safety was not always promoted. Guidelines for the safe and consistent application of topical creams were not in place. There was no information about the support people required to maintain their pressure areas. Where there were risks related to people’s healthcare conditions such as epilepsy and diabetes there was no guidance for staff. Other records had not always been fully completed to demonstrate the care and support people received and required. These shortfalls had not been identified by the quality assurance systems.

There was a range of activities in place but staff had not received the training they required to ensure people who were less able to participate as part of a group, had enough to do throughout the day. We made a recommendation about this. Training updates were not always followed in line with the provider’s policy.

Staff were kind and caring. They knew people well and had a good understanding of their individual needs. They responded appropriately to people’s changing needs.

Staff understood the procedures to safeguard people from abuse. Records showed there were enough staff who had been suitably recruited working at the home. Mental capacity assessments were in place.

People were supported to maintain a healthy and nutritious diet, they were offered a choice of meals and staff supported them when eating, encouraging independence and promoting safety. People were supported by staff to have access to the appropriate healthcare professionals when they needed them.

There was an open culture at the home. People, staff and relatives told us they were able to discuss concerns with the registered manager at any time.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We used a number of different methods to help us understand the experiences of people using the service, because some people who used the service had complex needs which meant they were not able to tell us their experiences.

People who could, told us that the staff were kind, and that the food was good and tasty. We were also told, "Very nice here." Another said, “I am happy here, I eat well.”

We found that before people received any care or treatment they were asked for their consent and agreement and the staff acted in accordance with their wishes.

Care plans were personalised and contained clear instructions on how people should be cared for and supported.

We saw that staff received safeguarding vulnerable adults training the provider responded appropriately to any allegation of abuse.

We found there were sufficient experienced and qualified staff on duty to meet people’s needs. We spoke with staff who told us they attended regular training. Staff felt the training provided by the organisation supported them in their role to deliver safe and person centred care.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

There were 25 people living at Rivendale Lodge EMI Care Home at the time of this inspection visit.

We spoke to 10 people using the service, one relative and five staff members. Some people had complex needs and were not always able to verbalise their experiences, so we observed the interaction between staff and other people closely.

People who used the service made some positive comments about the care and staff working in the home. A relative told us that they were ‘’impressed’’ with the care and support provided within the home.

We looked at the systems in place in relation to cleanliness and infection control. These were found to be effective with the standard of cleanliness being maintained at a good level.

We looked at the systems and processes the home had in place that ensured that the standards of quality were reviewed and maintained. These processes helped to keep people safe and ensured that a quality service was provided. We also looked at the staffing arrangements in place. These were kept under review in order to respond to changing needs.

Those people spoken with that expressed a view said that they made choices about various things and that staff were kind and respectful.

Visitors to the home spoken with said that they felt that people living in the home were well respected and that their privacy was respected.

People spoken with were happy to talk and commented on the care and service provided.

Relatives spoken with were positive about the care and support provided. They were kept informed of any changes and commented on how other professionals were involved in the care as necessary.

Rivendale Lodge EMI Residential Home is a detached property in a residential area in the outskirts of Eastbourne. It provides care and support for up to 27 older people who are living with a dementia.

At the time of this inspection 23 people were resident in the home. Everyone had a dementia and some had additional health care needs associated with age and fragility. This included people with limited mobility and people with conditions that affected their ability to eat safely.

The service had a registered manager in place. 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.

People and relatives spoke positively of the staff and care provided at Rivendale Lodge EMI Residential Home. Staff also spoke positively about working at the service.

However we found that people’s rights were not fully protected. We were told that most people living at the service lacked capacity. No assessment to confirm people’s level of capacity had been completed and therefore their understanding and ability to consent to everyday care. One person had a baby alarm in their room to monitor them. There was no evidence that any consent had been sourced or any best interest meeting had been held.

We found people’s safety was not always promoted. Some medicines were not administered in a consistent way. Guidelines to assist staff in the safe administration of medicines were not complete. The staffing provision was based on numbers rather than dependency and did not indicate how emergency situations would be responded to.

The management of the service had not supported staff to maintain people’s confidentiality. Systems were not fully in place to promote the individuality of people. Staff undertook staff handover within a communal area where people could hear staff conversations.

Up to date policies and procedures were not readily available to provide clear guidelines for staff to follow. Systems for planning the future of the home including the ongoing maintenance planning were not established.

There were a variety of activities and opportunities for interaction inside and outside of the home which met most people’s individual needs.. This took account of people’s physical and mental health needs. However there were some further opportunities for activity and entertainment. Staff supported people to maintain relationships inside and outside of the home that were important to them, this included friendships formed in the home. Visitors felt able to visit regularly and were offered beverages.

Staff knew people well and responded positively to their daily needs. There were systems for staff to share information on people’s changing needs. People had access to health care professionals when needed. Risk assessments were used to identify and respond to most risks effectively. Systems to assess people’s moving and handling risks had not been established.

Staff undertook safeguarding training and knew the correct procedures for reporting any suspicion of abuse. Recruitment records showed there were systems to ensure staff were suitable to work at the home.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the registered manager. On call arrangements were in place to provide suitable management cover.

People were very complementary about the food and the choices available. One person said the food was always “very good.” Staff were skilled in the way they assisted people when eating, promoting independence and safety. Staff monitored people’s nutritional needs and responded to them.

People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be. A complaints procedure was available for people to use.

Feedback was sought from people, relatives and staff. Staff meetings were being held on a regular basis and staff handover meetings enabled staff to be involved in people’s care and the running of the home. People were encouraged to share their views daily and satisfaction surveys were used to gather information from people and their representatives.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.