This inspection took place on13 and 27 February 2018. The first day was unannounced.

Riversdale Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Riversdale Nursing home accommodates up to 40 people at the time of this inspection 32 people were accommodated at the home. Accommodation is provided over three floors with some shared bedrooms available. Communal areas include a dining area, sitting areas and an enclosed back garden. The home is located near to the seafront and promenade. It is a converted detached house that fits in well with other houses in the local area.

The service did not 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 last inspection of the service was carried out in October and November 2015 and the service was rated ‘good’. No breaches of regulation were identified at that inspection. During this inspection we found breaches in relation to Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities). Regulations 2014.

Records at the home were not always accurate, well maintained or up to date. This meant that it was difficult to locate accurate records of some of the care and support people had received and to check that any issues identified had been followed up by staff. This included records relating to people’s wound care which did not reflect the care staff told us they had provided. Other records including staff training records and complaints records were similarly difficult to follow and not always accurate.

Equipment was not always used safely and in line with instructions. For example people did not always have their mattress at the correct setting to support their healthcare.

Communications with outside health professionals had not always been effective leading to concerns people had not received the care recommended. People’s private information was not always kept confidential. This was because staff sat in lounge areas whilst having discussions regarding people’s care.

The home has not had a registered manager for some time. An appointed manager was in place. However it was not always clear who was overseeing clinical practice within the home as the manager was not a registered nurse.

Systems within the home for checking the quality of the service provided were ineffective. They did not identify the areas of concern we noted during the inspection. These included records management, wound care records, DoLS applications and communication with outside professionals. The manager and nominated individual did acknowledge during the inspection that improvements were required and had begun to take action on these by the second day of the inspection.

Medication was safely stored and administered and records maintained. People told us they were happy with the way their medication was looked after by the home.

Systems were in place and followed for safely recruiting staff to check they were suitable to work with people at risk of abuse and neglect. People felt safe living at the home and staff knew what action to take if they had any safeguarding concerns.

Staff felt supported by senior staff. Staff told us that they had received training and supervision to enable them to carry out their role effectively. People living at the home knew senior staff well and felt comfortable approaching them.

People living at the home liked the staff team and had confidence in them. They found staff caring and friendly and this opinion was shared by people’s r

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

This is a summary of what we found:¿

Is the service safe?

We spoke with five care staff who told us that they felt the staffing levels were sufficient to meet people’s needs. Staff told us they were busy and four out of the five people told us they would prefer to have one more care assistant throughout the morning and afternoon shift. When we asked if they felt rushed in providing care they said they did on occasion.

The people who used the service told us they felt safe. The visiting professional we spoke to told us they had no concerns over the welfare of any of the people living at Riversdale and felt they were safe.

Is the service effective?

All care files contained a range of risk assessments, for example, skin integrity, bed rails and nutrition. We saw care plans were regularly reviewed. Files contained daily records and records from visiting professionals. We saw evidence and were told that staff liaised with professionals such as, GPs and social workers.

The people who used the service and the visiting professional we spoke to confirmed that staff were very knowledgeable about the people. Staff told us they felt they received adequate training and managers were obliging if they made suggestions on training that might be beneficial.

Is the service caring?

We spoke with four people who lived at the home. They all said that they were "Happy" at the home and described the staff as, "Helpful" and "Friendly". The three relatives told us that the staff communicate well with them and that the staff were "Always happy to help". During our observations we saw staff were polite and caring.

Is the service responsive?

We saw evidence that people who lived at the home, their representatives and staff were asked for their views about their care and treatment and the manager was responsive. We saw the provider sent out annual feedback questionnaires to people who used the service and staff.

Is the service well-led?

We asked people who lived at the home and staff about the manager and their ability to deal with concerns. They all felt the manager dealt with any issues very promptly and everyone we spoke with gave positive comments about their management style and personality for example, “She is always available”, “Very nice and kind” and “Good manager”.

We saw the manager conducted monthly audits in order to review the service. This allowed care plans, medication sheets and accidents to be scrutinised. Although the actions were not always documented on the audit forms so it was not clear what the provider was doing about any actions that needed taking.

