Rivermead View is a ‘care home’ that provides accommodation for a maximum of 34 adults, of all ages with a range of health care needs and physical disabilities. At the time of the inspection there were 21 people living at the service. 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.

Rivermead View is situated in the town of Looe in Cornwall. It is a three-storey building with a range of aids and adaptations in place to meet the needs of people living there. It is close to the centre of Looe, to shops and the beach with links to public transport. The service continued to undergo major environmental changes and therefore people had access to only one of the two lounges whilst work was being completed. Some bedroom areas were also not in use due to the refurbishment that was occurring. All bedrooms are for single occupancy. People had access to a communal dining area. There were a range of bathing facilities designed to meet the needs of the people using the service. There was a garden which people could use if they were being supported.

The last inspection took place on the 2 August 2017. The service was rated as Requires Improvement at that time. There were concerns around how risks for people were managed, how staff supported people who may become anxious, care plan records were not accurate and records had not been completed satisfactorily.

This unannounced comprehensive inspection took place on 6 August 2018. Since the previous inspection there has been several changes in the management team. From January 2018 a new manager has been in post and worked with the staff team to implement the necessary changes. At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection. The service is now rated as Good.

The service is required to have a registered manager and at the time of the inspection there was no 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. The manager had been in post since January 2018. They had submitted a valid registered manager application and this was being considered.

Staff told us with the change of manager there had been a number of positive changes for the people they supported and for them as a staff team. Staff told us the improvements were in record keeping, care planning and support for the staff. Staff felt this had a positive impact for the people they supported as care records clearly identified how a person needed support. Staff were clear about how they needed to record information to evidence how they supported and monitored a person’s health and the process to follow if a person had an incident. We found records were up to date and reflected the person’s individual needs. Accident and incident records were also completed and audited by the management team.

People, relatives and staff all told us they found the new management structure more open and approachable. They felt their views on the running of the service were sought and were complimentary about the changes to the service. A person told us, “I attend the resident’s meetings and my daughter comes too, my daughter will tell the Manager if I am not happy and I am not afraid to talk to staff if I need anything”. A relative told us ““We can visit at any time, the care is very good, better since the new management, the staff are lovely and helpful, we have no issues”. Visiting health and social professionals also

This unannounced comprehensive inspection took place on 2 August 2017. This was the first inspection for Rivermead View since registering under a new provider in late December 2016.

Rivermead View is a care home which offers care and support for up to 30 predominantly older people. At the time of the inspection there were 25 people living at the service. Some of these people had a diagnosis of dementia.

The service is required to have 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. The registered manager had left their post. There was an acting manager who had been in post for two months. They told us they were in the process of applying to become the registered manager.

Risks associated with peoples’ care and support needs were identified and assessed but not always managed effectively. Changes to peoples’ needs were not always recorded effectively. For example, one person had experienced many falls in a short period of time. The accident audit did not show what action had been taken to address the many falls recorded and the falls risk assessment for this person had not been reviewed. Staff we spoke with were knowledgeable about the circumstances around this person’s falls and told us they had been unwell. We judged the person had their needs met as the falls had stopped. Another person’s care needs had increased over the weeks prior to this inspection. Permanent staff were aware of this person’s care needs and they were being met. However, the service were using some agency care staff, to cover for holiday absence, and this person’s care plan did not contain current accurate direction and guidance for staff who were unfamiliar with people’s needs. This meant the person may not have had their needs met effectively.

The service was in the process of transferring care plan documentation over to a new format. Some people’s care plans had been completely reviewed and contained easy to access current information in the new format. Other care plans had undated assessments on a mixture of formats which did not make it easy for staff to find current information. Some monitoring records contained gaps where staff had not recorded care provided. Fluid intake monitoring charts were not totalled each day to ensure people had sufficient fluids to keep them well.

Mattresses provided for people who had been assessed as being at risk from skin damage were not always set correctly for the person using the equipment. People’s weight records held by the manager did not contain the names of all the people living at the service and were not up to date. This meant it was difficult for staff to ensure pressure relieving mattresses were always set correctly. Senior care staff told us there had been a recent audit carried out which checked the settings of the mattresses but this could not be found.

People's rights were protected because staff acted in accordance with the Mental Capacity Act 2005. People were asked to sign to consent to their care plan and photographs being displayed in their files. However, some people did not have the capacity to do this for themselves, requiring others to do so on their behalf. Only people with a Lasting Power of Attorney can do this. Some consent forms were signed by healthcare professionals and family members who did not hold this legal power. The manager was aware of this issue and consents were being reviewed at each care plan review.The principles of the Deprivation of Liberty Safeguards were understood and applied correctly. A Deprivation of Liberty Safeguard authorisation had been appropriately sought and was in place for one person. The conditions of this authorisation were being met by the