CQC report explained · a nursing home
What the CQC found at Seven Rivers - Care Home with Nursing Physical Disabilities
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, prompt responses to call bells, safe medicines systems and improvements to the building. They also identified some unresolved or recently identified risks, including an unlocked door near stairs, missed window restrictors and a risk assessment needing updating.
- Effective?
- Good
- Staff had relevant training, supervision and support. People received enough food and drink, had access to healthcare and were supported with consent and decision-making.
- Caring?
- Good
- People and relatives described staff as kind, friendly and respectful. Inspectors found a strong person-centred approach that promoted choice, privacy, independence and relationships.
- Responsive?
- Good
- Care plans reflected people's individual health needs, preferences, communication and goals. The home supported chosen activities, family relationships, advocacy and end-of-life wishes.
- Well-led?
- Good
- Managers were described as approachable and supportive. Regular audits, staff meetings, reviews and feedback were used to identify and monitor improvements.
What inspectors found, November 2018
Seven Rivers - Care Home with Nursing Physical Disabilities was rated Good; inspectors found kind, personalised care and improvements, but identified some safety issues that needed attention.
This was an unannounced inspection on 25 July 2018. Inspectors spoke with people living in the home, relatives, staff and managers. They observed care, checked records and reviewed medicines, recruitment, training and quality checks.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, prompt call-bell responses, safe medicines arrangements and staff who understood people's needs.
People were involved in decisions about their care and supported to maintain independence, relationships and activities of their choice. Care plans were detailed and personalised. Managers used audits, meetings and feedback to monitor the service.
The overall rating had improved from Requires Improvement in June 2017. The home had redecorated areas, installed a new lift and improved support and training for overseas volunteers. Inspectors still found some environmental and risk-management issues that needed follow-up.
Kind and respectful staff
People and relatives described staff as friendly, thoughtful and respectful. Inspectors found that staff knew people well and understood their preferences.
“People and relatives told us they found staff to be friendly and caring towards them.” from the report
Personalised support
Care plans included individual needs, communication methods, preferences, goals and support for independence. People were involved in decisions about their care.
“The service had a very strong, person-centred culture that was acknowledged by everyone we spoke with.” from the report
Safe medicines practice
Inspectors found medicines securely stored and records completed without unexplained gaps. Staff administering medicines had training and competency checks.
“We reviewed 10 people's electronic medication administration records (EMMS) and found them all correctly completed with no unexplained gaps or omissions.” from the report
Improved management oversight
The home had regular audits and checked whether actions were completed. People, relatives and staff felt able to raise concerns with managers.
“The registered manager carried out several quality monitoring audits monthly as to ensure the continued improvement of the quality of the service provided to people.” from the report
Progress since the previous inspection
The home had installed a new service lift, redecorated areas and improved support and training for overseas volunteers.
“At this inspection we found improvements had been made, notably a new service lift had been installed, people's room and communal areas had been redecorated.” from the report
Door near stairs
seriousInspectors found an unlocked door leading directly onto two stairs. The manager said a lock would be fitted and staff reminded to check it.
“We highlighted a door that led directly onto two stairs, which we found unlocked and placed people at risk of falls should they try to exit through this door.” from the report
Outdoor risk assessment
seriousOne person's risk assessment needed updating after inspectors saw them accessing outdoor fields without staff support. A lake was nearby and partly hidden by trees.
“We did however highlight that one person's risk assessment needed to be update and staff needed to pay more attention to them, as we observed them accessing the outdoor fields unattended.” from the report
Building safety and maintenance
needs fixingSome first-floor work remained outstanding. Inspectors said fire-exit signs needed improvement, and some windows still did not have restrictors. The lift gap was fixed after the inspection.
“We did highlight that better fire exit signage would be required on the first floor to ensure that people living on the first floor would have prompts available in the event of a fire.” from the report
Staffing pressure at busy times
needs fixingOne person said staff could feel rushed in the mornings and that more staff would help. The manager said extra support could be arranged, but one person's needs were putting pressure on current staffing levels.
“Could be more staff, sometimes they are rushed, mainly when they are washing and dressing them in the mornings, would be better if staff were not rushed, 1 or 2 more staff would help.” from the report
- 01Has the door leading onto the two stairs been fitted with a lock, and how is it checked now?
- 02How are outdoor risks managed for people who walk near the lake, and have the relevant risk assessments been updated?
- 03Have all window restrictors and the first-floor fire-exit signs now been checked and improved?
- 04How many staff are normally available during busy morning personal-care routines?
- 05What support is available when a person needs one-to-one staffing for walks or activities?
