We carried out an unannounced comprehensive inspection of Rivington Park Care Home on 03 September 2018.

Rivington Park Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 25 people. At the time of the visit there were 24 people who received support with personal care and nursing care.

The service was managed by 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.

At the last inspection on 03 and 08 January 2018, we found four breaches of the regulations. This was because the provider had not sought authorisation to deprive people of their liberty to keep them safe. In addition, risks to receiving care had not been adequately managed and staff had not been adequately supported with supervision and ongoing training. The governance and quality assurance systems were not effective in identifying shortfalls to generate improvements to the quality of the service. Following our inspection, we issued the provider and the registered manager with a warning notice in relation to good governance. We asked them to be compliant with the regulation relating to good governance by February 2018. We also asked the provider to send us an action plan telling us what actions they intended to take to ensure compliance with the other regulations.

At this inspection we found that significant improvements had been made and the provider was meeting all regulations.

People who lived at the home and their relatives were happy with staffing levels. They told us staff provided them with support when they needed it. People who lived at the home and their relatives told us they felt safe.

Improvements had been made to the management of risks including risks associated with the use of bed rails and people experiencing frequent falls.

Records showed that staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

There had been significant improvements to staff training. Staff received an effective induction and appropriate training. People who lived at the service and their relatives felt that staff had the knowledge and skills to meet their needs.

People told us the staff who supported them were caring and respected their right to privacy and dignity. They told us staff encouraged them to be as independent as they could be and we saw evidence of this during the inspection.

People received appropriate support with nutrition and hydration and their healthcare needs were met. Referrals were made to community healthcare professionals where required to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005. This was an improvement from our last inspection. However, further improvements were required to ensure capacity assessments were decision specific.

People told us they received care that reflected their individual needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines.

There was a person-centred approach to how people were supported with activities. People were supported to take part in activities and events. They

This unannounced inspection took place on 03 and 08 January 2018. Rivington Park Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates 23 people. At the time of the visit there were 21 people who received support with personal care and nursing care.

The service was managed by 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.

At the last inspection in January 2017, we found people's medicines were not safely managed and the service was in breach of the related regulation. We also made a recommendation in relation to the systems for checking the quality of the service. Following that inspection the provider sent us an action plan detailing the improvements they would make in relation to the safe use of medicines.

During this inspection we reviewed actions the provider told us they had taken to gain compliance against the breach in regulations identified in January 2017. We also looked to see if improvements had been made in respect of the breach.

During this inspection we found breaches of Regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider had not sought authorisation to deprive people of their liberties to keep them safe. In addition, risks to receiving care had not been adequately managed and staff had not been adequately supported with supervision and ongoing training. The governance and quality assurance systems were not effective in identifying shortfalls and generating improvements to the quality of the service. You can see what action we told the registered provider to take at the back of the full version of the report.

This is the third consecutive time this service has been rated Requires Improvement.

Feedback from people and their relatives regarding the care quality was positive. Views of a professional we spoke with were also positive. People who lived at the home told us that they felt safe. There was mixed feedback about the staffing levels in the home. Visitors and people who lived at the home spoke highly of the registered manager and the care staff.

Some improvements had been made to the management of medicines. People told us they received their medicines as prescribed and staff had been trained in the safe management of medicines. However, we noted that further improvements were required to ensure people’s medicines were robustly managed.

The staff who worked in this service made sure that people had choice and control over their lives and supported them in the least restrictive way possible. However; there was a lack of understanding of the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People’s consent to various aspects of their care was considered and where required some DoLS authorisations had been sought from the local authority. However, the systems for assessing and recording mental capacity assessments were not robust. The registered manager started to take action to address this.

Staff had received safeguarding training and knew how to report concerns to safeguarding professionals. Accident and incidents had been recorded; however improvements were required to demonstrate that people had been observed following incidents such as falls or unwitnessed falls. Recruitment checks were carried out to ensure suitable people were employed to work at the home.

Risk assessments had been developed t

We carried out an unannounced inspection of Rivington Park Care Home on 11, 12 and 13 January 2017. The first day of the inspection was unannounced.

Rivington Park Care Home is situated near to Chorley town centre, close to transport links and a variety of local shops. The home provides personal and nursing care for up to 25 older people. At the time of the inspection there were 20 people accommodated at the service. The accommodation is provided over two floors, accessed by a passenger lift and stairs. There are lounges with dining areas on both floors. There are three double bedrooms with en-suite facilities and 19 single bedrooms without en-suites. From the ground floor lounge there is access to an enclosed patio area, with flowers, shrubs and garden furniture. There are a small number of car parking spaces to the side of the premises.

The service was managed by 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.

At the previous inspection on 24 and 25 June 2015, we asked the provider to make improvements in relation to risks to people’s well-being, safety and security, staff recruitment practices, concerns and complaints processes and systems to assess, monitor and improve the quality of the service provided. We received an action plan from the provider indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made.

During this inspection we found the provider was in breach of one regulation of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breach related to the unsafe management of medicines. You can see what action we told the provider to take at the back of the full version of this report.

Because the shortfalls in the safe management of medicines ought to have been identified and put right without our intervention, we have made a recommendation about the service’s checking systems.

The people spoken with indicated satisfaction with the care and support they experienced at Rivington Park Care Home. There was an open and friendly atmosphere at the service. One person spoken with said, “We can have a good laugh” another commented, “I wouldn’t change a thing.” We found there were some good systems and arrangements in place to promote an efficient day to day running of the service.

