CQC report explained · a residential care home
What the CQC found at River Meadows
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People received their medicines as prescribed, but records and guidance were not always good enough. Some risks were not monitored or recorded effectively, including risks linked to distress, skin damage and window restrictors.
- Effective?
- Good
- This key question was not inspected during this visit. Its previous rating was used to calculate the overall rating.
- Caring?
- Good
- This key question was not inspected during this visit. Its previous rating was used to calculate the overall rating.
- Responsive?
- Requires improvement
- Care was generally personalised and staff responded to people's immediate needs. However, activities and emotional stimulation were limited, and some care plans lacked enough detail about people's emotional needs.
- Well-led?
- Requires improvement
- The manager was committed to improving the home, but audits and governance systems did not consistently identify or correct problems. Records were sometimes incomplete, conflicting or not updated promptly.
What inspectors found, July 2023
River Meadows was rated Requires Improvement; inspectors found caring staff but gaps in risk records, activities, medicines records and management checks.
Inspectors made an unannounced visit on 05 June 2023. Two inspectors and an Expert by Experience spoke with people, relatives, staff and healthcare professionals. They also observed care and checked care, medicines, recruitment and management records.
The home had enough staff and people usually received kind, personalised support. Staff helped people make choices and communicated in ways they could understand. Healthcare professionals said staff were available and shared information well.
However, some risks were not monitored or recorded well enough. Medicines records, care plans and daily records needed improvement. There was also too little physical and emotional stimulation, and quality checks had failed to identify some problems.
The overall rating changed from Good to Requires Improvement. Safe, Responsive and Well-led were all rated Requires Improvement. Effective and Caring were not inspected during this visit, so their previous ratings were used when calculating the overall rating.
Enough staff
Inspectors found enough staff to provide safe care, and people were usually helped without unreasonable waiting. Recruitment checks were also in place.
“There were enough staff to provide safe care. Our observations throughout our visit showed staff attended in a reasonable time to people's calls for assistance.” from the report
Good communication
Staff worked with healthcare professionals and shared information effectively. Staff also adapted information so people could understand and make choices.
“Staff supported people's communication by giving people information in a way they would understand.” from the report
Choice and involvement
People were supported to make day-to-day choices, including choices about meals, movement and where they wanted to spend time.
“We observed staff supported people in a responsive way as well as giving the choice of where they wanted to go and what they wanted to do.” from the report
Risk records were not reliable
seriousSome risks were not monitored or recorded well enough. Daily records could conflict with what had actually happened, which meant increased risks might be missed.
“This meant potential or increased risks could go unrecognised.” from the report
Medicines records needed improvement
needs fixingPeople received their medicines as prescribed, but guidance and records for medicines given when needed, refused or missed were incomplete. A skin patch was not always rotated as instructed.
“One person's plan to mitigate the high risk of skin damage to their feet, stated they should wear pressure relieving boots.” from the report
Limited activities
needs fixingThe home still lacked regular physical and emotional stimulation, as at the previous inspection. Plans were being made to recruit a dedicated activities worker.
“At this visit, we found similar issues remained as there was no member of staff dedicated to supporting engagement and activities.” from the report
Weak quality checks
seriousAudits did not identify several issues found by inspectors, including non-compliant window restrictors and incomplete or conflicting care records. This led to a breach of Regulation 17.
“The provider's systems and processes were not always effective to drive improvements through effective governance and quality assurance.” from the report
Some areas were not clean
needs fixingKitchenette areas were not always clean and hygienic, and some furniture and equipment needed deeper cleaning.
“Kitchenette areas were not always clean and hygienic, and some items of furniture and equipment required further deep cleaning.” from the report
- 01What action has been taken to improve records for medicines given when needed, refused or missed?
- 02How are you now recording and reviewing risks linked to anxiety, distress and skin damage?
- 03What regular activities are available each week, and has the dedicated activities staff member been appointed?
- 04How are audits being changed so they identify problems such as incomplete care records and window restrictors?
- 05How will you make sure care plans contain enough detail about each person's emotional needs and personal wishes?
This was an unannounced focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used for the overall rating. This explanation was written from the published report of 14 July 2023 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, February 2022
River Meadows was inspected but not rated; inspectors found mostly good infection control, but unsafe storage of sterile PPE needed attention.
This was an unannounced, targeted inspection on 18 January 2022. It focused on infection prevention and control, and on whether staffing pressures linked to COVID-19 were affecting care.
Inspectors were assured about visiting arrangements, social distancing, PPE use, testing, cleaning, safe admissions and the infection control policy. Staff had up-to-date guidance and training.
There was one shortfall. Sterile PPE was stored on trollies that also contained clinical waste which was not safely contained. The provider said it would seek advice or extra equipment. The service was inspected but not rated, so this visit did not give a new overall rating.
Visiting arrangements
There was a clear process for family visits. Visitors had to provide a negative lateral flow test before entering.
“There was a clear process to allow visitors to meet family members.” from the report
PPE and distancing
Staff were observed using PPE and keeping their distance in line with guidance.
“Staff were observed socially distancing and wearing personal protective equipment (PPE) in line with guidance.” from the report
Training and cleaning
Staff received updated infection control guidance and training. Touch points in communal areas were cleaned more often.
“There was additional cleaning of touch points in communal areas to mitigate the risk of cross infection.” from the report
Sterile PPE and clinical waste
needs fixingSterile PPE was kept on trollies that also contained clinical waste, and the waste was not safely contained. The registered manager said they would seek advice or extra equipment.
“We saw sterile PPE on trollies that also contained clinical waste that was not safely contained.” from the report
- 01What action was taken after inspectors found sterile PPE on trollies containing clinical waste?
- 02How do you now keep sterile PPE separate from clinical waste?
- 03How is the storage of PPE and clinical waste checked and recorded?
- 04What infection control training and updated guidance do staff currently receive?
- 05How do you manage COVID-19-related staffing pressures without affecting people living in the home?
This was an unannounced targeted inspection of infection prevention and control and COVID-19-related staffing pressures; the service was inspected but not rated. This explanation was written from the published report of 9 February 2022 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 River Meadows
3 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.
- July 2023Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2022Inspected but not ratedSafe: Inspected but not rated
- October 2017Goodstayed GoodSafe: GoodResponsive: Requires improvementWell-led: Good
- July 2015GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- December 2012
Report published without a new overall rating.
- February 2012
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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