This inspection took place on 22 March 2017 and was unannounced. This meant the registered provider did not know we would be visiting the service. A second day of inspection took place on 23 March 2017 and this was announced.

Rivermead is a nursing home that can provide care and accommodation for up to 69 older people. At the time of this inspection 63 people were using the service. The service is located in Norton, which has local amenities. Norton is very close to the market town of Malton, which has more services and rail links. The home has two distinct units. Those people with general nursing needs are cared for on the Westow unit, whilst those who have care needs primarily associated with dementia are cared for on the Malton unit.

There was a registered manager at the service who registered with CQC in December 2011. 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 people were protected from the risk of avoidable harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Care workers received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

The registered provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

Systems and processes were in place that helped to identify risks associated with the service’s environment and when providing care and support with people. Associated care plans enabled people to live at the service in line with their wishes and preferences with minimal restrictions in place.

Where people required support with their medicines this was done safely and people received their medicines as prescribed. Medicines were stored securely and staff competencies in this area were monitored by management.

Systems and processes were in place that ensured sufficient numbers of suitably trained and competent care workers were on duty to meet and respond to people’s needs and provide additional one to one support throughout the day. Pre-employment checks on employees were completed that helped to minimise the risk of unsuitable people from working with adults who are at risk.

Staff received a thorough induction when they joined the service and competency assessments were completed at regular intervals to ensure they were providing appropriate support. Staff received regular supervisions and appraisal where support, guidance and opportunities to develop were discussed.

Care workers had received training and understood the requirements of The Mental Capacity Act 2005 and the registered provider was following this legislation. Applications to deprive a person of their liberty had been submitted to the local authority when required.

People usually consented to care and support from care workers by verbally agreeing to it. Records included provision for people or their representative to sign their agreement to the care and support they received.

People were supported with a wide choice of food at meal times. Any special food requirements were catered for and people spoke positively about the meals on offer. Snacks and hot and cold drinks were available for people throughout the day. Staff were available to offer support with meals where needed.

People were supported to maintain their health and we saw evidence of close working relationships with other professionals. This was documented in people’s care records. Staff were deployed effectively which was demonstrated in how swiftly they responded to people’s requests.

All members of staff demonstrated a clear understanding of people’s i

At the previous inspection in June 2013 we found that there were not enough staff on duty to meet people’s identified needs fully. We asked the provider to make sure that at all times; there were sufficient numbers of suitably qualified, skilled and experienced staff on duty. At this inspection we found that there were sufficient staff on duty. We spoke to staff who confirmed that there was an increased number of staff on duty and that staffing levels had improved at key times during the day. One person who lived at the home said “The staff have a bit of time to chat with me now. They all seem to be a bit more relaxed.”

We also looked at how people were cared for. We found that some people's assessed care needs were not always met. Some people were not receiving the care and support they required to keep them clean and comfortable. We have asked the provider to improve on this outcome for people who live at Rivermead.

People told us that they were treated with dignity and respect and were able to make choices in most aspects of daily living. However, when we observed interactions between staff and those living at the home we found some examples where people's dignity was not maintained.

The people we spoke with told us they were well cared for. We received comments from people living at the home, relatives and a visiting GP who told us "They (the staff) care very much. I would be very keen for one of my relatives to be cared for here it is first class" and "I have been here for a while, the care is good."Care records contained detailed information about how people's needs should be met.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us that they felt safe and able to raise concerns.

People expressed concerns about staffing levels and the observations carried out during our inspection concluded that there were not always sufficient staff to ensure the health, safety and welfare of people. All of the people we spoke with confirmed that they liked the staff and that they were helpful and caring but that they were busy.

The home had systems to monitor the service and to gain feedback from people living and working at the home. People told us that they were able to attend meetings to express their views and opinions.

People's needs were assessed and their rights were respected by the staff. We saw that people made decisions for themselves or were supported by the staff to make decisions about how they wanted to spend their time. A person living at the home said “I am quite content. I am comfortable, clean and cared for. I follow my own routines.” We saw that staff treated people with dignity and respect.

People had care plans and risk assessments in place which helped staff to understand and meet people's needs. A person we spoke to said “My health is looked after.” We saw that people maintained their independence, where possible.

There were policies and procedures in place that helped to protect people from abuse. Issues raised were referred to the local authority's safeguarding of vulnerable adults team for further investigation or advice. This helped to protect and safeguard people.

We saw that staff received training and supervision to ensure that they had the skills they needed to be able to look after people safely. A member of staff said “We are trained to look after people.” This training was updated periodically to help to maintain the staff’s skills.

We saw that people were able to make complaints and give their comments about the services provided for them. We saw evidence that any issues raised were acted upon. This helped to ensure that people remained happy with the service that they received.

People said they were consulted about their care. One person said staff always gave them a choice about what they wanted to wear and that the menu was brought to her each morning so she could make a meal choice. The people we spoke to said their care had been discussed with them but that they had not seen written care plans. One person said that she spent much of her time alone in her room. This was by choice but she would appreciate some company from staff or from the activities organiser sometimes to cheer her up. People said they felt safe at the home. They said they could raise concerns which would be taken seriously and addressed. People said they were encouraged to attend residents meetings, and that they had the opportunity to voice their opinions on a one-to-one basis with staff.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We inspected Rivermead on 13 August 2014 and the visit was unannounced.  On the day of our inspection there were 59 people living at the home.

Our last inspection took place on 17 January 2014 and, at that time; we found the service was not meeting the regulations relating to staffing. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked and found improvements had been made.

Rivermead is a nursing home currently providing care for up to a maximum of 69 older people. The home has three distinct units. Those with general nursing needs are cared for on one wing, whilst those who have care needs primarily associated with dementia are on another which is divided into two separate units.

The service had 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 and has the legal responsibility for meeting the requirements of the law; as does the provider.

We saw there were systems in place to protect people from the risk of harm. Risk was managed in a manner to minimise any restriction on people who used the service.

People were supported by sufficient numbers of qualified, skilled and experienced staff. Staff felt supported by their manager. Procedures were in place for the recruitment and selection of staff and appropriate checks had been carried out prior to the staff starting work.

We saw documented evidence that staff accessed other healthcare professionals in a timely fashion.

We observed staff providing care and support in a caring and respectful manner.

The provider had a robust system to monitor and assess the quality of service provision. Good practice was encouraged and where practice could be improved, this was addressed.