This inspection took place on the 8 October 2018 and was unannounced. Riverdale Court 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. Riverdale Court accommodates up to 80 people across four separate units in one building, each of which have separate adapted facilities. At the time of our inspection there were 75 people using the service.

At our last inspection on 30 and 31 October 2017 the service was rated requires improvement in all key questions, safe, effective, caring, responsive and well led. We found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that sufficient numbers of staff were not deployed throughout the home to meet the care and support needs of people using the service. Appropriate action had not always been taken to support people where risks to them had been identified. Risk assessments where not always reviewed when people’s needs changed. Advice provided from health professionals was not always followed by staff. Some people’s care plans did not accurately reflect their needs. The provider’s systems for assessing, monitoring and improving the quality and safety of the services were not effective. We found other areas were improvement was required. People’s lunch time experience required improvement on the upstairs units of the home. Improvement was required in supporting people with meaningful activities when the home’s activities coordinators were not at work. The training delivered to staff was not always effective. There were mixed views from staff about the management of the home.

At this inspection we found that significant improvements had been made. Risk assessments where being reviewed when people’s needs changed. Advice provided by health professionals was being followed by staff. People’s care plans accurately reflected their current needs. People’s lunch time experience had improved. People were consistently provided with a range of activities that met their needs. The training delivered to staff was effective. Staff views about the management of the home was positive. Staff were appropriately deployed at the home to meet people’s needs, however further improvement was required to ensure people consistently received prompt support when needed.

Despite these positive improvements, we found a breach of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to medicines management. The provider’s systems for assessing, monitoring and improving the quality and safety of the services had not identified these issues. This is therefore the second time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Following the inspection the registered manager confirmed with us that immediate action had been taken to address these areas.

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 registered manager was aware of their responsibilities about the Health and Social Care Act 2014. Notifications were submitted to the CQC as required. They were aware of the legal requirement to display their current CQC rating which we saw was displayed at the home.

The service had safeguarding and whistle-blowing procedures in place and staff had a clear understanding of these procedures. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met. The home ha

Riverdale Court 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. Riverdale Court accommodates 80 people across four separate units in one building, each of which have separate adapted facilities. Two of the units specialises in providing care to people living with dementia. At the time of our inspection 74 people were using the service.

There was a registered manager in post 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.

At our last inspection on 5 and 6 October 2015 the home received a rating of good in all of the key questions. At this inspection we found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that sufficient numbers of staff were not deployed throughout the home in order to meet the care and support needs of people using the service. Appropriate action had not always been taken to support people where risks to them had been identified. Risk assessments where not always reviewed when people’s needs changed. Advice provided from health professionals was not always followed by staff. Some people’s care plans did not accurately reflect their needs. The providers systems for assessing, monitoring and improving the quality and safety of the services that people were receiving were not effective. You can see what action we told the provider to take at the back of the full version of the report.

We found other areas were improvement was required. People’s lunch time experience was poor on the upstairs units of the home. Improvement was required in supporting people with meaningful activities when the homes activities coordinators were not at work. The training delivered to staff was not always effective. There were mixed views from staff about the management of the home. Some staff said they were well supported by the registered manager and their line managers; however other staff said communication was not always good.

There were safe staff recruitment practices in place. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies. People had individual personal emergency evacuation plans which highlighted the level of support they required to evacuate the building safely.

Staff monitored people’s health and wellbeing and people had access to a GP and other healthcare professionals when needed. There were systems in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People were provided with sufficient amounts of nutritional foods and drink to meet their needs.

People’s privacy was respected. People and their relatives, where appropriate, had been consulted about their care and support needs. People received appropriate end of life care and support when required. People and their relatives were provided with appropriate information about the home. They knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary. The provider took into account the views of people and their relatives through residents and relatives meetings and satisfaction surveys.

We spoke with several people who used the service and observed the way they were treated throughout the day by staff. We also spoke to some people's relatives. People who used the service told us that they were happy living at the home. They told us that staff responded to their needs quickly if, for example they pressed their call bell, and that the majority of staff were good. We found staff interacted well with people who used the service and they were respectful of people's needs. Staff provided people with support when it was appropriate, for example during mealtimes, and we found staff explained what people's medication was for when they administered it. People's relatives we spoke with were happy with the care their family members received and they had no negative comments to tell us.