People told us they felt safe at the service and they made positive comments about the care and support they experienced. They were supported with their healthcare needs and received appropriate medical attention. Changes in people’s health and well-being were monitored and responded to.

Recruitment practices made sure appropriate checks were carried out before staff started working at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns about people’s wellbeing and safety.

People were happy with the variety and quality of the meals provided at the service. Support was provided with dietary requirements in response to individual needs. We found various choices were on offer. Drinks were readily accessible and regularly offered.

The service was working within the principles of the MCA (Mental Capacity Act 2005). During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences.

People spoken with indicated they were treated well by staff. They said their privacy and dignity was respected. Throughout the inspection we observed staff interacting with people in a kind, pleasant and friendly manner. They were respectful of people's choices and opinions.

There were opportunities for peo

Care files contained relevant information about people’s support needs. Information was regularly reviewed and updated; meaning staff always had current guidance to follow.

People living at the home told us they felt well cared for. We were told, “I’ve got every confidence in the staff.” And “They look after me very well.”

The relatives we spoke with told us they were kept informed of important changes and were very pleased with the quality of care provided. Comments included; “My mother’s health and weight has much improved. They got her eating again.” And “Staff are kind and friendly. They really know the people living here.”

Medicines were securely kept, handled appropriately and safely administered by qualified staff. Good standards ensured people received the correct medication at the right time.

The home appeared clean and well maintained. Equipment and adaptations were in place to meet the needs of those with restricted mobility. Regular maintenance, safety checks, staff training and good practice, helped to ensure the premises remained a safe and attractive place to live.

Staff received appropriate training, professional development, supervision and appraisal. This helped to ensure care was delivered safely and to an appropriate standard.

Audits and checks took place to identify any shortfalls and promote high standards. People benefited from safe quality care. Quality was monitored and risks were identified and managed.

The inspection was carried out on 24 and 25 June 2015. The first day of the inspection was unannounced.

Rivington Park Care Home is situated near to Chorley town centre, close to transport links and a variety of local shops. The home provides personal and nursing care for up to 25 older people. At the time of the inspection there were 24 people accommodated at the service.

The accommodation is provided over two floors, accessed by a passenger lift and stairs. There is a lounge with dining area on both floors. There are three double bedrooms with en-suite facilities and 19 single bedrooms. From the ground floor lounge there is access to an enclosed patio area, with flowers, shrubs and garden furniture. There are a small number of car parking spaces to the side of the premises.

At the previous inspection on 9 May 2013 we found the service provider was meeting the legal requirements.

At the time of the inspection, the registered manager was no longer 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 therefore needed to apply for de-registration, in order to formally relinquish their legal responsibilities. A new manager had been appointed at the service and they had applied for registration with the Commission.

During this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some environmental risks had not been identified and assessed. This meant appropriate action had not been taken to reduce the risks to people’s well-being, safety and security. We found staff recruitment practices had not been properly carried out for the well-being and safety of people who used the service. People’s concerns and complaints were not always properly managed and responded to. There was also a lack of effective systems to assess, monitor and improve the quality of the service provided. You can see what action we told the provider to take at the back of the full version of the report.

We found the providers had not consistently reviewed and updated their publicity information and operational policies and procedures. We have therefore made a recommendation about reviewing and updating the service’s written material.

There were some processes in place to manage and store medicines safely. However further safeguards were needed and the manager had already begun to make improvements. We have made a recommendation about the management of medicines.

People spoken with made positive comments about the staff team at Rivington Park, they said “I think the staff are kind and caring,” “We have some fantastic staff here, they give me a hug and are proper nice and kind” and “They are like my family.”

People had mixed views on the availability and numbers of staff on duty; however the manager took action to increase staffing levels during the course of the inspection. There was no formal process in place to asses staffing arrangements, to make sure there was always enough staff; the manager agreed to address this matter.

We found the care planning process was lacking in providing a person centred approach to care and treatment delivery. However there were clear plans in place to introduce a person centred approach within the service.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff confirmed they had received training on safeguarding and protection.

The MCA 2005 (Mental Capacity Act 2005) and the DoLS (Deprivation of Liberty Safeguards) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. We found appropriate action had been taken to apply for DoLS and authorisation by local authorities, in accordance with the MCA code of practice and people’s best interests.

Healthcare needs were monitored and responded to. We observed people being supported and cared for by staff with kindness and compassion. We saw people were treated with dignity and respect and people told us consideration was given to their privacy.

We found bedrooms did not have an appropriate door lock in place. Door locks are necessary to help ensure people's privacy and dignity is protected. We discussed this with the manager and were given assurances this matter would be resolved.

During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences. Discussion meetings were held and people had opportunity to complete satisfaction surveys. People spoken with had an awareness of the service’s complaints procedure and processes.

People made positive comments about the meals provided at the service and further improvements were being introduced. People’s individual dietary needs, likes and dislikes were catered for. Various drinks were readily available and regularly offered.

We observed examples where staff involved people in routine decisions and consulted with them on their individual needs and preferences. Staff spoken with described how they involved people with making decisions and choices.

Systems were in place to ensure all staff received regular training, supervision and support. Health care workers spoken with understood their role in providing people with effective care and support.

People were keeping in contact with families and friends. Visiting arrangements were flexible. Arrangements in place to provide activities and entertainment; however we found the programme of activities was being further researched and developed.