CQC report explained · a residential care home
What the CQC found at Rivers
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, September 2023
Rated Requires Improvement; inspectors found kind care but gaps in staffing, training, safeguarding notifications and quality checks.
Inspectors visited without warning on 20 July 2023. Two inspectors and an Expert by Experience spoke with people, staff and relatives. They reviewed care plans, medicines records, recruitment files and records about how the home was run.
People were generally treated with kindness and respect. Staff supported people with choices, independence, activities and health care. The home was clean and people were observed to be relaxed with staff. However, staffing levels were not always enough to provide all commissioned support, and staff training was not up to date in several safety areas.
The home did not always report safeguarding concerns and other significant events as required. Its checks on quality and improvement were not reliable enough. The overall rating fell from Good at the previous inspection, published in April 2019, to Requires Improvement. The current ratings were Requires Improvement for Safe and Well-led.
Kind and respectful care
Inspectors saw staff treating people with dignity and responding to their individual needs. People and relatives gave positive comments about the support.
“Throughout the inspection we observed kind, relaxed, compassionate, and caring interactions between people and staff.” from the report
Choice and independence
Staff involved people in decisions and supported them to do what they could for themselves. People were helped to take part in activities and pursue their interests.
“Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.” from the report
Care planning and health support
Care plans and risk assessments covered a range of needs. Staff worked with health professionals and recorded their input in people's care plans.
“People's care plans and risk assessments reflected their range of needs, and this promoted their wellbeing and enjoyment of life.” from the report
Staffing levels
needs fixingPeople's commissioned staffing hours were not always delivered because of staff absence. Inspectors were told this could limit people's everyday opportunities, including going out.
“People's staffing hours were not being consistently delivered due to staff absence.” from the report
Out-of-date training
needs fixingSeveral staff had not completed required or refresher training in safeguarding, medicines, moving people safely, health and safety, fire awareness and infection control.
“Not all staff had received relevant training to ensure the safety of people.” from the report
Safeguarding and notifications
seriousOne safeguarding concern had not been referred to the local authority safeguarding team. The provider also failed to notify CQC about significant events and a change in registered manager.
“The provider had failed to notify the CQC of significant events which had occurred.” from the report
Weak quality checks
seriousThe provider's systems did not consistently identify and manage improvements. The action plan did not clearly set out responsibility or timescales for several areas.
“The provider had failed to consistently assess, monitor, and improve the quality of the service.” from the report
Family communication
minorRelatives gave mixed feedback about communication. Some relatives said they did not feel listened to, and a family satisfaction survey had been delayed.
“Two relatives told us communication needed to improve, and one relative told us they felt the service did not involve and listen to them anymore.” from the report
- 01How many staff are currently working at the home, and how will you make sure each person's commissioned staffing hours are delivered?
- 02Which staff are still waiting for safeguarding, medicines, moving and handling, health and safety, fire and infection control training?
- 03What competency checks have now been completed for staff carrying out delegated clinical tasks?
- 04What action has been taken to make sure all safeguarding concerns and significant events are reported to the local authority and CQC on time?
- 05What specific improvements are in the action plan, who is responsible for them, and when will each one be completed?
This inspection looked at the overall quality of the care home and rated Safe and Well-led; the report does not give current ratings for Effective, Caring or Responsive. This explanation was written from the published report of 16 September 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, May 2019
Rated Good; inspectors found safe, kind and personalised care, with some medicines guidance and record-keeping to improve.
This was an unannounced comprehensive inspection on 17 and 18 December 2018. Inspectors spoke with people living in the homes, relatives, staff and health professionals. They also observed care and checked care plans, medicines records, staffing, training, incidents and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People were supported by trained staff, had choices about their care and activities, and were helped to stay independent and involved in their communities. Relatives and professionals gave very positive feedback.
Inspectors found some medicines issues. There was no written guidance for medicines given when needed, some emergency medicines had not been risk assessed for quick access, and records had not always been updated after changes. The manager acted on some of these points and received recommendations rather than a formal breach.
Enough staff
Inspectors found enough staff to keep people safe and support people when they became distressed or needed one-to-one care.
“There were sufficient numbers of staff available to keep people safe” from the report
Trained staff
Staff had an induction, regular support and training suited to people's complex needs, including specialist healthcare training.
“People received effective care and support from competent and well-trained staff.” from the report
Kind and respectful care
Staff used reassuring and respectful approaches. People were supported with privacy, dignity, choice and independence.
“Staff treated people with kindness respect and compassion.” from the report
Personalised support
Care plans included people's routines, likes, dislikes and communication needs. People were encouraged to choose activities and use their local community.
“People were fully encouraged to access their community when they wanted to.” from the report
Strong management checks
Inspectors found clear leadership and regular checks of medicines, care plans and health and safety. Feedback from people, relatives and staff was encouraged.
“There were effective quality assurance arrangements in place to raise standards and drive improvements.” from the report
Medicines given when needed
needs fixingThere was no written guidance to help staff give medicines prescribed for use when needed in a consistent way. Inspectors recommended that this guidance should be provided.
“Although people received their medicines as prescribed, there was no written guidance to support staff to administer medicines prescribed to be taken when required.” from the report
Emergency medicines access
needs fixingSome medicines that might be needed in an emergency were kept in a locked cupboard. This had not been risk assessed to check that staff could reach them quickly.
“We did find medicines that might be needed in an emergency were stored in a locked cupboard in the medicines room.” from the report
Updating medicines records
needs fixingStaff did not always update the home's own medicines records after changes made elsewhere, such as during a hospital stay. The manager arranged for one identified record to be updated.
“However, staff did not always update their own medicines records to reflect changes.” from the report
- 01What written guidance is now in place for medicines prescribed to be taken when needed?
- 02Where are emergency medicines stored now, and how do you make sure staff can reach them quickly?
- 03How are medicines records checked and updated after a person returns from hospital?
- 04How do you check that staff give medicines at the right time and in the right way?
- 05How will relatives be involved when medicines decisions are made in a person's best interests?
This was an unannounced comprehensive inspection of Rivers and The Cabin, covering all five CQC questions; all five ratings remained Good. This explanation was written from the published report of 2 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.
Every inspection of Rivers
3 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- September 2023Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- May 2019Goodstayed GoodSafe: GoodWell-led: Good
- August 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2014
Registered with the Care Quality Commission on 14 August 2014.
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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76 live-in carers within about two hours of Somerset
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £1,020 to £1,370 a week. 62 can care for a couple. 12 years' experience on average.
“She looked after my mum, who can be incredibly challenging, so well and so gently, and we always felt confident that my mum was getting the best care available.”
“She was not phased by anything, she was adaptable, kind & gave us complete confidence to go away & not worry about a thing!”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.