We found the provider had made the required improvements in relation to the management of medicines and staff support including training since our last inspections, and we found that the provider had increased the numbers of staff on duty following concerns that had been raised.

At our inspection on 12 June 2013 we followed up compliance and enforcement action that we had taken following our inspection on 13 February 2013. We required that the provider make improvements to staff training and the frequency of supervision. We also asked that they ensured there were enough staff available to meet people's needs, improved the way in which people's care was assessed, planned and delivered as well as improving the way in which records were maintained and stored.

People and relatives we spoke with were happy with the care on offer in the home. One person told us "the staff are kind and the food is good". One relative told us that staff "all seem very caring and genuine" and that they found the care their loved one received to be "excellent". Another relative told us that overall staff were very good and that any minor issues they'd raised had been addressed.

We found that people's needs had been appropriately assessed and their care delivered in line with their care plan. Records relating to their care were stored safely and were accurate and fit for purpose. There were enough staff on duty to meet people's needs and staff were supported in their roles through supervision. The provider had made progress in ensuring staff had undertaken training in key areas although some training remained outstanding. We also found that people had a choice of suitable food and drink and were supported to ensure they were eating and drinking in sufficient amounts.

People we spoke with told us that they were happy living in the home and that staff were "very respectful". They told us that staff ensured their privacy and dignity were maintained whilst living in the home. One person told us "staff always knock" before entering their room and that they ensured they were "covered" when assisting with personal care. One relative told us staff were always "very welcoming" whenever they visited and that they felt reassured by the feedback they received from staff caring for their loved one.

We found that people were involved in making decisions about their care and that they were supported by staff to maintain their independence. However we also found that care had not always been carried out in the way that it had been planned and that people’s records, including medication administration records were not always accurate or fit for purpose.

Staff we spoke with showed a good understanding of safeguarding of vulnerable adults but had not always been supported adequately in their role through training and supervision, in line with the providers own requirements. Medication was also not always stored securely and there were not always enough staff available to meet people's needs.

Some people said that the home was “absolutely amazing”, and a “terrific place” to live. They said that the food was good and that there was always a good quantity and variety of food available.

Some people told us that they were involved in decisions about their care and had no complaints about the staff or the home. People said that they felt safe living in the home.

People told us that they were comfortable talking to staff about any problems and felt that staff were responsive to their needs. People said that staff were “friendly”, “lovely”, “helpful” and “kind.”

Relatives said that they were keep informed of any changes experienced by people using the service. They told us that staff were always available to talk to and were approachable.

At our inspection 10 and 11 December 2014 we found several breaches of legal requirements. The systems for the management of medicines were not safe and did not protect people using the service. People were not receiving sufficient food and fluids or the correct diet as advised by health care professionals. People’s capacity to give consent had not been assessed in line with the Mental Capacity Act 2005 (MCA). Accurate records relating to the risks to people and their care needs were not always maintained. We asked the provider to make improvements in these areas. Following that inspection the provider sent us an action plan telling how and when they were going to make these improvements. They kept CQC informed of the changes that had been made.

At this inspection we found that significant improvements in all of these areas. We found that systems for the management of medicines were safe. People were receiving the food and fluids as recorded in their care plans and as advised by health care professionals. The provider was acting in accordance with the MCA. Action had been taken to support people where risks had been identified. There were arrangements in place to deal with foreseeable emergencies. People’s care plans were being maintained and had significantly improved. They included much more detail about the person, their needs and preferences.

Riverdale Court is a large care home located in the London Borough of Bexley. The home is registered to provide accommodation and support for up to 80 people and specialises in caring for people living with dementia. At the time of our inspection 80 people were using the service.

There was 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 using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider took into account the views of people using the service, their relatives and staff through questionnaires. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the manager. The manager conducted unannounced night time checks at the home to make sure people were receiving appropriate care and support.

People using the service, their relatives, staff and visiting professionals we spoke with during this inspection told us there had been improvements made at the home since the current manager arrived.