We spoke to three people who used the service and three relatives of others living at Riversdale. Their comments included:

"I am well but when I am not I can see a Doctor"

"Staff are alright"

"I am happy here"

"They let me be as independent as possible"

"It took a while for my relation to settle but staff were so helpful"

"They always let me know what is going on"

"Staff are friendly and helpful"

"The care is very good and there is always plenty to do"

"I have got no complaints but I would know who to speak to if I did and they would sort it out"

"I try to be as independent as possible and they let me"

"They have been so kind and so helpful"

"They are very patient"

"I feel so safe here, safer than I did at home"

"Staff are very knowledgeable"

"There is nothing that can be improved here, we work well as a team and I feel supported by the management team"

We found that the health needs of people were being promoted by the actions of staff, care planning and the safe management of medication. We found that people were being supported by trained and knowledgeable staff who felt supported in their role. People were protected from harm and systems were in place for people to feel confident that any complaints they had would be investigated and acted upon.

We spoke with three people living at the home and observed the care of people less able to communicate with us.

People told us that the staff were good and that they felt well looked after. One person told us the food was excellent and that there was always a choice of meals. We saw that staff members offered choices and assisted people discreetly with their needs.

People we observed were relaxed and being helped and assisted by staff in a caring and sensitive way.

One resident spoken with told us that staff were kind. One gentleman living in the home told us that the staff were "smashing". A relative said that the staff were wonderful and that they had looked after her mother very well. One relative told us that their mum had told them that living in the home was like “living in a community”. Relatives told us that they believed their relatives were well cared for living in the home and that their health was monitored by staff.

Residents spoken with told us that they felt safe living in Riversdale and that they were well looked after.

We carried out an unannounced comprehensive inspection of Riversdale Nursing Home on the 28 October 2015. We made a second visit on the 6 November 2015 which was announced.

Riversdale is a large detached Victorian home over three floors, in a quiet residential road. The home is near to local shops and facilities in West Kirby and benefits from having the River Dee estuary, promenade and beaches at the bottom of the road. There were two small car parks at the front of the building and gardens with seating areas to the rear of the building. The home is registered for nursing and personal care for up to 34 people, at the time of our inspection 30 people were living at Riversdale.

The home had bedrooms over three floors, there was a lift providing access to all three floors. In total there were 28 bedrooms at Riversdale, 25 single rooms and three rooms which can be used for two people. Many of the bedrooms in the home were large, benefited from having large windows and had comfortable seating areas within the rooms which could be used for visitors, 15 of the bedrooms were en-suite.

On the ground floor there was a dining room, two interconnecting lounge rooms with access to the rear garden, a kitchen, office, medication room / nurse’s station and laundry. We found the home to be reasonably well maintained with homely décor.

The home had a manager who had applied to be a registered manager with the Care Quality Commission (CQC), the application was in progress. 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 living at Riversdale and their relatives told us they felt safe at the home. We observed adequate numbers of experienced and well trained staff supporting people. Staff had completed Safeguarding training. The building and the environment was safe for people living at the home.

Medication was well documented and generally organised, there were some improvements that could be made which we highlighted to the manager.

Riversdale had an on-going training programme, to compliment this they also have training refreshers and different training topics for the staff each month. Staff receive regular supervision and appraisal and are supported in their on-going development at Riversdale.

Pressure area care was very good, nobody at the home was experiencing difficulties with pressure areas. People were well supported in other areas of their health, people had access to health professionals quickly with many visiting people at the home.

We observed that people were always treated with dignity and respect and their consent was sought in all areas of their care. The home was operating within the principles of the Mental Capacity Act 2005 (MCA).

People told us they enjoyed the food, mealtimes were well organised and people had a choice of food to eat. We observed that staff members were caring and thoughtful and there was a culture of caring at the home. New people were made to feel welcome and were helped to settle in.

People had effective care plans that were individualised and person centred, these contained even the smallest details of what was important to a person. People were encouraged to get involved in activities during the day, many people told us they enjoyed these.

The manager of the home was open, candid and thoughtful in their approach. Any observations we made that could lead to improvements were explored and acted on quickly. Both people living at the home and relatives expressed confidence in the manager.