CQC report explained · a nursing home
What the CQC found at Four Rivers Nursing Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found safe medicines systems, risk assessments, suitable staffing, safe recruitment and effective infection control. They also found procedures for responding to accidents, safeguarding concerns and behaviours that may challenge.
- Effective?
- Good
- People's health, nutrition and hydration needs were assessed and monitored. Inspectors found that staff understood consent and the Mental Capacity Act, and that people received support from health professionals when needed.
- Caring?
- Good
- Staff were observed treating people warmly, respectfully and with dignity. People were involved in daily choices, supported to stay in contact with important people and helped to remain as independent as possible.
- Responsive?
- Good
- Care plans included people's routines, preferences and important relationships. The home offered activities and accessible information, and inspectors found that complaints were taken seriously and investigated.
- Well-led?
- Good
- Inspectors found an open culture, clear staff responsibilities and effective audits and checks. The provider had improved its reporting of significant events and Deprivation of Liberty authorisations.
What inspectors found, May 2019
Four Rivers Nursing Home was rated Good; inspectors found safe, kind and personalised care, with clear improvements since the previous inspection.
This was an unannounced inspection on 25 April 2019. Inspectors spoke with 10 people living at the home, seven relatives and six staff. They observed care and checked care, medicines, training and management records.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found that people were protected from avoidable harm, received their medicines properly, and were supported by trained staff.
People and relatives spoke positively about the care. Inspectors found respectful staff, personalised care plans, activities, access to health professionals and improved checks on the quality of care.
The home had been rated Requires Improvement at the previous inspection in April 2018. The report says improvements had been made in medicines, protecting people's rights, reporting important events and checking the quality of care.
Medicines managed safely
The home had improved its medicines procedures. Staff were trained and competent, records were complete and medicines were securely stored.
“People's medicine administration records had been fully completed and there was an audit trail of all medicines held at the home.” from the report
Kind and respectful staff
People were supported by staff who listened, responded to requests and treated them with dignity and compassion.
“We observed staff interacting with people in a warm and caring manner.” from the report
Personalised care
Care plans recorded people's routines, preferences and important relationships. People and relatives were involved in planning and reviewing care.
“Care plans detailed information which was important to the person such as daily routines and family members.” from the report
Improved management checks
The provider had strengthened its audits and checks. Inspectors found these were being used to identify and address improvements.
“Regular internal audits and checks were carried out and these were effective in identifying and addressing areas for improvement.” from the report
Activities and community links
People had opportunities for exercise, music, animal visits, hairdressing and contact with local community groups.
“There were organised musical sessions and visits from 'pat dogs' and other animals.” from the report
Inspectors raised no specific concerns in this report.
- 01How do you make sure medicines, including 'as required' medicines and creams, are given as prescribed?
- 02How would you support my relative's specific risks, such as falls, pressure damage, mobility, eating and drinking, or behaviours that may challenge?
- 03How will my relative be involved in decisions about care if they have difficulty making or communicating a decision?
- 04What activities and community links would be available for my relative, based on their interests and abilities?
- 05How are relatives involved in care planning, reviews and raising concerns?
This was an unannounced comprehensive inspection of the care home, covering all five CQC questions and both the premises and the care provided. This explanation was written from the published report of 22 May 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, May 2018
Four Rivers Nursing Home was rated Requires Improvement; inspectors found kind, personalised care, but medicines and management oversight were not consistently safe.
This was an unannounced comprehensive inspection on 5 April 2018, followed by an announced visit on 9 April 2018. Inspectors spoke with people, relatives, staff and a health professional. They observed care and reviewed care, medicine, staff and management records.
The home was rated Good for caring and responsive care. People were treated kindly and with respect. Their care was personalised, and they had activities, food choices, healthcare support and ways to raise concerns.
The home was rated Requires Improvement overall, and also for safe, effective and well-led care. Inspectors found unsafe medicine practices, gaps in consent and mental capacity decisions, incomplete records and weak quality checks. They identified three breaches of regulation. The previous overall rating in 2015 had been Good.
Kind and respectful staff
Inspectors saw staff treating people with compassion and respect. People were supported to make choices and remain as independent as possible.
“People's rights to dignity and respect were always fully promoted by staff.” from the report
Staffing and safeguarding
People, relatives and staff said there were enough staff to meet people's needs safely. Staff understood how to recognise and report abuse.
“Safe staffing levels maintained at the home meant people's individual needs could be met safely.” from the report
Healthcare and nutrition
People had access to healthcare professionals, and inspectors found evidence of timely referrals. Food, drinks and nutritional support were available to meet individual needs.
“Staff supported people to access healthcare services to ensure their health was regularly monitored.” from the report
Medicine safety
seriousTwo people were given out-of-date medicines. Records for creams and as-needed medicines were incomplete, and regular medicine audits and staff competency checks were not in place.
“Out of date medicines had been administered to two people.” from the report
Care records and quality checks
seriousCare plans did not always match people's current needs. Audits were irregular and did not clearly show that identified problems had been dealt with.
“Care plans did not always reflect people's current care needs.” from the report
Missed statutory notifications
seriousThe provider failed to notify CQC about a serious injury, a health event and 20 approved Deprivation of Liberty Safeguards orders.
“Additionally, the provider had failed to notify us of 20 approved Deprivation of Liberty Safeguard Orders” from the report
- 01What changes have been made to prevent out-of-date medicines being given?
- 02How are prescribed creams and as-needed medicines now recorded and checked?
- 03How often are medicine audits and staff medicine competency checks completed?
- 04How do you make sure care plans reflect each person's current needs, including nutrition and oral care?
- 05How are consent and best-interests decisions recorded before using bed rails or taking photographs?
This was an unannounced comprehensive inspection of the whole home, covering all five CQC questions, with a further announced visit on 9 April 2018. This explanation was written from the published report of 22 May 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Four Rivers Nursing Home
3 rated inspections over 4 years: the service has held its Good rating throughout.
- May 2019Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2018Requires improvementdown from GoodSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- December 2013
Report published without a new overall rating.
- September 2012
Report published without a new overall rating.
- April 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 20 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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