This was an unannounced comprehensive inspection covering all five key questions, with records, care, medicines, staffing and the environment reviewed. This explanation was written from the published report of 10 November 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.
What inspectors found, July 2017
Seven Rivers was rated Requires Improvement; inspectors found kind, personalised care, but ongoing safety, staffing, building and management problems.
The inspection was unannounced and took place on 7 and 8 June 2017. Inspectors visited both the care home and the separate supported living service. They spoke with people, relatives, staff and managers, and checked care, medicines, recruitment, training and quality records.
The home was rated Good for caring and responsive care. People were treated kindly, involved in decisions, supported to be independent and helped to follow their interests. Care plans were personalised and generally explained how people wanted their support provided.
The home was rated Requires Improvement for safe, effective and well-led care. Inspectors found delays in answering call bells, risks from unrestricted windows and an exposed roof area, poor kitchen cleanliness and food storage, gaps in volunteer training, and weak checks on service quality. Some medicines management had improved, but further problems remained in the supported living service.
The report says the provider continued to breach four regulations. The overall rating stayed at Requires Improvement, the same as at the March 2016 inspection. The provider was told to send a report explaining what it would do, and CQC said it would check that action was taken.
Kind and respectful care
People described staff as kind, patient and respectful. Inspectors observed positive interactions and support that protected dignity.
“Staff were kind and thoughtful in their interactions with people.” from the report
Personalised support
Care plans recorded people's communication, routines, wishes, goals and preferred ways of receiving support. People and relatives were involved in reviews where possible.
“People received care and support that was personalised and responsive to their needs.” from the report
Support for independence
Staff encouraged people to do as much as they could for themselves, including daily tasks, shopping and banking.
“Staff demonstrated a passion and focus on enabling people to be as independent as possible.” from the report
Safe recruitment
The home checked applicants' work history, references and criminal records before staff started. Inspectors found evidence that recruitment was carried out safely.
“This meant that the manager followed safe recruitment practices, with steps taken to assess that staff employed were of good character, competent and had the necessary skills for the work they were employed to perform.” from the report
Long waits for call bells
seriousCall bells were sometimes unanswered for 20 or 30 minutes. Inspectors linked this to poor coordination, staffing arrangements and staff not consistently carrying pagers.
“A review of call bell monitoring logs showed us that it was not unusual for people to be left waiting for their call bell to be answered for up to 20 and 30 minutes.” from the report
Falls risks
seriousSome upstairs windows opened wide without restrictors. An outside roof area was also accessible through doors with a barrier that could be moved around, and there were no suitable checks or risk assessment.
“This demonstrated a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.” from the report
Building and kitchen problems
needs fixingThe building still needed refurbishment. The kitchen had cleaning problems and uncovered food, including items past their use-by dates.
“Several items were also found to be well past their use by date including spices by as much as seven years.” from the report
Volunteer training gaps
seriousOverseas live-in volunteers sometimes worked alone with people but had not received enough induction or training about safeguarding, their responsibilities and health and safety.
“Volunteers work programmes evidenced regular one to one working alone with people who used the service.” from the report
Weak quality checks
seriousThe provider's monitoring did not reliably identify or fix repeated problems with call bells, the environment, window risks and volunteer training. This was a continued breach.
“The provider's audits had also failed to identify this as an ongoing issue and provide additional resources and evidence planning for improvement.” from the report
Missed notifications
seriousThe provider had not told CQC without delay about grade three and above pressure ulcers, as required.
“The provider had failed to notify CQC as required of acquired grade three and above pressure ulcers.” from the report
- 01How long do people wait for call bells now, and how do you monitor and respond to any delays?
- 02Have window restrictors and safeguards for the exposed roof area been installed and checked?
- 03What refurbishment, lift replacement and kitchen improvements have been completed since this inspection?
- 04What induction, safeguarding and safety training must overseas volunteers complete before working alone with people?
- 05How are medicines, pressure ulcers, call bells and other risks audited now, and how are families told when problems are found?
This was an unannounced inspection of both the care home and a separate supported living service, covering the overall service and both regulated activities. This explanation was written from the published report of 27 July 2017 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 Seven Rivers - Care Home with Nursing Physical Disabilities
3 rated inspections over 3 years: the service has improved, from Requires improvement to Good.
- November 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
Read what inspectors found at Seven Rivers - Care Home with Nursing Physical Disabilities →
- July 2017Requires improvementstayed Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Seven Rivers - Care Home with Nursing Physical Disabilities →
- April 2016Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- October 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.
- January 2011
Registered with the Care Quality Commission on 12 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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